Respiratory Disease Flashcards
what is polycythaemia
this is when the bone marrow produces more red blood cells to carry more oxgyen
what does respiratory mean
designating, relating to, or affecting the organs involved in respiration, or of relating to respiration
of or relating to the processes of oxygen transport and respiration
what is respiration
the action of taking air into the lungs and expelling it again, especially as a continuous physiological process
a single act of breathing
the exchange of oxygen and carbon dioxide between an organism or cell and the environment, the process by which this occurs, also the process by which oxygen is distributed to the tissues of an organism
what is disease
sickness in a person, animal or plant, disturbance or impairment of the function and structure of the body, a part of the body, or the mind
normal respiratory rate for an adult
12-20 breaths a minute
normal respiratory rate for a newborn
30-40 breaths a minute
normal respiratory rate for a toddler
20-30 breaths a minute
normal respiratory rate for a 6-10 year old
18-25 breaths a minute
normal oxygen saturation
96-100%
what is the FEv1
the volume of air forcibly expired in the first second after a full inhalation
this is normally calculated based on age, weight and sex
the percentage of normal will be indication of disease severity
FEV1 in healthy adults is
greater than 3.5 litres for a male
greater than 2.5 litres for a female
what is the FVC
the maximum volume of air that can be expressed from the lungs forcibly
what are some rheumatological conditions
rheumatoid arthritis
systemic scelorosis
systemic lupus erythmatosis
myositis
what is obstructed sleep apnea
this is the most common disorder of breathing during sleep which affects 5-15% of the population
there is an upper airway obstruction but movement of the chest wall will persist.
which sleep zone is the most common for sleep apnoea to occur in and why
REM due to low muscle tone
what are the symptoms of OSA
snoring
apnoea periods
dry mouth
daytime fatigue
daytime somnolence
poor concentration
headaches
depression
what are the risk factors for OSA
male
obesity
type 2 diabetes
smoking
alcohol
down syndrome
craniofacial abnormalities
hypothyroidism
acromegaly
what is the STOP BANG questionnaire
used to diagnose OSA
S - do you snore loudly
T - do you often feel tired
O - has anyone observed you stop breathing or gasping during sleep
P - high blood pressure
B - BMI over 35
A - age over 50
N - neck circumference greater than 17 male or 16 female
G - gender, are you male
what are the methods used to diagnose OSA
STOP BANG questionnaire
epworth sleepiness scale
sleep studies
polysomnograph
how is OSA treated
lifestyle changes
continuous positive airway pressure (CPAP)
mandibular advancement devices
describe the common cold
a common, self limiting illness resolving without intervention in up to 10 days
predominantly viral (rhinovirus)
influenza, parainfluenza, adenovirus have been implicated
what is epiglottitis
localised swelling of the epiglottis caused by infection, obstructing the laryngeal inlet, leading to haemophilus influenzae
what does epligglotitis present as
unwell scared patients
muffled voices
quack cough in a child
increasing dysphagia
drooling
stridor
how does tonsillitis present as
patient c/o
- sore throat
- otalgia (earache)
- headache and malaise
on examination
- patient is pyrexial (raised body temperature)
- tonsils enlarged and exuding pus
- lymph nodes enlarged or tender
- foetar oris / halitosis (bad breath)
can be viral or bacterial
how to manage tonsillitis
analgesia
soft diet
if there is difficulty swallowing, refer to ent
what is COPD
chronic obstructive pulmonary disease
airflow obstruction due to chronic inflammation
describe chronic bronchitis
inflammation and excess mucous
chronic productive cough for over three months in two consecutive years
what is emphysema
an alveolar membrane degradation leading to recurrent inflammation, scarring and loss of parenchymal lung texture
how many people affected by COPD
1.2 million
is COPD curable
no
what is the pathology of COPD
mucous hypersecretion
ciliary dysfunction
airflow obstruction and hyperinflation
gas exchange abnormalities
pulmonary hypertension
describe mucous hypersecretion
increased goblet cells and size of bronchial submucosal glands
describe ciliary dysfunction
squamous metaplasia of epithelium
dysfunction of the mucociliary escalator
difficulty expectorating
describe airflow obstruction and hyperinflation
small airways inflammation and narrowing
loss of lung elastic recoil
progressive air trapping during expiration
