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5 Human Diseases > Respiratory disease > Flashcards

Respiratory disease Flashcards

1
Q

ventilation is one of the components that is needed to get adequate oxygen supply into the blood.

ventilation requires what 2 things?

A

airway patency

active muscles

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2
Q

what is airway patency?

A

how wide or narrow the airways are

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3
Q

what does active muscles mean in regards of ventilation?

A

ability of the muscles to move the ribcage in order for ventilation to take place

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4
Q

gas exchange is one of the components that is needed to get adequate oxygen supply into the blood

what does gas exchange require?

A

adequate number of alveoli

no fibrosis of alveolar wall

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5
Q

what can be a sign that ventilation is compromised in a patient clincally?

A

patient is anchoring arms by holding onto the dental chair so that the accessory muscles can assist in ventilation -> shows breathing is compromised

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6
Q

what happens if there is Inadequate ventilation due to airway patency or muscle action problems

A

oxygen levels fall and carbon dioxide levels rise in the alveoli

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7
Q

define type 2 respiratory failure

A

when ventilation is inadequate to deliver enough oxygen to the blood and remove the carbon dioxide

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8
Q

gas exchange failure can be due to what 3 things?

A

fibrosis - thick walls

emphysema - less aveoli

v-q mismatch - air and blood in same part of lungs for exchange to occur

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9
Q

what is emphysema?

A

destruction of alveoli, air sacs join up to form larger spaces with less surface area -> reduce gas exchange

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10
Q

gas exchange failure leads to what kind of respiratory failure?

A

type 1 respiratory failure

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11
Q

Symptoms of respiratory problems

Cough

Wheeze -> expiratory noise

Stridor -> inspiratory noise

Dyspnoea -> patient feels distressed or anxious by the effort of breathing
Pain

A
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12
Q
A
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13
Q

respiratory investigations

spirometry looks at the ability to ventilate the lungs

define these

tidal volume -

inspiratory capacity -

FVC

FEV 1

A

Tidal volume - normal breathing volume in and out

Inspiratory capacity - take big breath in

FVC - breathing out after taking a big breath

FEV 1 second - how much gas can be removed from the lungs in 1 second

PEFR - peak expiratory flow rate (patients can measure this at home)

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14
Q

Asthma is ? of the airways to seemingly innocuous stimuli, causing a change in the ?? which ? the airway, restricting the airflow in and out - typically makes breathing ? more difficult - characteristic wheeze on ?

A

overreaction
bronchial wall
narrows
out
expiration

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15
Q

Asthma cellular response

Allergen triggers ? production

which causes a ???? interaction and causes degranulation of ??

which eventually leads to ?, smooth muscle ? and ??.

A

IgE

B cell T cell
mast cells

oedema
constriction
mucus secretion

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16
Q

asthma is treated by modulating some of the inflammatory mediators

how do drugs ending in mab or ib often work, use omalizumab as an example?

A

often monoclonal antibody or biologic drugs

anti-IgE drug which will prevent IgE production preventing mast cells from degranulating

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17
Q

name the 3 features of asthma that cause bronchial narrowing

A

Bronchial smooth muscle contraction

Bronchial mucosal oedema -> swelling of the airway

Excessive mucous secretion into the lumen -> filling the airway

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18
Q

remember airflow is related to the radius to the power of 8 so small changes in the radius of the airway will significantly impact airflow

A
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19
Q

explain each symptom of asthma

Cough, wheeze (expiratory), shortness of breath

Diurnal variation

Difficulty breathing out and lungs fill with air

A

Caused by irritation from high levels of mucus being produced in the airway

Asthma often worse in the morning and overnight

Measure by falling peak expiratory flow rate (PEFR) over a few days which shows reduced airway patency

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20
Q

why is asthma a biphasic response?

A

There’s a first acute asthma attack and recovery

Then a late asthmatic response some hours later

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21
Q

how is an acute response of asthma managed?

A

acute beta agonists to open the airways quickly

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22
Q

how is a late response of asthma prevented?

A

low dose corticosteroid

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23
Q

asthma

if an acute beta agonist and low dose corticosteroid arnt adequate for controlling a pt asthma what is done?

A

increase corticosteroid to high dose and add long acting beta-adrenergic agonist

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24
Q

what is the clinical significance of aasthma being biphasic?

A

This is important to recognise as a patient sent home after management of the first response may then develop a more significant problem later
Ensure they get corticosteroids to prevent a late asthma response

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25
Q

Beta adrenergic receptors

Work by relaxing ???
- Reduce ?
- Reduce resting ??

