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Body Systems > Respiratory skills clinical cases > Flashcards

Respiratory skills clinical cases Flashcards

1
Q

what is COPD and what causes it

A

damage due to chronic inflammation that differs from that seen in asthma and which is usually the result of tobacco smoke
significant airflow obstruction may be present before the individual is aware of it

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2
Q

deaths from COPD in the UK is what in the world

A

12th

in the Uk COPD is one of three major causes of deaths

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3
Q

what happens to symptoms of smokers cough is you stop smoking

A

symptoms improve in 90%

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4
Q

what structures are affected in COPD

A

small and large airways with inflammation

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5
Q

what type of pulmonary disease is COPD

A

obstructive

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6
Q

what are the characteristics of COPD

A

airflow obstruction is not fully reversible, or change over several months, usually progressive in the long term

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7
Q

what happens to FEV1 and FVC in COPD compared to normal

A

decreases FEV1

same VC

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8
Q

what happens to FEV1 and FVC in restrictive (pulmonary fibrosis)

A

FEV1 is decreased as well as FVC

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9
Q

in COPD what is the FEV1/FVC

A

less than 70%

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10
Q

what are the environmental causes of COPD

A

air pollution, smoking, alpha trypsin 1 (cause of emphysema)- familial

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11
Q

how do you calculate pack years

A

It is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, 1 pack-year is equal to smoking 20 cigarettes (1 pack) per day for 1 year, or 40 cigarettes per day for half a year, and so on.

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12
Q

what is the common definition of asthma and its characteristics

A

chronic inflammation of the airway, airway hyperresponsiveness
recurrent episodes of wheezing, breathlessness
high chest, coughing - particularly in the morning or at night
it is variable - often reversible

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13
Q

what are the increased risks vs protection agents for asthma

A

increased risk:
genes, 10x higher first degree relative, maternal smoking, obesity
protection - breast feeding, early exposure to animals

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14
Q

what is the pathology of asthma

A 
chronic inflammation 
hyperactive smooth muscle 
increased basal tone
mucus hyper section 
mucosal oedema
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15
Q

what is the FEV1/FVC ratio in asthma

A

reduced ie less than 0.7 as is a obstructive disease

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16
Q

what are the hallmark symptoms of asthma

A 
variable 
intermittent 
worse at night 
worse in morning 
provoked by triggers
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17
Q

what is paradoxical pulse

A

large decrease in systolic blood pressure and pulse wave amplitude during inspiration

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18
Q

what can inhalers cause

A

thrush of the throat

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19
Q

what is the immediate treatment of of asthma

A

salbutamol, impratropium bromide

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20
Q

what is the subsequent management of asthma

A

same as immediate but also prednisolone or hydrocortisone IV

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21
Q

what is the most common caner mortality worldwide for men and women

A

lung cancer - 1.2 mil per year

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22
Q

what are the two main types of lung cancer

A

small cell and non-small cell

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23
Q

what are the symptoms of lung cancer

A

cough, breathlessness, bone pain, anorexia, weight loss, chest pain stridor
tachypnea

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24
Q

what is horners syndrome

A

interruption of sympathetic nerve supply to the eye
miosis - constricted pupil
partial ptosis
anhidrosis (loss of hemifacial sweating)

