CAse 5 Flashcards
1
Q
effect of nitrogen oxide on the lungs
A
inflammation of bronchiolitis
pulmonary edema
2
Q
asbestosis description
A
S = breathlessness / finger clubbing / inspiratory crackles
C = pleural effusion / thickening / plaques MESOTHELIOMA
3
Q
why do many diseases occur once substances have been inhaled into the lungs? (physiology of the lungs)
A
decreased flow rates / turbulence in air within lungs
takes 60-120 days to move mucus back up to mouth
less effective against viral infection
4
Q
what substances do nasal secretions contain to reduce infection
A
IgA antibodies
lysozyme
interferons
5
Q
spirometry - what does the test tell us
A
rate of air flow and lung size estimation
6
Q
what does a lung volume test tell us
A
accurate measure of amount of air the lungs can hold
7
Q
pulse oximetry - what does the test tell us
A
assessment of how well O2 gets to blood from inhaled air
8
Q
lung diffusion capacity - what does the test tell us
A
O2 blood level estimation
9
Q
arterial blood gas - what does the test tell us
A
direct measurement of level of gases in blood (from artery)
10
Q
fractional exhales nitric oxide - what does the test tell us
A
how much nitric oxide is in exhales air
11
Q
what two factors influence O2 volume inhaled
A
respiratory rate / depth
12
Q
name some conditions that cause respiratory depression (reduced depth)
A
head injuries
drugs
rib fractures
13
Q
name some conditions that interfere with the negative intrathoracic pressure (reduced rate)
A
tension pneumothorax
upper airway obstruction
O2 DECREASE
14
Q
what is the result of circulatory obstruction
A
decreased haemoglobin delivery to alveoli preventing O2 upload PULMONARY EMBOLISM
15
Q
what are some conditions which cause respiratory obstruction
A
FLUID
pulmonary oedema
pus
airway obstructions
16
Q
list some social impacts of lung disease
A
self-inflicted association (stigmatised behaviour - smoking)
visible effects of the condition (scars) more stigma
low socioeconomic status
17
Q
effect of lifestyle on the respiratory system function
A
irritation of the larynx decreased lung function = breathlessness impairment of lung clearance system increased infection risk destroyed alveoli
18
Q
effect of alcohol on respiratory system function
A
increased pneumonia risk
- alveolar macrophages reduces phagocytic capacity + cytokine release
- neutrophils ingesting and removing pathogens is impaired by alcohol
19
Q
effect of obesity on respiratory system function
A
- decrease lung volume / vital capacity / total lung volumeeeeeee / chest wall compliance / blood O2
- MICROATELECTASIS
20
Q
describe the primary innate immunity
A
alveolar macrophages
1 phagocytic cells ingest pathogens
2 cytokines released
3 cytokines attract increased neutrophils
21
Q
describe the early immure effector cells
A
NEUTROPHILS
1 recruited due to inflammation in early infection
2 degrade / remove pathogens
22
Q
what does FVC stand for / what is it
A
forced vital capacity \greatest total amount of exhaled breath volume
23
Q
what does FEV1 stand for / what is it
A
forced expiratory volume
forced expiratory volume in one second
24
Q
what does VC stand for / what is it / how is it calculated
A
vital capacity
gentle sigh when lungs are empty (volume)
VC = IRV + TV + ERV
25
What does the FEV1:FVC ratio show
% of lung capacity you can exhale in one second
| assessment of the obstruction / narrowing / inflammation of the airways (LOWER RATIO = OBSTRUCTION)
26
describe the spirometry process
deep breath
blow out fast into mouth piece
assess readings
27
what is a normal spirometry reading?
