B5- Examining Resp Disease Flashcards

1
Q

What % do resp diseases account for deaths in eu

A

15%

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2
Q

Jow many die w year in eu

A

600k

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3
Q

1 in how many deaths caused by reap diseases worldwide

A

1 in 5 deaths

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4
Q

What are rhe 3 steps of examination

A

1- clinical examination eg signs/sounds

2- lung functioning tests

3- radiology eg ct,pet scans, xray

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5
Q

What sorts of checks would you do on notmal bresthng

A

Nose flaring, check pace of breathing, mouth breathing, when they have difficulty eg lying down

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6
Q

What is tachypnoea and when is it ok

A

Tachypnoea is fast bresthing. Ok if acute eg sfger exercuse but hyperventilating chronically is worrying

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7
Q

What is it called when people have difficulty breathing lying down due to blood going to heart

A

Orthopnoea

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8
Q

What is dyspnoea

A

Breathlessness

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9
Q

Dyspnoea is common and not restricted to lung diseases. What other things

A

Allergens, hesrt failure, anxiety

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10
Q

What extea info you need to look at dyspnoea

A

Onset of it, where its worsened or wlleviated eg around cats could be allergy

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11
Q

How is it graded

A

1-5 1 being dyspnoea during vigorous exercise vs 5 too breathless to leave house

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12
Q

What 4 physical signs eg of digits should eb looked at

A

Cyanosis
Clubbing
Tar stains from smoking
Co2 retention

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13
Q

What is cyanosis and give the 2 types

A

Where artial po2 saturation is below 80% and causes blur discolouration

Central cyanosis is the worsened type at mcuosal surfsces eg tongue

Peripheral cyanosis is on skin eg of hands and ears

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14
Q

Whag is an issue with chdcking cuanosis as a sign of reap disease

A

Most likely mever hit below 80% oxygen saturation due to the body response

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15
Q

What causes clubbing of digits ie curvature of nail and refcued angle of nail bed

A

Chronic hypoxia eg in ipf and carcinoma most likely.

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16
Q

How does chronic hypoxia wg in ipf cause clubbing

A

Increqsed angiogenesis response

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17
Q

Which artticle discusses how both clubbing and cyanosis of lower limbs not accurate in only reap disease

A

Mocetti 2014

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18
Q

What did mocetti find cyanosis and clubbing asdociated with

A

Eisenmenger syndrome which is a heart condition

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19
Q

What is co2 retwntion signa in hands

A

Warm and perfused jands due to blood flow

Co2 retention tremor

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20
Q

What is the co2 retention flap aeen with in reap disease (wei et al 2018)

