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Clinical Science > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

What is asthma?

A

Airway hyper-responsiveness

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2
Q

What are some of the symptoms of asthma?

A

Cough
Chest tightness
Wheeze
Dyspnea

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3
Q

Is the airflow obstruction reversible?

A

Often reversible.

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4
Q

What are some of the clinical features of asthma? Describe the symptoms and the signs.

A

Symptoms:episodic, diurnal variant;

Signs: hyperinflatn,wheeze, atopic features

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5
Q

What are some of the difficult aspects of diagnosing asthma?

A

Children younger than 5 years old, not always possible to do spirometry, not all wheezing is asthma.

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6
Q

What are some of the main types of drugs used in asthma?

A

B2 agnostic= Short-acting (relievers) and Long-acting (controllers).

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7
Q

What is some of the anti-inflammatory drugs used in asthma?

A

Glococortiosteriods (preventers)=Inhaled and Oral

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8
Q

What are the symptoms of exercise-induced asthma?

A

Cough, wheeze, chest-tightness, shortness of breath associated with exercise. Typically onset after exercise or during period of “rest”.

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9
Q

What causes exercise-induced asthma?

A

Precise mechanism unknow, postulated mechanisms include airway cooling and airway heat loss. It is not associated with increased airway inflammation.

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10
Q

Describe the airway heat loss mechanisms during EIA.

A

Airway heat loss=neurogenic bronchoconstriction. Changes in blood vessel calibre.

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11
Q

What are the consequences of exercise-induced asthma?

A

Exercise becomes unpleasant.
Parents/teachers/care-givers discourage exercise.
Patient becomes deconditioned.
Vicious cycle->Loss of self-esteem_invalid role develops_exercise intolerance becomes entrenched.

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12
Q

What are some of the ways to cope with EIA?

A 
Improving overall asthma control. 
Nonspecific measures (sport choice, environment, improve overall cardiorespiratory fitness).
Specific measures (Use refractory period, prophylactic drug use).
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13
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease.

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14
Q

Define COPD.

A

A disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.

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15
Q

Describe some of the aspects of COPD.

A

Common, preventable, treatable, persistent air flow limitation, usually progressive, includes chronic bronchitis and emphysema.

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16
Q

Define/describe chronic bronchitis.

A

Chronic cough for 3 months in each of two successive years in a patient in whom other causes of chronic cough have been excluded.

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17
Q

Define/describe emphysema.

A

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanies by destruction of the airspace walls, without obvious fibrosis.

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18
Q

What are some of the causes of COPD?

A

Smoking, pollution, infection, childhood malnutrition, use of biomass fuels.

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19
Q

What are the consequences of COPD?

A

Causes absenteeism, disability and death.

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20
Q

What are the host risk factors for COPD?

A

Genes, hyperresponsiveness, lung growth.

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21
Q

What are the exposure risk factors for COPD?

A

Tobacco smoke, occupational dusts and chemicals, infections-childhood+PTB, socioeconomic status.

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22
Q

What is the pathogenesis of COPD?

A

Noxious agent (tobacco smoke, pollutants, occupational agent) + Genetic factors/respiratory infection/other=COPD.

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23
Q

What is the genetic component that plays a role in the development of COPD?

A

Alpha 1-antitrypsin deficiency. It is a protein that protects the lungs from damage caused by protease enzymes, that can be released as a result of an inflammatory response to tobacco smoke.

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24
Q

Is the airflow limitation reversible in the case of COPD compared to Asthma?

A

Asthma airflow limitation=completely reversible

COPD airflow limitation=completely irreversible.

25
Q

What are the clinical features of COPD?

A

Symptoms: usually smoker; chronic shortness of breath; chronic cough; acute exacerbations.
Signs: hyperinflation; barrel chest; soft breath sounds; prolonger expiration; pulmonary hypertension, cor pulmonale, respiratory failure.

26
Q

What is the criteria to diagnose COPD?

A

The presence of a post bronchodilator FEV1/FVC<0.70 confirms the presence of persistent airflow limitation and thus COPD.

27
Q

What are the objectives of COPD management?

A 
Prevent disease progression.
Relieve symptoms.
Improve exercise tolerance.
Improve health status.
Prevent and treat exacerbations.
Prevent and treat complications.
Reduce morality.
Minimize side effects from treatment.
28
Q

What are the aspects of physical conditioning that form part of intervention and management of COPD

A 
Lower extremity exercise.
Inspiratory muscle training. 
Breathing exercises.
Energy conservation.
Graded exercise programs.
29
Q

What are some of the management strategies for COPD?

A 
Bronchodilators.
Inhaled glucocorticosteroids.
Combination therapy.
Oxygen therapy.
Nutrition.
Pulmonary rehabilitation.
Surgery.
Stop smoking.
30
Q

What are the manifestations of bronchiectasis?

A

Chronic sputum production, halitosis.

Sputum. Clubbing. Chronic chest disease. Coarse crackles, audible at mouth. Underlying disease.

31
Q

What is bronchiectasis?

A

Pathologically dilated ectatic bronchi.
Loss of normal ciliary clearance mechanisms.
Persisting inflammatory response.
Persisting infection.
Retention of secretions.
Progressive fibrosis around small and large airways causing increasing airflow obstruction.

32
Q

What are the two types of bronchiectasis?

