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Year 2 Conditions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What causes respiratory distress syndrome in newborns?

A

Lack of surfactant

No reduction in surface tension, so smaller alveoli collapse

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2
Q

What is diffuse lung fibrosis?

A

Replacement of normal capillaries, alveoli and healthy interstitium with more interstitial tissue

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3
Q

What is the effect of pulmonary fibrosis.

A

Thickened capillary membrane increases diffusion distance for O2 and CO2
Impairs has exchange

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4
Q

What are the symptoms of pulmonary fibrosis?

A

Breathlessness

Dry cough

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5
Q

What is a sign of pulmonary fibrosis?

A

Bilateral reduction in chest expansion

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6
Q

What is emphysema?

A

Abnormal, permanent enlargement of air spaces distal to terminal bronchiole
Reduced elasticity due to destruction of elastin
Large air spaces causes reduced surface area for gas exchange

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7
Q

What is the most common cause of emphysema?

A

COPD

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8
Q

What occurs in carbon monoxide poisoning?

A

Hb has a v high affinity for CO

Unaffected subunits of Hb gain a higher affinity for O2, so they don’t give it up at tissues

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9
Q

What is type 1 respiratory failure?

A

pO2 <8kPa
O2 sats <90%
pCO2 normal or low

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10
Q

What is type 2 respiratory failure?

A

Low pO2

High pCO2

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11
Q

What are some causes of hypoxia?

A 
Low inspired O2 due to environmental problem 
Right to left shunt 
Hypoventilation 
V/Q mismatch 
Diffusion defect
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12
Q

What are some causes of acute hypoventilation?

A

Opiate overdose
Head injury
V severe acute asthma attack

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13
Q

What are some effects of acute hypoxaemia?

A

Impaired CNS function
Cyanosis
Cardiac arrhythmias
Hypoxic vasoconstriction of pulmonary vessels

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14
Q

What are some effects of acute hypercapnia?

A

Respiratory acidosis
Impaired CNS function
Peripheral vasodilation
Cerebral vasodilation

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15
Q

What are some effects of chronic hypoxaemia?

A

Increased EPO => raise Hb
Increase 2,3-BPG
Chronic vasoconstriction to under-perfused areas => pulmonary hypertension, cor pulmonale

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16
Q

What are occurs in chronic hypercapnia?

A

CO2 diffuse into CSF => lowers pH
Low pH damages neurones, so need to compensate
Choroid plexus secretes HCO3- into CSF to bring pH to normal
Although pCO2 is high, central chemoreceptors no longer respond to it

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17
Q

What is asthma?

A

A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

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18
Q

What is the pathophysiology of asthma?

A

Chronic inflammation driven by TH2
Release of cytokines attracts and activates mast cells and eosinophils
Activation of B cells => IgE production

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19
Q

What changes to airways in asthma result in airway obstruction?

A 
Mucosal oedema 
Infiltration of inflammatory cells 
Over production of mucus 
Smooth muscle contraction 
Shedding of epithelium
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20
Q

What are symptoms of asthma?

A

Dry, nocturnal cough
Wheeze
Breathlessness
Tight chest

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21
Q

What are signs of asthma?

A 
High resp rate 
High pulse 
Low O2 sats 
Bilateral wheeze 
Atopy - eczema, hayfever
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22
Q

In asthma, what are the effects on gas exchange?

A

Airway narrowing => reduced ventilation of affected alveoli => V/Q mismatch

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23
Q

What are signs and symptoms of acute severe asthma attacks?

A 
Pt can’t complete full sentences 
Wheezing 
Hypoxic (sats still >92%)
Tachypnoeic >25 
Tachycardia >110bpm
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24
Q

What are signs and symptoms of a life threatening asthma attack?

A 
Exhaustion 
Silent chest  due to little airflow 
Altered consciousness 
Central cyanosis 
Reduced resp effort 
Bradycardia 
Hypotension 
O2 sats <92%
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25
Q

What is COPD?

A

Obstruction to airflow

Umbrella term for emphysema and chronic bronchitis

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26
Q

What occurs in emphysema?

A

Destruction of terminal bronchioles and airspaces
Leads to loss of alveolar surface area
Causes destruction of supporting tissue surrounding small airspaces => collapse of airways during expiration
Loss of elastic tissue causes hyperinflation of lungs

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27
Q

What is chronic bronchitis?

