week 6 Flashcards
what are the subsections of non rem sleep 4
alpha
beta
theta
delta
what causes reduced breathing during sleep 4
reduced drive of breathing
reduced metabolic activity
increased airway resistance
decreased muscle tone of
intercostal muscles when lying down
definition of obstructive sleep apnoea
cessation of airflow due to upper airway resistance and obstruction resulting in partial/complete collapse
three components required in diagnosis of sleep apnoea, which of these is key
blood oxygen testing
home sleep apnoea
polysomnography
what is assessed in polysomnography 7
EMG
EOG
EEG
Pulse oximetry
Abdominal bands
Airflow
Microphone
mallampati score
evaluate the difficulty of incubation and severity of sleep apnoea based off the visibility of oral structures
acute social and lifestyle implications of sleep apnoea 4
day somnolence
headaches
cognitive impairement
partners affected by snoring
chronic complications of sleep apnoea
pulmonary hypertension
CVD disease
uncontrolled hypertension
central sleep apnoea
complete cessation of airflow due to lack of control from brainstem respiratory centres
no breathing with no chest or abdominal effort
causes of obstructive sleep apnoea
high BMI
large neck diameter
obesity
causes of central sleep apnoea
heart failure, drugs, neuromuscular disorder
4 forms of management for sleep disordered breathing
CPAP
mandibular splint
surgery
lifestyle modifications
type 1 RF (def + reason why)
hypoxaemia
due to gas exchange failure
type 2 RF (def + reason why)
hypercapnia
due to pump ventilation failure
reasons for gas exchange failure 5
fluid in alveoli
alveolar collapse
alveolar damage
pulmonary vascular narrowing
airway narrowing
reasons for pulmonary ventilation failure 4
CNS depression
chest cage restriction
neuromuscular weakness
nerve dysfunction
what physiological responses from hypoxemia and hypercapnia 4
dyspnoea
tachypnoea
diaphoresis
accessory muscle usage
hyopxic drive
innate mechanism to continue respiratory drive due to low oxygen levels, however as oxygen levels increased, increased offloading of co2 into the blood as a result of the haldane effect resulting in oxygen induced hyercapnia
results of hypoxemia 3
hypoxia
lactic acidosis
organ damage
results of hypercapnia 3
cerebral dysfunction
cardiopulmonary effects
respiratory acidosis
hypercapnia compensatory mechanism in acid base balance maintenance
kidneys increase bicarbonate levels which absorb carbon dioxide
hence bicarbonate levels determine whether T2RF is chronic or acute
treatment options for type 1 RF + type 2RF
oxygen therapy + controlled oxygen therapy
what is non invasive ventilation?
BPAP machine which uses a higher positive pressure on inspiration and lower positive pressure on expiration
types of oxygen therapy delivering methods
nasal specs aka nasal canula
CIG mask aka simple oxygen mask
high flow O2
non invasive ventilation aka BPAP
ECMO
what is extracorporeal membrane oxygenation ECMO
draws blood from the patient and oxygenates it blood outside the body and removes CO2
ABG
will test oxygen, carbon dixoxide, pH and bicarbonate levels to distinguish between type 1+2 RF
what is the ABG of asthma and COPD
hypoxaemia with likely hypercapnia
type 1 hypersensitivity reaction
allergen triggered IgE reaction
type 2 hypersensitivity reaction
iGg or iGm antibodies bind to cell surface causing cell destruction
type 3 hypersensitivity reaction
immune complex formation and deposition on tissues causing inflammation and destruction
type 4 hypersensitivity reaction
delayed t cell activation response
definition of atopy
genetic tendency to have an allergic immune response
definition of allergy
an adverse reaction to a foreign substance provoking an excessive response
role of environmental factors in atopic development
skews t helper cell levles to be overactive
role of genetic factors in atopic disease development
polymorphisms increase allergic risk
pathophysiology of atopic disease 6
allergen exposure
t cell response
cytokines release
activation of b cells
production of IgE antibodies
triggers eosinophil action and mast cell degranulation
the different atopic disease (simple def) and the type of hypersensitivity reaction they are
