Week 8 Respiratory Flashcards
what does SARS-CoV-2 stand for
severe acute respiratory syndrome coronavirus 2
Outline the epidemiology of SARS-CoV-2
Virus factors- virus genome mutates, leading to changes in viral proteins
Virus transmission-Zoonotic infection, respiratory and faecal-oral transmission
Host factors-receptors expressed by different hosts, ACE 2 receptors, contact with animals, air travel and other human behaviours
Outline the pathophysiology of COVID19
-infection of endothelial cells
-spread of virus
-innate immune response activated
-cytokine storm
-ARDS
-activation of ACE-2
-post covid symptoms
what are the post acute COVID 19 symptoms
fatigue, dyspnoea, cough, chronic co morbidities eg CKD
Name the two phases of COVID-19 infection
-rapid viral propagation
-uncontrolled inflammatory response (cytokine storm)
what are the phases of rapid viral propagation
-exposure and entry
-initial replication
-symptom onset
-viral shedding
describe the exposure and entry phase of rapid viral propagation
the infection begins with exposure to the SARS-CoV-2 virus, primarily through respiratory droplets. The virus enters the body through the respiratory tract (nose or mouth)
describe the initial replication phase of rapid viral propagation
after entry, the virus rapidly replicates in the URT (throat and nasal passages), it then spreads to LRT where it can infect the lungs
describe the symptom onset phase of rapid viral propagation
during the phase, many individuals may remain asymptomatic or experience mild to moderate symptoms, including fever, cough, sore throat, loss of taste or smell
describe the viral shedding phase of rapid viral propagation
infected individuals can shed the virus and are contagious during this phase, contributing to spread of disease to others
Describe what is meant by a cytokine storm
-During programmed cell death (PCD), pro-inflammatory cytokines are released.
-This can trigger a cytokine storm, an excessive immune response.
-Cytokines include PAMPs (pathogen-associated molecular patterns) and DAMPs (damage-associated molecular patterns), signaling danger to the immune system.
-A cytokine storm can cause widespread inflammation.
-This inflammation can result in end-organ damage (lungs, liver, kidneys) as the immune response becomes harmful instead of protective.
list the symptoms of COVID-19
fever
cough
fatigue
anosmia
sore throat
dyspnoea
headache
describe fever aș a symptom of COVID 19
Elevated body temperature, often a common early (premature) symptom of COVID-19
describe cough as a symptom of COVID 19
persistent dry or productive cough, typically accompanied by respiratory discomfort
describe fatigue as a symptom of COVID 19
profound tiredness and weakness, a common symptom experienced during COVID 19 infection
describe anosmia as a symptom of COVID 19
an abrupt loss or alteration of ones ability to smell, associated with COVID 19
describe sore throat as a symptom of COVID 19
a scratchy or painful throat, sometimes accompanied by difficulty swallowing can be a symptom of covid 19
describe dyspnoea as a symptom of COVID 19
SOB can present in severe COVID 19
describe headache as a symptom of COVID 19
a persistent and often severe headache, which can accompany other COVID symptoms
Outline acute respiratory distress syndrome as a complication of COVID
-in the second phase of COVID T2 alveolar cells can lose the ability to secrete surfactant
-this is due to structural changes to lungs (dysregulated pro-inflammatory cytokine release)
-ARDS can lead to tachypnoea, low blood O2, rattling sound on auscultation
List the preventions for COVID
-social distancing
-mask wearing
-vaccination
-hand hygiene
describe social distancing as prevention for COVID 19
maintain physical distancing of at least 2 m from others, particularly in high risk and crowded areas
describe mask wearing as a prevention for COVID
encourage face mask use, especially indoor or crowded areas to reduce spread of respiratory droplets
