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Conditions + definitions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the common obstructive airway diseases?

A

Chronic bronchitis
Emphysema
Asthma

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2
Q

What is the mechanism behind asthma?

A

Type 1 hypersensitivity in the airways to an allergen

Either specific IgE, stress, cold drugs or chemicals

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3
Q

What is the clinical definition of chornic bronchitis?

A

Cough productive of sputum most days in 3+ consecutive months for 2+ consecutive years
Exludes TB, bronchiestasis

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4
Q

What are the morphical changes in chronic bronchitis?

A 
Large airways
>Mucous gland hyperplasia
>Goblet gland hyperplasia
>Inflammation and fibrosis
Small airways
>Goblet cells appear
Inflammation and fibrosis in long term disease
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5
Q

What is emphysema?

A

Increase beyond the normal size of airspaces distal to terminal bronchiole
Either due to dilatation or destruction
And without obvious fibrosis

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6
Q

What are the types of emphysema?

A

Centriacinar
Panacinar
Periacinar
Scar

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7
Q

What is centriacinar emphysema?

A

Loss of respiratory bronchioles in proximal portion with sparing of distal alveoli
Typical in smokers

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8
Q

What is panacinar emphysema?

A

Loss of all portions of acinus, from bronchiole to alveoli

Typical in apla-1-antitrypsin deficiency

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9
Q

What is type 1 respiratory failure?

A

Where PaO2 is less than 8kPa

With PaCO2 normal or low

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10
Q

What is type 2 respiratory failure?

A

Where PaCO2 is greater than 6.5 kPa

With PaO2 usually being low

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11
Q

What are the four states associated with hypoxaemia?

A

Ventilation/perfusion imbalance
Diffusion impairment
Alveolar hypoventilation
Shunt

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12
Q

What are the pulmonary vascular changes in hypoxia?

A

Pulmonary arteriolar vasoconstriction
>Occurs in all vessels in hypoaemia
Due to protective mechanisms

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13
Q

What is cor pulmonale?

A

Hypertrophy of the right ventricle resulting from disease affecting the function and/or structure of lung

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14
Q

What is asthma?

A

A disease characterised by increased responsiveness of trachea/bronchi to various stimuli
Manifested by widespread narrowing of airways
Changes in severity either spontaneously or as a result of therapy

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15
Q

What is the prevalence of asthma?

A

10-15% of children (boys>girls)

5-10% adults (girls>boys)

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16
Q

What are the risk factors for asthma?

A

Inherited tendency to IgE response to allergens
>Asthma, eczema, hayfever, food allergy etc family history
>Maternal most influential (3x that of father)

Occupation
Obesity
Diet
Smoking (maternal during pregnancy)
Indoor pollution, maybe outdoor
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17
Q

How is obesity linked to asthma/airway problems?

A

Positively associated with:
>Asthma
Wheezing
>Airway hyperactivity

Also more breathless
>obesity pro-inflammatory

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18
Q

How do you diagnose asthma clinically?

A 
Wheeze (NO WHEEZE NO ASTHMA)
Short of breath, with severity
Chest tightness (/pain)
Cough - usually dry, paroxysmal
Sputum occasionally

Look for airflow obstruction + variability

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19
Q

What are the triggers for asthma?

A 
Exercise
Cold air
Smoke
Perfume
URTIs
Pets
Tree/grass pollen
Food
Aspirin
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20
Q

What signs on examination indicate it might not be asthma?

A 
Clubbing 
Cervical lymphadenopathy
Stridor
Assymetrical expansion
Dull percussion note
Crepitations
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21
Q

What tests can you do to confirm asthma?

A

Spiromitry
>If obstructed do full pulmonary function testing to exclude COPD
>If obstructed then check reversibility with B2 agonists/steroids

> If normal check peak flow monitoring
?If still okay, do bronchial provocation with nitric oxide

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22
Q

What are some useful investigations into asthma?

A 
Chest X ray 
>Check for hyperinflaton/hyperlucent
Skin prick testing
Total/specific IgE
Full blood count (for eosinophillia)
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23
Q

What indicated acute severe asthma?

