Respiratory Medicine Flashcards
What are the 2 components (issues) to the respiratory system?
=issues which affect ventilation
= gas exchange
Name 2 issues which can affect ventilation?
=airway patency - how wide or narrow airways are
= active muscles - ability of muscles to move rib cage to allow ventilation to take place
What factors allows for successful gas exchange?
= adequate number of alveoli
= no fibrosis of alveolar wall
How many lobes does the left lung have?
2
Name the 2 lobes of the left lung?
= superior
= inferior
How many lobes does the right lung have?
3
Name the 3 lobes of the right lung?
= superior
= middle
= inferior
If there were a tumour of a singular lobe how can this be treated and what is the procedure called?
= individual loves can be removed by sectioning the airways if there is a tumour
= lobectomy
What is the function of the ribs?
allow a change in intrathoracic volume
What happens when the ribs are lifted up?
= increases volume of chest, sucks gas in through trachea
What is the purpose of the accessory muscles of ventilation ?
= to elevate ribs if ventilation is compromised
Name 7 examples of accessory muscles of ventilation?
= major pectoralis
= minor pectoralis
= sternocleidomastoid
= external intercostal
= internal intercostal
=internal oblique
= external oblique
What happens to the size of the large airways as they go from the trachea to the alveoli? - what effect does this have and how is it overcome?
they become narrower
= radius of vessel reduces therefore the ability to transfer gas becomes less
== overcome by an increased number of airways
Why might a patient be using their accessory muscles? and examples of accessory muscles
It breathing is compromised - sternocleidomastoid, pectoralis major and minor
Inadequate ventilation can affect the levels of what …. (2)
Oxygen and CO2
What is type 2 respiratory failure?
ventilation inadequate to deliver enough oxygen to the blood
What type of respiratory failure is ‘ventilation inadequate to deliver enough oxygen to the blood’
Type 2
How does gas exchange occur?
In the alveoli by diffusion
What is the term for destruction of alveoli?
emphysema
What is emphysema?
air sacs join up to form larger spaces with reduced surface area
= ability of blood to be oxygenated properly and CO2 removes becomes more difficult
When there is adequate ventilation, what problem can still occur and why might this problem happen?
= ability of alveoli to get oxygen in and CO2 out of the blood
- thickening of alveolar wall (difficult diffusion)
- inadequate number of alveoli (emphysema)
- mismatch between where the air goes in to the lungs and where the blood goes to in the lungs (V-Q mismatch0
What type of respiratory failure is gas exchange failure?
Type 1
What is Type 1 respiratory failure?
Gas exchange failure
Name 5 respiratory symptoms?
=cough
= wheeze
= stridor
= dyspnoea
= pain
What type of noise is wheeze?
expiratory noise
What type of noise is stridor?
inspiratory noise
What is dyspnoea?
short of breath
Name 5 respiratory symptoms?
= chest movement with respiration
= rate of respiration (12-15 min)
=air entry (symmetrical, reduced?)
= if patient speaks with stethoscope then this should be heard
= percussion note
With regards to percussion not being a symptom of respiratory failure, what are 2 examples of sounds which might be heard
= resonant - air
= dull - consolidation with either liquid or solid region filling lung air
Name 5 types of respiratory diseases?
= ventilation disease
= gas exchange diseases
= respiratory infections
= inflammatory diseases
= lung malignancy
Name 3 ventilation diseases?
= asthma
= chronic obstructive pulmonary disease COPD
= bronchiectasis
Name 3 gas exchange diseases?
= chronic obstructive pulmonary disease (emphysema)
= pulmonary fibrosis
= ventilation-perfusion mismatch
Name 2 inflammatory diseases?
= cystic fibrosis
= sarcoidosis
Name 6 respiratory investigations?
= sputum examination
= CXR
= CT scan
= pulmonary function
= bronchoscopy
= VQ scan
What should be checked on a sputum examination? and some examples
= quantity and colour
= green - pus - infection
= yellow/white - excess production of normal sputum (asthma)
= blood- inflammatory condition in airways or malignancy
What test can be used to test pulmonary function?
spirometry
What three measurement can be taken to measure pulomonary function?
= PEFR- maximum flow rate
= FEV1 - forced expiratory volume
= fev1/VS - measure or resp. function
What is a bronchoscopy?
scope passed into lungs - allows doctor to look at airways and maybe take a biopsy
What can a VQ scan be used for?
ventilation/ perfusion mismatch
- also to check for obstructions
What does perfusion mean?
blood flow
What does ventilation mean?
airflow
Name 3 ways in which respiratory drugs can be administered
= inhalation
= oral
= intravenous
What 2 things can drugs used in ventilation do?
