Week 7- Respiratory

Question 1

What is a pulmonary embolism and infarction

Answer 1

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)

Question 2

List pulmonary circulation

Answer 2

To lungs (deox)
Vena cava
RA
Tricuspid
RV
Pulmonary artery

Back to heart (oxygenated)
Pulomaonry vein
LA
Bicuspid
LV
Aorta

Question 3

What is pulmonary hypertension

Answer 3

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)

Question 4

List pulmonary haemorrhage syndrome

Answer 4

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

Question 5

What is peneumonia

Answer 5

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

Question 6

What is a lung abscess

Answer 6

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

Question 7

What is pleura effusion

Answer 7

Abnormal amount of fluid in the pleura space

Increase in pressure causing elastic recoil of the lung

Question 8

What is penumothorax

Answer 8

-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

Question 9

What is a bleb

Answer 9

Air filed spaces between lung parenchyma and visceral plaura

Question 10

What is Bullae

Answer 10

Air filled spaces within lung parenchyma

Question 11

What is lung pleura

Answer 11

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

Question 12

Locations of pulmonary odema, pleura effusion, phneumothorax

Answer 12

Odem= fluid lung tissue

Effusion and thorax is in between pleura air/ fluid

Question 13

How would we diagnose pneumothorax

Answer 13

X-ray showing a lung decreased in size, ipsilateral

Ct scan

Respiratory exam showing crackly lung and impairment of breathing
Deviated trachea

Question 14

What is Virchow triad?
Identify components and how they contribute to the triad
Clinical examples when possible

Answer 14

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

Question 15

What can cause low back pain, lymphodema in their right leg and putting oedema

Answer 15

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)

Question 16

What is osteoporosis

Answer 16

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,

Question 17

Describe possible aetiologies and primary symptoms of RSH failure

Approach to assemnet

Suspected clinical findings (10)

Answer 17

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

Question 18

How would u assess bp in someone with suspected heart failure

Answer 18

BP bilaterally to assess for subclavian steel syndrome or atherosclerosis

Question 19

Describe a heart exam

Answer 19

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

Question 20

List chemical mediators of pain

Answer 20

Bradykinin

Prostoglandins

Histamine

Leukotrienes

Question 21

Describe the pathogenesis and clinical presentation of Hodgkin’s lymphoma. In your answer
discuss the hallmarks and red flags of cancer (10 marks)

Answer 21

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