Week 7- Respiratory Flashcards
What is a pulmonary embolism and infarction
Pulmonary E is when a blood clot usually from Deep vein thrombosis, travels to lungs and blocks one or more pulmonary arteries
Blockage reduced blood flow to lung tissue, impairing o2 exchange
Can lead to pulmonary infarction which is necrosis in the affected area of the lungs
Blood clots from Deep Vein thrombosis or severe burns, traumas, fractures
Causes:
hypercoagubility (thrombophillia), vascular damage, circulatory stasis
-prolonged imbolisation
-surgery
-pregnancy
-smoking
-obesity
-over 60 mc
Signs and symptoms=chest pain, cough, fainting, fever, tachycardia/ tachypnea, dyspnea (shortness of breath)
List pulmonary circulation
To lungs (deox)
Vena cava
RA
Tricuspid
RV
Pulmonary artery
Back to heart (oxygenated)
Pulomaonry vein
LA
Bicuspid
LV
Aorta
What is pulmonary hypertension
Abnormal elevation in pulmonary artery pressure
Women 20-40
Idiopathic
Caused by thickening of walls by vessels. Leads to build up of blood due to restriction of blood flow. Right side works harder to pump blood to the lungs which can weaken heart and lead to R heart disease
Symptoms= fatigue, ;ethargy, cough, sweating, chest pain, hoarse throat,
Signs= odema, rapid weight gain, systolic ejection murmur , cyanosis (blue skin)
List pulmonary haemorrhage syndrome
Goospasture syndrome
Idiopathic pulmonary hemosiderosis
Vasculistis- associated haemorrhage
Caused by circulating auto-antibodies against basement membranes in lungs and kidneys. Inflammatory destruction of basement membrane of glomerulus and alveoli
What is peneumonia
Mc lung infection, infec of alveoli
Inflames alveoli in one or both lungs causing them to fill with fluid or pus.
Difficult for o2 to enter bloodstream and results in symptoms. Caused by bacteria, virus, fungi
Cough, sweating, shortness of breath, fatigue, chest pain, confusion
Infants and young children
65+
Individuals with chronic disease as immune system is compromised, COPD, asthma, heart disease
Smokers
Weakened immune system, HIV, chemo
Diagnosed via physical exam, lab dub, chest-X-ray, blood test (pathogen)
Viral pneumonia, elderly
Bacterial pneumonia - young, elderly
Fungal
What is a lung abscess
Bacterial/viral/fungal infections cause Pus containing lesion of the lung tissue that formes a cavity
Liquefactive necrosis of lung tissue causing microbial infection
Reduce lung function gas exchange
Mc aspiration of material from GI tract to lungs
Risk factors= alcoholism, seizure sidorde, neuromuscular disorder, drug overdose, stroke, general aesthesia, TB, septic embolism , fungal or virus disease of lung
3 stages
What is pleura effusion
Abnormal amount of fluid in the pleura space
Increase in pressure causing elastic recoil of the lung
What is penumothorax
-Collapsed lung occurring when air collects in the pleural cavities
-Creates pressure against the lung, partial of full collapse
-Reduced anterior oxygen tension in addition to reduced vital capacity
associated with emphysema, asthma and tB
Smoking cause increase
Thoracic pain
Ispilaterl
Dry cough
Fatigue
Cyanosis
Shortness of breath
Absent breath sounds on affected side
Synapsids
Tachycardia/tachoponae
Deviated trachea
What is a bleb
Air filed spaces between lung parenchyma and visceral plaura
What is Bullae
Air filled spaces within lung parenchyma
What is lung pleura
Double layered membrane surrounding each lung, protecting lungs
Viscera = inner layer
Parietal pleura= outer layer
Between is small fluid filled space which actors a are a lubricant and creates surface tenion
Pleuritic is inflammation
Effusion is accumulation of excess fluid
Pneumothorax is collapsed lung due to air in cavity
Locations of pulmonary odema, pleura effusion, phneumothorax
Odem= fluid lung tissue
Effusion and thorax is in between pleura air/ fluid
How would we diagnose pneumothorax
X-ray showing a lung decreased in size, ipsilateral
Ct scan
Respiratory exam showing crackly lung and impairment of breathing
Deviated trachea
What is Virchow triad?
Identify components and how they contribute to the triad
Clinical examples when possible
Makes up what is needed to create a thrombus, each part could start a thrombus individually
Hypercoagubility can be caused by a person having a high platelet count, pregnancy, oral contraceptives or smoking.
Circulatory stasis can be caused by being elderly, immobile, hospitalised or on long haul flights.
