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General Respiratory stuff Flashcards

1
Q

Does a V/Q mismatch respond to 100% oxygen?

Does shunting respond to oxygen? Why?

A

YES

NO, because the alveoli are not adequately ventilated. Need to be careful with chronic COPD - too much oxygen dampens hypoxic respiratory drive.

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2
Q

What is a shunt?

A

Occurs when there is good perfusion but inadequate ventilation.

A pulmonary shunt is a pathological condition which results when the alveoli of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region.

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3
Q

What is V/Q mismatch?

A

Some alveoli have high V/Q, some alveoli have low V/Q.

Problem: no shunting; all capillaries receive same ventilation (but lower in this case). capillaries that have more perfusion but are poorly ventilated will average a lower O2 sats.

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4
Q

What does the O2Sats value need to be, to warrant ABG measurement?

A

< 94%

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5
Q

Does oxygen help with V/ Q mismatch?

A

Yes because the underventilated alveoli ( with good perfusion) receives more oxygen and that combines with alveoli with a good V/Q to give a better average SatO2.

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6
Q

What happens to Functional Residual Capacity with emphysema?

A

Increased because

REDUCED elastic recoil, and therefore less resistance to the elastic recoil of the chest.

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7
Q

why don’t you get infarction of lung parenchyma following a PE?

A

Because of bronchial blood supply

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8
Q

What is the definitive examination for a PE?

A

CT pulmonary angiogram (CTPA) computed tomography using a contrast dye to obtain an image of the pulmonary arteries.

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9
Q

What is mesothelioma?

A

Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium).

The most common area affected is the lining of the lungs and chest wall

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10
Q

What is hypoxic constriction?

A

capillaries to underventilated alveoli constrict to allow better perfusion to alveoli that are better ventilated.

If >>O2 supplemented then danger of reduced vasoconstriction to underventilated alveoli, and exacerbation of symptoms when oxygen reduced.

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11
Q

What are the four main infections of the lung?

A
  • pneumonia
  • TB
  • Influenza
  • HIV-related lung disease
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12
Q

What is the Wells score used for?

A

Objectives risks for PE

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13
Q

Diagram of Lung Volumes

A
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14
Q

What are the clinical features of a PE?

A
  • sudden and unexplained dyspnoea. This maybe the only symptom, especially in the elderly.
  • IMP> pleuritic chest pain and haemoptyosis are present only when infarction has occured. PE can be silent!
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15
Q

What’s the normal range for HCO3- ions?

A

22 - 26 mmol/L

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16
Q

What are the normal values for PaCO2 and PzO2?

A

PaCO2 = 4.5 - 6.0 kPa

Pa O2 = 11.5 - 13.5 kPa

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17
Q

What is LDH?

A

Tissue breakdown releases LDH, and therefore LDH can be measured as a surrogate for tissue breakdown.

(Lactate dehydrogenase)

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18
Q

Three big causes of secondary pulmonary hypertension

A

LHF

COPD and cystic fibrosis

thromboembolic disease (persistent blockage of arteries)

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19
Q

What is a muscarinic receptor antagonist?

A

A is a type of anticholinergic agent that blocks the activity of the muscarinic acetylcholine receptor.

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20
Q

what is a cardinal feature of bronchitis?

A

a productive cough.

(usually self resolving and viral)

  • an infection of the main airways (bronchi)

Chronic bronchitis features in COPD

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21
Q

What three volumes result in the vital capacity?

A

Tidal volume + residual inspiratory volume + residual expiratory volume

(what remains is the residual volume)

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22
Q

What are the adenoids?

A
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23
Q

What is IRV? (lung volumes)

A

Inspiratory reserve volume

At the end of quiet inspiration, the person could breathe in more and this is termed the inspiratory reserve volume.

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24
Q

Why is cancer on Wells score a related risk with PE?

A

People with cancer often have a higher number of platelets and clotting factors in their blood.

This may be because cancer cells produce and release chemicals that stimulate the body to make more platelets.

