COPD and Pneumonia Flashcards Preview

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Flashcards in COPD and Pneumonia Deck (92):
1

Give a brief outline of what COPD actually is

Characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways, which does not change markedly over several months

2

What is airflow obstruction?

• Reduced FEV1 • Reduced FEV1/FVC ratio

3

Outline the epidemiology of COPD

• 89% of the population is unaware • 3.7 million affected in the UK • 1 million symptomatic • 30,000 deaths • 1 million hospital inpatient days/year

4

What is COPD caused by?

• Abnormal inflammatory response of the lung to noxious particles or gases • Noxious particles can come from cigarette smoke or atmospheric pollutants (not just cigarettes! Manual workers, indoor cooking fire)

5

What is a less common cause of emphysema?

• Inherited deficiency of a1-antitrypsin

6

Two ways in which inflammation causes pathology of COPD

• Inflammation amplified by host factors • Oxidative stress • Proteinases (followed by various repair mechanisms)

7

Give four changes in the airways in patients with COPD

• Changes in large airway • Changes in small airways in COPD • Changes in lung parenchyma • Changes in pulmonary arteries

8

Give three main causes of COPD?

• Smoking • Environmental factors • Genetic predisposition

9

What are the mechanisms of COPD?

Airway and systemic inflammation
Alveolar destruction
Hyperinflation
Respiratory muscle inefficiency
Skeletal muscle dysfunction

10

What are the main consequences of COPD?

Airway obstruction
Dyspnoea
Exercise limitation
Nutritional depletion
Respiratory failure

11

What are five impacts of COPD?

• Mobility • Health status • Moos • Hospitalisations • Death

12

How does COPD make itself worse?

COPD -> Breathlessness -> Reduced exercise capacity -> Poor health related quality of life
Breathlessness reduces exercsise capacity

13

Give some symptoms of COPD

Productive cough
Wheeze
Breathlessness

14

Give some signs of COPD

Hyperventilation with prolonged expiration - Expiratory airflow limitation
Use of accessory muscles
Hyperinflation of the lung

15

What are the five main factors which you must assess to determine a diagnosis of COPD

• History ○ Include MRC dyspnoea scale • Chest X-ray ○ To rule out lung cancer • FEV1 ○ Reduced FEV1 ○ Reduced FEV1/FVC ratio • Other lung function tests ○ Lung volumes, loop • High resolution CT scan ○ Detect emphysema (bulla?)

16

What is the MRC dyspnoea scale?

1. Not troubled by breathlessness except on strenuous exercise
2. Short of breath when hurrying or walking up a slight hill
3. Walks slower than contemporaries on level ground because of breathlessness, or has to sop for breath when walking at own pace
4. Stops for breath after walking about 100m or after a few minutes one level ground
5. Too breathless to leave the house, or breathless when dressing or undressing

17

What is spirometry?

• Patient fills their lungs from the atmosphere and breathes out as far and fast as possible through a spirometer • Simple spirometery allows measurement of many lung volumes and capacities

18

What happens to respiratory rate, pO2 and CO2 in Type 1 Respiratory failure

• Respiratory rate increases • pO2 decreases • CO2 decreases or stays normal

19

What happens to respiratory rate, pO2 and CO2 in type 2 respiratory failure

• Respiratory rate increases • pO2 decreases • CO2 increases

20

Give four principles of the management of respiratory failure?

• Correct underlying cause • Supplementary oxygen • Support ventilation • Secretion management

21

What occurs in oxygen therapy?

• O2 given to patients to increase O2 saturation and alleviate symptoms.

22

What is O2 therapy a treatment for?

Hypoxia

23

Why is O2 therapy useful as a treatment?

• Long term • Portable • Intermittent

24

Can COPD be cured?

• No, only managed

25

Give 6 ways in which COPD can be treated

• Smoking cessation • Drug therapy • Oxygen therapy • Pulmonary rehabilitaton • A1 - antitrypsin replacement • Treat co-morbid conditions

26

How can smoking cessastion help with COPD?

• Prevents future worsening of the condition • Adds years onto life

27

How does drug therapy assist with COPD treatment?

• Used for short term management of exacerbation and the long term relief of symptoms

28

What drugs are used in COPD?

• Bronchiodilators ○ B2 antagonist • Corticosteroids ○ Immunosupressive • Antibiotics ○ Shortens exacerbations ○ Given as soon as sputum turns yellow or green

29

How does oxygen therapy help?

