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Respiratory System > General Respiratory stuff > Flashcards

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
Q

Definititon of asbestosis

A

Progressive disease characterised by breathlessness and accompanied by finger clubbing and bilateral basa end-inspiratory crackles

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26
Q

What is Polycythemia?

A

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)

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27
Q

What are anticholinergic agents?

A

A substance that blocks the neurotransmitter acetylcholine in the cns and pns.

These agents inhibit 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.

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28
Q

The inspiratory capacity consists of which two volumes?

A

The volume of a quiet breathe (Vt) plus the inspiratory residual volume.

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29
Q

What is ‘antigenic shift’?

A

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.

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30
Q

What is cor pulmonale?

A

Pulmonary heart disease.

Occurs in 25% of patients with COPD.

Caused by pulmonary hypertension causing enlargement of the right ventricle.

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31
Q

Why could you get pain and sob with pleural effusion?

A

pain due to swelling.

(Parietal membrane is pain sensitive.)

sob due to reduced lung volume

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32
Q

What is the most common cause of hypoxema, and why?

A

V/Q mismatch becauses the causes are so common.

eg. pneumonia

COPD

embolism

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33
Q

What can be the only symptom of a PE?

A

sudden onset of unexplained dyspnoea

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34
Q

Pathophysiology of pleural effusion due to LVF

A

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.

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35
Q

What’s the cause of primary pulmonary hypertension?

A

hereditary or idiopathic

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36
Q

Smokers/ COPD. What’s the risk problem following acute bronchitis?

A

bacterial infections; maybe step. pneumoniae, or H influenzae

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37
Q

What are the two groups of acetylcholine receptors?

A
  • muscarinic, which respond to muscarine
  • nicotinic, which respond to nicotine
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38
Q

What symptoms occur after infarction of a PE?

A

Pleuritic chest pain

haemoptysis

(also unexplained dyspnea)

* many pulmonary emboli occur silently *

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39
Q

(Lung volumes)

What is FRC?

A

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.

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40
Q

Whats the target O2 sats with COPD?

A

88-92%

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41
Q

What happens to Functional Residual Capacity with cystic fibrosis?

A

FRC occurs at a small volume because the lungs are STIFF and have increased elastic recoil.

42
Q

What do you get a V/Q mismatch with a PE?

A

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
Q

Nebulisers; what would you combine this with for asthma and COPD respectively?

A

Asthma: high driven oxygen

COPD: medical air

44
Q

What kind of things affect lung compliance?

A

Fibrotic tissue - eg. lung fibrosis

Loss of elastic recoil - eg. emphysema

atelectasis - greater density of tissue

45
Q

What is the most common cause of bronchiectasis?

A

CF

46
Q

Definition of bronchiectasis

A

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
Q

Name two key symptoms of bronchiectasis

A
  • persistent productive cough
  • large quantities of purulent odorous sputum
48
Q

Can lymphatic blockage cause pulmonary oedema?

A

YES

49
Q

What is the most common cause of pulmonary oedema?

A

cardiogenic - LHF

back pressure increases hydrostatic pressure; increases fluid leakage in interstitial tissue and then aleovli.

50
Q

What are the causes of non-cardiogenic pulmonary oedema?

A

Increased permeability of othe pulmonary capillaries following:

Sepsis

bacterial pneumonia

trauma

51
Q

What’s the most common type of lung cancer?

A

non-small-cell lung cancer

Squamous cell carcinoma

Squamous (42% of NSCLCs)

(slow growth and late metastasis)

(Adenocarcinoma is 39%)

52
Q

Which type of lung cancer spreads quickly?

A

Small cell carcinoma ; spreads quickly and highly malignant.

approx 15% of cases

53
Q

What are the three divisions of non-small cell carcinoma?

A
    • squamous cell carcinoma (most common) 42%
    • adenocarcinoma (39%)
    • large cell carcinoma (8%)
54
Q

Which lung cancer is more common in non-smokers?

A

adenocarcinoma

(NSCLC)

associated with asbestos and more common in non-smokers.

55
Q

What are the characteristics of adenocarcinoma?

A

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
Q

Staging classification

A

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
Q

Which type of cancer is most often associated with finger clubbing?

A

squamous carcinoma

58
Q

What are the risk factors for lung cancer?

A

Active or passive cigarette smoking is the main one.

Increasing age.

People with COPD

Previous history, exposure to environmental irritants

59
Q

Red flags for referral if CA lung is suspected:

A

CXR suggestive of lung cancer

Age >40 which unexplained haemoptysis

60
Q

Is RhA and Interstitial Lung Disease related?

A

Yes, over active immune system attacks the lungs.

History of RhA is a risk factor for ILD

61
Q

Can you get gastric reflux with Interstitial Lung Disease? Why?

A

Yes

Lung fibrosis can pull oesophagus apart and cause acid reflux.

62
Q

Some presenting symptoms of Interstitial Lung Disease

A
  • >> 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
Q

What is the definition of pneumoconiosis?

