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3 - Respiratory > deck_1670798 > Flashcards

deck_1670798 Flashcards

1
Q

Define COPD

A

Is a chronic, slowly progressive disorder characterised by airflow obstruction, which does not changed markedly over several months.

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2
Q

What are the characteristics of COPD?

A

Is preventable and treatable. — Have exacerbations— Certain disorders contribute to it — emphysema, chronic bronchitis and asthma—Collection of causes/diseases

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3
Q

How is airflow obstruction defined?

A

— Reduced FEV1— Reduced FEV1/FVC ratio

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4
Q

What are the main causes of COPD?

A
  1. An abnormal inflammatory response of the lungs to noxious particles or gases2. Anti protease deficiency3. Empysema can also be caused by alpha-1 antitrypsin deficiency
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5
Q

What are the main mechanisms of COPD?

A

Inflammation (airway and systemic)Alveolar destructionHyperinflationRespiratory muscle inefficiencySkeletal muscle dysfunction

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6
Q

What are the main impacts of COPD?

A

Mobility issues due to breathlessnessHealth status is generally poorerEffects on moodExacerbations HospitalisationsDeath

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7
Q

What is the pathogenesis of COPD?

A

Noxious substances are inhaled which triggers and immune response form the host. These responses amplify the effects of the noxious substancesDamage is done by oxidative stress adn anti-proteinases

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8
Q

What are the symptoms of COPD?

A

Productive cough (due to chronic bronchitis)DyspnoeaWheeze (from small airways)Tends to develop after years of having a smokers cough

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9
Q

What are the signs of COPD?

A

Quiet wheezesHyperventilation with prolonger expiration (due to emphysema)Need to use accessory muscles of inspirationHyperinflation of lungs

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10
Q

Why is hyperinflation of the lungs a sign of COPD?

A

Need to inhale more air in order to get sufficient amount of gas exchangeIs a compensatory mechanism for the loss of elastic recoil

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11
Q

What is a treatment that can help people who show signs of hyperinflation?

A

Can remove emphysematous lung in order to return the chest wall to normal. It can help to ease the act of breathing.

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12
Q

What are the main ways to asses someone who has COPD?

A

HistoryChest x-rayFEV1Lung function testsHigh resolution CT scan

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13
Q

What factors do you look for in the history of someone you suspects has COPD?

A

smokingLength of symptom occurrencePast medical history e.g. asthmaJob history e.g. coal worker, working with asbestosMRC dyspnoea scale

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14
Q

What is the MRC dyspnoea scale?

A

A scale which allows you to determine the severity of breathlessness depending on the activities that are limited

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15
Q

Why do you order an x-ray?

A

Rules out other lung pathologiesCan see certain COPD characteristics

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16
Q

Give some COPD chest x-ray characteristics

A

Flattening of the diaphragmIncreased size of the chest, as measured from front to back.A long narrow heart.Abnormal air collections within the lung (focal bullae).

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17
Q

What are the changes seen in FEV1 testing?

A

Reduced FEV1 (more so than expected for age)Reduced FEV1/FVC ratio (>70%)

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18
Q

Give some lung function measurements that confirm COPD?

A

Total lung volume – will be lowered in COPDLung diffusion testing determines how well gas exchange is taking place (also will be reduced)

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19
Q

Why is a high resolution CT scan performed?

A

Detects emphysema

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20
Q

What can be seen on a high resolution CT scan on someone with emphysema?

A

Damages parenchyma with loss of elasticityLarge holes are present where the lung has been damagedCan see giant bullas (dilated airways - air can enter but cannot leave so increase in size)

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21
Q

Define sprirometry

A

Patient fills their lungs from the atmosphere and breathes out as far and as fast as possible through a spirometer.

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22
Q

What is a normal blood gas seen in someone who has type one respiratory failure?

A

Increased respiratory rateDecreased pO2Normal/decreased pCO2

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23
Q

What is a blood gas seen in someone who has type two respiratory failure?

A

Increased respiratory rateDecreased pO2Increased pCO2

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24
Q

When is oxygen therapy given?

