B5- Examining Resp Disease Flashcards
What % do resp diseases account for deaths in eu
15%
Jow many die w year in eu
600k
1 in how many deaths caused by reap diseases worldwide
1 in 5 deaths
What are rhe 3 steps of examination
1- clinical examination eg signs/sounds
2- lung functioning tests
3- radiology eg ct,pet scans, xray
What sorts of checks would you do on notmal bresthng
Nose flaring, check pace of breathing, mouth breathing, when they have difficulty eg lying down
What is tachypnoea and when is it ok
Tachypnoea is fast bresthing. Ok if acute eg sfger exercuse but hyperventilating chronically is worrying
What is it called when people have difficulty breathing lying down due to blood going to heart
Orthopnoea
What is dyspnoea
Breathlessness
Dyspnoea is common and not restricted to lung diseases. What other things
Allergens, hesrt failure, anxiety
What extea info you need to look at dyspnoea
Onset of it, where its worsened or wlleviated eg around cats could be allergy
How is it graded
1-5 1 being dyspnoea during vigorous exercise vs 5 too breathless to leave house
What 4 physical signs eg of digits should eb looked at
Cyanosis
Clubbing
Tar stains from smoking
Co2 retention
What is cyanosis and give the 2 types
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
Whag is an issue with chdcking cuanosis as a sign of reap disease
Most likely mever hit below 80% oxygen saturation due to the body response
What causes clubbing of digits ie curvature of nail and refcued angle of nail bed
Chronic hypoxia eg in ipf and carcinoma most likely.
How does chronic hypoxia wg in ipf cause clubbing
Increqsed angiogenesis response
Which artticle discusses how both clubbing and cyanosis of lower limbs not accurate in only reap disease
Mocetti 2014
What did mocetti find cyanosis and clubbing asdociated with
Eisenmenger syndrome which is a heart condition
What is co2 retwntion signa in hands
Warm and perfused jands due to blood flow
Co2 retention tremor
What is the co2 retention flap aeen with in reap disease (wei et al 2018)
Copd when hypercapnia occurs
What is auscultation when listening to lung sounds
Intensity and cheracter of sounds
What is wheezing
Air passing through narrow tubes
What is difference between monophonic and polyphonic and give examples
Monophonic is blockage one of major airway eg carcinoma
Polyphonic is obstruction of many airways eg cb/copd, asthma
What other auscultation sound is there
Crackling where air passes across fluid ef mucus/oedema
Which article discusses crackling auscultstion
Howell 2006
What did howell say early inspiratory and expiratory crackling was sign if
Severe airway obstruction diseases
eg copd, chronic bronchitis, asthma
What could late inspiratirt crackles be from (howell 2006)
Restrictive lung diseases
Pneumonia, ipf and oedema
If lack of disappearance in crackling when changing position whay does this indicate (howell 2006)
Worsening lung disease
Why would pneumonia cause restrictive/late inspirstiry crackling
Causes Late openining of small airways
What is percussion of lung sounds
How muffled/resonant they are eg dull or hyper resonance
What are dull sounds from
More material eg fluid, mucus, fibrosis material
What would hyper reaonant sound be indicstion of
Destruction of airways, eg emphysema with large air spaces
What are coughs/forced expiratory blasts stimulated by
Sensory neurones/irritant receotrs down the vagal neeve (damaged on allograft)
What is sputum
What is coughed up ie saliva and mucus mixture
What would green/ yellow sputum indicate
Bacterial infection
Yellow is incrrased neutrophils
What would white sputumnindicate
Viral sputum
Which sputum cells were increwsed in asthma
Eosinophils (prominent in asthma)
Which article discusses sputum analysis
Lacy et al 2005
What is given tonpatient which infuces sputum production
Saline solution
Eosinophils jigher in astham but what was higher in copd
Neutrophilia, elastases and proteases (consistent with emphysema and cb)
What would be looked at in a physicsl examinstioj
Vibrations when speaking, asymmetry, shape, bruising, skeletal abnormality
What is pigeon breast abnormality
Where breast sternum pushed out too far
What is the word for coyghing up blood
Haemoptysis
What can haemoptysis be caused by
Tumour, infections or oedema
What can chest pain indicate
Non specific rib issues or muscle
Or can be infection , tumour or reflux in lungs
Why are meds looked st in patinet history
Eg if theh take b blockers for bronchodilstion indicates asthma
Which systemic illness has a 5% risk to lung fibrosis so is looked for in patient history
Ra
What needs ti be taken into account when makint ntomal references in lft
Age, height, sex. All affect fev values
What happens in spirometry
Spirometer which is a mouth piece is given and used to measure fev1 against fvc during expiration of patient
What should be the fev1/fvc ratio ie what % of air should be breathed out in 1 sex
70% or more if nromal
What is total lung capacity
Volume lung can hold at full inspiration (IRV + TV + ERV + Residual vol)
What is the tlc of frmales vs males
4200 ml femaile
5800 ml in male
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
What is vital capacity
Volume of air expelled out after max insp and exp
Tv+irv+erv
What is the calues of vital capscity in female and male (tlc - rv)
3100 ml for female
4600 ml for male
What is the viral capacjty in male and female (tlc - rv)
3100 ml in female
4600 ml in maleb
Why cant residuak volume be measured by spirometer
Its rhe cokume which cannot be expired. Left in lung after even erv
What is functional residual capacity
The volume left in lung after normal expiration (ERV +RV)
Whag is it for female and male
1800 ml ve 2300 ml
Which method is uaed to measure frv/rv alongside spirometry
Helium dilutjon merhod
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
Wjy does this work
Because helium will stay constant as its a closed system. Doesnt diffuse actoss alveoli
Give rxamples of obstructive
Copd (inc cb and emphysema) ,asthma, bos
Give examples of restrictivr disease
Ards, ipf, pneumothorax (air fills csvity)
How else can lung disease be classified
Cause
Pathopjysiology
Site of issue
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
What syndrome of muscles can cause lack of compliance therefore restrictive
Duchenne myscular dystrophy
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
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)
If the pefr is the same or up to 80% same as normal what does it indicate
Normal lungs and lack of obstruction
What does below eg at 50% mean
Need immediate care as obstruction is bad
What is the airway hyperresponsive test
Where spirometry combined with giving bronchoconstricters to see responsiveness to histamine or methacholine
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
What are fibreoptic bronchoscopes going down nose paired eith
Bal or biopsies to indicate levels of inflammation, foreign objects, tumours