• Increase blood oxygen saturation by administering oxygen

30

How does pulmonary rehabilitation help?

• Exercise training can modestly increase exercise capacity • Regular training periods can be used at home

31

What physiological effects does pulmonary rehabillitation have?

• Physiological ○ Muscle mass ○ Mitochondrial density • Health ○ Improved activity ○ Reduced care costs • Increases patients MRC grade by 1 point if done effectively

32

What can you do in hospitals to keep patients physically fit?

• Get them to the gym lad

33

How does a1-antitrypsin replacement work

• Replaces if deficient

34

What co-morbidities must be treated to fully effect improvement in COPD?

• Cardiac • Metabolic • Nutritional • Osteoporosis • Anxiety/depression

35

What is exacerbation of COPD?

• Worsening of previous stable condition • Increased wheeze, dyspnoea, sputum volum & colour • Chest tightness

36

What is NIPPV (Non-invasive positive pressure ventilation)in COPD?

• Acute exacerbation ○ Causes severe acidosis ○ Confusion

37

What surgery can be used to reduce effects emphsema?

• Lung volume reduction surgery

38

How do you calculate oxygen delivery?

• SaO2 x Hb x Cardiac Output

39

What is the definition of respiratory failure at sea levels in PaO2

40

Give four pulmonary causes of respiratory failure

• Hypoventilation • Ventilation/perfusion imbalnce • Alveolar/capillary diffusion block • True shunt

41

How does hypoventilation cause respiratory failure?

Raised PaCO2

42

How is ventilation/perfusion imbalance caused

• Asthma • Pulmonary embolism

43

How is a alveolar/capillar diffusion block caused?

• Pulmonary oedema • Fibrosing alveolitis

44

What is a true shunt?

• VSD and malformation

45

What does pO2 need to be to avoid hypercapnia?

• 88-92%

46

Outline four of the most common normal flora of the respiratory tract

• Viridans streptococci • Neisseria spp • Anaerobes • Candida spp

47

Give five less common flora in the URT

• Streptococcus pneumonia • Streptococcus pyogenes • Haemophillus influenza • Pseudomonas • E. coli

48

Give three of the main natural defences of the respiratory tract

• Cough and sneezing reflex • Muco-ciliary clearance mechanisms • Respiratory mucosal immune system

49

What are the muco-ciliary clearance mechanisims?

• Ciliated columnar epithelium • Nasal haris

50

What is the respiratory muscoal immune system?

• Lymphoid follicles of the pharynx and tonsils • Alveolar macrophages • Secrete IgA and IgG

51

List 5 upper respiratory tract infections

• Rhinitis • Pharyngitis • Epiglottitis • Laryngitis • Sinusitis

52

What are URT infections most commonly caused by?

• Viruses ○ Rhinovirus ○ Corona virus ○ Influenze ○ Respiratory Syncytial virus

53

What do bacterial super-infections cause?

• Common with sinusitis and otitis media• Can lead to ○ Mastoiditis ○ Meningitis ○ Brain abscess

54

What is pneumonia?

• General term denoting inflammation of the gas exchnage system of the lung, usually due to infection. Pneumonia is therefore an infection of the lung parenchyma.

55

What is lung inflammation due to other causes such as physical or chemical damage called?

Pneumonitis

56

What is lobar pneumonia?

• Pneumonia localised to a particular lobe of the lung • Most often due to streptoccocus pneumoniae

57

What is broncho pneumonia

• Pneumonia that is diffuse and patchy. Infection starts in the airways and spreads to adjacent alveoli and lung tissue. • Streptoccous pneumonia, Haemophilus influenza, Staphylococcus aureus, anaerobes

58

What is aspiration pneumonia

• Aspiration of food, drink, saliva or vomit can lead to pneumonia. • Most likely individuals with altered level of conciousness due to anathessia, alcohol or drug abuse - Also problems swallowing • Oral flora and anaerobes

59

What is interstitial pneumonia?

• Inflammation of the interstiticium of the lung • Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues)

60

What is chronic pneumonia?

• Inflammation of the lungs that persists for an extended period of time

61

What is the pathology of pneumonia?

• Fluid filled air spaces and consolidation • Gas exchange is impared - Results in systemic and local symptoms

62

In what four ways is pneumonia classified?

