Conditions

Question 1

what is pleural effusion?

Answer 1

excess fluid that accumulates in the pleural cavity

Question 2

what are the causes of a pleural effusion?

Answer 2

secondary to bacterial/viral infection (e.g. pneumonia/TB)
cancer
heart failure
pulmonary embolus

Question 3

what is pleurodesis?

Answer 3

sticking the parietal and visceral pleura together

Question 4

what is a pleurectomy?

Answer 4

stripping the parietal pleura from the chest wall

Question 5

what is empyema?

Answer 5

collection of pus in the pleural space

Question 6

what are the causes of empyema?

Answer 6

bacterial pneumonia
lung abscess
thoracic surgery
trauma / injury to the chest

Question 7

what is a pneumothorax?

Answer 7

the presence of air in the intrapleural space

Question 8

what are the causes of a pneumothorax?

Answer 8

an abnormal communication between either
the alveoli and the pleural space e.g. emphysema
the atmosphere and the pleural space e.g. stab wound
skeleton growing quicker than lungs, tearing a hole in the pleura (very tall young men)

Question 9

what would you hear on auscultation of someone with a pneumothorax?

Answer 9

reduced breath sounds

Question 10

what is a tension pneumothorax?

Answer 10

where the pleura has torn and acts as a one way valve. rapid build up of air, heart gets compressed and pushed away from the side of the pneumothorax, cant fill effectively with blood, can lead to cardiac arrest

Question 11

how can physios increase lung volume?

Answer 11

positioning
deep breathing exercises
physical exercise

Question 12

what is pneumonia?

Answer 12

inflammation of lung parenchyma associated with alveolar filling with exudate

Question 13

what are the causes of pneumonia?

Answer 13

infection
secondary to chemical or physical injury to the lungs
idiopathic
most common - viruses and bacteria

Question 14

why might someone with pneumonia get haemoptysis?

Answer 14

inflammation may cause leaking of the capillaries and therefore blood in sputum

Question 15

what are some potential complications of pneumonia?

Answer 15

respiratory failure
pleural effusion
empyema
lung abcess

Question 16

why doesnt HPVC work in pneumonia?

Answer 16

the presence of inflammatory cytokines reverses HPVC as inflammation is associated with vasodilation

Question 17

what is asthma?

Answer 17

an allergic, chronic, inflammatory disorder of the airways

Question 18

what are some of the cells that play a role in asthma?

Answer 18

mast cells, eosinophils, t lymphocytes

Question 19

what are the risk factors for asthma?

Answer 19

urban living conditions
family history of allergic disease
presence of allergen specific immunoglobulin E (IgE)
aeroallergen exposure
viral respiratory illness
lower socioeconomic status

Question 20

what is atopic asthma?

Answer 20

a genetic susceptibility to produce IgE directed towards common environmental allergens (house dust mites, animal proteins, funghi). IgE sensitises and activates mast cell lymphocytes causing a powerful inflammatory reaction

Question 21

what is non atopic asthma?

Answer 21

imbalance of the PNS and SNS responses in the airways

Question 22

what happens in the PNS response in non atopic asthma?

Answer 22

the release of acetocholine by PNS causes bronchoconstriction

Question 23

what happens in the SNS response in non atopic asthma?

Answer 23

the SNS stimulates mast cells producing inflammatory response

Question 24

what are the causes of airway obstruction in asthma?

Answer 24

airway inflammation
cellular infiltration
subsequent cytokine production

Question 25

what induces reduced airflow in asthma?

Answer 25

mucosal oedema (inflammation) bronchoconstriction thickening of the airway wall presence of secretions within the airway lumen

Question 26

where in the tracheobronchial tree do asthma airway changes occur first?

Answer 26

large airways (trachea, mainstem bronchi, lobar bronchi, segmental bronchi)

Question 27

what times of day are asthma symptoms worst?

Answer 27

at night or early in the morning

Question 28

what is status asthmaticus?

Answer 28

acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators and steroids

Question 29

what is COPD?

