Respiratory Flashcards
Explain perfusion and ventilation. what is the percentage of oxygen drawn into the lungs. What ventilation depends on
-ventilation (V): drawing oxygen into lungs (21%)
-perfusion (Q): the blood that reaches the alveoli via the capillaries, carrying de-oxygenated blood to lungs via veins, and oxygenated away in arteries .
-ventilation: depends on tidal volume, respiratory rate, resistance of airways, extensibility of lungs
Which muscles involved in inspiration and forced expiration
-inspiration= external intercostals and diaphragm
-expiration= internal intercostals and abdominal muscles
how perio can lead to respiratory issues
Periodontal disease can track down oropharynx to lungs causing pneumonia or lung abscess. Not common in the general population – but if in serious accident, sepsis from the oropharynx can easily track down cause secondary pneumonia/lung abscess.
Give examples of diseases associated with the airways, lung tissue and lung vasculature
airways= asthma, COPD
tissue (parenchyma)= fibrosis, pneumonia, asbestosis, bronchitis, carcinoma
vasculature= pulmonary embolism (from DVT), pulmonary vasculitis
How sedation affects respiratory system
slows respiratory rate, raises CO levels, hypoxia, danger of respiratory arrest
What could be causing breathlessness (dyspnoea) at rest or when walking
[cardiac and respiratory causes]
-at rest: MI, heart failure, cardiac tamponade, bronchospasm, pulmonary embolism, pneumothorax, bronchitis, pneumonia, upper airway obstruction by aspiration or anaphylaxis.
-walking - asthma, obesity, COPD, angina
Difference between wheeze and stridor and RS causes
-Wheeze (expiratory noise) = indicator of asthma, COPD, bronchitis, anaphylaxis
-Stridor – inspiratory noise = indicator of severe respiratory disease/cancer/central airway disruption/ something has been inspired
RS causes of coughing up phlegm or blood
-Cough – if patient bringing up much sputum (phlegm) – sign of infection. cystic fibrosis. bronchitis. COPD. Asthma
-Haemoptysis – coughing up blood = early sign of tumour, infection, pulmonary embolism, pulmonary oedema, pulmonary vasculitis.
- (haematemesis - vomiting up blood, sign of serious issue, investigate further – see GMP)
Difference between pain from lungs and angina
-pleuritic pain – pain that is worse on breathing in. Also when coughing, changing positions can also make it worse [Inflammation of pleura or lining of chest wall]
-angina- dull pain, ache, tight feeling in your chest. can spread to your arms, neck, jaw or back. On exertion. releived by GTN
What is normal breathing rate.
12-20 per minute
what is the main clinical sign of reduced oxygen. normal blood oxygen level %
-cyanosis -reduced Hb and O2.
-blue discolouration of skin or mucous membranes, when patient is warm. Seen clearly on lips or tip of tongue.
-normal = 95-100%
-deeply cyanosed= < 85%
What tests can be done to diagnose respiratory diseases
-Peak flow: forced expired volume
-Oximetry: measures oxygen saturation of blood (<90% is concerning)
-Haematology, biochemistry
-Spirometry to test lung function
-Bronchoscopy- Biopsies, histology, cytology
-chest x-rayt, CT
-microbiology for infections
Explain pink puffer, and blue bloater. causes. what blue bloater leads to
seen in COPD
-“pink puffer” (oxygenated/ fast/short breathing) chest anchored to maximise respiration
- “blue bloater” = Slow breathing, so low oxygen levels (cyanosis). Causes rise in pulmonary artery vasoconstriction causing right heart failure and peripheral oedema. Ankle swelling
why lungs cancer is one of the most fatal cancers. what are the main causes. treatment
-Poor prognosis. Can grow silently without experiencing symptoms. Has already spread before symptoms occur
-smoking and passive smoking
-surgery (if has not spread), radio/chemo therapy, palliation (for those with limited life expectancy)
symptoms of lung cancer
- Cough
- Haemoptysis – coughing up blood
- Weight loss, Anorexia
- Pain
- Metastases – spread of cancer causing secondary malignant growth elsewhere. Eg. A stroke due to lung cancer spreading to brain
-Also perhaps: finger clubbing
-facial swellings due to veins blocked
-oedema in upper arms,
-jugular vein protruding out
-veins across chest due to SVC obstruction
-enlarged cervical lymph nodes
-Horner’s syndrome
-stridor
Causes of finger clubbing (not just RS)
-RS (most common) - carcinoma, fibrotic lung disease (asbestosis, cystic fibrosis), bronchiectasis,
-CVS (rare) - IE, cyanotic congenital
-GI (rare) - liver disease. Crohn’s, coeliac disease
-hyperthyroidism
What is Horner’s syndrome (4 signs) and how lung cancer can cause it
loss of sympathetic nerve supply to one side of the face. If loss to right side then:
* Right eyelid is drooped compared to left (ptosis)
* Constriction of right pupil (meiosis)
* Anhidrosis –absence of sweating at side of face
* Enophthalmos = eyes sinking deeper in eye socket
-cancers on sympathetic nerve at top of right lung, hitting nerve going up to eye.