= improve airway patency
= prevent mast cell degranulation
Name 2 types of drugs which can improve airway patency?
= bronchodilators
= anti-inflammatory
name 2 types of bronchodilators?
= B2 agonists
= anticholinergic
What do anticholinergic drugs do? and give 1 example
relax tone of smooth muscle and allow airways to open
= corticosteroid
Name the 2 most common drugs/combination which improve airway patency..
= bronchodilators
= bronchodilators and corticosteroids
Why do we want to prevent mast cell degranulation in patients with respiratory failure?
= reduce inflammatory mediators released into the airway wall which will cause narrowing of airways
Give 2 drugs which can prevent mast cell degranulation?
= chromoglycate
= leukotriene receptor antagonists
What 2 types of drugs will impair ventilation?
= b - blockers
= respiratory depressants
How do B-blockers work?
make airways narrower- increase effect of smooth muscle constriction
Give some example of respiratory depressants and how they impair ventilation?
= benzodiazepines - muscle relaxation
= opiods - reduce stimulus for patient to breath
Which drug can improve gas exchange? and how does it work when given to a patient with respiratory failure
OXYGEN
= diffuses from alveoli into the blood and higher conc of gas in alveolus the more drug will move into the blood
Give 3 examples of inhaled drug delivery
= Meter dose inhaler - puffer
= breath activated device - spinhaler, turbohaler
name 2 aids for drug delivery (inhaled)
= nebuliser
= spacer
How does a nebuliser work
= liquid drug
= drug is held in a small chamber and compressor will blow air through the tube causing it to bubble through the liquid drug and the bubble is coated with the drug and into the airway
Name 2 types of b2 agonist drugs which can be inhaled? and what they do
= short-acting - reliever drugs
= long -acting - prevent acute asthma attack
Name 2 short acting b2 agonists and the colour of inhaler?
= salbutamol - blue
= terbutaline - blue
Name 1 long-acting b2 agonist and the colour of inhaler?
= salmeterol - green
For short acting B2 agonists: onset, last…. hours, route of administration, used to…
quick onset 2-3 mins
lasts 4-6 hours
inhaled, oral and IV
used to treat acute bronchial constriction
For long acting B2 agonists: onset, last…. hours, route of administration, used to…
slow onset 1-2 hours
last 12-15 hours
inhaled
used to prevent acute bronchial constriction - ALWAYS used with an inhaled steroid
What is long acting B2 agonist used with?
inhaled steroid
what happens if a long acting b2 agonist inhaler is not used with a steroid inhaler
increased risk of suffering from an acute coronary syndrome
How do anticholinergics work>
=inhibit muscarinic nerve transmission in autonomic nerves
= different mechanism to B2 agonist due to the fact it causes relaxation of the smooth muscle and opening of the airways
Example of an anticholinergic and colour of inhaler
ipratropium - GREY
How can corticosteroids be administered ?
topically- inhaler
systemically
how do corticosteroids work
reduce inflammation in the bronchial walls
What are the 2 standard corticosteroids ? and what colour are the inhalers
= beclomethasone - BROWN
= budesonide - BROWN
Name 2 other corticosteroids and what they are usually combined with? (INCLUDE COLOUR)
= Fluticosone (orange)
= Mometasone (pink)
both usually combined with long acting B2 agonist
Simple difference between brown inhaler and blue inhaler?
blue- to treat any acute episode which arises
brown- prevent asthma from happening
Name three types of inhaled steroid mixed with long acting B2 agonist? and name both the steroid and the b2 long acting agonist
= Seretide- fluticasone and salmeterol
= fostair - beclomethasone and fomoterol
= symbicort - budesonide and fomoterol
Name 4 other types of asthma drugs ?
=mast cell stabilisers
= leukotriene inhibitors
= biologic medicines
= oxygen
Example of mast cell stabiliser
chromoglycate (inhaler)
example of leukotriene inhibitor
montelukast (tablet)
What do biologic medicines do?
target specific immune modulators within inflammatory process
name 4 examples of biologic medicines
Xolair (omalizumab)
Nucala (mepolizumab)
Cinqaero (reslizumab)
Fasenra (benralizumab)