describe vaccination as a prevention for COVID
encourage eligible individuals to receive COVID vaccines to reduce risk of infection and severe symptoms
describe hand hygiene aș a prevention for COVID
promote good hand hygiene, including regular hand washing with water and soap/ hand sanitiser (>60% ETOH)
list the managements for COVID
analgesics
antivirals
oxygen therapy
describe analgesic use for managing COVID
analgesics can help reduced fever and provide relief from pain and inflammation
describe antiviral use for managing COVID
use antiviral medication like remdesivir in moderate to severe cases under medical conditions
describe oxygen therapy for managing COVID
administer supplemental oxygen for individuals with low blood oxygen levels due to severe respiratory symptoms
list the aetiological classifications of pneumonia
-bacterial
-viral
-aspiration
-atypical
-opportunistic
what is bacterial pneumonia
lung infection caused by bacteria (often Strep pneumoniae), leading to lung inflammation
what is viral pneumonia
lung infection caused by viruses such as influenza or respiratory syncytial virus (RSV), leading to lung inflammation
what is aspiration pneumonia
inflammation of lungs due to inhaling foreign material typically gastric contents into airways
what is atypical pneumonia
pneumonia caused by atypical pathogens like mycoplasma or chlamydia, often have milder symptoms
what is opportunistic pneumonia
lung infection occurring in individuals with weakened immune systems, caused by pathogens not typically harmful to healthy individuals
list the acquisition-based classifications of pneumonia
-community acquired
-healthcare acquired
-ventilator associated
what is community acquired pneumonia
pneumonia acquired outside of healthcare settings, often caused by common bacteria or viruses
what is healthcare acquired pneumonia
pneumonia that develops during or after hospitalisation or other healthcare interventions, often involving drug-resistant bacteria
what is ventilator associated pneumonia
pneumonia developing in patients on mechanical ventilation, often due to hospital acquired infections
cause of community acquired pneumonia
-bacteria, viruses, fungi in community
cause of healthcare acquired pneumonia
-bacteria or multi-drug resistant pathogens acquired in hospitalisation or long term care
cause of ventilator associated pneumonia
-hospital acquired Bacteria that enters lungs via mechanical ventilation support
list the clinical symptoms and signs of pneumonia
-productive cough
-dyspnoea
-pleuritic chest pain
-hypoxia
-dullness to percussion
-decreased breath sounds
-bronchial breathing
-coarse crackles
-increased vocal resonance
describe productive cough as a symptom of pneumonia
cough that produces mucus or phlegm (common in pneumonia)
describe dyspnoea as a symptom of pneumonia
SOB due to reduced lung function in pneumonia
describe pleuritic chest pain as a symptom of pneumonia
sharp chest pain worsened by deep breathing or coughing, indicating inflammation of pleura (lining of lungs)
describe hypoxia as a sign of pneumonia
insufficient oxygen in body’s tissues, a potential consequence of pneumonia when the lungs can’t supply enough oxygen to blood stream
describe dullness to percussion as a sign of pneumonia
A less resonant or “thud” sound heard when a healthcare provider taps the chest with their fingers, indicating possible consolidation of lung tissue in pneumonia.
describe deceased breath sounds as a sign of pneumonia
Reduced or absent breath sounds in a specific lung area, suggestive of blocked airways or consolidation.
describe bronchial breathing as a sign of pneumonia
Abnormal lung sounds with a hollow, echoing quality, often heard over areas of lung consolidation in pneumonia.
describe coarse crackles as a sign of pneumonia
Abnormal lung sounds resembling crackling or rattling, typically due to the movement of fluid or mucus in the airways, common in pneumonia.
