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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
Q

clinical features of lung cancer and horners syndrome (fingers)

A

clubbing of the fingers
tissue at the base of the nail is thickened
increased convexity of the nail fold

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26
Q

how would you investigate for lung cancer

A 
CXR
PET scan 
bronchoscopy 
biopsy 
VATS 
EBUS (endobronchiol ultrasound) 
percutaneous fine needle aspiration
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27
Q

what are the treatments of small cell vs non small cell treatment of lung cancer

A

small cell - chemotherapy, radiotherapy

non small cell - surgery, radiotherapy, chemotherapy

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28
Q

what is the most common cause of lung cancer

A

smoking from tobacco - 90%

smoking increases risk 8-20 fold

29
Q

what are some other common causes of lung cancer

A

asbestos
radioactive minerals, radon gas
pyrene, arsenic, nickel, naphthalenes
family history

30
Q

how common in cystic fibrosis

A

autosomal recessive
carrier 1 in 25
incidence 1 in 2500

31
Q

what is the gene mutation in cystic fibrosis

A

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
Q

what are the 3 common clinical features of cystic fibrosis

A

repeated chest infection
pancreatic insufficiency
male infertility

33
Q

what is the cause of cystic fibrosis

A

defective CFTR channel therefore increased sodium absorption and increased water absorption causing airway dehydration leading to inflammation and infection with viscous secretions

34
Q

how is DNA is associated with CF

A

high levels of extra cellular DNA are released from degenerating neutrophils and accumulate in the airways which is very thick

35
Q

what is the german folklore in CF

A

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
Q

how does CF kill someone

A

95% due to respiratory failure

median age of death 25.6 years

37
Q

what is the disease spectrum of cystic fibrosis

A

bronchiectasis (signet ring sign, bronchus should be smaller than artery in normal situation)
pulmonary exacerbation - increased sputum, colour change, increased cough

38
Q

what are the different treatments for CF

A 
nebulas antibiotics 
oral antibiotics 
DNase 
Vitamin A, D, E, K 
pancreatic enzymes 
insulin
39
Q

in CF a person may have, fatty stools, blood stained sputum and deteriorated vision, why so?

A

fatty stools - pancreatic problems
blood stained sputum - haemoptemisis
vision - low vis A

40
Q

what is common to see in the x ray of someone wit CF

A

white patch in lung to shown signs of collapsed lung due to thick secretions

41
Q

what are some signs of CF

A

clubbing, wheeze, crackles

42
Q

why is it common to lose weight in CF

A

infection and pancreatic failure causing malabsorption as not enough enzymes

43
Q

what is the correlation between diabetes and CF

A

over 30% of adult have CF related diabetes

44
Q

what is bronchiectasis

A

chronic dilation of one or more bronchi, poor mucous clearance
predisposition to bacterial infection

45
Q

what is the aetiology of post infection of bronchiectasis

A

measles, whooping cough, child pneumonia
TB
immune deficiency
allergic brnchopulomanary aspergillosis - spores in alveoli
kertageners syndrome - ciliary dyskinesia

46
Q

what are some symptoms of bronchiectasis

A 
sputum in non smokers 
haemoptysis 
breathlessness 
wheeze 
weight loss
47
Q

what are some signs of bronchiectasis

A

clubbing
crackles
wheezze

48
Q

what pathogens can cause bronchiectasis

A 
staphylococcus aureus 
streptococcus pneumoniae 
haemophilus influenza 
pseudomonas aeuginosa
aspergillus
49
Q

what is the treatment for bronchiectasis

A

physiotherapy
hypertonic saline
antibiotics
influenza vaccination

50
Q

what is community acquired pneumonia

A

CAP

an acute lower respiratory infection associated with recently developed radiological signs

51
Q

what are the symptoms of pneumonia

A

progressive breathlessness, fever, left sided chest pain (sharp, worse on inspiration), lethargy

52
Q

what are the signs of pneumonia

A

hot, flushed with peripheral dilation
dull to percussion / increased breath sounds
crackles
pleural rub

53
Q

how does hypotension occur in pneumonia

A

inflammatory stimulus, decreasing peripheral material resistance
cardiac output increases

54
Q

what is the treatment of pneumonia

A 
antibiotics 
oxygen 
analgesia 
fluids 
physio
nutrition 
stop smoking 
pleural aspiration 
drain 
rhDnase
55
Q

what does CURBA stand for

A 
confusion 
urea 
respiratory rate 
blood pressure 
age
56
Q

what are some symptoms of type two respiratory failure

A 
progressive breathlessness 
ankle swelling
sputum production 
cough/green sputum 
low oxygen saturation
57
Q

does giving up smoking always make a difference in respiratory function

A

yes - FEV1 decrees with age past 25 but in decreases a lot faster if you smoke

58
Q

what happens in type 2 respiratory failure

A

hypoxia and hypercapnia

inadequate alveolar ventilation and PaCO2 high

59
Q

what is the treatment of type 2 respiratory failure

A 
b agonist 
anticholinergic agents 
inhaled/oral steroids 
antibiotics
mucolytics
flu vaccination
60
Q

what therapies are there for type 2 RF

A

LTOT
pulmonary rehabilitation
surgery - bulls disease - lung volume decrease

61
Q

what is a tension pneumothorax

A

the tissue forms one way valve allowing air to enter the pleural space and preventing it escaping

62
Q

what are the symptoms of pneumothorax

A

bruised chest
pain and tender to touch
breathlessness

63
Q

what are the steps involved in pathology of pneumothorax

A

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
Q

what are the signs of pneumothorax

A 
tachypnoea
trachea deviated away from pneumothorax 
surgical emphysema 
decreased expansion 
increased percussion note 
decreased breath sounds 
raised central venous pressure
65
Q

what are primary vs secondary spontaneous pneumothorax caused by

A

primary - smoking - family history

secondary - many diseases such as COPD/CF etc

66
Q

is RA obstructive or restrictive

A

restrictive which means decreased FEV1 and reduced VC

it has an increased FEV1 and FVC ratio ie greater than 0.7

67
Q

what type of respiratory failure is caused by RA

A

type 1 respiratory failure
PaCO2 is low/normal
PaO2 is reduced

68
Q

Is lung fibrosis restrictive or obstructive

A

restrictive

69
Q

what is polycythenia

A

pathological increase in red blood cells

Body Systems (77 decks)

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