asthma = chronic obstruction due to inflammation of the airways
atopic dermatitis = chronic skin condition associated with dry, scaly patches
allergic rhinitis = inflammation of the nasal mucosa
all type 1
anaphylaxis symptoms 4
skin rashes
hypotension
upper airway obstruction and bronchosapsm
severe gastro symtpoms incl abdo pain
acute bronchoconstriction pathways 2 (inflammatory mech and parasympathetic mech)
allergen->chemical mediators->bind to smooth muscle receptors->increase intracellualr calcium levels in muscle->smooth muscle contraction
parasympathetic activation->acetylcholine release->binds to muscarinic receptors on smooth muscle
different theories of asthma (Try and explain each)
lung inflammation
airway hyper-responsiveness
airway remodelling
mucous hypersecretion
increased eosinophils/neutrophils in airway lumen
clinical symptoms asthma 4
wheezing
cough worse at night and morning
dyspnoea at night especially
chest tightness
COPD pathomech 6
long term exposure to noxious particles resulting chronic inflammation of airways and lungs leading to progressive obstruction->conintinual particle exposure leads to continual inflammation, oxidative stress and progressive tissue damage
chronic bronchitis
chronic inflammation of bronchi resulting in hyper-secretion of mucus, cough and airway narrowing
emphysema
destruction of alveolar walls resulting in loss of elastic recoil
clinical features of COPD 5
cough w thick sputum
dyspnoea worsens over time
chest tightness
cyanosis
barrel chest
difference between COPD and asthma
Asthma: early onset, worse at morning and night, acute, wheeze, mainly unproductive cough
COPD: late onset, no daily variation in worsen, chronic, productive cough, cyanosis and barrel chest
diagnosis of copd 4
history = chronic cough, dyspnoea, history of smoking
examination = barrel chest
pulmonary function test = spirometry
CXR for hyperinflammation
pharmacological management in asthma
ICS->LABA+ICS and SABA for acute response
ICS = reduces inflammation by supressing cytokines
LABA and SABA = act on beta 2 receptors causing bronchodilation
pharmacological management in COPD
LAMA->LAMA/LABA>ICS
LAMA and SAMA = short acting muscarinic antagonists block muscarinic receptors reducing bronchoconstriction
does sympathetic or paraymspathetic stimulation cause bronchodilation of bronchoconstriction
sympathetic causes bronchodilation
parasympathetic causes
bronchoconstruction
COPD team 3
respiratory physician
physiotherapist
nurse
preventers in asthma
ICS and LABA
relivers in asthma
SABA
self management in COPD 4
lifestyle changes
regular physical activity
medication adherence
monitoring symptoms
monoclonal antibodies in chronic airway disease+when its given
inhibit igE reducing inflammation cascade
used in patients who don’t respond to standard medication treatmenr
horizontal fissure
5th to 4th rib mid axillar-anterior
oblique fissure
t3 to 6th rib anteriorly
inferior margins of lungs
anterior t6
laterally t8
posteriorly t10
bronchopulmonary segement
portion of the lung supplied by its own pulmonary artery branch and bronchus
what is the clinical significance of the bronchopulmonary segment
as each bronchopulmonary segement has their own supply its useful in understanding the spread of disease
what innervates the parietal pleura 2
intercostal and phrenic nerve
what is the blood supply of the parietal pleura 3
interocostal thoracic and phrenic arteries
what is the blood supply of the visceral pleura 1
bronchial arteries
the innervation of the lungs 2
phrenic nerve and pulmonary plexus
where is the pulmonary plexus located
bifurcation of the trachea
capacity definition 2
can comprehend and retain information
use and weigh information when deciding
doctors role in occupational lung disease 3
determine the cause
evaluate the extent of impairment
act as an expert witness
two types of compensation in occupational lung disease
common law
statutory law
non clinical professionals in asthma and cOPd
occupational hygienist
environmental health officer
non clinical public health officer
Is their increased vocal resonance in pneumothorax and why
No because sound travels faster through solid then air