outline the pathophysiology of pneumonia
-underlying agent (bacteria or virus etc)
-colonisation of nasopharynx
-micro-aspiration
-colonisation of lung parenchyma
-programmed cell death
-release of pro-inflammatory cytokines
-systemic inflammatory response
-end organ and systemic inflammatory-associated damage
identify the complications of pneumonia
-sepsis
-lung abscess
-respiratory failure
-kidney failure
-neurological effects
describe sepsis as a complication of pneumonia
life threatening systemic response to infection, which can occur when pneumonia bacteria or viruses enter the blood stream
describe lung abscess as a complication of pneumonia
pockets of pus forming within the lung tissue, often requiring drainage or surgical intervention
describe respiratory failure as a complication of pneumonia
inability of the lungs to provide sufficient oxygen in the bloodstream and remove carbon dioxide, a serious consequence of pneumonia
describe kidney failure as a complication of pneumonia
impairment to kidney function, which can result from severe pneumonia and its impact on body’s overall physiology
describe neurological effects as a complication of pneumonia
rare issues affecting the NS, such as alerted mental states or confusion, occasionally associated with severe pneumonia
what is the severity parameter for pneumonia
SMART COP
what does SMART COP stand for
-systolic BP
-multi-lobar CXR involvement
-albumin (low)
-respiratory rate (>30 or >25 dep. on age)
-Tachycardia (>125)
-confusion
-O2 saturation (<90%)
-pH (<7.35)
(all worth 1 except O,P)
(score >5 is bad)
list the investigations for pneumonia
-CBC
-EUCA
-Viral swab
-Sputum MCS
-CXR
-bronchoscopy
purpose of CBC in Dx pneumonia
looking for high white cell count and raised inflammatory markers (C-reactive protein)
purpose of EUCA in Dx pneumonia
looking for implications on renal functions due to electrolytes, urea, creatinine changes
purpose of viral swabs in Dx pneumonia
looking for presence of an underlying viral contributor to pneumonia
purpose sputum MCS in Dx pneumonia
looking for bacterial contributors to pneumonia eg S.pneumoniae
purpose of CXR in Dx pneumonia
looking for consolidation and parapneumonic effusion/empyema
purpose of bronchoscopy in Dx pneumonia
flexible camera that enters via mouth/nose and suctions out mucous and can be used for biospy
List the management of community acquired pneumonia
-antibiotics
-symptomatic alleviation
-supportive management
-nutrition assessment
describe use of antibiotics for pneumonia management
used in the case of bacterial pneumonia, the specific antibiotic depends on the underlying bacterium causing the pneumonia; augmentin is first-line treatment
describe symptomatic alleviation as management for pneumonia
as required, to maintain stable SpO2 of >92% unless CO2 retainer, where aim saturations are 88-92%
describe supportive management for pneumonia
pulmonary rehab programs and input form a MD team to enable prompt and swift recovery with necessary lifestyle changes
describe nutrition assessment as a management for pneumonia
malnutrition is a common cause of pneumonia, so nutritional assessment may be required to remove a potent risk factor for future pneumonia episodes
Outline the pathogenesis of TB
-M.tuberculosis enters the upper airways
-first line: attempted phagocytosis by alveolar macrophages (if engulfed, infection is controlled)
-M.TB migrates to lymph nodes, activating t and b cells
-t and b cells are recruited to the lung parenchyma
-b and T cells enable macrophages to differentiate into epithelioid cells
-fusion of epithelial cells to from langhan’s giant cells (granuloma)
-granuloma encases M.TB, preventing its spread and proliferation
list the characteristics of Mycobacterium tuberculosis
slow growth
waxy cell wall
describe M.tuberculosis having a ‘slow growth’
M.tuberculosis has a relatively slow replication rate, which can make it challenging to culture and treat, contributing to the prolonged cause of TB infection
describe M.tuberculosis having a ‘waxy cell wall’
the bacterium’s cell wall is rich in waxy lipids, including mycotic acids, providing protection and resistance to environmental stresses and host immune responses, making it a unique feature of of M.tuberculosis
list the symptoms and signs of TB
-chronic cough
-haemoptysis
-chest pain
-dyspnoea
-loss of appetite
-night sweats
-fatigue
-general inspection
describe chronic cough as a symptom of TB
a persistent, long lasting cough that may produce septum and is a hallmark of TB
describe haemoptysis as a symptom of TB
coughing up blood or blood-tinged sputum, often associated with advanced TB
