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Case 5 > CAse 5 > Flashcards

CAse 5 Flashcards

1
Q

effect of nitrogen oxide on the lungs

A

inflammation of bronchiolitis

pulmonary edema

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2
Q

asbestosis description

A

S = breathlessness / finger clubbing / inspiratory crackles

C = pleural effusion / thickening / plaques MESOTHELIOMA

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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

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4
Q

what substances do nasal secretions contain to reduce infection

A

IgA antibodies
lysozyme
interferons

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5
Q

spirometry - what does the test tell us

A

rate of air flow and lung size estimation

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6
Q

what does a lung volume test tell us

A

accurate measure of amount of air the lungs can hold

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7
Q

pulse oximetry - what does the test tell us

A

assessment of how well O2 gets to blood from inhaled air

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8
Q

lung diffusion capacity - what does the test tell us

A

O2 blood level estimation

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9
Q

arterial blood gas - what does the test tell us

A

direct measurement of level of gases in blood (from artery)

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10
Q

fractional exhales nitric oxide - what does the test tell us

A

how much nitric oxide is in exhales air

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11
Q

what two factors influence O2 volume inhaled

A

respiratory rate / depth

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12
Q

name some conditions that cause respiratory depression (reduced depth)

A

head injuries
drugs
rib fractures

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13
Q

name some conditions that interfere with the negative intrathoracic pressure (reduced rate)

A

tension pneumothorax
upper airway obstruction
O2 DECREASE

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14
Q

what is the result of circulatory obstruction

A

decreased haemoglobin delivery to alveoli preventing O2 upload PULMONARY EMBOLISM

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15
Q

what are some conditions which cause respiratory obstruction

A

FLUID
pulmonary oedema
pus
airway obstructions

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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

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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
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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
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19
Q

effect of obesity on respiratory system function

A
  • decrease lung volume / vital capacity / total lung volumeeeeeee / chest wall compliance / blood O2
  • MICROATELECTASIS
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20
Q

describe the primary innate immunity

A

alveolar macrophages
1 phagocytic cells ingest pathogens
2 cytokines released
3 cytokines attract increased neutrophils

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21
Q

describe the early immure effector cells

A

NEUTROPHILS
1 recruited due to inflammation in early infection
2 degrade / remove pathogens

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22
Q

what does FVC stand for / what is it

A

forced vital capacity \greatest total amount of exhaled breath volume

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23
Q

what does FEV1 stand for / what is it

A

forced expiratory volume

forced expiratory volume in one second

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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

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25
Q

What does the FEV1:FVC ratio show

A

% of lung capacity you can exhale in one second

assessment of the obstruction / narrowing / inflammation of the airways (LOWER RATIO = OBSTRUCTION)

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26
Q

describe the spirometry process

A

deep breath
blow out fast into mouth piece
assess readings

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27
Q

what is a normal spirometry reading?

A

80+ %

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28
Q

what does an obstructive spirometry pattern look like

A

LOW FEV1 = LOWER RATIO
below 70%
COPD / asthma

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29
Q

what does an restrictive spirometry pattern look like

A

LOW FEV1 and FVC = NO CHANGE TO RATIO
total amount of air reduced
Pulmonary fibrosis / obesity

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30
Q

what spirometry reading would be considered very severe on the airway obstruction grade

A

below 30% post-medication

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31
Q

What does TV stand for and what is it

A

Tidal volume

volume of air entering / leaving lung in a single breath

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32
Q

describe the process of wet spirometry

A

air filled drum in water chamber
breath in and out (drum rises and falls)
soda lime canister absorbs CO2 and records

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33
Q

what is wet spirometry used to diagnose

A

COPD
asthma
restrictive lung disease

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34
Q

What does IRV stand for and what is it

A

inspiratory reserve volume

max. contraction of diaphragm (extra volume that can be inhaled at resting tidal volume)