hyperinflation of the lungs
describe gas exchange abnormalities
hypoxaemia with or without hypercapnia
abnormal distribution of ventilation and perfusion ratios
describe pulmonary hypertension
late COPD, loss of pulmonary capillary bed
endothelial dysfunction
remodelling of the pulmonary arteries
what are the symptoms of COPD
chronic cough
fatique
dyspnoea /difficulty breathing
excess mucous
shortness of breath
chest discomfort
causes of COPD
smoking
pollution
occupational exposure
genetics
lung development
asthma
deficiency in which gene leads to COPD
alpha 1.- antitrypsin
how to diagnose COPD
take a history
spirometry
chest radiograph
full blood count
SpO2
what is spirometry
most reproducible and objective measurement of airflow limitation
measure the post bronchodilator spirometry to confirm diagnosis of COPD
should be used to monitor disease progression
what is the function of a radiograph in diagnosing COPD
to exclude other pathologies
why is a full blood count taken to diagnose COPD
looking at anaemia or polycythaemia
what is the GOLD criteria for COPD diagnosis
persistent or worsening dyspnea
chronic cough
chronic sputum production
exposure risk factors eg smoking, dust or chemicals
family history
how to treat COPD
aim to prevent sequelae
minimise the progression of disease
minimise exacerbations
lifestyle measures
smoking cessation
exercise
end stage oxygen therapy
what are some after effects of COPD
reduced quality of life
Cor Pulmonale
frequent LRTI
secondary polycythaemia
pneumothorax
respiratory failure
lung cancer
muscle wasting and cachexi
what is cor pulmonale
right side heart failure due to lung failure
what is pneumothorax
this is where air leaks into the pleural space between the lung and the chest wall
what is asthma
a chronic respiratory condition associated with airway inflammation and hyper responsiveness
most common long term conditions worldwide
higher in children than in adults
more boys than girls, but more women than men have it
what is the asthma pathology
atopy
airway hyperactivity
what is atopy
the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis
susceptible individuals produce large amounts of IgE in response to trivial extrinsic allergens
describe airway hyperactivity in asthmatics
an increased responsiveness of the airways to non specific stimuli which may in part be due to inflammation of the bronchus
describe how a combination of atopy and airway hyperactivity can lead to airway limitation
bronchoconstriction which is contraction of the bronchial smooth muscle
mucosal oedema
an increased secretion of tenacious mucous
what is intrinsic asthma
late onset, unrelated to atopic conditions
no evidence of IgE mediation
no seasonal variation
pathophysiology is unknown
what are the symptoms of asthma
coughing
wheezing
chest tightness
shortness of breath
variable expiratory airflow limitation
varies over time and in intensity
what are the triggers of asthma
exercise
allergen or irritant exposure
changes in weather
viral respiratory infections
NSAIDs
beta blockers
how is asthma diagnosed
history
peak flow
trial SABA
blood tests
what does asthma lead to
death
respiratory complications
impaired quality of life
describe the respiratory complications arising from asthma
pneumonia
pulmonary collapse (atelectasis caused by mucous plugging of the airways) leading to respiratory failure
pneumothorax
status asthmaticus
how does asthma impair quality of life
fatigue
underperformance and time off school or work
what is atelectasis
collapse of a lung
how is asthma managed
aim to control the disease by avoiding exacerbations and reduce the risk of morbidity and mortality
complete control of asthma as there is no daytime symptoms, no nigh time awakening due to asthma, no need for rescue medication, normal lung functions and minimal medication side effects
what are some asthma medications categorised into
controllers, which are taken daily on a long term basis
relievers used as needed
what are some asthma control medications
systemic corticosteroids
methotrexate
leukotriene antagonists
LABA
inhaled corticosteroids
what are some asthma reliever medications
SABA
short acting theophylline
inhaled anticholinergics
describe cystic fibrosis
rare autosomal recessive condition
multisystem disorder affecting the lungs, pancreas, liver and intestine
impairs the normal clearance of mucous from the lungs which facilitates the colonisation and infection of the lungs by bacteria
which chromosome is mutated in cystic fibrosis
7 CTRF
how to diagnose cystic fibrosis
sweat tests, where if the chloride levels are higher than 60mmol/L is suggestive of CF
