deck_1670798 Flashcards
Define COPD
Is a chronic, slowly progressive disorder characterised by airflow obstruction, which does not changed markedly over several months.
What are the characteristics of COPD?
Is preventable and treatable. — Have exacerbations— Certain disorders contribute to it — emphysema, chronic bronchitis and asthma—Collection of causes/diseases
How is airflow obstruction defined?
— Reduced FEV1— Reduced FEV1/FVC ratio
What are the main causes of COPD?
- 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
What are the main mechanisms of COPD?
Inflammation (airway and systemic)Alveolar destructionHyperinflationRespiratory muscle inefficiencySkeletal muscle dysfunction
What are the main impacts of COPD?
Mobility issues due to breathlessnessHealth status is generally poorerEffects on moodExacerbations HospitalisationsDeath
What is the pathogenesis of COPD?
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
What are the symptoms of COPD?
Productive cough (due to chronic bronchitis)DyspnoeaWheeze (from small airways)Tends to develop after years of having a smokers cough
What are the signs of COPD?
Quiet wheezesHyperventilation with prolonger expiration (due to emphysema)Need to use accessory muscles of inspirationHyperinflation of lungs
Why is hyperinflation of the lungs a sign of COPD?
Need to inhale more air in order to get sufficient amount of gas exchangeIs a compensatory mechanism for the loss of elastic recoil
What is a treatment that can help people who show signs of hyperinflation?
Can remove emphysematous lung in order to return the chest wall to normal. It can help to ease the act of breathing.
What are the main ways to asses someone who has COPD?
HistoryChest x-rayFEV1Lung function testsHigh resolution CT scan
What factors do you look for in the history of someone you suspects has COPD?
smokingLength of symptom occurrencePast medical history e.g. asthmaJob history e.g. coal worker, working with asbestosMRC dyspnoea scale
What is the MRC dyspnoea scale?
A scale which allows you to determine the severity of breathlessness depending on the activities that are limited
Why do you order an x-ray?
Rules out other lung pathologiesCan see certain COPD characteristics
Give some COPD chest x-ray characteristics
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).
What are the changes seen in FEV1 testing?
Reduced FEV1 (more so than expected for age)Reduced FEV1/FVC ratio (>70%)
Give some lung function measurements that confirm COPD?
Total lung volume – will be lowered in COPDLung diffusion testing determines how well gas exchange is taking place (also will be reduced)
Why is a high resolution CT scan performed?
Detects emphysema
What can be seen on a high resolution CT scan on someone with emphysema?
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)
Define sprirometry
Patient fills their lungs from the atmosphere and breathes out as far and as fast as possible through a spirometer.
What is a normal blood gas seen in someone who has type one respiratory failure?
Increased respiratory rateDecreased pO2Normal/decreased pCO2
What is a blood gas seen in someone who has type two respiratory failure?
Increased respiratory rateDecreased pO2Increased pCO2
When is oxygen therapy given?
Treatment for hypoxaemia– it increases oxygen saturation levels
Give some characteristics of oxygen therapy
Can be used in the long term and is portable
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
What are the treatment options for COPD?
Stop smokingBronchodilatorsInhaled steroids– These control the symptoms rather than giving a cure
What bronchodilators would you use first?
Short term bronchodilator firstThen a long term bronchodilatorCorticosteroids are used when a patient has increased exacerbations
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.
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
Define an exacerbation
Worsening of a previously stable condition associated with a declining health status
What are the characteristics of an exacerbation?
— increase wheeze, dyspnoea, sputum volume and colour, chest tightness and fluid retention
What are some treatment options for exacerbations?
— Increase/add bronchodilator— Antibiotic if needed— Oral corticosteroids— Admit to hospital— Oxygen— Assisted ventilation
What are some common flora found in the URT?
Viridans streptococci Neisseria spp Anaerobes Candida sp
What are some less common flora found in the URT?
Streptococcus pneumoniae Streptococcus pyogenes Haemophillus influenzae
Give some examples of common upper respiratory tract infections
RhinitisPharynitisEpiglotitisLaryngitisTracheitisSinusitisOtitis media
What are the defences of the respiratory tract?
Cilia and mucusCough and sneeze reflexRespiratory mucosal immune system
What are the factors that make up the respiratory mucosal immune system?