A

Congenital (cystic fibrosis, ciliary dysfunction, immune disorders) and acquired (infections, post-aspiration)

33
Q

What are the mechanisms used to investigate bronchiectasis?

A

CXP, pulmonary function tests, sputum MC&S, high-resolution CT scan, bronchography, looking for underlying cause.

34
Q

What are the treatments for bronchiectasis?

A

Prevention.
Medical (antibiotic during acute flare-ups, bronchodilators).
Surgical.
Physiotherapy (coughing/huffing/flutter valves, postural drainage, percussion/vibes, exercise training).

35
Q

What is pneumonia?

A

Acute infection of the lung parenchyma distal to terminal bronchiole.

36
Q

What is the common cause and treatment for common pneumonia?

A

Commonly bacterial in origin.

Early appropriate antibiotic therapy may reduce mortality.

37
Q

Define pneumonia.

A

An acute infection. Inflammation/infections of the lung parenchyma (alveoli and bronchioles).
Pulmonary parenchyma.
It has some symptoms of acute infections.
Acute infiltrate on CXR or auscultatory findings.
In a patient not hospitalized or residing in a long term care facility for >14 days prior to onset of symptoms.

38
Q

What is pneumonitis?

A

Inflammation of pulmonary interstitium.

39
Q

Describe the pathogenesis of pneumonia.

A

Organisms gain entry into the lungs via:

  1. Inhalation (microbes in the air).
  2. Aspiration (organisms in nasopharynx/oropharynx).
  3. Haemotogenous spread (organisms in blood).
  4. Direct spread (organisms in adjacent structures).
40
Q

How is pneumonia classified?

A

By clinical setting.
By morphology/location in the lung.
By specific infectious agent.

41
Q

What clinical information do you use to diagnose pneumonia?

A

History: often preceding upper respiratory tract infection.
Symptoms: cough, dyspnoea, chills, malaise.
Signs: crackles, bronchial breathing, signs if inflammation (fever, tachycardia)/ shock/confusion.
Sensitivity=58% & specificity 67%

42
Q

Do you use X-ray to diagnose pneumonia?

A

Yes, chest X-ray

43
Q

What do you test for in the laboratory to diagnose pneumonia?

A

C-Reactive protein: inflammatory marker.
Sputum: microscopy and culture.
White cell count: raised neutrophils/lymphocytes.

44
Q

What is Community Acquired Pneumonia (CAP)?

A

An infection that begins outside the hospital of is diagnosed within 48 hours after admission to the hospital. In a person who has not resided in a long-term care facility for 14 days or more before admission.

45
Q

What s the bacteria called that causes CAP?

A

Streptococcus pneumonia

It is the commonest deadly cause.

46
Q

Lay out the causes of CAP, as well as how often the occur.

A

30% bacterial.
50% viral.
20% Mycoplasma

47
Q

What are the three types of pneumonia?

A

Lobar pneumonia.
Bronchopneumonia (lobular pneumonia).
Interstitial pneumonia.

48
Q

Describe lobar pneumonia.

A

Mainly affect alveoli. Unilateral lobar/multilobar diffuse opacification sparing bronchi.

49
Q

Describe bronchopneumonia.

A

Bronchitis and bronchiolitis with secondary spread into alveoli. Bilateral patchy reticulonodular basal opacification

50
Q

Describe interstitial pneumonia.

A

Interstitium inflamed. Bilateral ground glass opacification

51
Q

What are some of the risk factors for CAP?

A 
Smoking
Age
Recent influenza infection
Indoor air pollution
Corticosteroid therapy
Pre-existing lung disease
AIDS
Recent URTI
Alcohol
52
Q

What are the procedures for diagnosing CAP?

A

Acute onset, General (fever, myalgia, tachycardia), Local (productive cough, dyspnoea, pleuritic chest pain, increased RR, crackles on auscultation).

53
Q

What are the factors impacting the empiric antibiotic therapy for CAP?

A 
Knowledge of local pathogens and sensitivities. 
Must be given early in the disease.
Cost and availability.
Side-effects.
Few regimens validated prospectively.
Risk of resistance emerging.
54
Q

Describe viral pneumonia.

A

Mainly lymphocytic interstitial inflammation. Usually self-limiting. Respiratory syncytial virus and measles stimulate proliferative activity. Alveolar epithelial necrosis result in hyaline membrane formation, followed by regenerative change and epithelial metaplasia. Compromised mucociliary clearance predispose to secondary bacterial pneumonia.

55
Q

What are some of the causes of viral pneumonia in children?

A

Respiratory syncytial virus-obstructive bronchiolitis.
Parainfluenza-viral pneumonia.
Measles, Adenovirus.

56
Q

What causes viral pneumonia in adults?

A

Influenza most frequent.

57
Q

What is the approach of management towards CAP?

A

Prevention->pneumococcal, haemophilus and flu vaccines, hand hygiene.
Treatment.
Treat complications and rehabilitation.

58
Q

Define Hospital Acquired Pneumonia/

A

HAP develops in hospitalized patients after 48 h of admission, and does not require (but may include) artificial ventilation at the time of diagnosis.

59
Q

Define Ventilator Associated Pneumonia.

A

VAP occurs in intensive acre unit (ICU) patients who have received mechanical ventilation for at least 48 h.

Clinical Science (18 decks)

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