A 
Ability to speak inhibted
Heart rate >110
Resp rate >25
PEF
Oxygen sats down
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24
Q

What is a moderate asthma attack?

A

Increasing symptoms, however still able to speak and stats not as high as severe

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25
Q

What indicates life-threatening asthma?

A 
Grunting
Impaired conciousness, confusion / exhaustion
Bradycardic OR HR >130
Hypoventilating
Cyanosis

Raised PaCO2 is near fatal

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26
Q

What are the differentials of asthma?

A 
Viral induced wheeze
CF
Immune deficincy
Foreign body
Possibly aspiration
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27
Q

How do you treat episodic wheeze with a cold?

A

Salbutamol

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28
Q

What are the differentials for an isolated cough in children?

A

Brocnhitis (2-3 years)
Pertussis
Habitual cogh (8-12 years)
Tracheomalacia (life long)

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29
Q

What are the clinical features of bacterial bronchitis?

A 
Recurrent wet cough
Tractor (darth vader sounding)
Palpable fremitis
Often first born + very well child
Self limiting
30
Q

What is the natural history of bacterial bronchitis?

A

Follows URTI
Lasts 4 weeks
First winter bad, progressively better. 3rd is often fine

Often caused by pneumococcus

31
Q

What is pertussis?

A 
Coughing fits (whoping cough)
Often with vomiting, colour change + petechiae
Vaccination available
32
Q

What are the common URTIs?

A 
Coryza (common cold)
Sore throat syndrome
Acute laryngotracheobronchitis (croup)
Laryngitis
Sinusitis
Acute epiglottitis
33
Q

What two organisms cause acute epiglottitis?

A

Group A beta-haemolytic streptococci

H. Influenzae (type B)

34
Q

What are the LRTIs?

A

Bronchitis
Bronchiolitis
Pneumonia

+complications

35
Q

What are the respiratory tract defence mechanisms?

A

Macrophage-mucociliary escalator system
General immune system
Respiratory tract secretions

36
Q

What makes up the macrophage–mucociliary escalator system?

A

Alveolar macrophages
Mucociliary escalator
Cough reflex

37
Q

What are the aetiological calssifications of pneumonia?

A 
Community Acquired Pneumonia
Hospital Acquired (Nosocomial) Pneumonia
Pneumonia in the Immunocompromised
Atypical Pneumonia
Aspiration Pneumonia
Recurrent Pneumonia
38
Q

What are the patterns of pneumonia?

A

Bronchopneumonia
Segmental
Lobar

Hypostatic
Aspiration
Obstructive, Retention, Endogenous Lipid

39
Q

What is the bronchopneumonia pattern?

A

Often bilateral basal opacification

Due to focal nature of consolidation

40
Q

What are the possible complications of pneumonia?

A 
Pleurisy, Pleural Effusion and Empyema
Lung Abscess
Bronchiectasis
Constrictive bronchiolitis
Pneumonia is still a potentially fatal disease
41
Q

What can cause lung abcesses?

A

Tumours - leading to obstructed bronchus
Asipiration
Particular organisms - Staph A, some pneumococci
Necrotic lung (sencondary to infection)

42
Q

What is bronchiectasis?

A 
Pathological dilatation of bronchi due to
>Severe infection
>Recurrent infections
>Proximal bronchial obstruction
>Lung parenchymal destruction
43
Q

What is the clinical picture of bronchiectasis?

A 
Cough
Abundent foul sputum!!!
Haemoptysis
Signs of chronic infection
Coarse crackles
Clubbing
44
Q

How do you treat bronchiectasis?

A

Postural drainage
Antibiotics
Surgery

45
Q

What are the causes of aspirational pneumonia?

A 
Vomiting
Oesophageal Lesion
Obstetric Anaesthesia
Neuromuscular Disorders
Sedation
46
Q

What are opportunistic infections?

A

Infection via organism not usually capable of producing disease
However able to in patients with existing lung disease

47
Q

What are examples of opportunistic infections?

A

Low grade bacterial pathogens
CMV
Pneumocystis jirovecii
Other fungi and yeasts

48
Q

Why do you get hypoxaemia in pneumonia?

