RESPIRATORY Flashcards
Define Obstructive sleep apnoea
where airway is blocked and breathing interrupted for 10 seconds or more
Due to upper airway obstruction
How many desaturations per hour: Normal 0-5 Mild 5-15 Moderate 15-30 Severe >30
Aetiology of OSA
Muscle relaxation
Narrow pharynx
Obesity
Down syndrome - small nasal cavities obstruct
Symptoms and signs of OSA
heavy snoring Typically un-refreshing sleep which leads to: Daytime somnolence /sleepiness Poor daytime concentration Oxygen desaturation
How do you diagnose OSA
Clinical history and examination
Epworth Questionnaire
- questions aimed at determining your sleepiness during the at certain activities
Overnight sleep study:
Pulse oximetry
Limited sleep studies
Full Polysomnography
{-O2 saturation
-Ornonasal airflow, check for obstruction >10s
- record sleep/eye movements/peripheral muscles/heart }
What is the management and treatment of OSA
Identify and moderate exasperating factors:
(weight reduction, avoid alcohol, endocrine disorder)
CPAP
Mandibular repositioning splint
(creates more space at the back of the throat)
adenotonsillectomy
Define Chronic Ventilatory failure
Respiratory failure with PaCO2 >6kPa
Aetiology of Chronic ventilatory failure
Airway disease: COPD asthma bronchectasis OSA
Chest wall abnormalities:
kyphoscoliosis
Respiratory msucle weakness: motor neurone disease (ALS) muscular dystrophy cerebral palsy duchenne's MD (death due to resp failure)
Central hypoventilation:
obesity hypoventilation syndrome
Chronic neonatal lung disease:
cardiac complications
Cystic fibrosis:
FEV1 low / SaO2 low
Down syndrome (OSAS)
prader-Willi syndrome (excessive daytime sleepiness)
Signs and symptoms of Chronic ventilatory failure
Breathlessness
Orthopnoea - breathlessness lying flat
Ankle swelling
Morning headache - due to increased CO2
Recurrent chest infections
Disturbed sleep
Paradoxical abdominal wall motion: chest move inward during inspiration
Normal pH, elevated pCO2
What is the diagnosis and management of chronic ventilatory failure
Spirometry and Pulmonary function variations from lying down to standing up: Lung volume, CO
Assessment of Hypoventilation - overnight oximetry, CO2 monitoring
Fluoroscopic screening of diaphragms
- how well they are working
Non invasive ventilation and oxygen therapy
What is the aetiology of Pneumonia
inflammation of your lung and air sacs
community acquired Hospital acquired Immunocompromised Atypical (Iegionella) Recurrent
Aspiration: (Vomiting Oesophageal Lesion Obstetric Anaesthesia Neuromuscular Disorders Sedation)
What is the microbiology of Pneumonia
strep. Pneumonia, influenza Leigonella s.aureas mycoplasma pneumonia chlamydia psitacci
Symptoms and signs of pneumonia
Malaise Fever chest pain cough Plurent sputum Dyspnoea Headache
Pyrexia Tachpnoea Central cyanosis Dullness on percusion of affected lobe Harsh Bronchial breath sounds/decreased breath sounds Inspiratory crepitations Increased vocal resonance decreased expansion on one side
Investigations for Pneumonia
serum biochemistry
full blood count, blood culture ESR, CRP
CXR
Throat swab - Sputum microscopy and culture
Urinary legionella/pneumococcal antigen
(atypical pneumonia)
biopsy
What is the treatment for Pneumonia
Confusion blood urea>7 Respiratory rate >30 diastolic blood pressure <60 over the age 65
= CURB65
Blactams + macrilodes
0- amoxycillin
1-2 - Hospital treatment
Amoxycillin + clarithromysin
(levofloxacin-penicillin allergic)
3-5- Co-amoxiclav + clarithromysin
Oxygen, IV, CPAP/intubation+ ventilation, analagesia, fluids
Infants - nothing
if needed oral amoxycillin
What is the aetiology of bronchiectasis
damaged dilated airways, thickened airway wall and increased mucus production:
Sever or repetitive infections
Lung tissue destruction
Bronchial obstruction
immotile cilla syndrome
cystic fibrosis
childhood measles
allergic bronchopulmonary
aspergillios
crytogenic organising pneumonia
What is the signs and symptoms of Bronchiectasis