A

Treatment for hypoxaemia– it increases oxygen saturation levels

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25
Give some characteristics of oxygen therapy
Can be used in the long term and is portable
26
Why would you prescribe someone with oxygen?
Improves survival or people who are in respiratory failureRelieves dyspnoeaImproves the quality of life Can be used in the long term, portable and intermittent oxygen therapyGives the accessory respiratory muscles a rest
27
What are the treatment options for COPD?
Stop smokingBronchodilatorsInhaled steroids-- These control the symptoms rather than giving a cure
28
What bronchodilators would you use first?
Short term bronchodilator firstThen a long term bronchodilatorCorticosteroids are used when a patient has increased exacerbations
29
What is pulmonary rehabilitation?
Gives the patient exercises and allows them to improve exercise capacity which should help to improve their breathlessness. It increases muscle strength and density as well as mitochondrial density, capilliarisation and increase mitochondrial enzyme release.
30
Why is pulmonary rehabilitation beneficial?
Reduces effects of breathlessnessGives patient more independenceMakes patient feel more comfortable and improves their general health statusIs more cost effective and reduces hospital stays
31
Define an exacerbation
Worsening of a previously stable condition associated with a declining health status
32
What are the characteristics of an exacerbation?
— increase wheeze, dyspnoea, sputum volume and colour, chest tightness and fluid retention
33
What are some treatment options for exacerbations?
— Increase/add bronchodilator— Antibiotic if needed— Oral corticosteroids— Admit to hospital— Oxygen— Assisted ventilation
34
What are some common flora found in the URT?
Viridans streptococci Neisseria spp Anaerobes Candida sp
35
What are some less common flora found in the URT?
Streptococcus pneumoniae Streptococcus pyogenes Haemophillus influenzae
36
Give some examples of common upper respiratory tract infections
RhinitisPharynitisEpiglotitisLaryngitisTracheitisSinusitisOtitis media
37
What are the defences of the respiratory tract?
Cilia and mucusCough and sneeze reflexRespiratory mucosal immune system
38
What are the factors that make up the respiratory mucosal immune system?
Lmphoid follicles of pharynx and tonsilsAlveolar macrophagesSecretory IgA and IgG
39
What are upper respiratory tract infections mostly caused by?
Viruses- rhinovirus- coronavirus- influenza or parainfluenza- respiratory syncytial virus
40
What are the main LRTIs?
BronchitisBronchiolitisPneumonia
41
Define bronchitis
Inflammation do the mucosal membrane int he bronchial tubes- causes bronchospasms and coughing
42
Define pneumonia
Infection of the lung parenchyma which results in lung consolidation as the air spaces fill with pus.
43
What are the characteristics of pneumonia?
Fluid fills air spacesConsolidationImpaired gas exchange
44
How can pneumonia be classified?
By: clinical settingPresentationOrganismLung pathology
45
What are the main organisms that cause pneumonia?
30% — Streptococcus pneumoniae 10% — haemophilus influenzae — COPD10% — virusesMycobacterium tuberculosis
46
What is penumonitis?
Inflammation due to physical of chemical damage in the lungs
47
What is lobar pneumonia?
Pneumonia that is localise to a particular lobe of a lung- usually streptococcus pneumoniae
48
What is broncho pneumonia?
Pneumonia that is diffuse and patchy.Starts in the airways and spreads to adjacent alveoli and lung tissue
49
What usually causes broncho pneumonia?
Streptococcus pneumoniaeHaemophilus influenzaStaphylococcus aureusanaerobescoliforms
50
Describe aspiration penumonia
Aspiration of food, drink, saliva or vomit can lead to pneumonia- usually with people who have an altered level on consciousness- due to oral flora and anaerobes
51
What is interstitial pneumonia?
Inflammation of the Intersticium of the lung (Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues)
52
Define chronic pneumonia
Inflammation of the lungs that persists for an extended period of time
53
What are the main organisms that cause community acquired pneumonia?
Streptococcus pneumoniaeHaemophilua influenzaKlebisella penumoniaeChlamydia pneumophiliiaGram negative enteric bacteria
54
