Session 6 Flashcards
What are some of the symptoms of COPD?
Dyspnoea
Cough
What is COPD?
Chronic obstructive pulmonary disease - a chronic and slow progressing disorder that is characterised by airflow obstruction.
Has a reduced FEV1/FVC ratio and airflow limitation that is not fully reversible.
What can cause COPD?
Cigarette smoking
Coal mining
Anti-protease deficiency (genetic inheritance)
What are some of the sites of COPD?
Large airways
Small airways
Lung parenchyma
Pulmonary arteries
What are some of the mechanisms of COPD?
Airway & systemic inflammation Alveolar destruction Hyperinflation Respiratory muscle inefficiency Skeletal muscle dysfunction
What are some of the consequences of COPD?
Airway obstruction Dyspnoe Exercise limitation Nutrition depletion Respiratory failure
What can be the impact of COPD?
Mobility (disability) Health status Mood Exacerbations Hospitalisation Death
How would emphysema look on an X-ray?
There would be increased lung dilation
What investigations could you do if you thought a patient had COPD?
History MRC dyspnoea Chest x ray FEV1 Lung function tests CT scan
What does the MRC dyspnoea scale do?
Shows what activities the patient can do
What drugs would you use to treat COPD?
Bronchodilator drugs for when symptoms bad
Corticosteroid drugs for preventative
What is exacerbation in COPD?
Worsening of the previous stable condition
Declining health status
Increased wheezing
Dyspnoea
Chest tightness & fluid retention if going into respjratory failure
What are some of the causes of respiratory failure?
Hypoventilation
Ventilation/perfusion imbalance
Alveolar/capillary diffusion block
A VSD causing a true shunt
What is respiratory failure classed as?
A PaO2 of <7.3 kPa at sea level
What are some of the defences of the Upper Respiratory Tract?
Muco-Ciliary clearance mechanisms Nasal hair Ciliated columnar epithelium Flora Cough & Sneezing reflex Respiratory mucosal immune system
What are some examples of Upper Respiratory Tract infections?
Rhinitis (Common cold caused by viruses)
Pharyngitis & Laryngitis
Sinusitis
Otitis media (Can spread to the brain and cause meningitis)
What divides the upper and lower respiratory tract?
Lower respiratory is below the trachea
Upper respiratory is above the trachea
What are some examples of Lower Respiratory Tract infections?
Bronchitis
Bronchiolitis
Pneumonia
What can cause acute Bronchitis?
Viruses or bacteria. It can lead to Pneumonia
What is Bronchitis?
An infection of the main airways of the lungs which causes them to become irritated and inflamed
What is Pneumonia?
Infection of the Pulmonary Parenchyma with consolidation.
Inflammatory exudate in the distal airspaces.
Gas exchange becomes impaired.
What are some of the common bacteria that cause community aquired Pneumonia?
Streptococcus pneumoniae
Haemophilus influenzae
What does community aquired Pneumonia cause?
Fibrin rich exudate
Lobar Pneumonia - consolidation involving a complete lung lobe. (Most often due to Streptococcus Penumoniae)
What are some of the complications that can occur from community aquired Pneumonia?
Bronchiectasis
Lung abscesses
Empyema (Pus in pleural cavity)
What are some of the common bacteria that cause Hospital aquired Pneumonia?
Staphylococcus aureus
Pseudomonas
What does Hospital aquired Pneumonia cause?
Infection begins in the airways and spreads to the adjacent alveoli and lung tissue.
Fluid filled airspace
Bronchopneumonia (Patches of consolidation) is the complication of viral infection
Often seen in the context of pre-existing disease
Why do you have to vaccinate for influenza every year?
Because the RNA virus changes constantly due to point mutations therefore it evades the system each year
What is Aspiration Pneumonia?
Aspiration of an exogenous material or endogenous secretions into the respiratory tract. Usually Streptococcus and anaerobes
What group is usually at risk of Aspiration Pneumonia?
Nursing home residents
Patients with depressed reflexes so usually neurological problems
What are the symptoms of Pneumonia?
Fevder Chills Cough Dyspnoea Chest pain Malaise Sweats
How could you treat Pneumonia?
Amoxycillin is the first choice
Co-amoxiclav (Penicillin and Clavulanic) when more severe
How would you treat Legionella Pneumonia?
Levofloxacin
What is Pneumocystis Pneumonia?
The most common opportunistic affecting immunosuppressed patient eg HIV, transplant.
Fungus spores in the environment get into the lungs and alveolitis. Worsening hypoxia.
What causes Whooping cough?
Bordetella pertussis
What is the presentation of Whooping cough?
The patient begins with cold like symptoms that develop into severe coughing fits followed by a characteristic whoop (caused by partially opened glottis) and vomiting.
What age group is Whooping cough most dangerous in?
<1 years. Give childhood vaccination and, if mother not immunised can vaccinate during weeks 28-30 of pregnancy
What bacteria is most likely to cause Pneumonia in the elderly?
Streptococcus Pneumonae Acute onset, Increased fever, usually have co morbidities
What is post viral Pneumonia?
Staphylococcus aureus causes secondary Pneumonia after the original viral Pneumonia
What does consolidation of a lung look like on x-ray?
Opaque
Why do you treat Pneumonia caused by Chlamydia with Tetracyclines?
Because the bacteria is within the cell
What is CURB 65?
A severity assessment
What type of Pneumonia can cause necrosis?
Fungi Pneumonia can cause pressure necrosis. It can invade vessels and cause haemorrhages