80+ %
28
what does an obstructive spirometry pattern look like
LOW FEV1 = LOWER RATIO
below 70%
COPD / asthma
29
what does an restrictive spirometry pattern look like
LOW FEV1 and FVC = NO CHANGE TO RATIO
total amount of air reduced
Pulmonary fibrosis / obesity
30
what spirometry reading would be considered very severe on the airway obstruction grade
below 30% post-medication
31
What does TV stand for and what is it
Tidal volume
| volume of air entering / leaving lung in a single breath
32
describe the process of wet spirometry
air filled drum in water chamber
breath in and out (drum rises and falls)
soda lime canister absorbs CO2 and records
33
what is wet spirometry used to diagnose
COPD
asthma
restrictive lung disease
34
What does IRV stand for and what is it
inspiratory reserve volume
| max. contraction of diaphragm (extra volume that can be inhaled at resting tidal volume)
35
What does IC stand for and what is it
inspiratory capacity
| max. volume of air that can be inhaled post-normal expiration
36
What does ERV stand for and what is it
expiratory reserve volume
| extra volume of air that can be forced from lungs after normal expiration
37
What does RV stand for and what is it
residual volume
| minimum volume of air remaining in lungs after max expiration
38
What does FRC stand for and what is it
functional residual capacity
| volume of air in lungs at the end of passive expiration
39
How do you calculate IC
IC = IRV + TV
40
How do you calculate FRC
FRC = ERV + RV
41
process of taking a bacterial sputum sample
collect smear / complete blood count / blood culture
culture sputum
perform susceptibility testing
gram staining
42
grey sputum - what type of lung problem?
upper tract infection
sinus congestion
smoking
GERD
43
brown sputum - what type of lung problem?
tar
blood
chocolate
pneumoconiosis
44
pink sputum - what type of lung problem?
pulmonary oedema
45
red sputum - what type of lung problem?
bronchitis
cancer
abcess
tuberculosis
46
clear sputum - what type of lung problem?
COPD
infection
asthma
47
black sputum - what type of lung problem?
melanoptysis
| pneumoconiosis
48
frothy / mucoid sputum - what type of lung problem?
COPD
49
pink / mucoid sputum - what type of lung problem?
late stage congestive heart failure
50
green / black sputum - what type of lung problem?
gram NEGATIVE bacteria
51
What does TLC stand for
total lung capacity
| max. volume of air expired in a single breath
52
What is UARS?
upper airway resistance syndrome
| severe snoring / frequent waking during the night
53
describe the process of pulse oximetry (SpO2)
shines light on fingernails
differenting amount of light is absorbed by molecules
light absorbed is measured and calculated
54
what are the limitations of pulse oximetry
- painted fingernails
- not a full picture of patient ventilation
- slow circulation not taken into account
55
what are the normal values for a pulse oximetry reading
94-99%
56
how do COPD patients cope with low O2 and HIGH CO2 in blood?
switching to hypoxic drive mechanism
57
what is hypoxic drive
the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle
58
what are some causes of low SpO2
```
low atmospheric O2
respiratory depression
upper / lower airway obstruction
chest restriction
lack of -ve pressure
O2 transfer obstruction
```
59
causes of upper airway obstruction
inhaled something
| epiglottis
60
causes of lower airway obstruction
lung collapse
| bronchospasm
61
immune mechanisms in the nasal cavity
3x nasal conchae - respiratory epithelium with large particles trapped in this mucus lining
62
immune mechanisms in the trachea / bronchi (upper airway)
particles become lodged in the mucus lining of the upper respiratory tree MUCO-CILLIARY ESCALATOR
63
immune mechanisms of the lower airway
lower turbulent air so particles settle
| then phagocytosed by alveolar macrophages
64