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25
Definititon of asbestosis
Progressive disease characterised by breathlessness and accompanied by finger clubbing and **_bilateral basa end-inspiratory crackles_**
26
What is Polycythemia?
A disease state in which the haematocrit is above 55% (Haematocrit = volume percentage of RBC in the blood) Can be due to an increase in the number of RBC (absolute polycythemia), or a decrease in the volume of plasma (relative polycythemia)
27
What are **anticholinergic** agents?
A substance that blocks the neurotransmitter **acetylcholine** in the cns and pns. These agents in**hibit parasympathetic nerve** impulses The nerve fibers of the parasympathetic system are responsible for the **involuntary movement of smooth muscles** present in the gastrointestinal tract, urinary tract, **lungs**, etc.
28
The inspiratory capacity consists of which two volumes?
The volume of a quiet breathe (Vt) plus the inspiratory residual volume.
29
What is 'antigenic shift'?
**Antigenic shift** is the process by which two or more different strains of a virus combine to form a new subtype. Contains mixture of the surface antigens of the two or more original strains. The term is often applied specifically to **influenza**.
30
What is **cor pulmonale?**
Pulmonary heart disease. Occurs in 25% of patients with COPD. Caused by pulmonary hypertension causing enlargement of the right ventricle.
31
Why could you get pain and sob with pleural effusion?
pain due to **swelling**. (Parietal membrane is pain sensitive.) sob due to reduced l**ung volume**
32
What is the most common cause of hypoxema, and why?
**V/Q mismatch** becauses the causes are so common. eg. pneumonia COPD embolism
33
What can be the only symptom of a PE?
sudden onset of **_unexplained dyspnoea_**
34
Pathophysiology of pleural effusion due to **LVF**
back up of fluids increases pulmonary pressure resulting in pulmonary oedema in the alveoli, fluid in the interstitial fluid, and **finally into the pleural cavity.**
35
What's the cause of primary pulmonary hypertension?
hereditary or idiopathic
36
Smokers/ COPD. What's the risk problem following acute bronchitis?
bacterial infections; maybe step. pneumoniae, or H influenzae
37
What are the **two** groups of **acetylcholine receptors?**
* **muscarinic**, which respond to muscarine * **nicotinic**, which respond to nicotine
38
What symptoms occur after infarction of a PE?
Pleuritic chest pain haemoptysis (also unexplained dyspnea) \* many pulmonary emboli occur silently \*
39
(Lung volumes) What is FRC?
Functional Residual _Capacity_ The volume of air left in the lungs at the END of a normal breathe. (Includes residual volume) At this point the respiratory muscles are relaxed and volume is determined by the **_elastic_** properties of the lungs and chest wall.
40
Whats the target O2 sats with COPD?
88-92%
41
What happens to Functional Residual Capacity with cystic fibrosis?
FRC occurs at a small volume because the lungs are STIFF and have increased elastic recoil.
42
What do you get a V/Q mismatch with a PE?
No blood beyond the embolism. Blood is shunted to other parts of the lung. V/Q Perfusion increases, and this reduces V/Q ratio, resulting in \<\< PaO2
43
Nebulisers; what would you combine this with for asthma and COPD respectively?
Asthma: **high driven oxygen** COPD: **medical air**
44
What kind of things affect **lung compliance**?
**Fibrotic tissue** - eg. lung fibrosis **Loss of elastic recoi**l - eg. emphysema **atelectasis -** greater density of tissue
45
What is the most common cause of bronchiectasis?
CF
46
Definition of bronchiectasis
abnormal and **permanent dilation of proximal (\>2mm) bronchi** due to **inflammation** and subsequent **destruction** of the **elastic** and **muscular** components of their walls. * associated with \< mucociliary clearance * persistent respiratory infections
47
Name two key symptoms of bronchiectasis
* persistent productive cough * large quantities of purulent odorous sputum
48
Can lymphatic blockage cause pulmonary oedema?
YES
49