What are some associated features with S. pneumoniae?
Elderly Co-morbiditiesAcute onsetHigh feverPleuritic chest pain
55
What are some associated features with H. influenza?
COPD
56
What are some associated features with Legionella
Recent travelYounger patientSmokersIllnessMulti-system involvement
57
What are some associated features with Mycoplasma?
YoungPrior antibioticsExtra-pulmonary involvement
58
What are some associated features with S. aureus?
Post-viral so causes secondary bacterial pneumoniaIntra-venous drug user
59
What are some associated features with Chlamydia?
Contact with birds e.g. parrots, budgerigars, cockatoos, pigeons, turkeys
60
What are some associated features with coxiella?
Animal contact e.g. sheep
61
What are some associated features with Klebisella?
ThrombocytopeniaLeucopenia
62
What are some associated features with S. milleri?
Dental infectionsAbdominal sourceAspiration
63
What is the treatment for bronchopneumonia?
Amoxicilln then co-amoxiclav
64
What are the outcomes for bronchopneumonia?
Lung abscessBronchiectasisEmpyema
65
What is bronchiectasis?
airways of lungs become abnormally widened, leading to a build-up of excess mucus, leading to lungs which are more vulnerable to infection
66
What is empyema?
collection of pus in a naturally occurring anatomical cavity
67
Describe the features of atypical pneumonia
Have a more prolonged prodromal period with symptoms lasting for several weeks Caused by Mycoplasma pneumonia
68
Describe the features of viral pneumonia
Damage to cells lining the airways and alveoli by the virus and the immune cells in response to the virus. Fluid filled air spaces are present which interfere with gas exchange
69
Describe influenza
Caused by RNA virusPredominantly seen in winter monthsChanges genetic make up yearlyUse antivrial drugs in patients who are immunocompromised
70
Give some symptoms of pneumonia
fever / chills / sweats / rigors cough sputum - clear / purulent / ‘rust coloured’ / haemoptysis dyspnoea pleuritic chest pain malaise anorexia and vomiting headachemyalgia diarrhoea
71
What are some specific chest signs of someone with pneumonia?
Bronchial breath sounds Crackles Wheeze Dullness to percussion Reduced vocal resonance
72
What are the main marker of pneumonia?
White cell count (>20 or
73
Give some microbiological investigations for pneumonia
Sputum — very good for indicationsNose and throat swap — needed to confirm viral infections as cells have been invaded by the virusOpen lung biopsyBlood cultureUrineSerumBroncho Alveolar Lavage Fluid (BAL)
74
How can the severity of pneumonia be classified?
CURB 65 score- presence of one or more of the features is an indication for hospital treatment- the higher the score, the more likely that they need ICU treatment
75
What are the features of the CURB 65 score?
C – New mental ConfusionU – Urea > 7mmol/LR – Respiratory rate > 30 per minuteB – Blood pressure (Systolic
76
How can pneumonia be prevented?
Immunisation- either for influenza or pneumococcal vaccineChemoprophylaxis- penicillin or erythromycin to higher risk of LRTI patients
77
What is pneumocystis pneumonia?How do you treat it?
Acute onset, rapidly progressing pneumonia. Is an opportunistic infections in immunosuppressed patient. Treat with high dose Cotrimoxazole
78
What is whooping cough caused by?
Bordetella pertussis
79
What are the symptoms of whooping cough?
Cold like symptoms to begin with, followed by severe coughing bouts with characteristic whoop or vomiting. Coughing can last for 2-3 months. — Is highly infective (droplets aerosol spread)
80
What is the treatment for whooping cough?
Erythromycin
81
How are patients with pneumonia managed?
— Encouragement of oral fluid intake to prevent dehydration— Anti-pyretic drugs — Strong analgesics for pleural pain— Severe illnesses may need supplementary oxygen (cyanosis with good respiratory drive)— Intravenous Fluids
82
What are some complications of pneumonia?
Pleural effusionEmpyemaLung abscess formation
83
What are some pathogens that infect immunosuppressed hosts?
CytomegalovirusMycobacterium avium intracellulareAspergillusCandidaCryptosporidiaToxplasma
84
What are the antibiotics used for hospital acquired infections?
Intravenous co-amoxiclav

3 - Respiratory (20 decks)

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