Respiratory cycle - at rest features
no net volume of air in or out of lungs
lung volume = FRC
air pressure in alveoli = atmospheric pressure
-ve intrapleural pressure
65
Respiratory cycle - inhalation features
ACTIVE PROCESS
75% use of diaphragm (contracts) / external intercostal / accessory
-ve intrapleural pressure
66
Respiratory cycle - exhalation features
PASSIVE OR ACTIVE - dependent on exercise
diaphragm (arching upwards) internal intercostal / abs transversus + rectus abdominous
normal interpleural pressure
67
what is pulmonary surfactant
- secreted by type II alveolar cells
- mixes with water
- decreases surface tension in expiration
- prevents alveolar collapse
68
what is the diagnostic test for pulmonary embolism
D - dimer
69
what is the diagnostic test for inherited emphysema
alpha 1 - antitripsin
70
what is the diagnostic test for cystic fibrosis
genetic marker test
71
what is the diagnostic test for lung cancer
tumour markers
72
what is the diagnostic test for malignant mesothelioma
tumour markers
73
what is the diagnostic test for pneumonia
procalcitonin
74
what is the diagnostic test for tuberculosis
tuberculin skin tests
75
what is the diagnostic test for unexplained breathlessness
NT - proBNP
76
what is the diagnostic test for sarcoidosis
ACE
77
what is the diagnostic test for hypersensitivity pneumonitis
specific precipitatory antibodies
78
what is sarcoidosis
disease involving abnormal collections of inflammatory cells that form lumps known as granulomas (enlarged lymphs)
79
what is hypersensitivity pneumonitis
is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts
80
what is the diagnostic test for asthma
total and specific TgE
81
what is the diagnostic test for eosinophilic
eosinophils
82
what is the diagnostic test for connective tissue disorders
rheumatoid factors
83
what is the diagnostic test for pleural effusion
LHD / glucose / cholesterol levels
84
chesty cough features
productive
| caused by respiratory infections
85
tickly cough features
non-productive
| irritation of the throat
86
dry cough features
non-productive
| other cause?
87
persistent cough features
can be productive or not
| 3+ weeks
88
smokers cough features
caused by long term smoking, used to clear smoking toxins
89
what are the three phases of coughing
1 inspiratory
2 compressive
3 expulsive
90
what does the inspiratory phase of coughing involve
larynx closes momentarily at epiglottis
91
what does the compressive phase of coughing involve
simultaneous contraction of abdomen and chest
92
what does the expulsive phase of coughing involve
epiglottis relaxes
larynx opens
air released
93
what nerve stimulates the diaphragm during a cough reflex
phrenic
94
what nerve stimulates the throat during a cough reflex
vagus
95
what nerve stimulates the muscles (expiratory) during a cough reflex
spinal motor
96
where is the cough centre of the brain
medulla
| nucleus of tractus solitarius (brainstem nucleus)
97
what are expectorants used to treat
chesty coughs
| thins mucus
98
what are antitussives used to treat
dry/tickly cough
| suppresses cough reflex action
99
where are the cough receptors (list)
pharynx
trachea
bronchi
bronchioles
100
what are the afferent nerves involved in cough reflex (relieves signal from receptors)
vagus
| glossopharyngeal
101
describe a bronchial lung sound and were it should be heard
hollow / low / tubular
pause between inspiration and expiration
NORMAL = trachea
ABNORMAL = lungs
102
describe a rhonchi lung sound
ABNORMAL
low pitched continuous wheeze
heard in bronchi (larger)
103
what does a bronchial lung sound indicate if heard in the lung periphery
pneumonia
atelectasis
pleural effusions
104
what is atelectasis
a complete or partial collapse of a lung or lobe of a lung
105
describe a vesicular lung sound
NORMAL (over lung surface)
| soft low rustling
106
describe crackling (fine) lung sound
