Respiratory conditions

Question 1

What is pneumonia?

Answer 1

-lung inflammation caused by infection
-it typically affects the lower airway and causes the development of secretions which build up and block the airways
-this can create consolidation and cause the lung to collapse

Question 2

What are the signs and symptoms of pneumonia?

Answer 2

-malaise/ confusion
-fever
-chills
-rigor
-tachycardia
-tachypnoea/ dyspnea
-cough
-vomiting
-diarrhoea

Question 3

What are the causative agents of pneumonia?

Answer 3

-bacteria e.g strep, hemophilus influenza

-viruses e.g influenza, respiratory cidiil virus

-fungi aren’t common, only higher risk in immunocompromised

-they enter and infect the respiratory through inhalation, it enters the alveoli and initiates an immune response

Question 4

What are the (6) different types of pneumonia?

Answer 4

-lobam pneumonia= consolidation of one lobe

-broncho pneumonia=
affects patches throughout respiratory tract

-community acquired pneumonia= often bacterial or viral

-Nosocomial (hospital acquired)= not incubating at time of admission and develops in a patient hospitalised for longer then 48 hours

-aspiration pneumonia= when patient vomits they can aspirate stomach content with gut bacteria

-chronic pneumonia= usually involves fungal causative agents so more common in immunocompromised patients

Question 5

How is pneumonia managed and treated?

Answer 5

-oxygen
-IV fluids
-pain management
-use of antibiotics, if non complicated oral will be used, but if complicated may be IV

Question 6

What is bronchiolitis?

Answer 6

Inflammation of the bronchioles which involves narrowing of the airways due to mucous hyper secretion, cell wall thickening, and smooth muscle contraction, most commonly seen in neonates and under 2s

It can also cause air trapping where oxygen can be inhaled but gets trapped in the lower respiratory tract in the alveolus to surrounding inflammation, causing difficulty in breathing for infants

Question 7

What is the main causative agent for bronchiolitis?

Answer 7

Respiratory Syncytial Virus (RSV), a single stranded RNA virus that is spread through airborne droplets or direct contact with respiratory secretions

Question 8

What are the signs and symptoms of mild/ moderate bronchiolitis compared to severe bronchiolitis- how is this managed?

Answer 8

Mild/ moderate:
-fever
-increased work of breathing
-nasal flaring
-tracheal tug
-intercostal recessions
-wheezing
-abdominal breathing

Severe:
-infants appear very unwell
-very high or very low respiratory rate
-apnea (stop breathing)
-grunting
-cyanosis
-paleness
-difficulty feeding

-largely supportive focusing on maintaining oxygenation and hydration of the patient

Question 9

What actually happens to the respiratory tract in bronchiolitis?

Answer 9

-bronchioles, leading to the bronchi become inflamed

-the inflammatory process responds to the damage caused by the epithelial layer in the airways triggering the release of tissue mediators which activate the eosinophils, neutrophils and monocytes

-submucosa swells causing debris and fibrin to form plugs in the bronchioles

-bronchospasm can also occur

-secretions are produced which block the small airways and prevent oxygen getting to the alveoli and body, =hypoxia, co2 also is not excreted

-the volume of secretions can result in the airway becoming blocked, causing air trapping, where oxygen can be inhaled but gets trapped in the lower respiratory tract in the alveolus to surrounding inflammation, causing difficulty in breathing

-this produces a ventilation-perfusion mismatch

Question 10

How does the body respond to a covid-19 infection both in the lungs and in the bloodstream?

Answer 10

-in the lungs the reaction appears similar to a severe pneumonia where tissue mediators create inflammation and release cytokines

-once the virus enters the blood stream then the response is typical of the response seen in sepsis as the body releases tissue mediators to fight the infection.

Question 11

How and why might covid-19 affect people differently?

Answer 11

There is a hypothesis that the virus may be attacking the T cells trying to recognise it and kills them before a response can be initiated

The elderly are also more at risk due to a reduced immune response and ability for the lung epithelium to repair its-self.

Children are generally less affected as they have a thymus gland which supports the development and maturing of T cells

Question 12

What is asthma?

Answer 12

-defined as a chronic inflammation disorder of the airways
-having airway inflammation which narrows the airway causing obstruction to airways and resulting in a hyper-responsive airway

Question 13

What is atopic asthma?

Answer 13

-the most common type
-extrinsic meaning triggered by the environment
-this involves inflammation mediated by systemic IgE production

Question 14

What is non-atopic asthma?

Answer 14

-not common
-intrinsic meaning inflammation and constriction of airways that is not caused by exposure to allergen
-the inflammation is mediated by local IgE production

Question 15

What are some of the differences between a normal bronchi and an asthmatic bronchi?

Answer 15

Asthmatic bronchi:
-lumen is much narrower
-increased mucous production and goblet cells
-more mast cells= more histamine
-more neutrophils and T helper cells

Question 16

What are the risk factors for asthma?

Answer 16

-air pollution
-tobacco smoke
-respiratory tract viral infections
-oesophageal reflux
-obesity
-decrease in exposure to certain microorganisms (immunological imbalance)

Question 17

What is the pathophysiology of an early asthmatic response?

Answer 17

-antigen exposure to the bronchial mucosa, activates dendritic cells, T cells respond releasing cytokines

-this stimulates the production of B cells and antigen specific IgE.