gene tests
how to manage cystic fibrosis
antibiotics
airway clearance techniques such as active cycle of breathing techniques or use of airway clearance devices
regular exercise to improve lung function and overall fitness
heart lung transplant
lung cancer stats
which lung cancer types are non small cell carcinomas
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
which categories can lung cancer types be put into
non small cell carcinoma and small cell carcinoma
describe adenocarcoma
located peripherally in the smaller airways of the lungs
glandular differentiation histology
more common in non smokers and asian females
metastasise early
responds well to immunotherapy
describe squamous cell carcinoma
located centrally in the bronchi of the lungs
squamous differentiation and keratinisation is the histology
more common smokers
secretes PTHrP causing hypercalcaemia
metastisise late via the lymph nodes
describe large cell carcinomas
these are located peripherally and centrally
large and poorly differentiated
more common in smokers and will metastisise early
describe small cell carcinoma
located centrally
poorly differentiated histology
more common in older smokers
metastisise early
secretes ACTH leading to cushings syndome and ADH
associated with Lambert eaton syndrome
what are the symptoms of lung cancer
50% of cases are symptomatic
unexplained cough for over three weeks
unintended weight loss
new onset shortness of breath
pleuritic chest pain
bone pain
fatigue
what are the signs of cancer
cachexia
finger clubbing
cervical lymphadenopathy
wheeze
what is cachexia
a condition that causes muscle and fat tissue to waste away
what are some investigations for lung cancer
chest x ray
ct chest abdomen and pelvis
bronchoscopy and biopsy
PET CT for staging
describe non small cell lung cancer treatment
surgery
targeted therapy
immunotherapy
chemotherapy
palliative care
what are the treatment options for small cell lung cancer
chemo and radiotherapy
what is the pathogen that causes community acquired pneumonia
streptococcus pneumoniae
what are the symptoms and signs of pneumonia
cough
breathlessness
pleuritic pain
pyrexia
tachypnoea
tachycardia
which groups have greater severity of pneumonia
older age groups
cardiorespiratory comorbidities
low socioeconomic group
new eight loss or cachectic state
immunocompromised - should consider atypical organisms
describe tuberculosis
this causes more deaths than any other infectious disease
most cases were in Southeast Asia Africa and the western pacific
what are the signs and symptoms of tuberculosis
asymptomatic
malaise
weight loss
fever
night sweats
productive cough
shortness of breath
Chet pain
extra pulmonary disease
what causes the tuberculosis
mycobacterium tuberculosis
describe the course of tuberculosis
can reactivate when the immune system is impaired
there is destructive caveatting in the upper zone pneumonia, and multiplication of organisms within these cavities
airway communication with cavities leads to endobronchial spread within the lungs and airborne spread to others
describe military tuberculosis
this is when the disseminated disease begins to spread through the blood causing tuberculosis in the brain kidney and bone
this leads to tuberculosis meningitis and may follow primary or post primary infection
poor prognosis
how to diagnose tuberculosis
chest x ray
sputum sample
blood tests
HIV serology
brain MRI for miliary tuberculosis
lumbar puncture
describe the use of sputum sampling in the diagnosis of tuberculosis
ziehl nelson stain for acid fast bacilli
culture for confirmation of diagnosis and sensitivity testing
describe the blood testing used to diagnose tuberculosis
interferon gamma release assay
geneXpert nucleic acid amplification test and antibiotic sensitivity
describe the use of lumbar puncture
investigation for tuberculosis meningitis
describe pulmonary embolus
this is when a clot form a vein, originating in the venous sinuses of the calf of the femoral vein or the pelvis detaches and becomes lodged in the pulmonary arterial tree
what are the risk factors for a pulmonary embolism
age
obesity
previous venous thromboembolism
malignancy
hrt
pregnancy
immobility
hospitalisation
cancer
atrial fibrillation
factor v leiden deficiency
describe acute pulmonary embolus treatment
thrombolysis
percutaneous catheter removal of clot
describe what can be used for anticoagulation in pulmonary embolus treatment
DOAC
LMWH
warfarin
describe use of corticosteriods
inhaled pressurised metered dose inhalers with spacer
oral for severe disease and intravenous when emergency
how are muscarinic antagonists taken
inhaledd