Vascular damage can be caused by hypertension or trauma through surgery.
A common issue is deep vein thrombosis where poatients may present with asymmetrical calf pain and calf odema. Area can be cyanotic and could be pitting oedema.
Thrombus is most commonly found in tibial veins and coronary arteries but can be formed anywhere in the vascular system where the triad could begin.
Thrombus can dislodge causing an embolus which could causes myocardial infarction, pulmonary infraction or a stroke
Thrombus can be broken down by plasmin and blood flow will return to normal
What can cause low back pain, lymphodema in their right leg and putting oedema
Nephrotic disease (kidney disorder passing to much protein in urine causing oedma)
Deep vein thrombosis (blood clot within deep veins causing swelling in leg and oedema)
Heart failure
Luymphangitis (inflammation of lymph vessels causing swelling of limbs)
What is osteoporosis
Health condition weakening bones making them fragile and easily breakable
Women post menopause lose bone rapidly within the first few years
In America (80% is women) due to less bone density in women
Steroid tablets can cause this , heavy drinking and smoking, low bmi, no exercise,
Describe possible aetiologies and primary symptoms of RSH failure
Approach to assemnet
Suspected clinical findings (10)
HF is a condition where the heart loses its ability to pump blood efficiently to the body.
Right sided is usually due to a combination of right ventricular pressure overload and contractile abnormality, resulting in systemic venous hypertension, peripheral odema and reduced CO
Aetiology:
LVentrical failure, vol and pressure overload causing blood back up, increased fluid pressure which is transferred back to the lungs, damaging R side
Causes of RSHF include LSHF
Other conditions leading to RHF are:
-pulmonary fibrosis
-arrthymias
-COPD
-Congenital heart sideas
-Valvular insufficiency or regurgitation
-Cardiomyopathy
Primary symptoms: R side loses pumpin power, blood backs up in S and I vena cava causing peripheral oedema and Ascites
Renal congestion leads to fluid retention and peripheral oedema
Resulting with patients wheezing, coughing, cyanosis, shortness of breath, weight loss, chest pain, fatigue, enlarged liver or spleen, distended jugular veins, tachycardia
Assessment:
Full subjective assessment asking for coronary artery disease, chronic bronchitis, deep vein thrombosis, autoimmune diseases like TB or HIV
Vital sigs, BP bilaterally to assess for subclavian steel syndrome or atherosclerosis, respiratory and cardiovascular assessments
I would expect pulmonary odema and crackles in the chest at base of lungs
Dullness in percussion due to oedema
Laboured breathable
Bounding pulse, engorged veins on palpation
Full heart exam and palpate for thrills and listening with stethespope for high pitched noses or murmurs and any abnormalities
How would u assess bp in someone with suspected heart failure
BP bilaterally to assess for subclavian steel syndrome or atherosclerosis
Describe a heart exam
Listening to aortic (R, 2nd intercostal space),
pulmonary (L, 2nd intercostal space),
Tricuspid (L, 4th intercostal space)
mitral valve (L, 5th intercostal space mid
clavicular line).
I would palpate for thrills and listen with the diaphragm of the stethoscope for high
pitched noises
the bell for low pitched sounds such as murmurs
paying attention to the intensity,
pitch and location of heart sounds noting any abnormal heart sounds including mur
List chemical mediators of pain
Bradykinin
Prostoglandins
Histamine
Leukotrienes
Describe the pathogenesis and clinical presentation of Hodgkin’s lymphoma. In your answer
discuss the hallmarks and red flags of cancer (10 marks)
Description
Hodgkin’s lymphoma is a cancer of the lymphatic system, which is part of your immune system.
is most common in people between 20 and 40 years old and those over 55.
Pathogenesis:
• Genes that help cells grow, divide, and stay alive are called oncogenes.
• Genes that slow down cell division or cause cells to die at the right time are called tumour
suppressor genes.
Cancers can be caused by DNA changes that turn on oncogenes or turn off tumour supressor genes
Signs and symptoms:
-painless swelling of lymph nodes
-fatigue
-fever
-night sweats
-unexplained weight loss
-severe itching
-pain in lymph nodes after alcohol
Hallmarks of cancer:
1.self-sufficiency in growth signals
2.resistance to growth stop signals
3. Cell immortalisation through action of telomerase
4.angiogenesis : produce new blood vessels
5.Resistance to apoptosis
6.ability to invade and produce metastases
Red flags:
-worsening fatigue
-unexplained weight loss
-fever, chills, night sweats
-growing lymph nodes
-persistent pain which doesn’t go away with sleep or meds
