Respiratory system in health and disease

Question 1

what is the definition of respiratory?

Answer 1

designating, relating to, or affecting the organs involved in respiration

Question 2

what is the definition of respiration?

Answer 2

the exchange of oxygen and carbond dioxide between an organism or cell and the environment

Question 3

what is the definition of disease?

Answer 3

sickness; disturbance or impairment of the function and structure of the body, a part of the body, or the mind

Question 4

what is the normal respiratory rate of an: adult, new born and toddler?

Answer 4

adult: 12-20bpm
new born: 30-40bpm
toddler: 20-30bpm

Question 5

what is the ideal range for oxygen saturation?

Answer 5

96-100%

Question 6

what is FEV1? and what are the normal values for healthy adult males and females?

Answer 6

volume of air forcibly expired in first second after a full inhalation (forced expiratory volume in 1s)
* healty adult male >3.5L
* healthy adult female >2.5L

Question 7

what is FVC?

Answer 7

forced vital capacity - max volume of air that can be expressed from lungs forcibly

Question 8

give examples of rheumtological conditions

Answer 8

rheumatoid arthritis
systemic sclerosis
myositis
systemic lupus erythematosis

Question 9

what is obstructed sleep apnoea (OSA)?

Answer 9

upper airway obstruction, but movement of the chest wall persists

Question 10

what are the symptoms of obstructed sleep apnoea (OSA)?

8

Answer 10

snoring
apnoea periods
dry mouth
daytime fatigue
daytime somnolence (sleepiness)
poor concentration
headaches
depression

Question 11

what are the risk factors of obstructed sleep apnoea (OSA)?

9

Answer 11

male
obesity
type 2 diabetes
smoking
alcohol
down’s syndrome
craniofacial abnomalities
hypothyroidism
acromegaly (excess growth hormone)

Question 12

what are the treatments for obstructed sleep apnoea (OSA)?

3

Answer 12

lifestyle chnages
continuous positive airway pressure (CPAP)
mandibular advancement devices

Question 13

what viruses cause the common cold?

4

Answer 13

influenza, parainfluenza, respiratory syncytial viruses and adenoviruses

Question 14

what is epiglottitis? what does it obstruct?

Answer 14

localised swelling of the epiglottis caused by infection
obstructs the laryngeal inlet

Question 15

what can be identified on examination with a patient with epiglottitis?

6

Answer 15

unwell, scared patient
muffled voice
if child coughs, it may sound like a quack
increasing dysphagia
drooling
stridor (vibrating noise when breathing)

Question 16

what do patients complain of with tonsillitis?

3

Answer 16

sore throat
otalgia (ear pain)
headache or malaise

Question 17

what can be identified on examination with a patient with tonsillitis?

4

Answer 17

pyrexia (high temperature)
tonsils are enlarged and may exude pus
lymph nodes are enlarged and tender
foetar oris (bad breath)

Question 18

how do you manage tonsillitis? when do you refer to ENT?

4

Answer 18

analgesia - paracetamol
soft diet
if difficulty swallowing or unilateral, refer to ENT urgently
if recurrent symptoms, refer to ENT urgently

Question 19

what is chronic obstructive pulmonary disease (COPD)?

Answer 19

group of lung conditions that cause breathing difficulties due to chronic inflammation

Question 20

what are the two main types of COPD?

Answer 20

chronic bronchitis
emphysema

Question 21

what is chronic bronchitis?

3

Answer 21

inflammation of bronchi
excess mucus
chronic productive cough for >3months in 2 consecutive years

Question 22

what is emphysema?

2

Answer 22

alveolar membrane degradation
recurrent inflammation, scarring and loss of parenchymal luncg texture

Question 23

what is an exacerbation of COPD and what is it caused by?

2

Answer 23

symptoms beyond the normal expected symptoms of a disease
caused by acute inflammation or infections

Question 24

what is the pathology of COPD?

5

Answer 24

mucous hypersecretion
ciliary dysfunction
airflow obstruction and hyperinflation/air trapping
gas exchange abnormalities
pulmonary hypertension

Question 25

what are the symptoms of COPD?

6

Answer 25

chronic cough
fatigue
dyspnoea (difficult breathing)
excess mucus
shortness of breath
chest discomfort

Question 26

what are the causes of COPD?

6

Answer 26

smoking
pollution
occupational exposure
genetics (alpha-1-antitrypsin deficiency)
lung development
asthma

Question 27

how do you diagnose COPD?

4

Answer 27

history
spirometry (monitors disease progression)
cheset radiograph (to exclude other pathologies)
full blood count (to identify anaemia or polycythaemia)

Question 28

what is the sequale for COPD?

8

Answer 28

reduced QoL - quality of life
Cor Pulmonale - right ventricle enlarges
frequent lower respiratory tract infection (LRTI)
secondary polycythaemia
pneumothorax - collapsed lung
respiratory failure
lung cancer
muscle wasting and cachexia

Question 29

what is the treatment for COPD?

7

Answer 29

aim to prevent COPD sequale
minimise progression of disease
minimise exacerbations
lifestyle measures
smoking cessation
exercise
end-stage = oxygen therapy

Question 30

what is asthma?

Answer 30

chronic respiratory condition associated with airway inflammation and hyper-responsiveness

Question 31

what is the pathology of asthma? what do the pathologies lead to?

2,3

Answer 31

atopy - genetic predisposition as produce large amounts of IgE to allergens
airway hypersensitivity - increased responsiveness of the airways to non-specific stimuli which may be due to bronchus inflammation
atopy and airway hypersensitivity lead to:
* bronchoconstriction
* mucosal oedema
* increased secretion of tenacious mucus

Question 32

what is late onset (intrinsic) asthma?

4

Answer 32

not related to atopic conditions
no evidence of IgE medication
no seasonal variation
pathology relatively unknown

Question 33

what are the symptoms of asthma?

5

Answer 33

cough
wheeze
chest tightness
shortness of breath
variable expiratory airflow limitation

varies over time and in intensity

Question 34

what are the triggers of asthma?

6

Answer 34

exercise
allergen or irritant exposure
changes in weather
viral respiratory infections
NSAIDS
beta blockers

Question 35

how do you diagnose asthma?

4

Answer 35

history
peak flow
trial SABA
blood tests - IgE

Question 36

what is the sequalae for asthma?

3

Answer 36

death
respiratory complications (pneumonia, pulmonary collapse, pneumothorax, status asthmaticus)
impaired QoL - fatigue

Question 37

how do you control asthma?

2

Answer 37

avoid exacerbations
reduce risk of morbidity and mortality

Question 38

what does complete control of asthma look like?

7

Answer 38

no daytime symptoms
no night-time awakening due to asthma
no need for rescue medication
no exacerbations
no limitations on activity including exercise
normal lung function
minimal side effects from medication

Question 39

what medications are used for asthma?

2

Answer 39

controllers
* sytemic corticosteroids
* inhaled corticosteroids
* methotrexate
* leukotriene antagonists
* LABA - long-acting-beta-2-agonists
relievers
* SABA - short-acting-beta-2-agonists
* short acting theophylline
* inhaled anticholinergics