-could also be caused by an inner ear infection or surgical procedure hitting a nerve
What pleural effusion, cancer and pneumothorax looks like on an x-ray
-pleural effusion (fluid around lung compresses it) = white as no air getting to it
-cancer = if obstructing a lung then white
-pneumothorax -collapsed lung (severe pain followed by breathlessness)
Systemic effects of chemotherapy. and oral symptoms
- Marrow suppression - Low Hb [anaemia] Decreased WCC [prone to infection ] Low platelets – [prone to haemorrhage]
- Alopecia
- Nausea, vomiting
- Infertility, ototoxicity, renal toxicity, neuropathy
- Oral ulceration, mucositis
- Gingival bleeding, mucosal petechiae (thrombocytopenia)
- Xerostomia, caries
- Oral infection, dental abscess
- Oral candidiasis
- Altered taste
- Herpes simplex
what is chronic bronchitis and main symptom
-comprises COPD
-chronic or recurrent excessive mucus secretion in the bronchial tree. Increased coughing off phlegm. It is a symptoms-based diagnosis
What is emphysema. causes. diagnosis
-one of the diseases that comprises COPD
-gradual destruction of bronchioles
- damaged alveoli: increased air spaces with destruction of their walls, and without obvious fibrosis
- can end up with low oxygen saturation as unable to take in enough oxygen.
-Histological diagnosis and also seen on CT scan
-smoking main cause. Also coal dust
Symptoms and signs of chronic obstructive pulmonary disease. what is cor pulmonnale
Airway and tissue damage and chronic inflammation due to smoking. A mixture of chronic bronchitis and emphysema.
-shortness of breath
-raised shoulders, hyper inflated chest= pink puffer
-frequent exacerbation = periods where cough, phlegm and SOB worsens, perhaps caused by infection, so need antibiotics or steroids
-Cor pulmonnale – issue in lungs causing chronic hypoxia, causing strain on the RHS of the heart, leads to swollen ankles
-cyanosis
-laboured breathing
-chronic productive cough
-abnormal BMI
-respiratory failure
Explain FVC and FEV1. what the normal values, and what FEV1/FVC is in COPD and asthma
FVC= forced vital capacity: 5l. total volume in lungs
FEV1= forced expired volume in 1s.
COPD and asthma= reduced FEV1. Normal FVC. FEV1/FVC <70%
[from big breath in]
Is COPD reversible. management options
no, they have chronically lower O2 stopping smoking will cause lung function (FEV) to decline at a slower rate
-smoking cessation
-vaccinations
-pulmonary rehab
-inhalers - LABA, LAMA, ICS
-anti-inflammtory or antibiotic therapy (common to be on erythromycin, 3 times a week. Can predispose to heart arrythmia)
-meds to cough up phlegm (carbocisteine)
-long-term oxygen therapy for select pts.
Functions of LABA, LAMA and ICS inhalers for COPD
-LABA = long acting beta agonist: bronchodilator, open up airway (salmeterol, formoterol and indacateroll)
-LAMA = long acting muscarinic antagonist: blocks ACh to muscarinic receptors. bronchodilator, open up airway (ipratopium)
-ICS = inhaled corticosteroid: cortisol to reduce inflammation