describe chest pain as a symptom of TB
discomfort or pain in the chest, which can be sharp or aching and is often related to inflammation of lung tissue
describe dyspnoea as a symptom of TB
SOB or difficulty breathing, typically due to lung damage caused by TB
describe loss of appetite as a symptom of TB
a reduced desire to eat or unintended weight loss, common in TB due to the infections impact on overall health
describe night sweats as a symptom of TB
sweating profusely during sleep, often accompanied by low grade fever, classic symptom of TB
describe fatigue as a symptom of TB
persistent feeling of tiredness or weakness, which can be a result of the body’s efforts to combat TB infection and the associated inflammation
describe general inspection as a sign of TB
pallor, wasted appearance (cachectic), clubbing
list the symptoms and signs of extra pulmonary TB
haematuria
headache
back pain
hoarseness
abdominal discomfort
describe haematuria aș a symptom of extra pulmonary TB
blood in urine due to TB of kidney/GI system
describe headache as a symptom of extra pulmonary TB
headache or confusion due to TB meningitis, a rare complication
describe back pain as a symptom of extra pulmonary TB
persistent back pain due to TB of the spine or MSK system
describe hoarseness as a symptom of extra pulmonary TB
voice hoarseness due to TB of the larynx or the upper airways
describe abdominal discomfort as a symptom of extra pulmonary TB
abdominal discomfort, distension, and bloating due to peritoneal TB
list the investigations for TB diagnosis
-sputum microscopy
-sputum culture
-drug sensitivity
-CXR
describe sputum microscopy as a investigation for TB dx
a diagnostic technique that involves examining a patients sputum (phlegm) under a microscope to detect the presence of Tb bacteria (acid fast bacili) and confirm a TB infection
describe sputum culture for TB Dx
a lab test where a sample of a patients sputum is cultured to grow and identify M.tuberculosis bacteria, allowing for a definitive dx of TB
describe drug sensitivity as an investigation for TB dx
testing performed on cultured TB bacteria to determine their susceptibility to specific anti-TB drugs, guiding the choice of an effective treatment regimen for the patient’s strain of TB
describe chest x ray as an investigation for TB dx
there is no unique TB pattern, however fibro-nodular changes are common
list the common complications of TB
-pleural effusion
-haematogenous TB
-cardiac TB
-ocular TB
-hepatic TB
-GI TB
describe pleural effusion as a complication of TB
TB invades pleura leading to inflammation and accumulation of fluid in the pleural space, causing chest pain and breathing difficulties
describe haematogenous TB as a complication of TB
spread of TB through the bloodstream, potentially affecting various organs and systems
describe cardiac TB as a complication of TB
TB infection of the heart or its membranes, leading to heart-related symptoms and complications
describe ocular TB as a complication of TB
TB involving the eye, leading to eye pain , visual disturbances or even blindness
describe hepatitis TB as a complication of TB
TB affecting the liver, which may result in hepatomegaly or liver dysfunction
describe gastrointestinal TB as a complication of TB
TB in the digestive tract, causing symptoms like abdominal pain, diarrhoea and weight loss
how to treat bacterial pneumonia
treatment with specific antibiotics (amoxycillin for S.pneumoniae)
how to treat viral pneumonia
treatment with oseltamivir only in cases with risk factors for poor outcomes of influenza (pregnant).; cease immediately when influenza is ruled out
principles for managing TB
NEVER use one drug only and NEVER add one drug to a failing regimen
what are the two phases of TB
intensive and continuation
what is the management for intensive (bactericidal) phase of TB
isoniazid, rifampicin, pyrazinamide, ethambutol (treat for 2 months)
peri
what is the management for continuation (sterilisation) phase of TB
isoniazid, rifampicin (treat for 4 months)
what is DOT
directly observed therapy
-involves a practitioner observing treatment administration.
-ensures compliance and monitors for side effects.
-can be done in person or via video.
-recommended for patients with cultural barriers, cognitive issues, or high-risk cases
distinguish classification of acute and chronic chest infection
Acute chest infection is defined as infection that lasts <3 weeks in duration; anything longer is defined as a chronic chest infection.
what is persistent infection aka
persistent chest infection is the preferred term for chronic chest infection and is characterised by stability and interruptions by exacerbations.