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35
Q

What does IC stand for and what is it

A

inspiratory capacity

max. volume of air that can be inhaled post-normal expiration

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36
Q

What does ERV stand for and what is it

A

expiratory reserve volume

extra volume of air that can be forced from lungs after normal expiration

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37
Q

What does RV stand for and what is it

A

residual volume

minimum volume of air remaining in lungs after max expiration

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38
Q

What does FRC stand for and what is it

A

functional residual capacity

volume of air in lungs at the end of passive expiration

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39
Q

How do you calculate IC

A

IC = IRV + TV

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40
Q

How do you calculate FRC

A

FRC = ERV + RV

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41
Q

process of taking a bacterial sputum sample

A

collect smear / complete blood count / blood culture
culture sputum
perform susceptibility testing
gram staining

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42
Q

grey sputum - what type of lung problem?

A

upper tract infection
sinus congestion
smoking
GERD

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43
Q

brown sputum - what type of lung problem?

A

tar
blood
chocolate
pneumoconiosis

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44
Q

pink sputum - what type of lung problem?

A

pulmonary oedema

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45
Q

red sputum - what type of lung problem?

A

bronchitis
cancer
abcess
tuberculosis

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46
Q

clear sputum - what type of lung problem?

A

COPD
infection
asthma

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47
Q

black sputum - what type of lung problem?

A

melanoptysis

pneumoconiosis

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48
Q

frothy / mucoid sputum - what type of lung problem?

A

COPD

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49
Q

pink / mucoid sputum - what type of lung problem?

A

late stage congestive heart failure

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50
Q

green / black sputum - what type of lung problem?

A

gram NEGATIVE bacteria

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51
Q

What does TLC stand for

A

total lung capacity

max. volume of air expired in a single breath

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52
Q

What is UARS?

A

upper airway resistance syndrome

severe snoring / frequent waking during the night

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53
Q

describe the process of pulse oximetry (SpO2)

A

shines light on fingernails
differenting amount of light is absorbed by molecules
light absorbed is measured and calculated

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54
Q

what are the limitations of pulse oximetry

A
  • painted fingernails
  • not a full picture of patient ventilation
  • slow circulation not taken into account
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55
Q

what are the normal values for a pulse oximetry reading

A

94-99%

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56
Q

how do COPD patients cope with low O2 and HIGH CO2 in blood?

A

switching to hypoxic drive mechanism

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57
Q

what is hypoxic drive

A

the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle

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58
Q

what are some causes of low SpO2

A 
low atmospheric O2
respiratory depression 
upper / lower airway obstruction
chest restriction 
lack of -ve pressure 
O2 transfer obstruction
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59
Q

causes of upper airway obstruction

A

inhaled something

epiglottis

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60
Q

causes of lower airway obstruction

A

lung collapse

bronchospasm

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61
Q

immune mechanisms in the nasal cavity

A

3x nasal conchae - respiratory epithelium with large particles trapped in this mucus lining

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62
Q

immune mechanisms in the trachea / bronchi (upper airway)

A

particles become lodged in the mucus lining of the upper respiratory tree MUCO-CILLIARY ESCALATOR

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63
Q

immune mechanisms of the lower airway

A

lower turbulent air so particles settle

then phagocytosed by alveolar macrophages

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64
Q

Respiratory cycle - at rest features

A

no net volume of air in or out of lungs
lung volume = FRC
air pressure in alveoli = atmospheric pressure
-ve intrapleural pressure

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65
Q

Respiratory cycle - inhalation features

A

ACTIVE PROCESS
75% use of diaphragm (contracts) / external intercostal / accessory
-ve intrapleural pressure

66
Q

Respiratory cycle - exhalation features

A

PASSIVE OR ACTIVE - dependent on exercise
diaphragm (arching upwards) internal intercostal / abs transversus + rectus abdominous
normal interpleural pressure

