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MAY MEDICINE 1 REVISION > Respiratory pathology > Flashcards

Respiratory pathology Flashcards

1
Q

What does COPD stand for ?

A

Chronic obstructive pulmonary disease

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2
Q

What is the basic problem for people with COPD?

A

They struggle to get air out of there lungs.

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3
Q

What are the names of the two conditions which combine to produce COPD?

A

Chronic bronchitis and emphysema

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4
Q

What is the largest risk factor for COPD ?

A

Smoking

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5
Q

What are some other risk factors for COPD ?

A 
Pollution 
Dust 
Older age 
Genetics 
Socioeconomics
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6
Q

What is Alpha-1 Antitrypsin deficiency?

A

An inherited condition which causes early onset COPD and COPD lower in the lung than normal

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7
Q

Why does maternal smoking effect the risk of COPD ?

A

If a mother or grandmother smoked in pregnancy then the babies lungs will be smaller which causes an increased risk of COPD

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8
Q

What is the prognosis of COPD?

A

it is incurable and irreversible

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9
Q

What is Alpha 1 Antiprotease deficiency ?

A

It is a genetic condition which causes emphysema without chronic bronchitis

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10
Q

What is chronic bronchitis ?

A

It is a cough which produces sputum most days for three consecutive months for two or more consecutive years.

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11
Q

What condition does chronic bronchitis sometimes look like ?

A

Chronic bronchial asthma

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12
Q

What does Chronic bronchitis do to the large airways ?

A

Causes hyperplasia in the mucous glands and goblet cells
Minor inflammation
Fibrosis

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13
Q

What does chronic bronchitis do to the small airways ?

A

It causes the appearance of goblet cells
Long standing inflammation.
Fibrosis

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14
Q

What happens to complicate chronic bronchitis ?

A

Infection occurs and the FEV1 falls

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15
Q

What is emphysema ?

A

An increase beyond the normal size in the size of the airspaces distal to the terminal bronchioles arising as a result of dilation or destruction of walls.
i.e. loss of alveolar surface area

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16
Q

What is an acinus ?

A

The region of the lung distal to the bronchioles

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17
Q

What are the names of the different types of emphysema

A

Centriacinar emphysema
Scar emphysema
Panacinar emphysema
Periacinar emphysema

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18
Q

What is centriacinar emphysema ?

A

Emphysema which starts with the bronchiolar dilation and then alveolar tissue is lost. it is found at the top of the lobes

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19
Q

What s scar emphysema ?

A

No clinical effect but is the formation of emphysema next to scars

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20
Q

What is panacinar emphysema ?

A

Infects all the alveoli in a whole area of lung

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21
Q

What is periacinar emphysema ?

A

Causes loss of tissue at the edge of the acini and if it leaks air into the pleura cavity then it causes an pneumothorax to develop

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22
Q

What % of smokers will develop emphysema ?

A

Less than 50%

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23
Q

How does emphysema develop ?

A

In our healthy lungs we have neutrophils and macrophages that help protect us. These cells however produce elastase (protease) enzymes which if lets to build up in cause tissue destruction and emphysema in the lung. Therefore we also have anti-elastase (anti-proteases) which prevent elastases from causing tissue destruction. Note that the lung is not very good at repairing itself.
If there is a alpha 1 antitrypsin deficiency then there is a lack of anti-elastases which cause a build up of elastases and therefore tissue destruction. Smocking causes an decrease in anti-elastases as well as knocking out any repair mechanisms that the lungs did have and increasing the immune cell action which in tern produces more elastase. All of which result in an increase in tissue destruction.

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24
Q

Describe what happens to blood vessels when emphysema develops.

A

In Emphysemic lungs there is a reduced ability to perform effective gas exchange. This causes vasoconstriction of the blood vessels diverting blood to a better functioning alveoli. If the damage in the lungs is great this extensive construction in the lungs increases the pressure at which the heart must pump the blood to get it through the lungs therefore resulting in high blood pressure. It also causes cor pulmonale which causes hypertrophy of the right ventricle and can cause oedema. Long term vasoconstriction causes fibrosis which constricts vessels even further, loss of capillary’s which adds to the hypoxic state of the body, and production of red blood cells which makes the blood more viscous and harder to pump (known as secondary polycythaemia).

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25
Q

What is the main effect of emphysema ?

A

Hypoxia throughout the body

26
Q

What does COPD present with ?

A 
Cough 
breathlessness
Production of sputum 
Chest infections 
Wheezing 
Weight loos 
Loos of muscle mas 
Fatigue 
Swollen ankles 
Continues worsening of symptoms 
Cyanosis 
Raised JVP
27
Q

How is COPD diagnosed ?

A

Diagnosed based on a combination of symptoms, history and spirometry.