• By clinical setting - Community/hospital acquired • By presentation - Acute/sub acute and chronic • By organism - Bacteria/Viral/fungal • By lung pathology - Lobar pneumonia/bronchopneumonia/interstitial pneumonia

63

What are the three most common bacterial causes of community acquired infection

• Streptococcus pneumoniae • Haemophilus influenza • Klebsiella pneumoniae

64

Give three atypical bacteria involved in community based pneumonia

• Chlamydia pneumophillia • Mycoplasma pneumoniae • Legionelle pneumophilia

65

What are the three most comon causes of hospital acquired baceria/

• Pseudomonas • Staphylococcus aureus • MRSA

66

What are the two most common bacterial causes of aspiration pneumonia

• Anaerobes • Oral flora

67

What are the associated features of S. Pneumniae

• Elderly, co-morbidities, acute onset , high fever, pleuritic chest pain

68

What are the associated features of H. Influenza

COPD

69

What are the associated features of legionella

• Recent travel • Younger patient • Smoker • Illness • Multisystem involvement

70

What are the associated features of mycoplasm pneumonia

• Young • Prior to antibiotics • Extra-pulmonary involvement (haemolysis, skin and joint)

71

What are the associated features of staph aureus pneumonia

• Post viral • Intravenous Drug User

72

Give an associated feature of chalmydia pneumonia

• Contact with birds

73

Give an associated feature of coxiella pneumonia

• Animal contact

74

Give an associated feature of klebsiella pneumonia

• Thrombcytopenia, leucopenia

75

Give an associated feature of s.milleri

• Dental infections • Abdominal source • Aspiration

76

Outline the symptoms always present in pneumonia

• Fever • Malaise • Productive cough • Pleuritic chest pain • Breathlessnes

77

What will the sputum of someone with pneumonia look like?

• Purulent or rusty coloured

78

How quick is the onset of pneumonia, and what types are the fastest?

• Very rapid onset • Pneumoccoccal or staphylococcal, fatal outcome

79

Give some specific features of hospital acquired pneumonia

• Pneumonia occuring 48 hours after hospital • Make up 15% of all hospital acquired infections • Common in ventilated post surgical patients

80

How can the symptoms of pneumonia be assessed?

• CURB 65 score - presence of two or more indication for hospital treatment, patients with higher scores may require ICU treatment. ○ C - new mental Confusion (AMT 7mmol/l ○ R - Respiratory rate >30 per minute ○ B - Blood pressure (systolic 65

81

What does CURB 65 score assess?

• The severity, NOT the resistance of the pneumonia

82

Where are samples collected from to investigate pneumonia?

• Sputum • Nose and throat swabs • Endotracheal aspirate • Broncho alveolar lavage fluid • Blood culture

83

What microbiological investigations can be done for pneumonia?

• Macroscopic ○ Sputum, purulent, blood stained• Microscopy ○ Gram staining, acid fast• Culture ○ Bacteria and viruses• PCR ○ Respiratory viruses• Antigen detection ○ Legionella• Antiobody detection ○ Serology

84

What is an opportunistic infection?

• Pathogens infecting immunosupressed hosts

85

Give an example of 4 different types of opportunistic pathogen

• Viruses - Cytomegalovirus • Bacteria - Mycobacterium avium intracellulare • Fungi - Aspergillus candida, pneumocystitis jirovecil • Protozoa - Toxoplasmosis

86

Outline management of pneumonias

• Oral fluid /IV fluid if severe ○ Avoids dehydration • Anti-pyretic drugs ○ Reduce fever and malaise • Stronger analgesics ○ Deal with the pain • Oxygen ○ If there is cyanosis • Specific anti-biotics

87

What kind of anti-biotics is a community acquired pneumonia treated with

• Pneumococcus, which is sensitive to penicillin (antibiotics which affect the cell wall)

88

What kind of anti-biotics is hospital acquired pneumonia treated with?

• Target organism is more likely to be gram -'ve, making it necessary to use antibiotics that cover these organsims

89

Give the three main outcomes of pneumonia

• Resolution • Complications • Death

90

hat is involved in resolution of pneumonia?

Organisation (fibrous scarring)

91

What are three possible complication of pneumonia?

• Lung abscess • Bronchiectasis • Empyema (pus in pleural cavity)

92

How can pneumonia be prevented?

• Immunization ○ Flu vaccine, given anually to high risk patients ○ Pneumococcal vaccine - two vaccines• Chemoprophylaxis ○ Oral penicillin/erthromycin to patients with high risk of lower respiratory tract infections ○ Asplenia, dysfunctional spleen, immunodefiency