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2 - Diseases Of The Human System > Respiratory Medicine - 1 > Flashcards

Respiratory Medicine - 1 Flashcards

1
Q

What are the two components of the respiratory system?

A
  • VENTILATION (airway/muscles)
  • GAS EXCHANGE (alveoli)
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2
Q

What is the main role of the ribs?

A

aid respiration by allowing a change in intrathroacic volume
inhalation = decrease in pressure
exhalation = increase in pressure

During inspiration the ribs are elevated, and during expiration the ribs are depressed.

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3
Q

In surgical procedures, why is the presence of seperate lobes helpful?

A

lobectomy can be carried out in individual lobes without compromising the entire lung i.e. during tumour removals

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4
Q

What are the accessory muscles?

A

inspiration = sternocleidomastoid, alae nasi, genioglossus

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5
Q

How is gas transported via alveoli?

A

diffusion

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6
Q

What happens during ventilation?

what type of respiratory failure can it lead to?

A

Lung ventilation is the mechanical process of moving air into and out of the lungs. Two main phases: inhalation and exhalation. It’s driven by changes in pressure within the chest cavity created by the diaphragm and intercostal muscles, accessory muscles during distress
Inadequate ventilation affects oxygen and carbon dioxide levels, leading to type 2 respiratory failure

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7
Q

What is gas exchange (diffusion) dependant on?

what factors impair gas exchange and type of respiratory failure?

A

Depends on adequate number of alveoli and lack of fibrosis (scarring) in alveolar walls

Factors impairing gas exchange:
- Thickened alveolar walls
- Reduced number of alveoli (emphysema)
- Ventilation/perfusion (V/Q) mismatch - Mismatch between where the air goes to in the lungs and where the blood goes to in the lungs

Failure of gas exchange causes type 1 respiratory failure

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8
Q

What are usual respiratory symptoms?

A
  • Cough - Dry, sputum (colour?), blood
  • Wheeze - expiratory noise
  • Stridor - inspiratory noise
  • Dyspnoea (shortness of breathe)
  • Pain - general/inspiratory
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9
Q

What lung conditions is pain a common symptom?

A

pleurisy
pneumonia

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10
Q

What is the rate of respiration in asthma?

A

20-30/ min
increased

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11
Q

What respiratory signs can be seen?

A
  • Chest movement with respiration
  • Rate of respiration (normal 12-15/min)
  • Air entry - symmetrical? reduced?
  • Vocal Resonance?
  • Percussion note - resonant, dull
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12
Q

What does a resonant percussion mean?

A

suggests there is air

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13
Q

What does a dull percussion mean?

A

replacement of air with either liquid or solid

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14
Q

What are the ventilation diseases?

A
  • Asthma
  • Chronic Obstructive Pulmonary Disease -Bronchiectasis
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15
Q

What are the gas exchange diseases?

A
  • Chronic Obstructive Pulmonary Disease (Emphysema)
  • Pulmonary Fibrosis
  • Ventilation-Perfusion mismatch
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16
Q

What are the inflammatory diseases?

A
  • Cystic Fibrosis
  • Sarcoidosis
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17
Q

What tests can be taken?

A
  • Sputum examination
  • CXR - chest radiograph
  • CT Scan
  • Spirometry
  • Bronchoscopy
  • VQ scan - ventilation/perfusion mismatch
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18
Q

What do different sputums indicate?

A

green = pus present, therefore infection
yellowly white = excess production
bloody = inflammatory or malignant

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19
Q

What does spirometry measure?

A

measures ability to ventilate the lungs

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20
Q

How is bronchoscopy carried out?

A

fibre optic scope passed into lungs while patient is awake to look at airways and biopsy any suspicious lesions

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21
Q

What can a VQ scan look for?

A

particular obstructions such as tumours and embolisms

22
Q

How can respiratory drugs be administred?

A

inhalation
oral
intravenous

23
Q

Where do inhaled respiratory drugs absorb?

A

does not enter systemic circulation
a topical method for the bronchial tree

24
Q

What are drugs used to improve airway patency?

A

Bronchodilators - B2 agonist, anticholinergic (Ipratropium)

Anti-inflammatory - corticosteriod

25
Q

What drugused to prevent mast cell degranulation?

A
  • Chromoglycate
26
Q

What are drugs that impair ventilation?

A
  • B-blockers - make airways narrow
  • Respiratory depressants (benzodiazepines, opiods) - slow down CNS
27
Q

What is a drug used to improve gas exchange?

A

oxygen

28
Q

What are the ways inhaled drugs can be delivered?

