Respiratory Disease I: Asthma, Bronchitis and Respiratory Failure Flashcards
What is dyspnea?
shortness of breath
What is paroxysmal nocturnal dyspnea?
sudden awakening from sleeping with shortness of breath
What is orthopnea?
difficulty breathing while lying down
What is stridor?
a harsh vibrating noise when breathing, caused by obstruction/swelling of the windpipe or larynx.
What is forced vital capacity (FVC)?
The maximum volume of air it is possible to breathe forcefully out of the lungs after a really deep breath in.
What is forced expiratory volume?
Amount of air exhaled in the first second after a full inspiration
What does the FEV1/FVC curve look like for normal, asthmatic and pulmonary fibrosis patients?
slide 3
What instrument is used to measure lung function and what does it measure?
Peak flow meter - Measures PEFR (rate of vol of air that can be forcefully exhaled after deepest inhalation.
What are 3 things that can lead to a sudden cough/cold?
- Foreign body inhaled 2. Pulmonary embolism (clot in vessels of the lung) 3. Pneumothorax (collapsed lung)
What are 2 things that can cause a cough/condition lasting days?
- Lung cancer
- Pleural effusion (collection of liquid between chest and lung).
What is a bronchoscope?
instrument used to examine the bronchi
slide 4
What are some upper respiratory tract infections?
Common cold/sinusitis/rhinitis/pharyngitis/laryngo-tracheo-bronchitis/influenza
What is sinusitis?
Obstructed sinus due to mucosal oedema increasing pressure and causing pain near maxillary region
What is rhinitis?
inflammation of the nose - sneezing+congested nose
what is pharyngitis?
typically a viral sore throat, occasionally bacterial.
step pneumoniae - sore throat can lead to Rh fever.
haemophius influenzae can be life-threatening and rapidly advancing and may need tracheotomy.
What is the epiglottis?
a flap that flips down to cover the entry to the trachea during swallowing. (Life threatening)
What does AIR RAID stand for in relation to epiglottis?
A- airway inflammation
I-Increased pulse
R-Restlessness
R- retractions
A-anxiety increased
I-Inspiratory stridor
D- Drooling
What is used to treat epiglottis?
Don’t examine throat
oxygen/cool mist for hydration don’t give fluids
position for comfort.
What is used to treat rhinitis?
Anti-histamines
Why can inhalation of foreign body be a risk in dentistry?
Dental equipment is used which can go down the back of peoples throat
How can we prevent foreign bodies from going down peoples throat during dental procedures?
Rubber dam
If a foreign objected is inspired, where does it usually go and why?
Right main bronchus Because it more vertical compared to the left bronchus
What is asthma?
chronic REVERSIBLE inflammatory disorder of the airways
What is asthma defined by?
Hyper responsive airways, inflammatory airway changes and excess mucus production.
What are extrinsic factors of asthma?
House dust mites, pollen and animal fur.
What are intrinsic factors of asthma?
Atopy (immune problem making you more likely to develop allergies), bronchial hyper reactivity.
What are additional factors that cause asthma?
Exercise
cold air
pollution
stress
infection
drugs
diet
What is the Pathogenesis (development of disease) of asthma?
-Triad of oedema (vascular leakage)
-Bronchoconstriction
-increased mucus secretion
mediated by:
1. mast cells - degranulate when x2 surface IgE receptors are X-linked which release Histamine, IL C4, PGD2 and thromboxanes.
2. Lymphocytes - IL5 activated eosinophils which release major basic protein which causes shedding of the epithelium.
slide 8
What are the first symptoms of asthma?
Shortness of breath
wheeze
cough (nocturnal)
quietening of voice
increased expiratory time.
How is asthma investigated?
1.Family history
2.measuring PEFR at different times of the day and compare most asthmatics show diumal variation and AM dipping
3. lung function tests
4. skin tests to identify extrinsic causes and provocation allergen test.
5. others
slide 9
How is asthma managed?
- Educate patients about cause and effect and ensure regular medication use
- prevention - avoid allergens
- therapy - immunosuppressant drugs, sodium chromoglycate.’
look ar slide 9
what is the aetiology of asthma?
- smoking - persistent mucosal imitation.
- atmospheric pollution
- alpha 1 anti-trypsin deficiency: failure to block proteases before return to systemic circulation leads to accelerated degenerative pulmonary damage.
what are the available drug therapies for asthma?
- sodium chromoglycate - stabilise mast cells
- Beta 2 adrenoceptors agonists - bronchodilators MDI’s
- anticholinergics - bronchodilators MDI’s
- Beclomethasone - steroid-metered dose inhalers.
- systemic corticosteroid
- immunosuppressant drugs - MTX, Cyclosporin.
What is sodium chromoglycate used for?
Stabilising mast cells
What are mast cells?
Cells that release chemicals (such as histamine) that promote inflammation.
What is a side effect of using inhalers? And how is this overcome?
Oral thrush- to overcome this use inhaler chamber tube
slide 11
How are acute asthma phases dealt with using ASTHMA?