ABNORMAL
| high pitched popping (like a fire)
107
describe coarse crackling lung sounds
ABNORMAL
| discontinuous long deep hard sound
108
describe a wheeze lung sound
ABNORMAL
continuous whistling
low pitch - squeak
high pitch - snoring
109
what causes a wheezing lung sound
airway narrowing
110
describe a pleural rub lung sound
ABNORMAL
creaking / grating sound
during inspiration and expiration
111
what is the cause of pleural rub sound
two inflamed surfaces rubbing together in the lungs
112
describe a bronchiovascular lung noise
NORMAL
| mixed pitch breath sounds
113
what does a bronchiovascular lung noise mean if it occurs in the periphery of the lungs
early or partial atelectasis
114
What can lung crackling noises indicate
during early inspiration - chronic bronchitis
during late inspiration - pneumonia / atelectasis
other - interstitial lung disease / pulmonary oedema
115
what are basilar crackles and what do they indicate
- crackles apparently originating in or near the base of the lung
BRONCHITIS
116
what determines the partial pressure of O2 in a saturation curve
amount of O2 bonded to Hb
117
why is the middle section of an O2 saturation curve steep
peripheral tissue withdraws large amounts of O2 for a small drop in pO2
118
what is the utilisation coefficient and its normal value
% of blood that gives O2 to normal tissue
| 25%
119
does left or right line shift represent increased affinity
LEFT
120
Description / symptoms / treatment - bronchiestasis
D= permanent damage to elastic tissue due to inflammation from infection
S= jaundice / rectal prolapse / cough / wheeze
T= stop smoking / flue vaccine / balanced diet
121
Description / symptoms / treatment - asbestosis
D= reduced elasticity from scar tissue
S= cor pulmonale / hypertension / cough / finger clubbing / crackling in lungs
T= transplant / hydration / pulmonary rehabilitation
122
Description / symptoms / treatment - empyema
D= bacterial infection (pneumonia) preventing expansion
S= chest pain / SOB / weight loss
T= surgery / antibiotics
123
Description / symptoms / treatment - chronic bronchitis
D= inflammation of airways due to cilia / bronchial tube damage - COPD
S= SOB / wheezing / fever
T= bronchodilators / steroids / stop smoking
124
what is cor pulmonale
abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels
125
factors affecting pO2 + and causing LEFT shift
- CO increase = lower O2
| - CO2 (Bohr Effect) = carbonic acid = decreased pH= LEFT in LUNGS
126
factors affecting pO2 + and causing RIGHT shift (more dissociation / decreased affinity)
- temp increase
- CO2 (Bohr Effect) = carbonic acid = RIGHT in TISSUE
- chronic hypoxia = 2,3 DPG by RBC
- hormones = 2.3 BPG by erythrocytes
127
LOW pH
LOW Bicarb
LOW PACO2
metabolic ACIDOSIS
128
LOW pH
HIGH Bicarb
HIGH PACO2
respiratory ACIDOSIS
129
HIGH pH
LOW Bicarb
LOW PACO2
respiratory ALKALOISIS
130
HIGH pH
HIGH Bicarb
HIGH PACO2
metabolic ALKALOISIS
131
what causes metabolic ACIDOSIS
kidney failure
shock
drunk
diabetic ketoacidosis
132
what causes respiratory ACIDOSIS
COPD
asthma
airway obstruction
133
what causes respiratory ALKALOISIS
hyperventilation
pain
anxiety
pneumonia
134
what causes metabolic ALKALOISIS
vomiting
low potassium
heart failure
135
Description / symptoms / treatment - pulmonary embolism
D =obstruction of pulmonary artery
S = chest pain / cough - pink foam / dyspnoea
T = anticoagulants / thrombolytic therapy / vena cava filter
136
Description / symptoms / treatment - pulmonary fibrosis
D = low elasticity caused by fibrosis leading to lung damage
S = weight loss / SOB / finger clubbing / dry cough
T = lung transplant / Corticosteroids /
137
Description / symptoms / treatment - asthma
D = swollen / narrowed airways + clogged mucus
S = wheezing / breathlessness/ drowsy / tight chest
T = reliever + prevention inhalers / injections
138
What two forms are O2 carried in?