A

Chronic mucus hypersecretion
Caused by inflammation of large airways => proliferation of mucus producing cells
Airflow obstruction is due to remodelling and narrowing of airways

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28
Q

What causes COPD?

A

Mostly caused by smoking

Other causes include:
α1-antitrypsin deficiency
Occupational exposure
Pollution

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29
Q

What are some symptoms of COPD?

A

Productive cough
Progressive breathlessness
Exacerbations are associated with increased breathlessness, cough and sputum production

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30
Q

What are some signs of COPD?

A 
Pursed lip breathing 
Tachypnoea 
Use of accessory muscles 
Hyperinflation (barrel chest) 
Wheezing
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31
Q

What is the management of COPD?

A 
Smoking cessation 
Bronchodilators => symptomatic relief 
Antimuscarinics 
Steroids => reduce inflammation 
Mucolytics => reduce sputum thickness
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32
Q

What is bronchiectasis?

A

Chronic dilatation of one or more bronchi

Bronchi also have poor mucus secretion which predisposes to infection

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33
Q

What are symptoms of bronchiectasis?

A 
Chronic cough 
Daily sputum production 
Breathless on exertion 
Intermittent haemoptysis
Chest pain 
Wheeze
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34
Q

What are the causes of bronchiectasis?

A

Post infective; whooping cough, TB
Immune deficiency
Mucociliary clearance defects; CF

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35
Q

What is the management of bronchiectasis?

A

Physio/airway clearance
Sputum sampling
Exclude immunodeficiency
Flu vaccine

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36
Q

What are common causative organisms of bronchiectasis?

A 
Haemophilus influenzae 
Pseudomonas aeruginosa 
Streptococcus pneumoniae 
Aspergillus 
Candida albicans
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37
Q

What is cystic fibrosis?

A

Mutation in CFTR gene from an autosomal recessive condition
Leads to ineffective cell surface chloride transport
Results in thick dehydrated body fluids in organs which express the CFTR gene

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38
Q

What is the presentation of cystic fibrosis?

A

Meconium ileus - bowel obstruction, delay in passing meconium
Intestinal malabsorption- deficiency in pancreatic enzymes
Chest infections

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39
Q

What are some complications of CF?

A 
Lungs - bronchiectasis, pneumothorax 
Upper resp tract - chronic sinusitis, nasal polyposis 
Pancreas - DM, pancreatic insufficiency 
Liver - cirrhosis 
Biliary tree - gallstones 
Repro - male infertility
40
Q

What are some organisms that cause lower respiratory tract infections?

A 
Common;
Viridans streptococci 
Neisseria 
Anaerobes 
Candida

Less common;
Streptococcus pneumoniae
Streptococcus pyogenes
Haemophilus influenzae

41
Q

What are usual defences of the respiratory tract?

A

Ciliated columnar epithelium and nasal hairs
Cough and sneeze reflexes
Lymphoid follicles of pharynx and tonsils
IgA and IgG

42
Q

What are some examples of LRTIs?

A 
Bronchitis 
Bronchiolitis 
Bronchiectasis 
Pneumonia 
Empyema 
Lung abscess
43
Q

What occurs in acute bronchitis?

A

Inflammation of medium sized airways
Most commonly caused by S. pneumoniae

Symptoms;
Cough, fever, sputum production, SoB

Treat;
Bronchodilation, physiotherpy, maybe abx

44
Q

What is pneumonia?

A

Inflammation of the alveoli

Consolidation of lungs seen on CXR

45
Q

How does pneumonia present?

A

Fever
Cough
Pleuritic chest pain
SoB

46
Q

How is pneumonia classified?

A

Clinical setting;
Community or hospital acquired

Presentation;
Acute or chronic

Lung pathology;
Lobar, bronchopneumonia or interstitial pneumonia

47
Q

What organisms commonly cause community acquired pneumonia?

A 
Streptococcus pneumoniae 
Haemophilus influenzae 
Staphylococcus aureus 
Moraxella catarrhalis 
Klebsiella pneumoniae
48
Q

What are symptoms of community acquired pneumonia?

