Other Flashcards
Is carbon dioxide more or less soluble in the blood than oxygen?
carbon dioxide is more soluble than oxygen
Why is there never co2 retention in pulmonary fibrosis?
pulmonary fibrosis is not an airway disease but the problem is in the gas exchange so there is never Co2 retention
What is the first line treatment for COPD?
- oxygen if their levels are low (remember that the target is lowered for patients with type 2 failure)
- salbutamol
- steroids
- ipratropium
What is the second line treatment for COPD?
second line is IV aminophylline but this doesn’t always work
How do you treat acute asthma?
oxygen if needed, salbutamol, ipratropium and oral steroids
What ventilation treatment do you never use with asthma?
NIV
Which way does a tension pneumothorax shift?
away from the pneumothorax
What is the first diagnostic test for pneumonia?
sputum culture
What is the first line treatment for legionella?
levofloxacin
What disease is most commonly associated with honeycombing?
idiopathic pulmonary fibrosis
What does type 1 respiratory failure mean?
short of oxygen
What does type 2 respiratory failure mean?
short of oxygen and too much carbon dioxide
What is perfusion without ventilation?
shunting
What is ventilation without perfusion?
dead space
What is the difference between effort dependent and effort independent tests?
- effort dependent tests include FEVs and flow rates with spirometry
- effort independent tests include relaxed vital capacity with spirometry, whole body plesmography etc
What are the changes to FEV1 and FVC in asthma?
- decrease FEV1
- FVC will be normal
What are the changes to FEV1 and FVC in COPD?
- decrease FEV1
- FVC reduced
What are the measurable changes in obstructive lung disease?
- decreased PEFR
- decreased FEV1
- normal FVC (asthma), reduced in COPD
- less than 75% ratio
- greater than 15% FEV1 response to beta 2 agonist in asthma
What are the measurable changes in restrictive lung disease?
- normal PEFR
- decreased FEV1 and FVC
- greater than 75% for the ratio
- no FEV1 response to beta 2 agonist
Which of the white cells are granulocytes?
neutrophils, eosinophils and basophils
Which of the white cells are agranulocytes?
lymphocytes and monocytes
What is the word for low levels of platelets?
thrombocytopenia
How is plasma assessed?
secondary haemostats and viscosity
What is MCV in haematology?
the average volume of red cells
What are the three types of MCV classifications of red cells?
- microcytic (smaller cells) due to iron deficiency
- macrocytic cells (larger cells) due to B12/folate deficiency or alcohol excess
- normocytic cells due to acute blood loss or anaemia of chronic disease
What are the reasons for anaemia of chronic disease?
changes in
- iron supply to developing red cells
- proliferation of erythroid cells
- production of erythropoietin
- life span of red cells
What is the add on ‘cytosis’ used for?
high numbers of total and agranulocytes
What is the add on ‘philia’ used for?
high numbers of granulocytes
How are coagulation times measured?
- prothrombin time
- activated partial thromboplastin time
What can plasma viscosity reflect?
changes in plasma proteins and increased can be found in inflammation
What is palliative care?
palliative care is the active total care of patients whose disease is not responsive to curative treatment both for cancer and not
What are common symptoms experienced by palliative care patients?
- pain
- nausea and vomiting
- fatigue
- anorexia
- breathlessness
- itch
- drowsiness
What is Advance Care Planning?
a sensitive but realistic conversation with a patient to find out and try to meet the patients needs
How long is a normal pregnancy term?
37-42 weeks
When is surfactant released in babies?
30-32 weeks
What is the management of a baby with surfactant deficiency?
keep the baby warm and administer surfactant
What is there increased risk of in preterm babies?
risk of pneumothorax with IPPV (bag) and CPAP
What classifies as chronic lung disease in neonates?
oxygen required beyond 36 weeks, evidence of pulmonary parenchymal disease on CXR and wheeze
How does diaphragmatic hernia present in neonates?
severe breathing difficulty
How is neonatal diaphragmatic hernia treated?
tube not a bag-mask and surgery
What is transient tachypnoea in neonates and what does it cause?
fluid in the lungs and causes shortness of breath
What is the carrier incidence of cystic fibrosis?
1 in 25 people
What type of disease is cystic fibrosis?
multi-system genetic disorder that is autosomal recessive
What does asthma present as in children?
wheeze, cough, chest tightness and difficulty breathing
What will be seen on a flow volume graph in an asthma patient?
scallop shape
How do you treat paediatric asthma?
inhaled beta-agonist, inhaled steroids then add a long acting beta agonist or leukotriene antagonist
What is commonly used to administer inhaled asthma drugs in children?
a spacer
How is acute asthma attack treated in children?
oxygen and nebuliser bronchodilator
What caused bronchiolitis?
viral infection by RSV
How does paediatric pneumonia present?
cough and high temperature and dullness of chest on percussion and bronchial breathing
What are the common bugs for pneumonia in neonates?
GBS, E.coli, Klebsiella and staph aureus
What are the common bugs for pneumonia in infants?
strep pneumonia and chlamydia
What is the presentation of croup in children?
stridor and barking cough
What is the treatment of paediatric croup?
oral steroid to reduce inflammation
What are some causes of breathlessness?
- heart failure
- asthma and lung disease
- PE
- angina
- hyperventilation syndrome
- anaemia
What causes instant breathlessness?
PE or pneumothorax
What causes acute breathlessness?
asthma, pneumonia, acute MI and cardiac tamponade
What causes subacute breathlessness?
pleural effusion, pulmonary vasculitis and SVCO
What causes chronic breathlessness?
COPD, ILD, pulmonary hypertension or anaemia
What are the assessments for breathlessness?
- oxygen transport
- mechanical disadvantage
- respiratory drive
- perception of breathing
What are the tests for breathlessness?
spirometry, peak flow, CT, CXR, VQ scan
Where does the respiratory system develop from?
mid section of the foregut just anterior to the pharynx in the fourth week of gestation
What are the first few steps of embryological development of the lungs?
laryngeotracheal groove forms on the ventral side
this deepens to become the diverticulum which then separates from the oesophagus and splits into a left and right bronchial bud
What has happened by weeks 5 and 6 of embryological development?
by week 5 there is asymmetrical branching and by week 6 the main divisions are in place
What does the distal end of the diverticulum development into?
the tracheal bud
What is the diverticulum lined by?
endoderm so all the respiratory epithelium and glands are endodermal in origin
What comes from the mesoderm layer?
supporting structures such as cartilage, blood vessels, muscles and connective tissue
What does the mesoderm regulate?
branching so inhibit around the trachea and stimulates around the bronchi
What are two common congenital defects of the respiratory system?
- oesophageal atresia (blind-ending)
- tracheoesophageal fistula (communication)
What are the three periods of respiratory embryological development?
- glandular period
- canalicular period
- terminal saccular period
What happens in the glandular period?
(weeks 7-16)
All major lung elements develop
Bronchial tree develops to level of terminal bronchioles
What happens in the canalicular period?
(weeks 16-26)
The bronchioles, alveolar ducts and the primitive alveoli develop
The lung tissue becomes very vascular and capillaries develop
What happens in the terminal saccular period?
(weeks 26-40)
More alveoli develop and mature
Alveolar cells differentiate into type 1 and 2 pneumocytes
Epithelium thins and surfactant secretion begins
Capillaries develop around the alveoli
What do the type 1 pneumocytes do?
these predominate and are the specialised cells for gas exchange
What do the type 2 pneumocytes do?
secrete surfactant that decreases surface tension of the mucoid lining the alveoli (prevents respiratory distress syndrome)