67
Q

what is pulmonary surfactant

A
  • secreted by type II alveolar cells
  • mixes with water
  • decreases surface tension in expiration
  • prevents alveolar collapse
68
Q

what is the diagnostic test for pulmonary embolism

A

D - dimer

69
Q

what is the diagnostic test for inherited emphysema

A

alpha 1 - antitripsin

70
Q

what is the diagnostic test for cystic fibrosis

A

genetic marker test

71
Q

what is the diagnostic test for lung cancer

A

tumour markers

72
Q

what is the diagnostic test for malignant mesothelioma

A

tumour markers

73
Q

what is the diagnostic test for pneumonia

A

procalcitonin

74
Q

what is the diagnostic test for tuberculosis

A

tuberculin skin tests

75
Q

what is the diagnostic test for unexplained breathlessness

A

NT - proBNP

76
Q

what is the diagnostic test for sarcoidosis

A

ACE

77
Q

what is the diagnostic test for hypersensitivity pneumonitis

A

specific precipitatory antibodies

78
Q

what is sarcoidosis

A

disease involving abnormal collections of inflammatory cells that form lumps known as granulomas (enlarged lymphs)

79
Q

what is hypersensitivity pneumonitis

A

is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts

80
Q

what is the diagnostic test for asthma

A

total and specific TgE

81
Q

what is the diagnostic test for eosinophilic

A

eosinophils

82
Q

what is the diagnostic test for connective tissue disorders

A

rheumatoid factors

83
Q

what is the diagnostic test for pleural effusion

A

LHD / glucose / cholesterol levels

84
Q

chesty cough features

A

productive

caused by respiratory infections

85
Q

tickly cough features

A

non-productive

irritation of the throat

86
Q

dry cough features

A

non-productive

other cause?

87
Q

persistent cough features

A

can be productive or not

3+ weeks

88
Q

smokers cough features

A

caused by long term smoking, used to clear smoking toxins

89
Q

what are the three phases of coughing

A

1 inspiratory
2 compressive
3 expulsive

90
Q

what does the inspiratory phase of coughing involve

A

larynx closes momentarily at epiglottis

91
Q

what does the compressive phase of coughing involve

A

simultaneous contraction of abdomen and chest

92
Q

what does the expulsive phase of coughing involve

A

epiglottis relaxes
larynx opens
air released

93
Q

what nerve stimulates the diaphragm during a cough reflex

A

phrenic

94
Q

what nerve stimulates the throat during a cough reflex

A

vagus

95
Q

what nerve stimulates the muscles (expiratory) during a cough reflex

A

spinal motor

96
Q

where is the cough centre of the brain

A

medulla

nucleus of tractus solitarius (brainstem nucleus)

97
Q

what are expectorants used to treat

A

chesty coughs

thins mucus

98
Q

what are antitussives used to treat

A

dry/tickly cough

suppresses cough reflex action

99
Q

where are the cough receptors (list)

A

pharynx
trachea
bronchi
bronchioles

100
Q

what are the afferent nerves involved in cough reflex (relieves signal from receptors)

A

vagus

glossopharyngeal

101
Q

describe a bronchial lung sound and were it should be heard

A

hollow / low / tubular
pause between inspiration and expiration
NORMAL = trachea
ABNORMAL = lungs

102
Q

describe a rhonchi lung sound

A

ABNORMAL
low pitched continuous wheeze
heard in bronchi (larger)

103
Q

what does a bronchial lung sound indicate if heard in the lung periphery

A

pneumonia
atelectasis
pleural effusions

104
Q

what is atelectasis

A

a complete or partial collapse of a lung or lobe of a lung

105
Q

describe a vesicular lung sound

A

NORMAL (over lung surface)

soft low rustling

106
Q

describe crackling (fine) lung sound

A

ABNORMAL

high pitched popping (like a fire)

