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Lung Diseases Flashcards

1
Q

What are the causes of hypoxaemia

A 
V/Q mismatch
Alveolar hypoventilation
Impaired diffusion: pulmonary fibrosis
Low partial pressure of inspired oxygen
Anatomical R-L shunt: PAVM lobar pneumonia - deoyxgenated bypassing capillary bed of lung - won't respond well to O2 therpay
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2
Q

What is the PaO2 for hypoxaemia

A

Less than 8kPa

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3
Q

What is the most common cause of arterial hypoxaemia

A

V/Q mismatch. Ventilation and perfusion must be exactlymatched

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4
Q

What happens in regions of high ventialtion

A

High blood flow i.e. base of lungs

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5
Q

What happens in regions of low ventilation

A

Low blood flow

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6
Q

What is a shunt alveolar unit

A

Va/Q = 0

Alveolar that are perfused but not ventilated. Q>V. Wasted perfusion

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7
Q

What is dead space

A

No perfusion. Gas makeup in alveolar same as room air - ventilation but no perfusion. Q

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8
Q

What is hypercapnia

A

PaCO2>6 kPa

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9
Q

What is alveolar respiration determined by

A

RR and tidal volume

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10
Q

What is T1 resp failure

A

Normal CO2 with hypoxaemia

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11
Q

What is T2 resp failure

A

Hypoxaemia and hypercapnia

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12
Q

How is alveolar respiration calculate

A

Va=Ve-VD

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13
Q

What are the two responses to O2 therapy

A

PaCO2 and clinical state may improve or px may become drowsy

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14
Q

What is the classical teach of what happens when px with COPD is given O2

A

Px with COPD rely on their hypoxia ventilatory drive due to blunted sensitivity to CO2 and H+
Hypercapnia results from a suppression of hypoxic ventilatory drive causing alveolar hypoventilation

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15
Q

What may actually happen when px with COPD is given O2

A

Worsened Va/Q matching due to attenuation of hypoxic pulmonary vasoconstriction - directs blood to areas of lung that are better ventilated. Giving O2 increase partial pressure and releases vasoconstriction, but not does increase ventilation. Decreased binding affinity of haemoglobin or CO2. Decreased Ve

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16
Q

What is hypercapnic respiratory failure caused by

A

Acute (on chronic) imbalance in load-capacity-drive
relationship
Caused by defect in each area or combination

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17
Q

What are examples of drive failure

A

Drive failure: cortical and brain stem lesion (encephalitis, ischaemia, haemorrhage), drugs (sedative, opioids), metabolic alkalosis (loop diuretics - reduces threshold of CO2 needed)

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18
Q

What are examples of load impedance

A

Elastic load - pulmonary infection, alveolar oedema, pleural effusion
Resistive load - bronchospasm, UAO, OSA

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19
Q

What is auto intrinsic PEEP

A

Incomplete expiration prior to the initiation of the next breath causes progressive air trapping (hyperinflation). This accumulation of air increases alveolar pressure at the end of expiration.

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20
Q

What are underlying conditions of resp failure

A

COPD, pneumonia, pulmonary oedema (cardiogenic, non-cardiogenic), pulmonary embolism, pulmonary fibrosis, asthma

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21
Q

How is resp failure assessed

A

ABC
Assess vital signs
Oxy-haemoglobin sats (>92% excludes hypoxia unless CO poisoning)
ABG analysis - asses for hypercapnia (hypoventilation from Duchenne’s)
If pH of venous gas is greater than 7.34, very unlikely to have resp failure (no need for ABGs)

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22
Q

How is resp failure managed

A

Treat underlying condition
Hypoxia kills - titrated oxygen
Non benefit from oxygen if not hypoxic - stroke, MI
Oxygen may worsen hypercapnia (tissue injuries are delivered by free radicals, increasing O2 increases free radicals. High O2 can cause vasoconstriction of the coronary and cerebral vessels)
Oxygen is not ventilation

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23
Q

What are the four types of resp support

A

Oxygen
Non-invasive ventilation (NIV)
Invasive mechanical ventilation (IMV)
Extra-Corporeal Membrane Oxygentation (ECMO)