A- andrenergics (beta 2 agonists)(albuterol)
S- Steroids
T- Theophylline
H-Hydration
M- O2 Mask
A- Anticholinergics
What are the 2 chronic obstructive airway diseases?
-Chronic Bronchitis
-Emphysema
What is chronic bronchitis?
Bronchi swell and become clogged with thick mucus, narrowing lumen, limiting airflow.
look at muska flash card image
What are symptoms of chronic obstructive airway disease?
Cough,dyspnoea, wheeze
What is emphysema?
Tissues in the lungs lose elasticity limiting expiratory airflow.
dilation of the air spaces by wall destruction. Obstruction by decreasing the lung’s elastic recoil which holds airways open in expiration, limiting expiratory airflow.
look at muska flash card image
What is anti-trypsin protein used for in the lungs?
Photolytic enzyme that gets rid of all old protein debris from the blood. Without it, lungs are more easily damaged by smoking/pollution (Pulmonary damage)
What is a pink puffer (emphysema)?
-Increased alveolar ventilation
-normal/low PaCO2
-normal PaO2
-Breathless (amount of O2 taken in is adequate to oxygenate the tissues)
- Very fast breathing
look at slide 15
What is a blue bloater (chronic bronchitis)?
-decreased alveolar ventilation
-Raised PaCO2
-Low PaO2
-Become blue and bloated
-deeper and slower breaths
look slide 15
What is cystic fibrosis?
autosomal recessive disorder affecting lungs and digestive system. (Mutation in CTFR gene).
defective chloride ion exchange system leads to alteration in chloride, water and salt transport.
What is a symptom of cystic fibrosis?
Heavy, thick, sticky mucus clogging air way passages and ducts.
how do investigate in cystic fibrosis?
- CXR: hyperinflation > 6 anterior ribs above diaphragm flat hemidiaphragm
- Lung function test:
- FBC - secondary polycythaemia - rare disease that involves the overproduction of red blood cells
what are the complications of cystic fibrosis?
- respiuratory failure
- corpulmonale (when a lung issue causes your right ventricle (heart chamber) to get so big that your heart starts to fail)
- Pneumothorax
what is the management of cystic fibrosis?
- stop smoking
- drug therapy - similar to asthma if reversible element to obstruction
- Domiciliary O2
- Venesection for secondary polycythaemia to avoid coagulation.
however poor prognosis
What is bronchiectasis?
permanent dilatation of bronchioles and bronchi; easy target for secondary infections
what is lung parenchyma?
The lung parenchyma comprises a large number of thin-walled alveoli, forming an enormous surface area, which serves to maintain proper gas exchange.
The alveoli are held open by the transpulmonary pressure, or prestress, which is balanced by tissue forces and alveolar surface film forces.
What is the main disease of the lung parenchyma?
Pneumonia
What is pneumonia?
inflammation of the lungs. Typically bacteria but can be viral or other
how is pneumonia classified?
- by area that is has affected:
a) lobar - 1 lobe involved
b) broncho - affecting lobules and brochi - by causative agents
what are causative agents of pneumonia?
- community acquired:
- step pneumoniae - 50% of all cases
- Mycoplasma pneumoniae
- Influenza A virus - hospital acquired:
- gram negative bacteria
- staph aureus
- anaerobes
what patients are affected by pneumonia?
immunocompromised patients:
- transplant patients
-leukaemia
-AIDS
what are the signs and symptoms of pneumonia?
pyrexia - raised body temp
pleuritic chest pain- lung abscess/pleural effusion
dry cough
whats the management for pneumonia?
antibiotics
analgesia for pleuritic chest pain
O2 for hypoxia
What is mendelson’s syndrome?
Aspiration of gastric acid into lungs, severe inflammation and destructive pneumonia- it is often fatal
What is a lung abscess and what does it usually result from?
localized collection of pus within lung surrounded by inflamed tissue,
often a complication of pneumonia
secondary to:
bronchial obstruction
Pulmonary infarction
how to treat lung abscess?
bronchoscopy + drainage
What is tuberculosis?
Caused by bacterium called mycobacterium tuberculosis and it attacks the lungs, lymph nodes and guts.
where is there a high incidence for TB?
- immigrants
- alcoholics
- diabetics
-immunocompromised
What are some symptoms of tuberculosis?
productive cough
unexplained fever
night sweats
unintentional weight loss
loss of appetite
lethargy
coughing up blood/blood streaked sputum
slide 20&22 go through primary tb
How is tuberculosis diagnosed?
- chest x-ray
- septum testing
- TB skin test
How is tuberculosis prevented?
Immunization with BCG vaccine, contact tracing
notifying public health authority
Is tuberculosis contagious?
Yes, highly contagious
What is pneumoconiosis (coal miners lung)?
Caused by inhalation of inorganic dust particles that are too small for nasal filtration.
What is asbestosis?
Asbestosis is condition developed in lungs as a result of inhalation of asbestosis fibers. These fibres cannot be broken down by macrophages.
What is pleurisy?
inflammation of the pleura, breathing becomes painful
What is a pneumothorax?
air in pleural space; collapsed lung
What is bronchial carcinoma?
lung cancer
