Define Pharyngitis, its main microbial causes and its presentation

Define epiglottitis, its microbial cause and its presentation

What is the management?

Inflammation of the epiglottis caused by haemophilus influenza. It presents in children more commonly with stridor, drooling, dysphonia, dysphagia and a drawn face

This is a medical emergency and an airway needs to be secured follows by IV cerufoxime

Inflammation of the walls of the bronchi caused by bacterial or viral infections.

It presents with green/yellow mucus production (due to goblet cell increase) but doesn't show on CXR.

Inflammation and consolidation of the lung tssue due to an infectious agent. It is an acute LRTI presenting with fever, cough + rusty-green mucus, pain, malaise, myalgias and dyspnoea

Confusion and tachycardia can also present

Morphine: ↓ mucociliary

Atropine: ↓ mucociliary

Sedatives: ↓ cough and epiglottis function

Steroids: ↓ phagocytosis

Salicylates: ↓ phagocytosis

Bronchitis dry cough ± green/yellow sputum

Pneumonia productive cough, rusty/green

Bronchitis mild to no fever

Pneumonia high fever

Bronchitis normal CXR

Pneumonia abnormal CXR

The investigations for suspected pneumonia

• S - sputum; AFB, culture, Gram stain
• U - urine; legionella antigen, output; <30ml/hr = ARF
• B - blood; culture, WBC, urea,serology
• E - ECG; mycoplasma penumoniae,TB
• X- CXR; consolidation, sillhouette sign

C - Confuson

U - Urea >7 mmoM (normal 3.6-5)

R - Respiratory rate >30/min

B - Blood pressure SBP <90 or DBP <60

65- Age >65

1 point for each:

0-1; low severity (risk of death <3%)

2; moderate severity (risk of death 9%)

3-5; high severity (risk of death 15-40%)

• Sputum + tracheal aspiration
• Blood cultures
• Emperic antibiotics 
• If no change bronchoscopy performed:
• ± Bronchoalveolar lavage ± brushings

Clarithromycin

IV rifampicin ± IV tetracycline

IV cefuroxime ± IV metronidazole ± IV flucoxacillin

Empyema - Can be drained

Acute respiratory distress syndrome - inflammation of parenchyma, reduced gas exchange, long term fibrosis and organ failure

Abscess

Bronchiectasis - localised irreversible dilation of bronchial tree via muscle and elastin destruction

Pulmonary emboli 

Pleural effusion - can be drained

Hypoxia without hypercapnia

Low O2 without high CO2 therefore a pH increase occurs

Caused by V/Q mismatch from parenchymal and vascular disease, shunts, ARDS, pneumonia and emphysema

Hypoxia with hypercapnia

Low O2 and high CO2 and a pH decrease

Caused by inadequate ventilation from COPD, asthma, suffocation, brainstem lesions, obesity and chronic bronchitis (due to reduced SA)

What is the genetic predisposition that can lead to emphysema?

What is the pathophysiology behind this?

α-1 antitrypsin deficiency

This regulates elastase, therefore a reduction will result in elastin breakdown and alveolar wall damage

• Dyspnoea
• Barrel chest
• Accessory muscle use
• weight loss
• Decreased chest expansion
• Intercostal recession

• Less breathlessness
• Cyanosis
• Flapping tremor
• Bounding pulse
• Oedematous
• Raised JVP
• Cor pulmonale

β-2 agonists

Anticholinergics

Mucolytics

Salbutamol

Induce bronchodilation through smooth muscle relaxation

Ipratropium

M1/M3 antagonist - prevents muscle contractions

Carbocistiene

Decreases acute exacerbations

What is the treatment used for bullae of the lungs?

What benefit does this have?

Surgery

Gradually increases oxygen saturation by reducing compression

1. Ventilation of alveoli (convection)
2. Diffusion of oxygen across alveolar membrane
3. Oxygenated blood pumped around vessles (convection)
4. Diffusion of O2 from capillaries into tissue

Flow of oxygen into lungs

Movement of blood trhough circulation 

Tremor

Hypokalaemia

Tachycardia

Dry mouth

Blurred vision

GI disturbances

Glaucoma

Salbutamol & terbutaline - Short acting

salmerterol & Formoterol - Long acting

Deep inspiration

Coughing

Twisting

1. Pneumonia
2. Pulmonary Embolism
3. Carcinoma

Congenital pleural bleb

Marfan's (young, tall & thin)

Spontaneous

Acute or chronic lung disease

COPD ++

• Hyper-resonant to percussion
• Decreased chest expansion
• Decreased breath sounds
• Decreased voal resonance
• Increased RR
• Increased HR

Heart failure

Hypoproteinemia

Ovarian tumours

Pneumonia

TB

Carcinoma

Pulmonary infarction

What are the signs of a pleural effusion

(if greater than 500ml)

Decreased chest wall movement

stony dull percussion

decreased breath sounds

decreased vocal resonance

What are the treatment options for a pneumothorax?

(4)

• Allow spontaneous resorption (1-2%/day)
• Needle aspiration
• Chest drain
• Surgery

What is the treatment for a tension pneumothorax?

What is the treatment for a transudate pleural effusion?

Treat the underlying cause

Drain if symptomatic

What is the treatment for an exudate pleural effusion when pH >7.2 and/or empyema or haemothorax is present? 

4th-5th intercostal space

Mid-axilary line

Superior border of inferior rib (avoid neurovascular bundle)

Laminar

Turbulent

Transitional 

Parapneumonic effusion

Empyema

Malignancy