A

lung fibrosis secondary to inhaled organic dust

64
Q

Why do you get CXR consolidation around the hilum with Interstitial Lung Disease?

A

maybe because dust particles phagocyted and collect in the lymphatics around the hilum.

65
Q

Possible causes of pneumoconiosis…

A
  • coal dust
  • silica (found in stone and sand)
  • asbestos (brake linings)
66
Q

What is allergic interstitial lung disease?

A

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
Q

If patients has dry high pitched cough with Interstitial Lung Disease, little can be done except…

A

codeine/ morphine dampens cough reflex.

68
Q

With Interstitial Lung Disease, apart from fibrosis, what else can cause restriction in breathing?

A

reduction in costal muscle strength

69
Q

Where is there consolidation with Interstitial Lung Disease?

How does it present?

A

more prevalent at bottom of lungs.

could be reticular or nodular.

70
Q

Interstitial Lung Disease and ausculation - what would you find?

A

Fibrotic crackles

71
Q

A really important symptom Interstitial Lung Disease is….

A

unexplained chronic exertional dyspnoea

and

dry cough

(and finger clubbing)

72
Q

What would you find on auscultation with Interstitial Lung Disease?

A

Fine ‘velco-like’ inspiratory crackles.

73
Q

What might you find on a CXR with Interstitial Lung Disease?

A

Kerley B Lines

Reticular lines

Nodular

reticulonodular

74
Q

What is pivotal when case history taking and suspecting Interstitial Lung Disease?

A

Hobbies, workplace, exposure to allergens.

75
Q

What is a diagnostic sign of asbestosis?

A

asbestos plaques seen on CT scans

76
Q

What happens to the lymph nodes in silicosis? (classic sign if present)

A

Eggshell calcification

refers to fine calcification seen at the periphery of a mass and usually relates to lymph node calcification

77
Q

what are the surfactant cells in the lungs?

A

type II alveolar cells

78
Q

How is TB spread?

+ organism

A

aerosolized droplets; mycobacterium tuberculosis

79
Q

Cough reflex; efferent pathways travel where?

A

to the ‘cough centre’ in the medulla via the vagus nerve.

80
Q

Common causes of ankle oedema

A

Impaired venous return;pregnancy, immobility

Obstruction; DVT, pelvic mass

Congestive cardiac failure (CCF)

Hypoalbuminaemia (liver disease, nephrotic syndome, malnutition)

Cellulitis

81
Q

What four groups of drugs can lower respiratory drive centrally?

A

Alcohol

Opiates

Benzodiazepines

Anaesthetics

82
Q

What drugs are used in the treatment of acute pulmonary oedema?

A

diruetics, nitrates, analgesics, and inotropes.

bronchodilators

83
Q

How does furosemide IV reduce fluid overload in pulmonary oedema?

A

inhibits NaCl reabsorption in the ascending loop of of Henle to cause diuresis.

(ototoicity potential side effect)

84
Q

What drug is often combined with furosemide for more aggressive diuresis?

A

Metolazone

(potent thiazide-related diuretic)

85
Q

Name an aldosterone inhibiting drug

A

Spironolactone

86
Q

Name three loop diuretic drugs

A

Furosemide

Bumetanide

Ethacrynic acid

87
Q

What is sodium nitroprusside (SNP)?

Brand: Nitropress

A

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
Q

What is GTN?

A

Glyceryl Trinitrate.

Onset of action of spray is 1-3 minutes, half life 5 mins.

89
Q

Which drug can do the following; anxiolysis, analgesic, venedilator (and arterial dilator)

A

Morphine (eg. Oramorph, morphine sulphate)

90
Q

What is Naloxone used for?

A

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
Q

What is an inotrope?

A

An inotrope is an agent that alters the force or energy
of muscular contractions.

92
Q

Name some inotropes

A

In patients with hypotension who present with CHF, the
principal inotropic agents are dopamine, dobutamine,
inamrinone, milrinone, dopexamine, and digoxin.

93
Q

What are digoxin, dopamine, dobutamine examples of?

A

Inotropic agents

94
Q

What are chronotropic drugs?

A

Chronotropic drugs change the heart 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
Q

What are the signs and symptoms of hypoxemia?

A

sweating

tachycardia

poor peripheral perfusion

central cyanosis

restlessness

confusion

96
Q

Management of Type I Respiratory failure

A

ABC

oxygen therapy

CPAP

Treat underlying cause

Sputum clearance

Assisted ventilation?

97
Q

What are the signs and symptoms of type II respiratory failure? (hypercapnia)

A

breathlessness

cyanosis

confusion (parallels increading CO2 levels)

Flapping tremor

warm peripheries

bounding pulse

98
Q

What are the risk factors for a pneumothorax?

A

Smoking is the most important factor. More common in men too.

Marfan’s syndrome

99
Q

Management of primary pneumothorax

A

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
Q

PE: What’s the treatment option if CTPA not feasible?

A

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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