107
Q

describe coarse crackling lung sounds

A

ABNORMAL

discontinuous long deep hard sound

108
Q

describe a wheeze lung sound

A

ABNORMAL
continuous whistling
low pitch - squeak
high pitch - snoring

109
Q

what causes a wheezing lung sound

A

airway narrowing

110
Q

describe a pleural rub lung sound

A

ABNORMAL
creaking / grating sound
during inspiration and expiration

111
Q

what is the cause of pleural rub sound

A

two inflamed surfaces rubbing together in the lungs

112
Q

describe a bronchiovascular lung noise

A

NORMAL

mixed pitch breath sounds

113
Q

what does a bronchiovascular lung noise mean if it occurs in the periphery of the lungs

A

early or partial atelectasis

114
Q

What can lung crackling noises indicate

A

during early inspiration - chronic bronchitis
during late inspiration - pneumonia / atelectasis
other - interstitial lung disease / pulmonary oedema

115
Q

what are basilar crackles and what do they indicate

A
  • crackles apparently originating in or near the base of the lung
    BRONCHITIS
116
Q

what determines the partial pressure of O2 in a saturation curve

A

amount of O2 bonded to Hb

117
Q

why is the middle section of an O2 saturation curve steep

A

peripheral tissue withdraws large amounts of O2 for a small drop in pO2

118
Q

what is the utilisation coefficient and its normal value

A

% of blood that gives O2 to normal tissue

25%

119
Q

does left or right line shift represent increased affinity

A

LEFT

120
Q

Description / symptoms / treatment - bronchiestasis

A

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
Q

Description / symptoms / treatment - asbestosis

A

D= reduced elasticity from scar tissue

S= cor pulmonale / hypertension / cough / finger clubbing / crackling in lungs

T= transplant / hydration / pulmonary rehabilitation

122
Q

Description / symptoms / treatment - empyema

A

D= bacterial infection (pneumonia) preventing expansion

S= chest pain / SOB / weight loss

T= surgery / antibiotics

123
Q

Description / symptoms / treatment - chronic bronchitis

A

D= inflammation of airways due to cilia / bronchial tube damage - COPD

S= SOB / wheezing / fever

T= bronchodilators / steroids / stop smoking

124
Q

what is cor pulmonale

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

125
Q

factors affecting pO2 + and causing LEFT shift

A
  • CO increase = lower O2

- CO2 (Bohr Effect) = carbonic acid = decreased pH= LEFT in LUNGS

126
Q

factors affecting pO2 + and causing RIGHT shift (more dissociation / decreased affinity)

A
  • temp increase
  • CO2 (Bohr Effect) = carbonic acid = RIGHT in TISSUE
  • chronic hypoxia = 2,3 DPG by RBC
  • hormones = 2.3 BPG by erythrocytes
127
Q

LOW pH
LOW Bicarb
LOW PACO2

A

metabolic ACIDOSIS

128
Q

LOW pH
HIGH Bicarb
HIGH PACO2

A

respiratory ACIDOSIS

129
Q

HIGH pH
LOW Bicarb
LOW PACO2

A

respiratory ALKALOISIS

130
Q

HIGH pH
HIGH Bicarb
HIGH PACO2

A

metabolic ALKALOISIS

131
Q

what causes metabolic ACIDOSIS

A

kidney failure
shock
drunk
diabetic ketoacidosis

132
Q

what causes respiratory ACIDOSIS

A

COPD
asthma
airway obstruction

133
Q

what causes respiratory ALKALOISIS

A

hyperventilation
pain
anxiety
pneumonia

134
Q

what causes metabolic ALKALOISIS

A

vomiting
low potassium
heart failure

135
Q

Description / symptoms / treatment - pulmonary embolism

A

D =obstruction of pulmonary artery

S = chest pain / cough - pink foam / dyspnoea

T = anticoagulants / thrombolytic therapy / vena cava filter

136
Q

Description / symptoms / treatment - pulmonary fibrosis

A

D = low elasticity caused by fibrosis leading to lung damage

S = weight loss / SOB / finger clubbing / dry cough

T = lung transplant / Corticosteroids /

137
Q

Description / symptoms / treatment - asthma

A

D = swollen / narrowed airways + clogged mucus

S = wheezing / breathlessness/ drowsy / tight chest

T = reliever + prevention inhalers / injections

138
Q

What two forms are O2 carried in?