what is the pathogenesis of chronic chest infection
-Underlying lung pathology
-Inflammation
-Impaired (ability to clear secretions,
respiratory effort, cough or gag reflex, immunocompromised patients)
-microbial colonisation
-Infection
-Further inflammation
-Further damage in a vicious
cycle
risk factors for persistent chest infection
-inability to clear secretions
-reduced respiratory effort
-decreased cough or gag reflex
-immunocompromised patients
list the clinical features of persistent chest infection
productive cough
malaise
chest pain
fever
describe productive cough as a symptom of persistent chest infection
cough that produces mucus or phlegm
describe malaise as a symptom of persistent chest infection
general feeling of discomfort or unease, often accompanied by fatigue
describe chest pain as a symptom of persistent chest infection
discomfort or pain in chest area, can vary in intensity
describe fever as a symptom of chest infection
elevated body temperature, often a sign of infection or inflammation
list the treatment methods for persistent chest infection
antibiotics
airway clearance
vaccination
education
smoking cessation
emergency pack use
describe antibiotic use for persistent chest infection
medications that target and eliminate the infectious agents responsible for chest infection (only of bacterial aetiology)
describe airway clearance as a treatment for persistent chest pain
techniques and therapies to help remove mucus and improve airflow in the respiratory tract
describe vaccination for treatment in present chest infection
preventative immunisation to protect against specific respiratory infections
describe education as a treatment for persistent chest infections
providing information and guidance on managing the condition and preventing exacerbation
describe smoking cessation as a treatment for persistent chest infection
quitting smoking to reduce respiratory infection and lower risk of recurrent infections
describe emergency pack use as treatment for persistent chest infection
the use of a prepared kit containing necessary mediations and instructions for managing acute exacerbations of chronic chest infections
what is bronchiectasis
chronic respiratory condition characterised by the abnormal widening and scarring of the airways in the lungs, leading to recurrent infections and mucus build-up
what are the events in the pathogenesis of bronchiectasis
-impaired drainage/obstruction
-host response
-transmural inflammation
describe the impaired drainage part of bronchiectasis
impairment of mucus clearance and drainage within the airways due to structural abnormalities, leading to mucus accumulation and bacterial growth.
describe host response as part of bronchiectasis
In response to chronic infection and inflammation, the body’s immune system mounts a prolonged defence, contributing to tissue damage and the perpetuation of the condition.
describe the transmural inflammation part of bronchiectasis
Bronchiectasis is associated with inflammation that extends through the full thickness of the airway wall, leading to structural changes in the bronchi and bronchioles.
list the clinical features of bronchiectasis
productive cough
dyspnoea
sleep changes
change in appetite
systemic infection
describe productive cough as a symptom of bronchiectasis
Bronchiectasis patients often experience a persistent cough that produces excessive mucus or sputum.
describe dyspnoea as a symptom of bronchiectasis
Shortness of breath is a common symptom, which can worsen during physical activity or exacerbations.
describe sleep changes as a symptom of bronchiectasis
sleep disturbances may occur due to coughing, breathlessness, or discomfort.
describe appetite changes as a symptom of bronchiectasis
some individuals with bronchiectasis may experience changes in their appetite, possibly due to chronic symptoms or medication side effects.
describe systemic infection as a symptom of bronchiectasis
bronchiectasis can lead to recurrent lung infections that may affect the entire body, causing symptoms like fever and malaise
list the investigations for clinical diagnosis of bronchiectasis
history/exam
sputum culture
chest x ray
LFT
CBE
how is sputum culture used to dx bronchiectasis
Collecting a sample of respiratory secretions to identify the presence of bacteria, fungi, or other pathogens in the airways.
how is CXR used to dx bronchiectasis
Using radiographic imaging to visualize the chest and assess for structural abnormalities or signs of bronchiectasis.
how is LFT used to dx bronchiectasis
Measuring lung capacity and function to evaluate respiratory health and assess for any obstructive patterns indicative of bronchiectasis.
how is CBE used to dx bronchiectasis
Analysing blood samples to check for signs of infection, inflammation, or anaemia, which can be associated with bronchiectasis.
list the management for bronchiectasis
physical therapy
positive airway pressure
antibiotic therapy
pulmonary rehab
smoking cessation
purpose pf physical therapy in managing bronchiectasis
airway clearance techniques to remove mucus and improve lung function in bronchiectasis.
purpose of positive airway pressures in managing bronchiectasis
Application of continuous or bilevel air pressure to support breathing and alleviate airway obstruction.
purpose of antibiotic therapy in managing bronchiectasis
Medications to treat and prevent bacterial lung infections associated with bronchiectasis
purpose of pulmonary rehab in managing bronchiectasis
Comprehensive program involving exercise, education, and support to enhance respiratory function and quality of life in bronchiectasis patients.
purpose of smoking cessation in managing bronchiectasis
The process of quitting smoking, a critical step in managing bronchiectasis to reduce lung irritation and complications.