Lmphoid follicles of pharynx and tonsilsAlveolar macrophagesSecretory IgA and IgG
What are upper respiratory tract infections mostly caused by?
Viruses- rhinovirus- coronavirus- influenza or parainfluenza- respiratory syncytial virus
What are the main LRTIs?
BronchitisBronchiolitisPneumonia
Define bronchitis
Inflammation do the mucosal membrane int he bronchial tubes- causes bronchospasms and coughing
Define pneumonia
Infection of the lung parenchyma which results in lung consolidation as the air spaces fill with pus.
What are the characteristics of pneumonia?
Fluid fills air spacesConsolidationImpaired gas exchange
How can pneumonia be classified?
By: clinical settingPresentationOrganismLung pathology
What are the main organisms that cause pneumonia?
30% — Streptococcus pneumoniae 10% — haemophilus influenzae — COPD10% — virusesMycobacterium tuberculosis
What is penumonitis?
Inflammation due to physical of chemical damage in the lungs
What is lobar pneumonia?
Pneumonia that is localise to a particular lobe of a lung- usually streptococcus pneumoniae
What is broncho pneumonia?
Pneumonia that is diffuse and patchy.Starts in the airways and spreads to adjacent alveoli and lung tissue
What usually causes broncho pneumonia?
Streptococcus pneumoniaeHaemophilus influenzaStaphylococcus aureusanaerobescoliforms
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
What is interstitial pneumonia?
Inflammation of the Intersticium of the lung (Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues)
Define chronic pneumonia
Inflammation of the lungs that persists for an extended period of time
What are the main organisms that cause community acquired pneumonia?
Streptococcus pneumoniaeHaemophilua influenzaKlebisella penumoniaeChlamydia pneumophiliiaGram negative enteric bacteria
What are some associated features with S. pneumoniae?
Elderly Co-morbiditiesAcute onsetHigh feverPleuritic chest pain
What are some associated features with H. influenza?
COPD
What are some associated features with Legionella
Recent travelYounger patientSmokersIllnessMulti-system involvement
What are some associated features with Mycoplasma?
YoungPrior antibioticsExtra-pulmonary involvement
What are some associated features with S. aureus?
Post-viral so causes secondary bacterial pneumoniaIntra-venous drug user
What are some associated features with Chlamydia?
Contact with birds e.g. parrots, budgerigars, cockatoos, pigeons, turkeys
What are some associated features with coxiella?
Animal contact e.g. sheep
What are some associated features with Klebisella?
ThrombocytopeniaLeucopenia
What are some associated features with S. milleri?
Dental infectionsAbdominal sourceAspiration
What is the treatment for bronchopneumonia?
Amoxicilln then co-amoxiclav
What are the outcomes for bronchopneumonia?
Lung abscessBronchiectasisEmpyema
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
What is empyema?
collection of pus in a naturally occurring anatomical cavity
Describe the features of atypical pneumonia
Have a more prolonged prodromal period with symptoms lasting for several weeks Caused by Mycoplasma pneumonia
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
Describe influenza
Caused by RNA virusPredominantly seen in winter monthsChanges genetic make up yearlyUse antivrial drugs in patients who are immunocompromised
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
What are some specific chest signs of someone with pneumonia?
Bronchial breath sounds Crackles Wheeze Dullness to percussion Reduced vocal resonance
What are the main marker of pneumonia?
White cell count (>20 or
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)
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
What are the features of the CURB 65 score?
C – New mental ConfusionU – Urea > 7mmol/LR – Respiratory rate > 30 per minuteB – Blood pressure (Systolic
How can pneumonia be prevented?
Immunisation- either for influenza or pneumococcal vaccineChemoprophylaxis- penicillin or erythromycin to higher risk of LRTI patients
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
What is whooping cough caused by?
Bordetella pertussis
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)
What is the treatment for whooping cough?
Erythromycin
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
What are some complications of pneumonia?
Pleural effusionEmpyemaLung abscess formation
What are some pathogens that infect immunosuppressed hosts?
CytomegalovirusMycobacterium avium intracellulareAspergillusCandidaCryptosporidiaToxplasma
What are the antibiotics used for hospital acquired infections?
Intravenous co-amoxiclav