A

dissolved

haemoglobin

139
Q

Describe Henry’s law

A

the amount of O2 dissolved in the blood is proportional to partial pressure

140
Q

Describe the 3 types of haemoglobin

A

Hb A - normal adult
Hb F - fetal (more O2 carried)
Hb S - sickle cell

141
Q

what is Hb production controlled by

A

erythropoietin in the kidneys when there is reduced )2 delivery to them

142
Q

polycythaemia description

A

chronic mountain sickness

increased blood viscosity

143
Q

What is the gibbs - donnan equilibrium

A

CO + HO ⇌ HCO ⇌ H+ + HCO

(carbonic anhydrase enzyme needed) and Cl- ions diffuse into cells to maintain electrical neutrality

144
Q

what is the haldane effect

A

H+ + HbO2 ⇌ H + Hb + O2

deoxygenated blood increases the O2 carrying ability

145
Q

what is the carboamino constitution of arterial blood

A 
CO2 = 90%
bicarbonate = 5%
146
Q

what is the carboamino constitution of venous blood

A 
CO2 = 60%
bicarbonate = 30%
147
Q

Description / symptoms / treatment - central sleep apnoea

A

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
Q

Description / symptoms / treatment - lung cancer

A

D = cancer

S = bloody cough for 3+ weeks / fever / chest pain /

T = lobectomy / chemotherapy / radiotherapy / segmentectomy

149
Q

Description / symptoms / treatment - COPD

A

D = emphysema / chronic breathlessness / refractory asthma

S = breathlessness / coughing / SOB / oedema / losing weight

T = pulmonary rehabilitation / steroid + theophylline tablets / beta-2-antagonist inhalers

150
Q

what side graph shift represents respiratory acidosis / alkalosis

A

acidosis - LEFT

alkalosis - RIGHT

151
Q

Description / symptoms / treatment - cystic fibrosis

A

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
Q

Description / symptoms / treatment - silicosis

A

D = macrophages die and release toxins due to inhalation of silica dust

S = SOB / persistent cough

T = stop smoking/ healthy eating

153
Q

Description / symptoms / treatment - emphysema

A

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
Q

Salbutamol (reliever)

A

short acting bronchodilator beta2 agonist

T = COPD / asthma

DT = diabetes / hypertension / thyroid things / heart problems

SE = nervous tension / feeling shaky / headache

155
Q

Terbutaline (reliever)

A

short acting bronchodilator beta2 agonist

T = COPD / asthma

DT = diabetes / hypertension / thyroid things / heart problems

SE = headache / feeling shaky

156
Q

Formoterol

A

long acting bronchodilator beta2 agonist

T = COPD / asthma

DT = diabetes / hypertension / thyroid things / heart problems / low potassium

SE = headache / feeling shaky / palpitations / cough

157
Q

Salmeterol

A

long acting bronchodilator beta2 agonist

T = COPD / asthma

DT = diabetes / hypertension / thyroid things / heart problems / low potassium

SE = muscle cramps / headaches

158
Q

Theophylline

A

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
Q

Clarithromycin

A

macrolide antibiotic (inhibit the growth of bacteria )

T = pneumonia / stomach ulcers

DT = kidney + liver problems

SE = nausea / diarrhoea / headaches / sore mouth

160
Q

fluticasone (preventer)

A

Corticosteroid (steroid) inhaler

T = asthma / COPD

DT = chest infection / TB

SE = chest infection / skin bruises / hoarse voice

161
Q

dextromethorphan

A

Antitussives
T =

DT =

SE =

162
Q

what type of medication is dextromethorphan

A

Antitussives

Case 5 (1 decks)

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