Protective -> take in ? of attack e.g. ? exercise

Short acting -> ‘?’ drug

Long acting -> ‘?’ drug (must use with inhaled steroid)

A

bronchial smooth muscle
bronchostriciton
bronchial tone

anticipation
before

reliever

preventer

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26
Q

Corticosteroids

Work by reducing ??§, ?? and ?? which cause bronchial smooth muscle constriction

  • Immune and epithelial cell action
A

mucosal oedema
mucus secretion
inflammatory mediators

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27
Q

what are the issues with corticosteroids?

A

risk of adrenal suppression and osteoporosis though there is no evidence that this happens with the inhaled steroid doses

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28
Q
A
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29
Q

Coronary obstructive pulmonary disease is a mixture of what 2 things?

A

reversible airway obstruction - bronchiectasis

irreversible lung disease - emphysema

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30
Q

in short what is bronchiectasis?

A

recurring damage to the airways caused by chronic infection.

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31
Q

Bronchiectasis aetiology -> recurring damage to the airways caused by chronic infection.

increase in ? from the disease process and inflammation. This happens ? in the same places leading to ? and ??? and damage to the ?? on the outside.

Airways are less ? and its difficult to ? mucus from them.

the mucous excess is caught in the airways and acts as a focus for ?

A

mucous
recurrently
scarring
thickened airway walls
muscle layers

responsive
clear

infection

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32
Q

what are the symptoms of bromchiectasis?

A

Productive cough often with green sputum

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33
Q

what is emphysema?

A

destruction of alveoli and dilation of others to fill the space (reduced SA for gas exchange)

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34
Q

how does emphysema lead to increase risk of cardiac failure?

A

increase in cardiac size as more work to pump blood round the body leading do cardiac failure being more likely

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35
Q

symptoms of COPD

A

Cough
Mucus
Fatigue
Shortness of breath
Dyspnoea - difficulty breathing
Chest discomfort

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36
Q

causes of COPD

A

Asthma
Pollution
Age
Smoking -> largest risk
Chemical exposure
Genetic - AAT deficiency
Chronic bronchitis

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37
Q

complications of COPD?

A

Pneumonia
Heart failure
Acute respiratory distress syndrome ARDS
Frailty
depression

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38
Q
A
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39
Q

remember
COPD risk assessment cant be based upon the medicine used (asthma can) as it is very specific to the patient

A
40
Q

no drug based management of COPD 3

A

Smoking cessation

Prevention of flu

Pulmonary rehabilitation

41
Q

inhlaed therapies for COPD are only given if non-drug based methods dont cause improvement

name 3 inhaled drug therapies for COPD

A

Beta agonists if features suggest reversibility of airways

Corticosteroids can be useful if significant inflammatory change

Oxygen support if there is failure of the respiratory system

42
Q

when may it be necessary to give COPD patients antibiotics?

A

if they have acute COPD exacerbation from infection

43
Q

what is type 1 respiratory failure caused by?

A

alveolar effects (hypoxia - lack of oxygen reaching tissues)

Reduced surface are for gas exchange

Thickening of alveolar mucosal barrier from scarring of the alveolar surface

44
Q

what is a person with type 1 respiratory failure called based on their clinical presentation?

A

Pink puffer -> hyperventilate to increase oxygen conc. Gradient to compensate

45
Q

how is type 1 respiratory failure diagnosed?

A

arterial oxygenation below 8kPa on air, easier to measure oxygen saturation <90%

46
Q

what is type 2 respiratory failure caused by?

A

poor ventilation (CO2 retention and hypoxia)

Airway narrowing

Restrictive lung defects
- Muscle disease preventing ventilation

47
Q

what is a person with type 2 respiratory failure called based on their clinical presentation

A

blue bloater
Oxygen levels fall and CO2 levels rise, which is mirrored in the blood and the patient becomes oedematous and hypoxic

48
Q

how is type 2 respiratory failure diagnosed?

A

if arterial CO2 is above 6.7kPa

49
Q

how is respiratory failure managed?

A

Giving oxygen 24hrs a day increases chance of survival as low level hypoxia makes acute coronary events much more likely

50
Q

why must patients given oxygen with COPD be carefully monitored especially respiratory rate?

