Productive diseases

Question 1

What is bronchiectasis?

Answer 1

the permanent abnormal dilation in one or more of the lungs bronchi. Extra mucus is secreted and pools in the areas of the airways that are dilated making the person more prone to infection

Question 2

In which gender is bronchiectasis more common in?

Answer 2

females

Question 3

In what age population are 60% of bronchiectasis diagnoses made?

Answer 3

over 70s

Question 4

What is the first stage of the pathophysiology cycle of bronchiectasis?

Answer 4

impaired mucocilliary clearance leads to the accumulation of secretions

Question 5

What is the second stage of the pathophysiology cycle of bronchiectasis?

Answer 5

accumulation of secretions leads to infection by bacteria because it is a good environment for bacteria to grow

Question 6

What is the third stage of the pathophysiology cycle of bronchiectasis?

Answer 6

infection by bacteria leads to increased mucus production, impaired cillary performance and an inflammatory response

Question 7

What is the fourth stage of the pathophysiology cycle of bronchiectasis?

Answer 7

excessive inflammatory response causes tissue damage

Question 8

What is the fifth stage of the pathophysiology cycle of bronchiectasis?

Answer 8

tissue damage eventually produces dilated bronchi including loss of cilliated epithelium and impaired mucocilliary clearance

Question 9

Name some causes of bronchiectasis

Answer 9

idiopathic (arises spontaneously/unknown cause)
infection (usually in childhood)
immunodeficiency
cillary dysfunction
ABPA (allergic bronchopulmonary aspergillosis)
inflammatory conditions
aspiration/obstruction

Question 10

Name some clinical features of bronchiectasis

Answer 10

Very wet and productive cough
chronic sputum production
dyspnoea
wheeze
chest pain
chronic sinusitis
nasal polyps

Question 11

How can we diagnose bronchiectasis?

Answer 11

chest X ray
HRCT ( high resolution computed tomography)
bloods and sputum microbiology
pulmonary function tests

Question 12

What is bronchiectasis characterised off of?

Answer 12

What the damage to the airways looks like

Question 13

Name three types of bronchiectasis

Answer 13

Saccular/cystic (occurs in large bronchi that become large and balloon like)
cylindrical (involves medium sized bronchi which usually are symmetrically dilated)
varicose (constrictions and dilations deform bronchi)

Question 14

Name some symptoms of acute exacerbation of bronchiectasis

Answer 14

change in sputum production
increased dyspnoea
increased cough
temperature > 38
increased wheezing
malaise, fatigue, lethargy or decreased exercise tolerance
reduced pulmonary function
x-ray changes consistent with a new pulmonary process
changes in chest sounds

Question 15

How can we treat and manage bronchiectasis?

Answer 15

physiotherapy
IV/oral/nebulised antibiotics
bronchodilators
steroids
nasal sprays
flu and pneumococcal vaccinations
surgery

Question 16

What is the prognosis for someone with bronchiectasis?

Answer 16

Unclear but related to lung function and presence of infection

Question 17

What is pneumonia?

Answer 17

an inflammatory condition of the lung leading to abnormal alveolar filing with consolidation and exudation

Question 18

What is the single largest infectious cause of death in children worldwide?

Answer 18

pneumonia

Question 19

What are the 4 stages of pneumonia?

Answer 19

congestion
red hepatization
gray hepatization
resolution

Question 20

In what time frame does congestion occur (pneumonia)?

Answer 20

First 24 hours

Question 21

In what time frame does red hepatization occur (pneumonia)?

Answer 21

2-3 days

Question 22

In what time frame does gray hepatization occur (pneumonia)?

Answer 22

4-6 days

Question 23

In what time frame does resolution occur (pneumonia)?

Answer 23

> 6 days

Question 24

Describe the first stage of pneumonia

Answer 24

congestion -> characterised by vascular engorgement, intra-alveolar fluid and numerous bacteria; the lung is heavy, boggy and red

Question 25

Describe the second stage of pneumonia

Answer 25

red hepatization -> massive exudation develops with red blood cells, leukocytes and fibrin filling the alveolar spaces; the affected area appears red, firm and airless, with a liver like consistency

Question 26

Describe the third stage of pneumonia

Answer 26

characterised by progressive disintegration of red blood cells and the persistence of fibrin exudate

Question 27

Describe the fourth stage of pneumonia

Answer 27

Resolution -> the consolidated exudate within the alveolar spaces undergoes progressive digestion to produce debris that is later reabsorbed, ingested by macrophages or coughed up

Question 28

Name some causes of pneumonia

Answer 28

bacteria fungi virus parasites chemical aspiration inhalation (smoke, burns)

Question 29

What are the two anatomical classifications of pneumonia?

Answer 29

lobar pneumonia bronchopneumonia

Question 30

What are the four setting classifications of pneumonia?