A

Copd when hypercapnia occurs

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21
Q

What is auscultation when listening to lung sounds

A

Intensity and cheracter of sounds

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22
Q

What is wheezing

A

Air passing through narrow tubes

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23
Q

What is difference between monophonic and polyphonic and give examples

A

Monophonic is blockage one of major airway eg carcinoma

Polyphonic is obstruction of many airways eg cb/copd, asthma

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24
Q

What other auscultation sound is there

A

Crackling where air passes across fluid ef mucus/oedema

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25
Which article discusses crackling auscultstion
Howell 2006
26
What did howell say early inspiratory and expiratory crackling was sign if
Severe airway obstruction diseases eg copd, chronic bronchitis, asthma
27
What could late inspiratirt crackles be from (howell 2006)
Restrictive lung diseases Pneumonia, ipf and oedema
28
If lack of disappearance in crackling when changing position whay does this indicate (howell 2006)
Worsening lung disease
29
Why would pneumonia cause restrictive/late inspirstiry crackling
Causes Late openining of small airways
30
What is percussion of lung sounds
How muffled/resonant they are eg dull or hyper resonance
31
What are dull sounds from
More material eg fluid, mucus, fibrosis material
32
What would hyper reaonant sound be indicstion of
Destruction of airways, eg emphysema with large air spaces
33
What are coughs/forced expiratory blasts stimulated by
Sensory neurones/irritant receotrs down the vagal neeve (damaged on allograft)
34
What is sputum
What is coughed up ie saliva and mucus mixture
35
What would green/ yellow sputum indicate
Bacterial infection | Yellow is incrrased neutrophils
36
What would white sputumnindicate
Viral sputum
37
Which sputum cells were increwsed in asthma
Eosinophils (prominent in asthma)
38
Which article discusses sputum analysis
Lacy et al 2005
39
What is given tonpatient which infuces sputum production
Saline solution
40
Eosinophils jigher in astham but what was higher in copd
Neutrophilia, elastases and proteases (consistent with emphysema and cb)
41
What would be looked at in a physicsl examinstioj
Vibrations when speaking, asymmetry, shape, bruising, skeletal abnormality
42
What is pigeon breast abnormality
Where breast sternum pushed out too far
43
What is the word for coyghing up blood
Haemoptysis
44
What can haemoptysis be caused by
Tumour, infections or oedema
45
What can chest pain indicate
Non specific rib issues or muscle Or can be infection , tumour or reflux in lungs
46
Why are meds looked st in patinet history
Eg if theh take b blockers for bronchodilstion indicates asthma
47
Which systemic illness has a 5% risk to lung fibrosis so is looked for in patient history
Ra
48
What needs ti be taken into account when makint ntomal references in lft
Age, height, sex. All affect fev values
49
What happens in spirometry
Spirometer which is a mouth piece is given and used to measure fev1 against fvc during expiration of patient
50
What should be the fev1/fvc ratio ie what % of air should be breathed out in 1 sex
70% or more if nromal
51
What is total lung capacity
Volume lung can hold at full inspiration (IRV + TV + ERV + Residual vol)
52
What is the tlc of frmales vs males
4200 ml femaile 5800 ml in male
53
What is tidal volume and what ml for both f and m
Volume of air breahted in and out without force (no irv or erv) 500ml
54
What is vital capacity
Volume of air expelled out after max insp and exp | Tv+irv+erv
55
What is the calues of vital capscity in female and male (tlc - rv)
3100 ml for female | 4600 ml for male
56
What is the viral capacjty in male and female (tlc - rv)
3100 ml in female | 4600 ml in maleb
57
Why cant residuak volume be measured by spirometer
Its rhe cokume which cannot be expired. Left in lung after even erv
58
What is functional residual capacity
The volume left in lung after normal expiration (ERV +RV)
59
Whag is it for female and male
1800 ml ve 2300 ml
60
Which method is uaed to measure frv/rv alongside spirometry
Helium dilutjon merhod
61
Explain
Helium ar known amount with oxygen fills spirometer and lungs when pateint breathes in. The amount of air left in lung is determined after expiration
62
Wjy does this work
Because helium will stay constant as its a closed system. Doesnt diffuse actoss alveoli
63
Give rxamples of obstructive
Copd (inc cb and emphysema) ,asthma, bos
64
Give examples of restrictivr disease
Ards, ipf, pneumothorax (air fills csvity)
65
How else can lung disease be classified
Cause Pathopjysiology Site of issue
66
Why are obstrcutive and resitrcitive different
Obstructive can have same capacity ans therefore same fvc (can sometimes decrease) but slow rxpiration due to obstruction/narrowing Restrictive have a lowered lung capscity wg due to lack of compliance in fibrosis, oedema filling
67
What syndrome of muscles can cause lack of compliance therefore restrictive
Duchenne myscular dystrophy
68
Fev1/fvc ration reduces in obstrucive due ti decrewsed fev1 below 70%. Is this seen with restrictive
No because both fvc and fev1 decrease st the same rate so no change in ratio
69
What does peak flow metre measure eg in asthma/obstructive
The peak expirstort flow rate (ie where dlow is largest l/min. Its compared to the references eg normal at same age/height)
70
If the pefr is the same or up to 80% same as normal what does it indicate
Normal lungs and lack of obstruction
71
What does below eg at 50% mean
Need immediate care as obstruction is bad
72
What is the airway hyperresponsive test
Where spirometry combined with giving bronchoconstricters to see responsiveness to histamine or methacholine
73
Why would fall in 20% fev1 at lowrr conc of methacholine or histamine indicate issues
Shows hyper responsiveness to constrict eg asthmatic. If mormal lunfs you need kuch greater conc to cause decrease in fev1 by 20%/ major constriction
74
What are fibreoptic bronchoscopes going down nose paired eith
Bal or biopsies to indicate levels of inflammation, foreign objects, tumours