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25
clinical features of lung cancer and horners syndrome (fingers)
clubbing of the fingers tissue at the base of the nail is thickened increased convexity of the nail fold
26
how would you investigate for lung cancer
``` CXR PET scan bronchoscopy biopsy VATS EBUS (endobronchiol ultrasound) percutaneous fine needle aspiration ```
27
what are the treatments of small cell vs non small cell treatment of lung cancer
small cell - chemotherapy, radiotherapy | non small cell - surgery, radiotherapy, chemotherapy
28
what is the most common cause of lung cancer
smoking from tobacco - 90% | smoking increases risk 8-20 fold
29
what are some other common causes of lung cancer
asbestos radioactive minerals, radon gas pyrene, arsenic, nickel, naphthalenes family history
30
how common in cystic fibrosis
autosomal recessive carrier 1 in 25 incidence 1 in 2500
31
what is the gene mutation in cystic fibrosis
DF508 mutation - deletion of 3 nucleotides (loss of phenylalanine) on chromosome 7 (long arm) but there are more than 2000 genes that can be affected
32
what are the 3 common clinical features of cystic fibrosis
repeated chest infection pancreatic insufficiency male infertility
33
what is the cause of cystic fibrosis
defective CFTR channel therefore increased sodium absorption and increased water absorption causing airway dehydration leading to inflammation and infection with viscous secretions
34
how is DNA is associated with CF
high levels of extra cellular DNA are released from degenerating neutrophils and accumulate in the airways which is very thick
35
what is the german folklore in CF
sweat is sectored in duct with high salt which leads to high salt concentration in sweat - sweat test - greater than 60 mol/l - milder cases 30 - 60
36
how does CF kill someone
95% due to respiratory failure | median age of death 25.6 years
37
what is the disease spectrum of cystic fibrosis
bronchiectasis (signet ring sign, bronchus should be smaller than artery in normal situation) pulmonary exacerbation - increased sputum, colour change, increased cough
38
what are the different treatments for CF
``` nebulas antibiotics oral antibiotics DNase Vitamin A, D, E, K pancreatic enzymes insulin ```
39
in CF a person may have, fatty stools, blood stained sputum and deteriorated vision, why so?
fatty stools - pancreatic problems blood stained sputum - haemoptemisis vision - low vis A
40
what is common to see in the x ray of someone wit CF
white patch in lung to shown signs of collapsed lung due to thick secretions
41
what are some signs of CF
clubbing, wheeze, crackles
42
why is it common to lose weight in CF
infection and pancreatic failure causing malabsorption as not enough enzymes
43
what is the correlation between diabetes and CF
over 30% of adult have CF related diabetes
44
what is bronchiectasis
chronic dilation of one or more bronchi, poor mucous clearance predisposition to bacterial infection
45
what is the aetiology of post infection of bronchiectasis
measles, whooping cough, child pneumonia TB immune deficiency allergic brnchopulomanary aspergillosis - spores in alveoli kertageners syndrome - ciliary dyskinesia
46
what are some symptoms of bronchiectasis
``` sputum in non smokers haemoptysis breathlessness wheeze weight loss ```
47
what are some signs of bronchiectasis
clubbing crackles wheezze
48
what pathogens can cause bronchiectasis
``` staphylococcus aureus streptococcus pneumoniae haemophilus influenza pseudomonas aeuginosa aspergillus ```
49
what is the treatment for bronchiectasis
physiotherapy hypertonic saline antibiotics influenza vaccination
50
what is community acquired pneumonia
CAP | an acute lower respiratory infection associated with recently developed radiological signs
51
what are the symptoms of pneumonia
progressive breathlessness, fever, left sided chest pain (sharp, worse on inspiration), lethargy
52
what are the signs of pneumonia
hot, flushed with peripheral dilation dull to percussion / increased breath sounds crackles pleural rub
53
how does hypotension occur in pneumonia
inflammatory stimulus, decreasing peripheral material resistance cardiac output increases
54
what is the treatment of pneumonia
``` antibiotics oxygen analgesia fluids physio nutrition stop smoking pleural aspiration drain rhDnase ```
55
what does CURBA stand for
``` confusion urea respiratory rate blood pressure age ```
56
what are some symptoms of type two respiratory failure
``` progressive breathlessness ankle swelling sputum production cough/green sputum low oxygen saturation ```
57
does giving up smoking always make a difference in respiratory function
yes - FEV1 decrees with age past 25 but in decreases a lot faster if you smoke
58
what happens in type 2 respiratory failure
hypoxia and hypercapnia | inadequate alveolar ventilation and PaCO2 high
59
what is the treatment of type 2 respiratory failure
``` b agonist anticholinergic agents inhaled/oral steroids antibiotics mucolytics flu vaccination ```
60
what therapies are there for type 2 RF
LTOT pulmonary rehabilitation surgery - bulls disease - lung volume decrease
61
what is a tension pneumothorax
the tissue forms one way valve allowing air to enter the pleural space and preventing it escaping
62
what are the symptoms of pneumothorax
bruised chest pain and tender to touch breathlessness
63
what are the steps involved in pathology of pneumothorax
progressive build up of air within the pleural space air cane space into the pleural space but not return progressive build up of pressure pushes the mediastinum to the opposite side obstruction to venous return to the heart
64
what are the signs of pneumothorax
``` tachypnoea trachea deviated away from pneumothorax surgical emphysema decreased expansion increased percussion note decreased breath sounds raised central venous pressure ```
65
what are primary vs secondary spontaneous pneumothorax caused by
primary - smoking - family history | secondary - many diseases such as COPD/CF etc
66
is RA obstructive or restrictive
restrictive which means decreased FEV1 and reduced VC | it has an increased FEV1 and FVC ratio ie greater than 0.7
67
what type of respiratory failure is caused by RA
type 1 respiratory failure PaCO2 is low/normal PaO2 is reduced
68
Is lung fibrosis restrictive or obstructive
restrictive
69
what is polycythenia
pathological increase in red blood cells

Body Systems (77 decks)

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