A 
SoB 
Cough +/- sputum
Fever 
Rigours 
Pleuritic chest pain 
Malaise 
Nausea and vomiting
49
Q

What are signs of pneumonia?

A 
Pyrexia 
Tachycardia 
Tachypnoea 
Cyanosis 
Dullness to percussion 
Bronchial breathing 
Crackles
50
Q

What is atypical pneumonia?

A

Caused by organisms without a cell wall

Therefore requires abx which act on protein synthesis

51
Q

What is hospital acquired pneumonia?

A

Pneumonia which occurs after >48 hrs in hospital

Common organisms:
Staph aureus
Pseudomonas 
H influenzae 
Fungi eg Candida
52
Q

What is aspiration pneumonia?

A

Aspiration of endogenous or exogenous secretions into the respiratory tract
Common in pts with neurological dysphagia, epilepsy, alcoholics or drowning

Often caused by a mixed infection;
Viridans streptococci and anaerobes

Treated w/ co-amoxiclav

53
Q

How is pneumonia prevented?

A

Immunisation - flu vaccine
Chemoprophylaxis - oral penicillin/erythromycin for pts w/ high risk of LRTI
Smoking cessation

54
Q

What are the stages of pneumonia?

A

1) Congestion; days 1 - 2
2) Red hepatisation; days 3 - 4
3) Grey hepatisation; days 5 - 7
4) Resolution; day 8 - 3 weeks

55
Q

What happens in the congestion stage of pneumonia?

A

Blood vessels and alveoli fill with excess fluid

56
Q

What happens in the red hepatisation phase of pneumonia?

A

Exudate (RBCs, neutrophils and fibrin) fill air spaces => more solid
Appearance resembles liver

57
Q

What happens in the grey hepatisation stage of pneumonia?

A

Tissue is still firm

Colour change due to break down of RBCs in exudate

58
Q

What happens in the resolution stage of pneumonia?

A

Exudate is digested, ingested or coughed up

59
Q

What is tuberculosis?

A

A common worldwide bacterial infection

Affects the lungs, and can progress so affect other systems

60
Q

What bacteria causes TB?

A

Mycobacterium tuberculosis - most common

M bovis
M africanum

61
Q

Describe the structure of the bacteria causing TB

A

Non-motile rod shaped
Obligate anaerobe
Cell wall contains lots of fatty acids and glycolipids - gives structural rigidity and staining characteristics (acid fast, red in Ziehl-Neelsen stain)

62
Q

How is TB spread?

A

Inhalation

63
Q

What is the natural history of TB?

A

Primary TB
Latent TB
Reactivation

64
Q

What occurs in primary TB?

A

Macrophage ingests mycobacterium
Mycobacterium produces proteins which inhibit lysosomal breakdown
Mycobacterium proliferates
A granuloma is produced to inhibit spread of infection
Caseous necrosis occurs in the granuloma - Ghon focus
This caseating tissue can spread to hilar lymph nodes

65
Q

What occurs post-primary TB infection?

A

Fibrosis of Ghon complex => Ranke complex

Most often TB is killed off
Other times it can remain still viable, but walled off

66
Q

What are some risk factors for reactivation of TB?

A 
AIDS
Substance abuse 
Corticosteroids 
Organ transplant 
Diabetes mellitus 
Low BMI
67
Q

When should you suspect TB?

A

Non-UK born, recent migrants or travel
HIV or other immunosuppressed states
Homeless
Close contact w/ TB pts

68
Q

What are symptoms of pulmonary TB?

A 
Fever 
Night sweats 
Weight loss 
Anorexia 
Tiredness/malaise
Haemoptysis 
Breathlessness
69
Q

What are signs of pulmonary TB?

A

Crackles in affected lobe
Signs of effusion if pleura is involved
Extensive disease can show signs of cavitation and fibrosis

70
Q

What is the treatment for TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

These are given for two months, then rifampicin and isoniazid for a further four months

71
Q

What is miliary TB?

A

Spread of the bacilli through the blood causing a widespread infection
Occurs in either primary infection or reactivation

72
Q

What can miliary TB affect?

A

Headache; meningeal involvement
Pericardial or pleural effusion
Ascites
Retina; choroid tubercles

73
Q

How is active TB diagnosed?