A

they rely on CO2 drive for their ventilation so it will reduce their need to breath

51
Q

dental impact of COPD? 3

A

ability to attend appt. - O2 therapy

candida risk from oral steroids (rinse and spacer)

oral cancer risk as often smokers/ex-smokers

52
Q

Cystic fibrosis is a ? disease where there is an inherited defect in ???

Mutation in the ? gene on chromosome ?

Causes the production of excess ? mucus and affects all ?? (mainly lungs and pancreas)

Lungs fill with sticky secretions. ? and ? also occur

Preventing ? is a large part of ensuring survival

A

genetic
cell chloride channels

CFTR
7

sticky
bodily secretions

bronchiectasis
emphysema

infection

53
Q

diagnosis of cystic fibrosis 4

A

Prenatal screening

Perinatal testing - all children screened at 5 days with blood spot test

Sweat test -> greater salt content in CF patients as more chloride

CFTR gene testing -> specific mutation depends on ethnicity

54
Q

symptoms of cystic fibrosis in children 4

A

Troublesome cough

Repeated pulmonary (chest) infection -> staph

Malnutrition -> from the lack of fat absorption and the inability of the pancreas to produce enzymes

Prolonged diarrhoea and poor weight gain -> Due to high fat content being passed through the gut

55
Q

cystic fibrosis can lead to what? 4

A

Liver dysfunction

Prone to osteoporosis -> not absorbing fat soluble nutrients e.g. vit D

Diabetes symptoms -> chronic pancreatic inflammation gradually destroys B cells

Reduced fertility -> mainly men

56
Q

one of the treatmnets for cystic fibrosis is physiotherapy, how does this help?

A

Help remove the mucus secretions out the lung (like a massage, done by parents)

57
Q

what medication is given to treat lung problems associated with cystic fibrosis?

A

Bronchodilators to open airways

Antibiotics to reduce chest infection frequency

Steroids to reduce airway inflammation

58
Q

what medication is given to treat the digestive system problems associated with cystic fibrosis?

A

Pancreatic enzyme replacement
Nutritional supplements

59
Q

CFTR modulators can be given to cystic fibrosis patients

they change ?? regulation so there is a more normal response to stimuli
Only suitable for F508del patients which is 90% of patients

A

chloride channel

60
Q

how do stem cell treatments help cystic fibrosis patients?

A

Replace bad gene with new one

Difficult as has to be given to stem cells (not stable ‘adult’ cells) so that all body cells have the new gene copy

61
Q

how does exercise help cystic fibrosis patients?

A

Keep lung function optimal

Build physical bulk and strength

62
Q

transplantation is a treatment option for cystic fibrosis that has lead to end stage lung disease

A

also effects the heart so lung-heart transplant)

10 year survival

Complications from the transplant suppression medicines

63
Q

causes of lung cancer

A
  • Smoking
    • Genetics
    • Other lung diseases
      Environmental: chemicals, radon, air pollution, radiation therapy
64
Q

Lung tumours can be a ? mass or a ? mass that blocks the ? allowing a collection of ? and ? in the lung resulting in ? and ? of the whole lobe of the lung.

A

peripheral
central
bronchus
fluid
inection
pneumonia
occlusion

65
Q

almost all lung tumours are benign or malignant?

A

malignant

66
Q

what are the 2 main types of lung cancer?

A

Small cell

Non-small cell (most common)
- Squamous cell carcinoma
- Large cell
- Adenocarcinoma

67
Q

signs and symptoms of lung cancer

A

Cough

Haemoptysis -> blood stained sputum

Pneumonia -> from bronchi blockage

Metastasis -> bone, liver, brain

Other
- Dysphagia -> difficulty swallowing from central tumour at bronchus compressing the oesophagus
- Superior vena cava compression -> from tumour within mediastinum -> oedema as blood doesn’t return to right heart from upper body.
- Recurrent laryngeal nerve palsy -> persistent hoarseness from tumour in contact with laryngeal nerve -> may be first sign of lung cancer

68
Q

Diagnosis of lung tumours
When a tumour starts there is a long time before symptoms develop and diagnosis so metastasis can occur leading to bad patient outcomes

A
69
Q

what is stage 1 lung cancer?

A

Stage 1: one tumour

70
Q

what is stage 2 lung cancer?

A

Stage 2: multiple lesions but only on one side of the thorax

71
Q

what is stage 3 lung cancer?

A

Stage 3: lesions on both sides of the thorax

72
Q

what is stage 4 lung cancer?

A

Stage 4: metastatic lesions throughout the lung and symptoms of oedema, fluid or pneumonia

73
Q

Treatment of lung cancer

Dependant on ?