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24
Q

What are the clinical features of resp failure

A

– Confusion
– Cyanosis
– Dyspnoea
– Somnolence / drowsiness

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25
What are the benefits of NIV
Patient remains conscious Maintains structural host defence system Level 2 support Positive pressure ventilators used more often
26
What are the benefits of invasive ventialtion
Greater control of ventilation Secure ventilatory delivery Level 3 support Gold 3 standard treatment
27
What is given in severe resp failure
ECMO, VA for paeds
28
What is the pleura
Lung lining - parietal and visceral
29
What is pleural effusion
Fluid falls to bottom of pleural space usually Decreased expansion on side of fluid Mediastinum shifted away from side of fluid and trachea)
30
What are the signs of pleural effusion
Stony dull percussion Breath sounds reduced - bronchial breathing at level of effusion Vocal resonance reduced
31
Where is thoracentesis and where is it performed
An invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. Go above rib to avoid neuromuscular bundle
32
What is an exudate
Thick fluid - over 35g/L
33
What is a transudate
Thin fluid - less than 25g
34
What is pleural fluid protein is between 25-35
``` Use Light's criteria: Exudate if one or more: Pleural protein/serum protein over 0.5 Pleural LDH/serum LDH is >0.6 Pleural LDH is 2/3 upper limit of lab normal LDH ```
35
What are the causes of transudates
``` Systemic failures: Left ventricular failure, liver cirrhosis Hypoalbuminaemia Peritoneal dialysis Hypothyroidism Nephrotic syndrome Mitral stenosis ```
36
What are the causes of exudates
``` Problems local to lungs: Malignancy, parapneumonic effusions, TB PE Rheumatoid arthritis Other autoimmune pleuritis ```
37
What should pleural pH be
Around 7.2. Less than 7.2 - complicated paraneumonic effusion. Indication for tube drainage
38
What is empyema
Collection of pus in the pleural cavity
39
What can strep milleri cause
Grows on teeth - can cause bacterial endocarditis
40
What are malignant pleural effusions
Lung, breast, ovarian cancer Lymphoma Medial survival 4-6 motnhs
41
Describe spontaenous pneumothorax
Can be primary (absence of underlying lung pathology) or secondary (due to presence of underlying lung pathology)
42
What is tension pneumothorax
Forms due to one way valve where air can enter the pleural space upon inspiration, but not lave. Should have contralateral tracheal deviation, hypotension, tachy, hypoxia, increased JVp
43
What is restrictive lung disease
Clinical syndrome, reduced lung compliance, reduced lung volume
44
Describe normal respiration
Diaphragm and inspiratory muscle contract -> thorax expands -> Intrapleural pressure becomes subatmospheric -> increase in trans-pulmonary pressure -> lungs expand -> Alveolar pressure becomes subatmoshperic -> air flows into alveoli
45
What are the four types of interstitial lung disease
ILD of known association Idiopathic interstitial pneumonia Granulomatous ILD Miscellaneous ILD
46
Describe granulomatous ILD
Sarcoidosis: Multisystem granulomatous disease Pulmonary most commonly affect organ Range of pulmonary involvement including lung fibrosis
47
Describe idiopathic interstitial fibrosis
Usually interstitial pneumonia histologically Male predominance, progressive disease Associated with finger clubbing
48
What is hypersensitivity pneumonitis
Reaction to exposure including bacteria, fungi, avian proteins, animal proteins
49
What is pneumonconiosis
Occupational lung disesae - coal workers pneumoconiosis, silicosis, berylliosis, asbestosis
50
What is acute respiratory distress syndrome
Acute lung injury - sepsis, toxic inhalation, trauma, drugs, pancreatitis
51
What are the symptoms of restrictive lung disease
Breathlessness: others due to underlying disease, but may include Dry cough, wheeze, chest pain, haemoptysis, fever, myalgia, weight loss, weakness
52
What are the signs of restrictive lung disease
General - tachypnoea, use of accessory muscle, cyanosis | Other signs - chest or spine deformity, obesity, reduced chest expansion, crackles (fibrosis), wheeze
53
What investigations need to be carried out
Spirometry - FEV1/VC ratio unchanged | Flow volume loop - inspiratory moves to the left. Shape remains the shame
54
What is the management step for restrictive lung disease
Conservative, pharmacological, oxygen, surgery, ventilatory support
55
What is spirometry
Measurement of expire and inspired flows and volumes
56
What is FVC
Forced vital capacity
57
What is VC
Total volume of gas exhaled after breathing in total lung capacity
58
What is normal ratio
FVC should be same as VC
59
What if FVC
Airflow obstruction
60
How is reversibility defined
Increase in FEV1 following BD of >12% from baseline → significant reversibility
61
What does increase in residual volume indicate
Gas trapping - can be due to airway collapse
62
What is above horizontal axis in flow volume loop
Expiratory
63
What is below horizontal axis in flow volume loop
Inspiratory
64
What does obstructive lung disease look like on flow volume loop
Scooping of expiratory curve
65
What does restrictive lung disease look like on flow volume loop
Miniature version of normal volume
66
What is the gold standard of lung volume measurement
Body phethymosgraph - gold standard | Inert gas dilution - method underestimates volumes in px with airflow obstruction
67
What causes an increase in FRC and RV
Intrapulmonary - airway obstruction | Extra pulmonary - expiratory muscle weakness
68
What causes increased TLC
Emphysema
69
What causes decreased TLC
Intrapulmonary: pneumonectomy, collapsed lung, consolidation, oedema, fibrosis Extra pulmonary: pleural disease, rib cage deformity, respiratory muscle weakness
70
How to measure gas exchange
CO - Measure of gas diffusion from lung to blood AND the combination of gas with Hb.
71
What is TLCO
Reflects the ability of the lung to transfer gas from lung to blood
72
What is normal for standardised residual
Between -1.64 to +1.65
73
What is bronchiolitis obliterans
Inflammatory obstruction of the lung's tinniest airways

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