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Pathophysiology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

function of respiratory system

A

gas exchange between air and bloodstream
moves air in and out of body
filters, warms and humidify incoming air
vocalisation: speech

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2
Q

what does the upper and lower respiratory tract consist of

A

upper:

  • nasal cavity
  • pharynx
  • larynx

lower:

  • trachea
  • primary bronchi
  • lungs
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3
Q

function of upper airway tract

A
  • hair and mucous membrane trap particles like dust and smoke
  • inhaled air is moistened, warmed
  • during exhalation the nasal cavity collects and retains the moisture from the air that is leaving the body
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4
Q

function of larynx and epiglottis

A
  • larynx allow the passage of air through the trachea
  • with the help of the epiglottis, the larynx prevents food or liquid from entering the lower respiratory tract while swallowing
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5
Q

zones of the lower respiratory tract

A

conducting zone

  • trachea to bronchus
  • no gas exchange occurs
  • supported by cartilages

respiratory zone

  • bronchioles with alveoli
  • gas exchange occurs here
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6
Q

what are alveoli

A

moist, thin walled pockets which are site of gas exchange

slightly oily surfactant prevents the alveoli walls from collapsing and sticking together

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7
Q

what controls ventilation

A

PaCO2 in the central chemoreceptors

PaO2 and blood pH in peripheral chemoreceptor

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8
Q

define respiratory failure

A
  • when lungs fail to oxygenate the arterial blood adequately or fails to prevent carbon dioxide retention

hypoxemia
- partial pressure of oxygen PO2 <60mmHg, can lead to tissue hypoxia

hypercapnia
- partial pressure of carbon dioxide PCO2 >50mmHg

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9
Q

symptoms of hypoxemia

A

spectrum of symptoms depending on severity

  • mild: impairment of mental performance, diminished visual acuity, tachypnea
  • profound:
    a. CNS: headache, seizures, somnolence, loss of consciousness
    b. CVS: palpitations, chest pains
    c. respiratory: SOB
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10
Q

complication of tissue hypoxia

A

CNS - hypoxic ischemic encephalopathy
myocardium - acute myocardial infarction
renal - acute kidney injury
vascular - vasoconstriction

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11
Q

symptoms of hypercapnia

A

spectrum of symptoms depend on severity

  • restlessness, tremor, slurred speech, asterixis
  • headache
  • altered mental status, loss of consciousness, comatose state
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12
Q

what is asthma

A

heterogenous disease, usually characterised by chronic airway inflammation
defined by the history if respiratory symptoms such as wheeze, SOB, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation

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13
Q

risk factor for developing asthma

A

genetic characteristics
occupation exposures
environmental exposures

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14
Q

symptoms of asthma

A
  • troublesome cough, particularly at night
  • awakened by coughing
  • coughing or wheezing after physical activity
  • breathing problems during particular season
  • coughing, wheezing or chest tightness after allergen exposure
  • colds that last > 10 days
  • relief when medication is used
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15
Q

what is used to diagnose asthma

A

spirometry - to test lung function

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16
Q

risk factors for adverse outcomes of asthma

A
  • uncontrolled asthma symptoms
  • having more than 1 exacerbation in last 12 months
  • ever intubated for asthma
  • low lung function on spirometry
  • incorrect inhaler technique and/or poor adherence
  • smoking
  • obesity, pregnancy, blood esoinophilia
17
Q

definition of COPD

A

common, preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases

18
Q

risk factors for COPD

A
  • smoking
  • genetic reasons
  • occupational dust and chemicals
  • indoor smoke from wood, coal, cow dungs, crop residues used for cooking
  • frequent lung infections as a child
19
Q

risk factor for lung cancer

A
  • smoking
  • radon
  • asbestos
  • environmental tobacco exposure
  • genetics
  • other lung disease
  • prior radiation
20
Q

symptoms of lung cancer

A

related to primary lesion
- cough, SOB, hemoptysis, localised wheeze

related to intrathoracic spread
- pleural, pericardial effusion, SVCO, hoarseness, brachial plexus/ skeletal invasion (chest pain)

related to distant metastasis
- brain, bone, (liver, adrenal), skin

paraneoplastic

21
Q

principles of management of respiratory failure

A
  • identify: clinical symptoms and signs
  • resuscitate/stabilise
  • investigate
  • treat the cause
22
Q

symptoms of respiratory failure

A

respiratory: SOB, wheeze, chest tightness, cough
CNS: light headedness, giddiness, lethargy, headache, anxious, confusion, delirium, seizures
constitutional, manifestation with underlying disorder

23
Q

what are the asthma management goals

A
  • achieve and maintain control of symptoms
  • maintain normal activity levels, including exercise
  • maintain pulmonary function as close to normal levels as possible
  • prevent asthma exacerbations
  • avoid adverse effects from asthma medications
  • prevent asthma mortality
24
Q

2 types of COPD

A

chronic bronchitis
- inflammation and excess mucus

emphysema
- alveolar membranes break down

25
Q

systemic manifestation of COPD

A
  • skeletal muscle weakness (cachexia)
  • ischemic heart disease
  • cardiac failure
  • osteoporosis
  • diabetes metabolic syndrome
  • normocytic anaemia
  • depression
26
Q

role of spirometry

A
  • diagnosis
  • assessment of severity of airflow obstruction
  • follow up assessment
27
Q

result of spirometry

A

measures amount of air expired

FEV1/FVC <0.7 indicates obstructive disease

28
Q

COPD classification

A

most minimal symptoms - Group A

most severe - Group D

29
Q

treatment for the different groups of people for COPD

A

Group A - A bronchodilator
Group B - LABA or LAMA
Group C - LAMA
Group D - LAMA or LAMA+LABA or LABA+ICS

30
Q

non drug based interventions for COPD

A
  • immunisation
  • long term home oxygen
  • lung reduction surgery for emphysema
  • bronchoscopic directed therapy
  • surgical therapy
  • rehab
  • lung transplant
  • palliative
31
Q

management of COPD

A

diagnosis -> initial assessment -> initial management -> review adjust

32
Q

management of acute exacerbation

A
  • assess severity of symptoms, blood gases and chest radiographs
  • administer appropriate amount of oxygen
  • bronchodilators
  • steroids
  • consider antibiotics
  • consider non invasive mechanical ventilation
  • manage comorbidities
33
Q

diagnosis of lung cancer

A

imaging:

  • chest xray
  • CT
  • PET scan

definitive diagnosis can be made only by viewing a tissue sample (biopsy) under microscope. obtaining tissue biopsy:

  • bronchoscopy
  • thorascopy
  • mediastinoscopy
  • transbronchial needle (open lung) biopsy
  • sputum cytology
34
Q

TNM staging of lung cancer

A

stage 1: tumour 1-4cm; disease not spread outside the lung
stage 2: tumour 3-7cm; disease may be in the lymph nodes or nearby tissues, but not in distant parts of the body
stage 3: tumour 3 to more than 7cm; disease can be in more than 1 LN, but not in distant parts of body
stage 4: cancer has spread to distant part of body

35
Q

ways to stage lung cancer

A
  • CT and bone scan
  • PET-CT scan
  • endobronchial ultrasonography (EBUS)
  • mediastinoscopy
  • bronchoscopy
  • endobronchio ultrasound
  • navigation bronchoscopy
  • biopsy of pleural fluid

Pathophysiology (12 decks)

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