A
  • Meter Dose Inhaler MDI) - puffer
  • Breath Activated Device - spinhaler, turbohaler
29
Q

How do MDI’s work?

A

propels drug into the oropharynx to be captured by air breathed

however a lot of the drug will be deposited in surrounding tissues leading to local immunosuppression and sometimes candidosis

30
Q

How do breath activated devices work?

A

they pick up drug as it moves across device and carry it into the airway

31
Q

What does a nebuliser do?

A

turn liquid medications into a fine mist (bubbles coated with drug) allowing for easy absorption into the lungs with a delivered larger dose

32
Q

What does a spacer do?

A

allows you to breathe in the medicine more easily. using a spacer wastes a lot less medicine than spraying the medicine directly into your mouth.

33
Q

What are the types of B-agonist inhalers and what are examples of them?

A

Short acting (blue inhaler)
* Salbutamol
* Terbutaline

Long acting (green inhaler)
* Salmeterol

34
Q

What is the onset, duration, administration and purpose of short acting B2 agonists?

A
  • Quick onset – 2-3 minutes
  • Last 4-6 hours
  • Inhaled, Oral, Intravenous
  • Used to TREAT acute bronchial constriction
35
Q

What is the onset, duration, administration and purpose of long acting B2 agonists?

what should it always be used with

A
  • Slow onset – 1-2 hours
  • Last 12-15 hours
  • Inhaled
  • Used to PREVENT acute bronchial constriction
  • ALWAYS used with an inhaled steroid.
36
Q

Why should an inhaled steriod always be used with long acting B agonists?

A

reduced inflammation in open airways

37
Q

What do anticholinergics do and what is an example?

A
  • Inhibit muscarinic nerve transmission in autonomic nerves relaxing smooth muscle
  • Additive effect in bronchial dilatation with b agonists and effective in reducing mucus secretion
  • Ipratropium (Grey inhaler)
38
Q

What do corticosteroids do?

A

Reduce inflammation in the bronchial walls
* Effective topically or systemically

39
Q

What are examples of corticosteroids?

A
  • Beclomethasone
  • Budesonide
  • Fluticosone
  • Mometasone
40
Q

What is MART?

A
  • Maintenance & reliever therapy
  • Use for acute episodes as well as prevention

compound preparations are MART

41
Q

What are other asthma drugs, administration and examples of each?

A
  • Mast Cell Stabilisers
  • Leukotriene inhibitors
  • Biologic Medicines
  • Oxygen - inhaled during severe asthma attack
42
Q

What is asthma?

what is the triad of symptoms

A

REVERSIBLE AIRFLOW OBSTRUCTION
overreation of airways to mild stimuli causing bronchial wall hyperreactivity to narrow the airways and restricts air flow

Inflammation: Airways become hypersensitive and inflamed due to allergens or irritants.
Bronchoconstriction: This inflammation narrows the airways, making breathing difficult.
Increased mucus production: The inflamed airways produce more mucus, further obstructing airflow.

exhalation is more affected as powerful muscles are able to overcome the asthma on inspiration however expiration is more difficult as it is passive

43
Q

What are drugs ending in MAB/AB?

A

monoclonal antibody drugs used to block specific parts of the inflammatory process

44
Q

What are the symptoms of asthma?

A

Wheezing: A whistling sound during breathing caused by narrowed airways and chest tightness
Shortness of breath: Difficulty catching your breath or feeling out of breath.
Coughing: Especially at night or early morning, often productive (with mucus).

45
Q

What does the PEFR track in asthma?

A

airway resistance

46
Q

What are the triggers of asthma?

A
  • Unknown
  • Infections
  • Environmental stimuli
  • Cold air
  • ‘Atopy’ (allergy)
47
Q

What is the asthma biphasic response?

A

Early phase: This happens within minutes and is caused by muscle contraction in the airways.
Late phase: This occurs hours later (usually 4-8 hours) and is due to inflammation in the airways. (prevented by steriods)

48
Q

What are the core asthma drugs?

A
  1. Intermittent short acting/ regular long acting Beta-adrenergic Agonists
  2. Inhaled Corticosteroids – low/high dose
49
Q

What are qualities of beta-adrenergic agonists?

A
  • Nebulised as highly effective in emergency
  • Relax bronchial smooth muscle
  • PROTECTIVE against stimuli – take in anticipation of need
  • Short & Long acting
    – Short = ‘reliever’ drug
    – Long = ‘preventer’ drug – MUST USE WITH INHALED STEROID
50
Q

What dose and under is recommended to prevent adrenal suppression and osteoporosis?

A

daily dose
adults <1500 micrograms
children <800 micrograms

2 - Diseases Of The Human System (19 decks)

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