Y2 revision Flashcards
What is bronchiectasis?
Airways become widened and full of secretions, mostly due to an infection such as pneumonia
- Like COPD but infection rather than smoking
- Can often clinically resemble COPD and asthma
What is wheezing?
- Heard on EXPIRATION
- Musical noise produced by air moving through narrowed airways
- Think asthma and COPD
What is stridor?
- Heard on INSPIRATION
- Think whooping cough, epiglottitis, foreign body, tumour, oedema
Discuss asthma
REVERSIBLE AIRFLOW OBSTRUCTION
- Eosinophil infiltration (IL-5)
- Excessive Th2 response – cytokines and inflammation
- Smooth muscle hypertrophy
- Increased mucus production
- Polyphonic
What is Cheyne Stokes respiration?
- Abnormal breathing pattern
- Progressively deeper and faster breathing
- resulting in apnea (temporary cessation of breathing)
Define apnea
Temporary cessation of breathing
Outline some respiratory symptoms
- Clubbing (>180)
- Astrexis (flapping tremor)
- Use of accessory muscles
- Intercostal drawing
- Pursed lip breathing
What are rhonchi?
Low pitched wheezes
What is the leading cause of death amongst all infectious diseases?
Lower respiratory tract infections
Discuss acute bronchitis
- Inflammation of bronchial tree
- Peak incidence in winter
- S.O.B, wheezing, chest pain
- No consolidation
- Usually viral
Discuss legionella pneumophilia
* penecillins don’t work: quinolones or macrolides*
- Gram negative bacteria, aerobic, non spore forming
- Resides in water >50 degrees – killed
- Causes Legionnaire’s - a type of atypical pneumonia
- Can be caught from air conditioning systems and spas
- Replicates inside macrophages
What is mycoplasma pneumoniae?
- Atypical bacteria that commonly causes mild infections of the URT
- Pneumonia caused by M.pneumoniae is referred to as walking pneumonia because symptoms are a lot milder that other types
- Treated with macrolides or tetracycline
What is haemophilus influenzae?
- Gram negative, coccobacillary, anaerobic
- Grows well on chocolate agar at 37 degrees with a CO2 rich environment
type B: most common, meningitis, septicaemia, pneumonia
Types of asbestos
- Serpentine – 99%, white (least potent), curly and flexible fibres
- Amphiboles – 1%, blue or brown (most potent), straight and rigid fibres
Discuss TB
- Caused by m.tuberculosis and m.bovis (mainly the former)
- Bacterial infection spread via aerosols
- Strict aerobes, acid fast (bright red when ziehl-neelsen stained)
- Rod shaped, non classified as either gram +/-
- Grows inside macrophages (obligate intracellular pathogen
- 2 million people infected worldwide, 90% asymptomatic
What are the mechanisms of airflow obstruction?
- Excessive secretions
- Contraction of bronchial smooth muscle
- Loss of outward traction due to lack of alveoli tethering walls
Outline the airway changes seen in asthma
Acute:
- smooth muscle contraction
- Mucus hypersecretion
- Plasma leakage
- Oedema
- Sensory nerve activation
Chronic:
- Smooth muscle hypertrophy
Diagnosis of asthma
- presence of reversible airflow obstruction
- Increase of FEV1 of 15% when bronchodilator given
Discuss COPD
- Encompasses emphysema, chronic bronchitis and chronic asthma
- NEUTROPHILS
- Chronic, slowly progressing
- Airflow obstruction that doesn’t change for months
- chronic productive cough
- FEV1 does not improve after bronchodilator given
- mucus gland hypertrophy, smooth muscle hypertrophy, inflammatory cell infiltrate
Discuss emphysema
- Pink puffers
- Abnormal enlargement of airspace due to wall destruction
- alveoli become damaged and elasticity is lost – decreased surface area and alveoli can collapse
- Air trapping occurs because recoil mechanism is lost
Discuss chronic bronchitis
- Blue bloaters
- Smooth muscle hypertrophy and mucus hypersecretion
What are the stages of COPD?
FEV1 % of predicted:
80% = stage 1
50-79% = stage 2
30-49% = stage 3
<30% = stage 4
How is chronic pulmonary hypertension treated?
- Long term oxygen therapy
- Anticoagulants to reduce clot risk
- Diuretics to address oedema
