Module 2B - Respiratory Flashcards
Pathophysiology of bronchiectasis
- Chronic inflammation and dilation of bronchi –> mucus plugs form –> obstructs airflow
- Deficit in mucocliary clearance + immune cells release cytokines –> damages ciliated epithelial cells –> destroys elastin –> eleastin replaced with collagen –> less elastic and more stiff –> cannot clear mucus –> more mucus plugging and recurrent infections
- .
- .
Gas exchange video
Dr Matt and Dr Mike video:
https://www.youtube.com/watch?v=xLtLY9qaQks
Basic breathing mechanics video
Dr Matt and Dr Mike video:
https://www.youtube.com/watch?v=59knV9PJ3Rs
- Thoracic volume increases (due to diaphragm contracting and moving down + external intercostals moving up and out –> ‘bucket handle’) –> air rushes into lungs
- Internal intercostals bring ribcage in and down, abdominal muscles contract –> reduces thoracic volume and air is forced out of the lungs
Commonly found pathogens on sputum culture in patient with bronchiectasis
- Haemophilus influenzae (most commonly found) and Pseudomonas aeruginosa
The gold standard diagnostic imaging for bronchiectasis is a high-resolution CT scan (HRCT), what findings would there be?
- bronchial dilation
- ‘signet ring sign’
- Lack of tapering of bronchi
4 differentials for a chronic cough.
- COPD
- Asthma
- Lung cancer
- TB
- Cystic fibrosis
what is pt has > 2 exacerbations per year?
Bronchiectasis management –> general + infective excaerbation
- Airway clearance techniques (resp. physio) +/- pulmonary rehab
- Annual influenza and pneumococcal vaccines
Infective exacerbation:
- sputum culture
- 7-14 day course of antibiotics (local guidelines - ciprofloxacin is choice for exacerbations caused by Pseudomonas aeruginosa)
- (note: if >2 exacerbations in one year, consider mucoactive treatment and long-term antibiotic therapy)
What type of inheritance does cystic fibrosis have?
- autosomal recessive
Which gene is affected in cystic fibrosis and what does this cause? + which mutation is most common
- Mutations on the CFTR gene on chromosome 7 (delta-F508 mutation most common)
- Dysfunction of CFTR leads to the production of thick, sticky mucus that mainly affects the respiratory and GI systems
Pathophysiology of CF:
- The role of CFTR is to regulate the transport of _______ ions and bicarbonate across epithelial cells
- A dysfunctional CFTR results in a _______ and _______ retention inside cells, this imbalance establishes a ______-rich environment outside the cell, prompting sodium and water reabsorption.
- Consequently, mucus becomes dehydrated and _________.
- The role of CFTR is to regulate the transport of chloride ions and bicarbonate across epithelial cells
- A dysfunctional CFTR results in a chloride and water retention inside cells, this imbalance establishes a sodium-rich environment outside the cell, prompting sodium and water reabsorption.
- Consequently, mucus becomes dehydrated and thickened.
one for growing children?
Clinical features of cystic fibrosis
- Meconium ileus
- Chronic cough with thick sputum production –> recurrent respiratory tract infections
- Malabsorption in GI tract
- Loose, greasy stools (steatorrhoea) due to a lack of fat-digesting lipase enzymes
- Fertility problems
- Failure to thrive (poor height and weight gain)
Salty sweat is a characteristic of what condition + cause
- Cystic fibrosis (CF)
- due to a defective chloride channel –> reduced reabsoprtion of chloride and consequently sodium
How is cystic fibrosis usually diagnosed?
And what is usually the first sign of CF?
- Newborn blood spot screening programme (CF is 1/9 rare genetic conditions screened for)
- Sweat chloride test is gold-standard diagnostic test for CF
- Meconium ileus
- the first stool that a baby passes is called meconium in the first 24hrs, in CF this is thick and sticky, not passed within 24hrs and can obstruct the bowel
Management of cystic fibrosis.
(general)
(pharmacological)
(nutritional)
(monitoring)
General:
- Chest physio + high-freq. chest wall oscillation
- Exercise –> promotes airway clearance, enhances lung function, and improves overall health
Pharm:
- Mucolytics (eg. dornase alfa, hypertonic saline) –> reduces mucus viscosity
- Bronchodilators (SABA/LABA)
- Anti-inflammatories: ICS or oral NSAIDs
- Regular inhaled antibiotics to manage chronic infections –> systemic antibiotics for acute exacerbations
- CFTR modulators: selection depends on specific CFTR genotype
Nutrition:
- Pancreatic enzyme replacement therapy (PERT) with meals
- Fat-soluble vitamin supplementation (Vit A, D, E, and K)
- High-energy diet
Monitoring:
- Monitor LFTs, bone health, diabetes, fertility
Influenza is spread via _______
droplets (when an infected person coughs or sneezes)
Prevention and management of influenza.
- Prevention: annual influenza vaccine
Consider antivirals (has to be started within 48hr onset):
- First-line: oseltamivir
- Second-line (and for immunocompromised): zanamivir
Is pneumonia a disease of the airways or the alveoli?
alveoli
What is the most common causative organism in community-acquired pneumonia (CAP)?
Streptococcus pneumoniae
Haemophilus influenzae is often the causative organism of pneumonia in patients with what condition?
COPD
What is often the causative organism of pneumonia in patients who are alcoholics?
Klebsiella pneumoniae
What is often the causative organism of pneumonia in patients with cystic fibrosis (or immunocompromised states)?
Pseudomonas aeruginosa
Atypical pneumonia pathogens
- Legionella pneumophilia –> air conditioning or dirty water
- Chlamydia psittaci –> psittacosis –> associated with birds
- Mycoplasma pneumoniae
- Pneumocystis jirovecii (fungus) –> if mention HIV in the stem
- Chlamydophila pneumoniae
- Coxiella burnetii –> Q fever
What virus is the most common cause of viral pneumonia?
(and what virus is most common cause in infants and elderly?)
Influenza virus
- Infants and elderly: Respiratory syncytial virus (RSV)
pneumonia that occurs ≥ 48 hours after admission to hospital is called ____________________.
Hospital-acquired pneumonia (HAP)