Answer 29

A disease state characterised by airflow obstruction resulting from chronic bronchitis or emphysema. Progressive and only partially reversible

Question 30

what is chronic bronchitis?

Answer 30

persistent cough with sputum production for at least 3 months of the year for 2 consecutive years. chronic inflammatory disease of the airways

Question 31

what is emphysema?

Answer 31

disease of the alveoli, the permanent enlargement of the air spaces distal to the terminal bronchiole

Question 32

what is the genetic cause of emphysema (2-3% of cases)?

Answer 32

alpha 1 antitrypsin deficiency

Question 33

how does alpha 1 antitrypsin deficiency cause emphysema?

Answer 33

alpha 1 antitrypsin inhibits the action of enutrophil elastase (which destroys elastin, a major structural protein within alveolar walls)

Question 34

what is polycythaemia?

Answer 34

increase in total volume of RBC in response to chronic hypoxia to increase the oxygen carrying capacity of the blood. however, increases blood viscosity which can reduce blood flow and result in blood clots

Question 35

what are the signs of respiratory distress?

Answer 35

pursed lip breathing prolonged expiration tachypnoea active expiration fixing upper limbs use and hypertrophy of accessory muscles soft tissue recession hoovers sign

Question 36

why is pursed lip breathing a sign of respiratory distress?

Answer 36

breathing out against resistance created at the mouth generates a positive pressure within the airways to help splint airways open during expiration

Question 37

what is tachypnoea?

Answer 37

increased respiratory rate

Question 38

why is fixing upper limbs a sign of respiratory distress?

Answer 38

allows reversal of the origin and insertion of pec minor so it can be used as an accessory muscle of inspiration

Question 39

how are SCM and scalenes used as accessory muscles of inspiration?

Answer 39

elevate the rib cage and increase thoracic diameter in a vertical direction

Question 40

what is hoovers sign?

Answer 40

indrawing of lower ribs on inspiration (a sign of diaphragmatic fatigue)

Question 41

what are the FEV/FVC % for mild, moderate and severe COPD?

Answer 41

mild 60-80% moderate 40-59% severe <40%

Question 42

what is lung volume reduction surgery?

Answer 42

removes bullae, relieving compression on healthy lung tissue and reducing lung volumes so the lungs are less hyperinflated. allows the diaphragm to assume a domed position again and improves length-tension relationship of the diaphragm and facilitates contraction

Question 43

what is type 1 respiratory failure?

Answer 43

low PaO2, normal PaCO2

Question 44

what is type 2 respiratory failure?

Answer 44

low PaO2, low PaCO2

Question 45

what is interstitial pulmonary fibrosis?

Answer 45

a chronic, relentlessly progressive fibrotic disorder of the lungs of unknown aetiology.

Question 46

who does IPF typically affect?

Answer 46

age 40+ more common in males than females

Question 47

what is the average survival time from diagnosis?

Answer 47

2.5-3.5 years

Question 48

what is bronchiectasis?

Answer 48

chronic disease of one or more bronchi (airways widening)

Question 49

what is cystic fibrosis?

Answer 49

an inherited, genetic condition leading to mucus build up in the lungs

Question 50

what is the gene effected and on what chromosome in cystic fibrosis?

Answer 50

cystic fibrosis transmembrane regulator on chromosome 7

Question 51

what tests can be used for CF?

Answer 51

sweat test - high chloride concentration meconium ileus heel prick blood test

Question 52

what organs are affected in CF?

Answer 52

reproductive organs liver nose and sinuses sweat glands pancreas lungs

Question 53

which lung lobes are most affected in CF?

Answer 53

upper lobes

Question 54

what is pulmonary tuberculosis?

Answer 54

Contagious bacterial infection caused by the bacterium mycobacterium tuberculosis, that mainly involves the lungs but may spread to other organs (lymph nodes, kidneys, liver, bones)

Question 55

what is Duchenne muscular dystrophy?

Answer 55

gradual loss of functional muscle fibres and those muscle fibres are replaced with fat and connective tissue. inherited condition, in males only

Question 56

what is guillian barre syndrome?

Answer 56

mistargetted immune response affecting peripheral nerves