? (genetic mutations of the lesion) help decide what treatment is best

In locally advanced unresectable non-small cell lung cancer the treatment is ?? with the aim of prolonging life expectancy not ? the disease

In some peripheral solitary lesions ? of the infected lobe can be curable

A

stage
biomarkers
chemoradiation therapy
curing
removal

74
Q

what is obstructive sleep apnoea?

A

airway obstruction whilst asleep preventing normal breathing for 10seconds or more.

75
Q

symptoms of obstructive sleep apnoea

A

Drowsiness during the day as cant sleep -> car accidents

Snore

76
Q

Problems associated with obstructive sleep apnoea

Its a multisystem problem but manifests as an ? problem

Affects the ? -> cognitive function etc.

? systems -> cardiovascular disease and insulin resistance (diabetes)

increased risk of ??? such as MI as hypoxia occurs during sleep apnoea

A

airway

brain

control

acute cardiac events

77
Q

The number of times a obstructive sleep apnoea patient suffers obstruction during the night is key to their long term survival and need for treatment

A
78
Q

how do mandibular advancement appliances help obstructive sleep apnoea?

A

Aims to move the tongue away from the pharynx. Move the mandible forward pulling the tongue with it

79
Q

how does CPAP help obstructive sleep apnoea?

A

continuous positive airway pressure

Mask is worn to maintain pressure in the airways to blow apart the tongue and pharynx maintaining patency

80
Q

how does positional therapy help obstructive sleep apnoea?

A

An alternative if obstruction only occurs when the patient sleeps on their back. Devices to encourage to sleep on side.

81
Q

what drugs improve ventilation through improving airway patency?

A

Bronchodilators -> relax the smooth muscle
- B2 agonist and anticholinergic

Anti-inflammatory -> reduce mucosal oedema and mucus production
- Corticosteroids

82
Q

what drugs improve ventilation through preventing mast cell degranulation?

A

Reduce inflammatory mediators released into the airway wall that cause narrowing of the airways
- Chromoglycate
- Leukotriene receptor antagonists

83
Q

drugs that impair ventilation

?? -> Narrow airways by increasing airway smooth muscle constriction

??
- Benzodiazepines -> reduce ?? by causing muscle relaxation
- Opioids -> reduce the ? for the patient to ?

A

B blockers

respiratory depressants
ventilation rate
stimulus
breath

84
Q

what drug is used to improve gas exchange?

A

Oxygen -> higher conc. In alveolus = more oxygen diffuses into blood

Remember oxygen is a drug so must be prescribed

85
Q

what is the problem with a metered dose inhaler MDI?

A

fires a jet of drug into the oropharynx to be captured by the air being breathed in but a lot of the drug will be deposited around the oropharynx and may lead to local immunosuppression (especially corticosteroids) and candidiasis

86
Q

inhaled drug delivery
what is a breath activated device?

A

Pics up the drug as the air moves across the device and carries it into the airway

Spinhaler, turbohaler

87
Q

name two aids to inhaled drug delivery

A

Nebuliser
- liquid version of the drug
- The compressor blows air through the tube causing the drug to bubble and be breathed into the airway

Spacer
- useful for patients with a MDI
- Don’t need to coordinate activating the inhaler and the breath so effectively
- Activate device into chamber then take breath from chamber

88
Q

B agonist
Relieve the symptoms of asthma by ?

A

relaxing the airway

89
Q

short acting B agonists

? onset

administration ?

use?

A

quick

inhaled, oral, intravenous

Treats acute bronchial constriction

90
Q

long acting B agonist

? onset

administration ?

use ?

A

slow

inhaled

prevents acute bronchial constriction

Always used with an inhaled steroid to reduce chance of acute coronary syndrome

91
Q

what do anticholinergics do?

A

Cause relaxation of the smooth muscle and opening of the airways

Used with b agonists for bronchial dilation and mucus secretion reduction

92
Q

what do corticosteroids do?

A

Reduce inflammation in the bronchial walls

93
Q

how do mast cell stabilisers treat asthma?

A

Prevent the release of chemical mediators in the bronchiole wall which initiate asthma

94
Q

how do leukotrine inhibitors treat asthma

A

Prevent the release of chemical mediators in the bronchiole wall which initiate asthma

95
Q

how do biological medicines treat asthma?

A

Target specific immune modulators within the inflammatory process

96
Q
A

5 Human Diseases (16 decks)

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