dissolved
| haemoglobin
139
Describe Henry's law
the amount of O2 dissolved in the blood is proportional to partial pressure
140
Describe the 3 types of haemoglobin
Hb A - normal adult
Hb F - fetal (more O2 carried)
Hb S - sickle cell
141
what is Hb production controlled by
erythropoietin in the kidneys when there is reduced )2 delivery to them
142
polycythaemia description
chronic mountain sickness
| increased blood viscosity
143
What is the gibbs - donnan equilibrium
CO + HO ⇌ HCO ⇌ H+ + HCO
| (carbonic anhydrase enzyme needed) and Cl- ions diffuse into cells to maintain electrical neutrality
144
what is the haldane effect
H+ + HbO2 ⇌ H + Hb + O2
| deoxygenated blood increases the O2 carrying ability
145
what is the carboamino constitution of arterial blood
```
CO2 = 90%
bicarbonate = 5%
```
146
what is the carboamino constitution of venous blood
```
CO2 = 60%
bicarbonate = 30%
```
147
Description / symptoms / treatment - central sleep apnoea
D = brain does not respond to increased CO2 so breathing stops for 10+ seconds
S = increased HR / RR
T = lose weight / less alcohol / O2 supplements
148
Description / symptoms / treatment - lung cancer
D = cancer
S = bloody cough for 3+ weeks / fever / chest pain /
T = lobectomy / chemotherapy / radiotherapy / segmentectomy
149
Description / symptoms / treatment - COPD
D = emphysema / chronic breathlessness / refractory asthma
S = breathlessness / coughing / SOB / oedema / losing weight
T = pulmonary rehabilitation / steroid + theophylline tablets / beta-2-antagonist inhalers
150
what side graph shift represents respiratory acidosis / alkalosis
acidosis - LEFT
| alkalosis - RIGHT
151
Description / symptoms / treatment - cystic fibrosis
D = too much Na+ so water leaves cells leading to thick mucus and widened airways
S = pseudomonas aeruginosa infections / coughing / wheezing
diagnosis = sweat tests (Na+) / genetic markers
T = inhalers / antibiotics
152
Description / symptoms / treatment - silicosis
D = macrophages die and release toxins due to inhalation of silica dust
S = SOB / persistent cough
T = stop smoking/ healthy eating
153
Description / symptoms / treatment - emphysema
D = alveoli breakdown as tripsin is not broken down so digests lungs reducing surface area
S = productive cough / SOB / pursed lip breathing
T = stop smoking / bronchodilator / O2 / antibiotics
154
Salbutamol (reliever)
short acting bronchodilator beta2 agonist
T = COPD / asthma
DT = diabetes / hypertension / thyroid things / heart problems
SE = nervous tension / feeling shaky / headache
155
Terbutaline (reliever)
short acting bronchodilator beta2 agonist
T = COPD / asthma
DT = diabetes / hypertension / thyroid things / heart problems
SE = headache / feeling shaky
156
Formoterol
long acting bronchodilator beta2 agonist
T = COPD / asthma
DT = diabetes / hypertension / thyroid things / heart problems / low potassium
SE = headache / feeling shaky / palpitations / cough
157
Salmeterol
long acting bronchodilator beta2 agonist
T = COPD / asthma
DT = diabetes / hypertension / thyroid things / heart problems / low potassium
SE = muscle cramps / headaches
158
Theophylline
Xanthine bronchodilator
T = COPD / Asthma
DT = heart condition / liver + kidney issues / hyperthyroidism / hypertension / epilepsy / low potassium / drink or smoke
SE = upset stomach / fast heartbeat / headache
159
Clarithromycin
macrolide antibiotic (inhibit the growth of bacteria )
T = pneumonia / stomach ulcers
DT = kidney + liver problems
SE = nausea / diarrhoea / headaches / sore mouth
160
fluticasone (preventer)
Corticosteroid (steroid) inhaler
T = asthma / COPD
DT = chest infection / TB
SE = chest infection / skin bruises / hoarse voice
161
dextromethorphan
Antitussives
T =
DT =
SE =
162
what type of medication is dextromethorphan
Antitussives