A

CXR
Samples; sputum, pus, biopsy

Ziehl-Neelson stain; rapid direct microscopy for acid fast bacilli, TB shows up red

74
Q

How is latent TB diagnosed?

A

Mantoux test - tuberculin skin test

However can have a false positive in pts who have had BCG

75
Q

What is a pneumothorax?

A

Presence of air in the pleural space resulting in a collapsed lung

76
Q

What are the symptoms of a pneumothorax?

A 
Sudden onset chest pain 
Sharp, localised pain 
Tachycardia
Tachypnoea 
Cough
77
Q

What is a primary spontaneous pneumothorax?

A

Rupture of an underlying small sub-pleural bulla

Most commonly occurs in young, thin, tall males with no predisposing factors

78
Q

What causes a secondary pneumothorax?

A

Underlying lung disease; COPD, asthma, bronchiectasis

Trauma; fractured rib punctures pleura

High pressure ventilation

79
Q

What is a tension pneumothorax?

A

Occurs when air enters the pleural cavity, but cannot escape due to a flap which closes on expiration

80
Q

What are some signs of a tension pneumothorax?

A 
Tachycardia 
Hypotension 
Raised JVP
Deviated trachea 
Displaced apex beat 
Silent breath sounds 
Hyper-resonance on percussion
81
Q

What are some symptoms of a tension pneumothorax?

A

Severe distress and dyspnoea
Pleuritic chest pain
Fatigue

82
Q

What is a pleural effusion?

A

Accumulation of fluid in the pleural space

Either failure of absorption, or overproduction of the fluid

83
Q

How does a failure of absorption cause a pleural effusion?

A

Most commonly due to hypoproteinaemia (liver failure, nephrotic syndrome)
Congestive heart failure
Lymphatic obstruction

84
Q

How does overproduction of fluid cause a pleural effusion?

A

Increased capillary permeability

Inflammation; infection or pulmonary infarct

85
Q

What are some signs and symptoms of a pleural effusion?

A 
Chest pain 
Dry cough 
Fever 
Orthopnea 
SoB 
Difficult taking deep breaths 
Persistent hiccups
86
Q

What is a pulmonary embolus?

A

Part of a thrombus from the venous system which has broken off, travelled through the right side of the heart and lodges in the pulmonary arteries

87
Q

What are some risk factors for thromboembolism?

A 
Smoking 
Pregnancy 
Obesity 
Prolonged immobilisation 
Cancer 
Contraceptive pill
88
Q

Describe the pathophysiology of PE

A

Right ventricular overload;
Increase in pulmonary artery pressure => right ventricular dilatation and strain
Release of NA and adrenaline to try to maintain systemic circulation => pulmonary artery vasoconstriction

Respiratory failure;
Areas of V/Q mismatch
Low right ventricle output

Pulmonary infarction;
Small distal emboli => alveolar haemorrhage
Causes haemoptysis, pleuritis and small pleural effusion

89
Q

What are some signs and symptoms of a PE?

A 
Dyspnoea
Pleuritic chest pain 
Cough
Haemoptysis 
Unilateral leg pain

Tachycardia
Low BP
Raised JVP

90
Q

What are some differential diagnoses for a PE?

A 
Pneumothorax 
Pneumonia 
Pleurisy 
MSK chest pain 
MI 
Pericarditis
91
Q

What are the investigations and findings for a PE?

A

Blood gases; hyperventilation => respiratory alkalosis (hypoxaemia, hypocapnia)

CXR; mostly normal, used to exclude other diagnoses eg pneumonia

ECG; can have evidence of RV strain, although mostly just get sinus tachycardia

D dimer

92
Q

What is the treatment for a PE?

A

Oxygen

Immediate heparinisation

93
Q

How does heparin reduce mortality from a PE?

A

Stops propagation of the thrombus and allows the fibrinolytic system to lyse the thrombus

Reduces frequency of further pulmonary embolism

Does not dissolve the clot

94
Q

How are high risk PE pts treated?

A 
Haemodynamic support 
Respiratory support 
Exogenous fibrinolytics
Percutaneous catheter directed thrombectomy 
Surgical pulmonary embolectomy
95
Q

What treatment is there for PE pts after initial heparinisation?

A

Oral anticoagulant eg warfarin, rivaroxaban

Year 2 Conditions (3 decks)

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