28
Q

What will the FEV1/FVC of a COPD patient be

A

<0.7

29
Q

What tools can be used in order to diagnose someone with COPD?

A 
Chest X-ray 
mMRC breathlessness scale results 
Lung volume 
Transfer factor tests 
CT scans
30
Q

What does a COPD exacerbation look like ?

A 
Worsening symptoms
Chest tightness 
Temperature 
Fatigue 
Systemic upset
31
Q

Should all patients with a COPD exacerbation be brought into the hospital ?

A

No

32
Q

What will the hospital do to a patient with a COPD exacerbation ?

A 
Establish the trigger (i.e. is it bacterial or viral)
CXR
Blood gases 
RBC 
U&E
Sputum culture 
VTS
Check for other conditions such as a heart attack
33
Q

What is respiratory failure ?

A

COPD can be fatal when there is a reduction in ventilation and perfusion.

34
Q

What sign does respiratory failure cause in a patient ?

A

Flapping tremor due to CO2 retention

35
Q

What is it called when there is a build up of CO2 in the blood ?

A

Hypercapnic

36
Q

What is type 1 respiratory failure?

A

Decrease in O2

37
Q

What is type 2 respiratory failure ?

A

Decrease in O2 and increase in CO2

38
Q

What is the GOLD scale used for ?

A

Determining the severity of COPD

39
Q

What is the most effective treatment for COPD?

A

Non - pharmacological management

40
Q

What are examples of non-pharmacological management ?

A

Smoking cessation
Pulmonary rehabilitation
Vaccination

41
Q

What are pharmacological treatments for COPD?

A
  • SABA
  • LAMA
  • ICS
  • LABA
42
Q

What is used to treat COPD patients who are in an acute exacerbation of symptoms ?

A

SABS
Steroids
Antibiotics

43
Q

What is your treatment pathway for a patient with COPD and breathlessness

A 
SABA 
(patient is requiring it every day)
SABA + LAMA 
(Still so breathless normal life is restricted)
SABA + LAMA/LABA 
(Still no response)
No benefit or further treatment
44
Q

What is your treatment pathway for a patient with COPD who is experiences exacerbations?

A 
SABA + LAMA (Duel therpay)
(Continued exacerbations)
SABA + LAMA/LABA (duel therapy)
(Continued exacerbations)
SABA + LAMA/LABA/ICS
45
Q

How do you remember what Alpha 1 Antiprotease deficiency and Alpha 1 Antitrypsin deficiency is

A 
Trypsin = 'Trip'ing and falling into early onset COPD
Protease = 'Pro'duct of bad genes and gives you emphysema
46
Q

Alpha 1 Antitrypsin deficiency causes early on set COPD and …

A

COPD which is further down in the lung

47
Q

What is Asthma ?

A

An obstructive pulmonary disease resulting from type 1 hypersensitivity. Where people have an increased reactivity which causes an increased reactivity to stimuli.

48
Q

What causes narrow airways in asthma ?

A

Inflammation and smooth muscle contraction

49
Q

What are the most common asthma triggers in children ?

A

Upper respiratory tract infections
Pollen
Smoke
Pets

50
Q

What is the course of Asthma like ?

A

Relapsing and remission throughout the patients life

51
Q

What % of children are effected by asthma ?

A

10-15%

52
Q

What % of adults are effected by asthma ?

A

5-10%

53
Q

What are the main risk factors for asthma ?

A

Genetics - i.e. Atropy
Smoking
Occupation

54
Q

What is the atopic gene ?

A

Predisposes a person to a family of conditions which include eczema, hay fever, asthma etc

55
Q

How does smoking cause asthma ?

A

Causes smaller lungs and activation of genes which cause asthma in offspring

56
Q

What occupations can increase the risk of asthma ?

A

Bakers

Painters

57
Q

What is the hygiene hypothesis ?

A

Decreased exposure to bacteria increases the chance of asthma.

58
Q

How is asthma diagnosed?

A

It is hard because there is no clear test. Key things are variability of symptoms, cough, wheeze, dyspnoea, chest tightness

59
Q

What is is good to investigate in the history when trying to diagnose asthma ?

A 
Childhood asthma 
Bronchitis 
Wheeze in infancy 
Eczema 
Hay fever 
Any current inhalers 
family history
60
Q

What investigations are done to diagnose asthma ?

A
  • Spirometry
  • Reversibility test
  • Peak flow monitoring
  • CXR
  • Skin allergen test
61
Q

Differential diagnosis of asthma ?

A 
COPD 
Bronchiectasis 
Cystic fibrosis 
Tumour or foreign body 
Cardiac 
Lung cancer
Infection
62
Q

What is the aim of Asthma medication ?

A

To have no daytime symptoms and no night time wakening’s, no rescues mediation, no attacks and no limit on activity.

MAY MEDICINE 1 REVISION (23 decks)

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