What is the most common cause of pulmonary oedema?
**cardiogenic - LHF** back pressure increases hydrostatic pressure; increases fluid leakage in interstitial tissue and then aleovli.
50
What are the causes of **non-cardiogenic** pulmonary oedema?
**Increased permeability** of othe pulmonary capillaries following: **Sepsis** **bacterial pneumonia** trauma
51
What’s the most common type of lung cancer?
**non-small-cell lung cancer** **Squamous cell carcinoma** **Squamous** (42% of NSCLCs) (slow growth and late metastasis) (Adenocarcinoma is 39%)
52
Which type of lung cancer spreads quickly?
**_Small cell_** carcinoma ; spreads quickly and highly malignant. approx 15% of cases
53
What are the three divisions of non-small cell carcinoma?
* * squamous cell carcinoma (**_most common)_** **42%** * * adenocarcinoma (39%) * * large cell carcinoma (8%)
54
Which lung cancer is more common in non-smokers?
adenocarcinoma (NSCLC) associated with asbestos and more common in non-smokers.
55
What are the characteristics of adenocarcinoma?
More common in non-smokers, associated with asbestos. Invasion of the pleura and mediastinal lymph nodes is common. Often metasises to the brain and bones.
56
Staging classification
Stage 1: localised with no lymph node involvement Stage 2: 2A, 2B lymph node involvement Stage 3: spread into mediastinal nodes/ mediastinum Stage 4: distant spread
57
Which type of cancer is most often associated with finger clubbing?
squamous carcinoma
58
What are the risk factors for lung cancer?
Active or passive cigarette smoking is the main one. Increasing age. People with COPD Previous history, exposure to environmental irritants
59
Red flags for referral if CA lung is suspected:
CXR suggestive of lung cancer Age \>40 which unexplained haemoptysis
60
Is RhA and Interstitial Lung Disease related?
Yes, over active immune system attacks the lungs. History of RhA is a risk factor for ILD
61
Can you get gastric reflux with Interstitial Lung Disease? Why?
Yes Lung fibrosis can pull oesophagus apart and cause acid reflux.
62
Some presenting symptoms of Interstitial Lung Disease
* \>\> dyspnoea * dry cough * patients over 60 yrs old, and incidence higher with males. * finger clubbing (except asbestosis) * fine crackles on auscultation * Right ventricular heart strain
63
What is the definition of pneumoconiosis?
lung fibrosis secondary to inhaled organic dust
64
Why do you get CXR consolidation around the hilum with Interstitial Lung Disease?
maybe because dust particles phagocyted and collect in the lymphatics around the hilum.
65
Possible causes of pneumoconiosis...
* coal dust * silica (found in stone and sand) * asbestos (brake linings)
66
What is **allergic** interstitial lung disease?
inhalation of organic matter with hypersensitive patients. eg **bird faeces** (bird fancier's lung), cotton fibres, **farmer's lung** (caused by a **fungus** in mouldy hay) NB\> acute dysnpoea and cough a few hours after inhalation.
67
If patients has dry high pitched cough with Interstitial Lung Disease, little can be done except...
codeine/ morphine dampens cough reflex.
68
With Interstitial Lung Disease, apart from fibrosis, what else can cause restriction in breathing?
reduction in costal muscle strength
69
Where is there consolidation with Interstitial Lung Disease? How does it present?
more prevalent at **bottom** of lungs. could be **reticular** or **nodular**.
70
Interstitial Lung Disease and ausculation - what would you find?
Fibrotic crackles
71
A really important symptom Interstitial Lung Disease is....
**_unexplained chronic exertional dyspnoea_** and dry cough (and finger clubbing)
72
What would you find on auscultation with Interstitial Lung Disease?
Fine 'velco-like' inspiratory crackles.
73
What might you find on a **CXR** with Interstitial Lung Disease?
**Kerley B Lines** **Reticular lines** **Nodular** reticulonodular
74
What is pivotal when case history taking and suspecting Interstitial Lung Disease?
Hobbies, workplace, exposure to allergens.
75
What is a diagnostic sign of asbestosis?
asbestos plaques seen on CT scans
76