-activation of the eosinophils= causes tissue injury and releases toxic neuropeptides

-neutrophils are activated= reduces ability to clear secretions and supports constriction of smooth muscle to narrow the airway

-inflammatory response increases as IgE causes mast cells to release more tissue mediators= tigger capillary permeability, vasodilation, mucosal oedema, bronchospasm and sticky secretions

Question 18

What is the pathophysiology of a delayed asthmatic response?

Answer 18

-late release of more tissue mediators= creates more tissue damage and increased secretions that can plug the airway

-increase in synthesising nitric oxide creates oxidative injury and chronic inflammation= creates oxidative injury and chronic inflammation

-untreated inflammation can lead to the airway remodelling which is irreversible= can lead to the airway remodelling which is irreversible

Question 19

Explain how asthma is seen as being type 1 hypersensitivity to the IgE

Answer 19

-Type 1= reactions in response to environmental allergens
-IgE is produced and the person becomes sensitised to the level of IgE
-IgE attaches to mast cell triggering inflammatory response

In asthma histamine:
-contracts smooth muscle narrowing the airways
-dilates blood vessels
-attracts eosinophils into the area

Question 20

What are the other physiological reactions in as asthma attack?

Answer 20

-expiratory wheeze
-use of accessory muscles
-feeling tight
-breathless and tachypnoea
-hypoxia and hypoxaemia
-tachycardia
-non productive cough

Question 20

What are the major physiological reactions that happens in an asthma attack?

Answer 20

-airway obstruction= increased resistance

-inability to exhale= air trapping and increase WOB

-intrapleural and alveolar gas pressure increases= V:Q mismatch = hypoxic

-Hypoxia stimulates respiratory centre= CO2 levels fall

Question 21

What are the severe physiological reactions that happens in an asthma attack?

Answer 21

-severe hyper-expansion and an inability to adequately move muscles in the chest, putting pressure on the heart, compromising cardiac output

-bronchospasm

-using accessory muscles wheezing on both inspiration and expiration

Question 22

What medications are used to treat asthma?

Answer 22

-supplemental oxygen

Nebulisers:
-bronchodilators e.g salbutamol B2 agonist
-anticholinergic if response to salbutamol is poor

Steroids:
-moderate asthma= oral prednisolone
-severe asthma= IV hydrocortisone

If these don’t work IV magnesium or IV aminophylline

Question 23

What long term asthmatic medications can be used?

Answer 23

-short acting B adrenergic agonists

-anticholinergic medicine

-systemic corticosteroids

-anti-inflammatory agents

Question 24

What is cystic fibrosis?

Answer 24

-a recessive genetic condition

-the gene that is responsible for making a protein which regulates the amount of chloride and sodium going in and out of the cell is faulty. This makes the mucus that lines the airways and other organs thick and sticky and therefore less able to clear secretions and protect against infection

Question 25

What are the signs and symptoms of cystic fibrosis?

Answer 25

coughing, regular chest infections, difficulty absorbing fat which results in poor weight gain

Question 26

How can cystic fibrosis be controlled/ managed?

Answer 26

-a combination of medication and physiotherapy can help control lung infections and prevent lung damage

-medications may include antibiotics to help treat or control chest infections, medicines to help clear mucous from the lungs, and steroids or bronchiodilators

Question 27

How is cystic fibrosis diagnosed?

Answer 27

Apart of routine screening in newborn babies from a heel prick blood sample at a few days old

Question 28

What is croup?

Answer 28

Croup is a common condition that mainly affects babies and young children airways, caused by a virus

Question 29

What are the symptoms of croup?

Answer 29

-a barking cough
-a hoarse voice
-difficulty breathing
-high pitched rasping sound when breathing in
-and other normal cold symptoms like a temperature and runny nose

-croup symptoms usually worsen over night and improve during the day

Question 30

What is the treatment for croup?

Answer 30

-croup is caused by a virus therefore it cannot be treated with antibiotics
-some children may require steroids to reduce swelling and inflammation in their throats

Question 31

What is a pneumothorax?

Answer 31

-An air leak in the lungs when air from the lungs leaks into the chest area
-often occurring 24-36 hours after birth
-how serious the illness is depends on where the leak is, how quickly it occurs and how much air is leaking
-can potentially lead to cardiac arrest or death

Question 32

What are some of the potential causes of a pneumothorax?

Answer 32

-most common cause is air delivered by a breathing machine, a baby born with lung disease may need to be on a breathing machine

-meconium aspiration- when a baby is still in its mothers uterus and breathes in its first stool. Air may become trapped causing lungs to expand too much

-pneumothorax can also occur suddenly in children but this is uncommon

Question 33

What are the symptoms of pneumothorax?

Answer 33

-irritability and restlessness
-rapid breathing
-grunting
-nostril flaring
-skin on the chest sinks in around the ribs when the child breathes
-pale or blue-ish skin

Question 34

How can pneumothorax be diagnosed?

Answer 34

-chest x ray= may show air in places that is not normal, a collapsed lung, or abnormal structures

-transillumination= a fibre-optic light probe is put on the baby’s chest wall and the side of the chest with the air leak shows a brighter light. This is often used in an emergency

Question 35

How can pneumothorax be treated?