chronic cough sputum production Heamoptysis frequent chest infection wheeze dyspnoea tiredness chest pain
Finger clubbing
Lung crackles inspiration and expiration
What is the investigations and treatment for bronchiectasis
CT Sputum culture serum immunoglobulins total IgE and aspergilus CF genotyping (look for underlying cause)
antibiotics
surgery
postural drainage
Chest physiotherapy - break up mucus
beta 2 agonist/ steroid - needed for wheeze
Empyema
Infection in fluid - creates a trapped lung
Results in Chest pain and fever
Investigation: CT, pleural ultrasound, Pleural aspiration
Treatment: IV antibiotics 6 weeks, chest drain, pleuroectomy
Aetiology of Cystic fibrosis
A defect mutuation on chromosome 7Q which has the autosomal recessive CGTR gene
(regulates the movement of salt in and out of the cell)
Prevents the transport of chloride ions, so no longer regulates the liquid volume on the epithelia surface
cilla collapse
- decreased muco-cillary clearance
- production of a thick, sticky mucus in the respiratory and digestive system
- increased bacterial adherence
- Build up mucus and bacterial adherence/colonisation leads to inflammation and airway damage/ulceration
- Progressive airflow obstruction = bronchiectasis
Signs and symptoms of CF
Symptoms:
recurrent chest infections (pneumonitis / bronchiectasis / scarring / abscesses)
chronic purulent sputum production (due to bronchiectasis)
onset diabetes (due to pancreas issues)
weight loss
fever
Signs: haemopytsis (infection) pneumothroax (older males) male infertility nasal polyps failure to thrive (pancreatic insufficiency) abnormal stools (pancreatic insufficiency); steatorhea meconium delay in babies (first poop) osteoporosis; vitamin D issue malnutrition;
CARDINAL FEATURES:
RECCURENT BRONCHOPULMONARY INFECTIONS
PANCREATIC INSUFFICENY
What is the management and treatment of CF
Pancreatic insufficiency: Enteric coates enzyme pellets (deal with fat) H2 antagonists Proton pump inhibitors Good nutrition - high energy diet Fat soluble vitamin + mineral supplements Active life
Recurrent bronchopulmonary infection: Mucolytics Prophylactic antibiotics Annual influenza vaccination Segregation to other CF patients
Reduce inflammation:
{Ibuprofen, Azithromysin, Prednisolone}
Suppress bacterial load
by Antibiotics: 2 antibiotics large dose 2 weeks
-beta lactams
-aminoglycosides
Psuedomonase aeruginosa
- Oral ciprofloxacin/IV cefazdime + nebulised colomycin
Ivacaftor
Double lung transplant
Microbiology of cystic fibrosis
pseudomonas aeruginosa (60%) IV
staphylococcus aureus (42%) ORAL haemophilus influenzae (15%) ORAL stenothrophomonas maltaphillia (5.5%) IV burkholderia cepacia (3.5%) IV mycobacterium abscessus
What is the investigation for CF
(to analyse lung transplant necessity)
- pulmonary function test
- spirometry
CxR
- look for over-inflated lungs or abdomen (for intestines)
Screening
Guthrie test (heel-pin test) for day 5 babies;
looks for immunoreactive trypsinogen; if positive, mutation analysis tests + sweat chloride test
Diffuse alveolar damage aetiology and pathology
Signs and symptoms
major trauma chemical injury circulatory shock Drugs infection autoimmune disease radiation idiopathic
exudative stage:
damage results in leaky capillaries causing pulmonary oedema and forms hyaline membrane
proliferation stage:
Fibril and inflammatory cells = Fibrosis
= Acute respiratory distress, dysnopea, type 1 respiratory failure
What is the aetiology and pathology of Interstitial pneumonitis response
Connective tissue disease e.g. rheumatoid Drug reaction post infection industrial exposure acute DAD
Progressive decline in lung function
Lung tries to reapir itself with cystic fibrosis but fails and creates the appearance of a honey comb lung, scarring on both lungs as type 2 pnuemocytes enlarge and fibroblastic foci appear (No granulomas)
What is the signs and symptoms of Interstitial pneumonitis response
Dysnopea Cough basal crackles cyanosis clubbing abnormal CXR Type 1 respiratory failure