describe the epidemiology of cystic fibrosis
-3385 people living with cystic fibrosis
-median age of dx is 20.2 y/o
-mostly inherited by Caucasians
-autosomal recessive
how many classifications for CF is there
six
I, II, III, IV, V, VI
APP NAS
what is I cystic fibrosis
A
caused by a mutation that results in the absence of functional CFTR protein, leading to severe disease with minimal/no CFTR activity
what is II cystic fibrosis
P
associated with mutations that results in defective CFTR protein processing and reduced function, causing moderate to sever symptoms
what is III cystic fibrosis
P
involves mutations leading to partially functional; CFTR protein, resulting in variable and typically milder symptoms
what is IV cystic fibrosis
N
characterised by mutations casing normal CFTR protein production, but with impaired function, resulting in mild or atypical CF symptoms
what is V cystic fibrosis
A
involves mutations that affect CFTR regulation and unction, leading to mild or atypical CF symptoms
what is VI cystic fibrosis
S
associated with mutations causing reduced CFTR protein stability, resulting in mild or atypical CF symptoms with residual CFTR function.
how does dysfunctional CTFR effect the respiratory system
CFTR mutations result in the production of thick and sticky mucus in the airways, making it difficult to clear mucus. This leads to chronic airway obstruction, recurrent lung
infections, and progressive lung damage.
how does dysfunctional CTFR effect the digestive system
In the digestive system, CFTR mutations affect the pancreas, reducing its ability to release enzymes necessary for digestion. This leads to malabsorption of nutrients,
malnutrition, and gastrointestinal issues.
how does dysfunctional CTFR effect the glandular system
The CFTR protein plays a role in regulating salt and water balance in sweat glands. Mutations in CFTR lead to salty-tasting skin due to elevated salt levels in sweat, which is a diagnostic feature of cystic fibrosis.
how does dysfunctional CTFR effect the reproductive system
CFTR mutations can cause infertility in both males and females due to issues with the production and transport of reproductive fluids.
how does dysfunctional CTFR effect other systems
CFTR mutations can also affect the liver, leading to complications such as liver disease. Additionally, they can impact other organ systems to varying degrees, resulting in a wide range of symptoms and complications beyond the respiratory and digestive systems
what is anticipation (genes)
-pt presents with more severe symptoms or appears at an earlier age in each successive generations.
-Example: Huntington’s disease (trinucleotide repeat expansion)
what is incomplete penetrance
-Some individuals carry a gene mutation but do not show symptoms.
-Influenced by other genetic and environmental factors.
what is variable expressivity
-Disease severity and clinical manifestations vary among individuals with the same mutation.
-Influenced by genetic modifiers and environmental factors.
what are modifier genes
-Other genes can enhance or reduce the effects of the disease-causing mutation.
-Affect disease severity and presentation.
what are multifactorial diseases
-Common diseases (e.g., heart disease, cancer) involve multiple gene variations and environmental factors.
-Leads to a wide range of disease presentations and complications in management.
purpose of genotype testing in CF
- Genotype testing identifies specific CFTR mutations, helping determine an individual’s genetic profile in cystic fibrosis.
- Different CFTR mutations respond to different therapies, guiding the selection of mutation-specific medications like modulator therapies.
-also helps inform treatment plans which includes optimising airways. nutritional support and antibiotic regimens
list the therapies for CF
symptomatic therapy
CFTR modulator drugs
genetic therapies
what is symptomatic therapy for CF
Treatment aimed at managing and alleviating the symptoms and complications of cystic fibrosis to improve quality of life.
what are CFTR modulator drugs for CF
Medications designed to correct the function of the defective CFTR protein in cystic fibrosis patients, addressing the underlying genetic cause of the disease.
what are genetic therapies for CF
Emerging treatment approaches that aim to correct or modify the genetic mutations responsible for cystic fibrosis to provide a potential cure or long-term
disease management.
clinical presentation of CF
-Persistent cough with thick mucus
-Frequent lung infections (e.g., pneumonia, bronchitis)
-Wheezing or shortness of breath
-Salty-tasting skin
-Poor growth or weight gain despite good appetite
-Frequent greasy, bulky stools (malabsorption)
-Sinus infections or nasal polyps
-Infertility in males