Answer 30

community acquired pneumonia (CAP) health care associated pneumonia (HCAP) hospital acquired pneumonia (HAP) ventilator associated pneumonia (VAP)

Question 31

Name some common symptoms of pneumonia

Answer 31

Fever Malaise muscle ache/fatigue coughing (productive and non productive) Dyspnoea pleuritic or chest pain loss of appetite rapid heartbeat

Question 32

Name some less common symptoms of pneumonia

Answer 32

coughing up blood fatigue nausea/vomiting diarrhoea wheezing confusion

Question 33

Name some complications of pneumonia

Answer 33

lung abscess pleural effusions empyema (infection/pus between the pleural cavity) septic shock

Question 34

Name 5 findings that can lead to a medical diagnosis of pneumonia

Answer 34

temperature>37.8 HR>100 bpm crackles decreased breath sounds or bronchial breath sounds absence of asthma

Question 35

Describe the clinical prediction rule for pneumonia

Answer 35

5 findings = 84-91% probability 4 findings = 58-85% 3 findings = 35-51% 2 findings = 14-24% 1 finding = 5-9% 0 findings = 2-3%

Question 36

Name some diagnostic tests for pneumonia

Answer 36

CXR CT scan Blood test sputum culture pleural fluid culture bronchoscopy

Question 37

What general management is used for pneumonia?

Answer 37

Antibiotics/anti-fungal medication oxygen support hydration - IV fluids rest analgesics cough suppressant medication fever reducing medication prevention through vaccine programmes

Question 38

What is cystic fibrosis?

Answer 38

an inherited autosomal recessive disease

Question 39

What causes cystic fibrosis?

Answer 39

It is the result of a gene mutation - single gene defect on chromosome 7

Question 40

What is chromosome 7 responsible for?

Answer 40

encoding the cystic fibrosis membrane conductance regulator, a transmembrane protein involved in ion transport called the cystic fibrosis transmembrane regulating (CFTR) protein

Question 41

What does a defect on chromosome 7 lead to for cystic fibrosis?

Answer 41

It leads to a compromise in ion transport -> it impairs transport of chloride ions, and also affects the levels of sodium and water in the cell

Question 42

What does cystic fibrosis affect?

Answer 42

It affects several organs causing ducts to become obstructed with mucus (affects any organ that relies on the CFTR protein for ion transport)

Question 43

What type of protein is CFTR?

Answer 43

channel protein

Question 44

What does CFTR protein control?

Answer 44

the flow of water and chloride ions between membranes

Question 45

What happens to the natural accumulation of mucus when the CFTR protein is altered?

Answer 45

Mucus is much thicker than it should be

Question 46

What happens when the natural accumulation of mucus is thicker than it should be due to altered CFTR protein?

Answer 46

Thickness of mucus means it is stagnant, it blocks ducts and airways and is breading ground for infection which if repeated, damages structures and leaves scar formation

Question 47

What does defect in CFTR protein result in, in terms of problems for patient?

Answer 47

respiratory disease high sodium sweat pancreatic insufficiency biliary disease infertility cirrhosis of the liver gastrointestinal disease

Question 48

In which sex is infertility a problem for cystic fibrosis patients and why?

Answer 48

male CF patients are often infertile due to the absence of vas deferens which prevents the transport of sperm from testes to the urethra

Question 49

What are three ways to diagnose cystic fibrosis?

Answer 49

Genetic testing heal prick test sweat test

Question 50

What are some common lung symptoms of someone with cystic fibrosis?

Answer 50

persistent cough coughing fits wheezing SOB difficulties breathing

Question 51

Name some common digestive system symptoms of people with cystic fibrosis

Answer 51

large smelly stools malnutrition/poor weight gain/stunted growth

Question 52

Name some general symptoms of cystic fibrosis (not lung or digestive system related)

Answer 52

diabetes sinusitis nasal polyps arthritis osteoporosis infertility liver failure urinary incontinence delayed puberty kyphosis of the spine resulting in neck and back pain

Question 53

Name some medications that can be used to treat cystic fibrosis

Answer 53

bronchodilators hypertonic saline nebs antibiotics mucolytic steroids routine vaccines digestive enzymes

Question 54

What is treatment for cystic fibrosis dependent on?

Answer 54

The patients main symptoms/problems

Question 55

Name some treatments for cystic fibrosis

Answer 55

medication dietary advice education exercise lung transplant psychological support physiotherapy

Question 56

What physiotherapy techniques can be used for cystic fibrosis?

Answer 56

Postural drainage percussion, vibs/shakes ACBT AD Adjuncts Mobilisation/exercise Suction

Question 57

What is the prognosis for cystic fibrosis?

Answer 57

no cure or prevention lung complications are normally cause of death