What happens to the lymph nodes in silicosis? (classic sign if present)
**Eggshell calcification** refers to **fine calcification** seen at the **periphery of a mass** and usually relates to lymph node calcification
77
what are the surfactant cells in the lungs?
**type II** alveolar cells
78
How is TB spread? + organism
aerosolized droplets; **mycobacterium tuberculosis**
79
Cough reflex; efferent pathways travel where?
to the 'cough centre' in the medulla via the vagus nerve.
80
Common causes of ankle oedema
**Impaired venous return;**pregnancy, immobility **Obstruction**; DVT, pelvic mass **Congestive cardiac failure** (CCF) **Hypoalbuminaemia** (liver disease, nephrotic syndome, malnutition) **Cellulitis**
81
What four groups of drugs can lower respiratory drive centrally?
Alcohol Opiates Benzodiazepines Anaesthetics
82
What drugs are used in the treatment of acute pulmonary oedema?
diruetics, nitrates, analgesics, and inotropes. bronchodilators
83
How does furosemide IV reduce fluid overload in pulmonary oedema?
**_inhibits_** NaCl reabsorption in the ascending loop of of Henle to cause diuresis. (ototoicity potential side effect)
84
What drug is often combined with furosemide for more aggressive diuresis?
**Metolazone** | (potent **thiazide-related** diuretic)
85
Name an aldosterone inhibiting drug
Spironolactone
86
Name three loop diuretic drugs
Furosemide Bumetanide Ethacrynic acid
87
What is sodium **nitroprusside** (SNP)? Brand: Nitropress
Nitrate causes **vasodilation of venous and arterial circulation.** Onset is immediate and effect can last up to 10 mins. ( on World Health Organization's List of Essential Medicines)
88
What is GTN?
Glyceryl Trinitrate. Onset of action of spray is 1-3 minutes, half life 5 mins.
89
Which drug can do the following; anxiolysis, analgesic, **venedilator** (and arterial dilator)
Morphine (eg. Oramorph, morphine sulphate)
90
What is Naloxone used for?
blocks the effects of opioids, especially in overdose. Effects last 1/2 to 1 hour. (opioid antagonist) (It is on the World Health Organization's List of Essential Medicines)
91
What is an **inotrope**?
An inotrope is an agent that alters the **force** or **energy** of **muscular contractions.**
92
Name some inotropes
In patients with **hypotension** who present with **CHF**, the principal inotropic agents are **dopamine, dobutamine, inamrinone, milrinone, dopexamine, and digoxin.**
93
What are digoxin, dopamine, dobutamine examples of?
Inotropic agents
94
What are **chronotropic** drugs?
Chronotropic drugs change the h**eart rate and rhythm** by affecting the **electrical conduction system** of the heart and the nerves that influence it, such as by changing the rhythm produced by the sinoatrial node. Positive chronotropes increase heart rate; negative chronotropes decrease heart rate.
95
What are the signs and symptoms of hypoxemia?
**sweating** tachycardia **poor peripheral perfusion** central cyanosis **restlessness** confusion
96
Management of Type I Respiratory failure
**ABC** oxygen therapy CPAP **Treat underlying cause** **Sputum clearance** Assisted ventilation?
97
What are the signs and symptoms of type II respiratory failure? (hypercapnia)
**breathlessness** cyanosis **confusion (parallels increading CO2 levels)** **Flapping tremor** warm peripheries **bounding pulse**
98
What are the risk factors for a pneumothorax?
Smoking is the most important factor. More common in men too. Marfan's syndrome
99
Management of primary pneumothorax
## Footnote if the rim of air is **\< 2cm** and the patient is **NOT short of breath** then discharge should be considered **otherwise aspiration** should be attempted if this FAILS (defined as **\> 2 cm** or **still short of breath**) then a **chest drain** should be inserted patients should be advised to avoid smoking to reduce the risk of further episodes
100
PE: What's the treatment option if CTPA not feasible?
A **V/Q scan** is the preferred option if the patient has an **allergy to contrast media** or has **renal impairment.**

Respiratory System (7 decks)

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