A

Ventilation mismatch due to bronchitis

Shunt in severe bronchipneumonia - leads to no ventilation of abnormal alveoli

49
Q

What is a shunt?

A

Blood passing from right to left side of heart without contacting ventilated alveoli
Lung shunts respond poorly to increased fractional oxygen intake

50
Q

What can cause pathological shunt?

A

AV malformations,
congenital heart disease
and PULMONARY DISEASE

51
Q

What are the causes of COPD (Emphysema + chronic bronchitis)?

A 
Smoking (85%)
Chronic asthma
Passive smoking
Maternal smoking
Air pollution
Occupation (Dusts, vapours/fumes: coal mining, concrete, farming, plastics, textiles etc)
Rare: alpha1-antitrypsin deficiency
52
Q

What are the clinical features of COPD?

A 
Cough
Sputum
Dyspnoea
Wheeze
Weight loss
Tachypnoea
Prolonged expiratory pahse
Hyperinflation (barrel chest)
Cynaosis
Inspiratory crackles
Cor pulmonale
53
Q

What indicates emphysema?

A 
Emphysema (pink puffers)
>Increased alveolar ventilation - pink but breathless
>Normal PaO2
Normal/low PaCO2
T1 respiratory failure
54
Q

What indicates chronic bronchitis?

A

Chronic bronchitis (blue bloaters)
>Decreased alveolar ventilation - cyanosed not breathless
>Decreased PaO2 + increased PaCO2
>Type 2 respiratory failure + cor pulmonale

55
Q

How do you investigate COPD?

A

CXR (look for hyperinflation, prominent pulmonary arteries + peripheral oligaemia)
ECG (R Atrial hypertrophy)
Spirometry

56
Q

What are the causes of lung cancer?

A 
Tobacco
Asbestos
Environmental causes
Radiation
Pulmonary fibrosis
57
Q

What are the four main types of cancer in the lungs?

A

Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma
Large cell carcinoma

58
Q

What genes cause adenocarcinoma of the lungs?

A

KRAS (35%) = smoking induced
EGFR = 15% (not smoking)
BRAF, HER2, ALK

59
Q

Why is a primary lung cancer often fatal?

A

Symptoms don’t show until late in disease

By that time often too late to cure

60
Q

What are the local effects of lung cancer?

A 
Bronchial obstruction (through collapse or otherwise)
Pleural issues of inflammation/malignancy
61
Q 
What are the effects of a cancer invading the following nerves?
Phrenic
L recurrent laryngeal
Brachial plexus
Cervical sympathetic
A

Phrenic - Diapragmatic paralysis
L recurrent laryngeal - Hoarse, bovine cough
Brachial plexus - Pancoast T1 damage
Cervical sympathetic - Horners syndrome

62
Q

Where can a lung cancer locally spread to?

A

Chest wall
Nerves
Mediastinum
Lymph nodes

63
Q

Where can a lung cancer distally spread to?

A 
Liver
Adrenals
Bone
Brain
Skin
64
Q

What hormones does a small cell cancer affect?

A

ACTH

siADH

65
Q

What hormones does a squamous cell lung cancer affect?

A

PTH

66
Q

What non-metastatic effects do you get from lung cancer?

A 
Finger clubbing
Hypertrophic pulmonary osteoarthropathy
Endocrine disruption
Acanthosis nigricans
Nehprotic syndrome
67
Q

How do you investigate lung cancer?

A

CXR
Bronchoscopy
FNA
Pleural effusion

Maybe CT, MRI etc

68
Q

What is the prognosis of lung cancer?

A 
7% 5 year survival
Mostly dependant on stage
If operable then better:
>Stage 1 60%
>Stage 2 35%
69
Q

What is the prognosis of small cell carcinoma of lungs?

A

4% - median survival is 9 months

70
Q

What are the two main thromboembolic diseases?

A

DVT

PE - pulmonary embolism

71
Q

What is virchows triad?

A

Decreased blood flow
Abnormal vessels
Hypercoagulable state

> States risk factors for thromboembolic disease

72
Q

What causes decreased blood flow?

A 
Immobility
Travel
Bed bound
Obesity
Heart failure

Conditions + definitions (68 decks)

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