CVR

Question 1

What is COPD?

Scenario 1

Answer 1

A progressive lung disease that includes emphysema and chronic bronchitis. It is characterised by airflow limitation that is not fully reversible and is associated with chronic inflammation of the airways and alveoli. It is also a disease which obstructs the airflow from the lungs. Typically caused by long-term exposure to irritable gases or particles, most often cigarette smoke, or in mines or retired firemen.

Question 2

What is the pathophysiology of COPD?

Scenario 1

Answer 2

Chronic Inflammation: Long-term exposure to irritants, such as cigarette smoke, leads to inflammation of the bronchial tubes and alveoli, causing airway narrowing and destruction of the lung wall.

Emphysema: This involves the destruction of the alveolar walls, leading to enlarged air spaces and loss of surface area for gas exchange. This results in reduced oxygen uptake and carbon dioxide removal.

Chronic Bronchitis: Characterised by hyposecretion of mucus, leading to persistent cough and airway obstruction. Thick mucus can block airways, impairing ventilation and promoting bacterial infections.

Airway Remodelling: The structure of the airway changes over time, with thickening and fibrosis, further restricting airflow.

Question 3

What is the prognosis of COPD?

Scenario 1

Answer 3

COPD is a chronic condition with no cure. Progression varies based in factors such as smoking cessation and adherence to treatment. Proper management can improve quality of life and reduce exacerbations, but severe COPD can lead to respiratory failure.

Question 4

What are the signs and symptoms of COPD?

Scenario 1

Answer 4

Persistent cough with mucus, shortness of breath, wheezing, chest tightness and fatigue. Advanced cases may present with cyanosis, digital clubbing and frequent respiratory failure.

Question 5

What are risk factors of COPD?

Scenario 1

Answer 5

Smoking is the leading cause, but other risk factors include exposure to air pollutants, occupational dust, and a history of respiration infections. Genetic factors, such as alpha-1 antitrypsin deficiency, may also play a role.

Question 6

How does COPD present clinically?

Scenario 1

Answer 6

Patients may present with dyspnoea (on exertion), a chronic cough, and signs hyperinflation (e.g. barrel chest). Breath sounds may be diminished, with wheezes (restriction of air) or crackles (fluid present) heard on auscultation.

Question 7

What can you assess in COPD?

Scenario 1

Answer 7

Spirometry: To measure lung function and confirm airflow limitation.

Physical Examination: Observe breathing patterns, use of accessory muscles, and listen for abnormal breath sounds. (Demonstrate)

Oxygen Saturation: To assess the need for supplemental oxygen.

Question 8

What are treatment or management methods of COPD?

Scenario 1

Answer 8

Chest physiotherapy: Percussion and vibration techniques to help loosen mucus.

ACBT: Breathing exercise to clear mucus effectively.

Incentive Spirometry: To encourage deep breathing and lung expansion.

Positioning: Techniques such as postural draining to facilitate mucus clearance.

Factors influencing choice: Patient’s ability to cooperate, comfort level, and the severity of symptoms.

Question 9

What is an acute exacerbation of COPD?

Scenario 2

Answer 9

An acute exacerbation of COPD (AECOPD) refers to a sudden worsening of symptoms beyond normal day-to-day variations, often triggered by infections or environmental pollutants.

Question 10

What is the pathophysiology of an acute exacerbation of COPD?

Scenario 2

Answer 10

o Increased Inflammation: Acute exacerbations are marked by a surge in airway inflammation, leading to increased bronchoconstriction and mucus production. This further narrows the already compromised airways.

o Impaired Gas Exchange: Excess mucus and airway narrowing cause ventilation-perfusion mismatch, leading to hypoxemia (low oxygen) and hypercapnia (high carbon dioxide).

o Air Trapping: The inability to fully exhale leads to air trapping, increased lung volumes, and respiratory muscle fatigue.

Question 11

What are the signs and symptoms of an acute exacerbation of COPD?

Scenario 2

Answer 11

Increased shortness of breath, wheezing, productive cough with change in sputum colour or amount, chest tightness, and signs of respiratory distress, such as tachypnoea and accessory muscle use.

Question 11

What is the prognosis for acute exacerbation of COPD?

Scenario 2

Answer 11

Exacerbations accelerate the decline in lung function and increase the risk of mortality. Frequent exacerbations lead to higher hospitalisation rates and poorer long-term outcomes.

Question 12

What risk factors of an acute exacerbation of COPD are there?

Scenario 2

Answer 12

Respiratory infections (viral or bacterial), exposure to air pollutants, cold weather, and failure to adhere to prescribed COPD treatments.

Question 13

How does an acute exacerbation of COPD Clinically present?

Scenario 2

Answer 13

Severe dyspnoea, cyanosis, confusion, or lethargy due to hypoxia, increased respiratory rate, and wheezing or crackles on auscultation.

Question 14

What can you assess in an acute exacerbation of COPD?

Scenario 2

Answer 14

Lung Sounds: To detect wheezing, crackles, or diminished breath sounds.

Arterial Blood Gas (ABG): To determine levels of hypoxia and hypercapnia.

Physical Examination: Assess for signs of respiratory distress, such as rapid, shallow breathing, and use of accessory muscles.

Question 15

What interventions can you give for acute exacerbation of COPD?

Scenario 2

Answer 15

Bronchodilators: Short-acting bronchodilators (e.g., albuterol) to relieve bronchoconstriction.

Steroids: To reduce inflammation and help with breathing.

Oxygen Therapy: To maintain adequate oxygen saturation but careful not to over-oxygenate and worsen CO2 retention.

Airway Clearance Techniques: Techniques like ACBT or use of devices such as flutter valves.

Factors Influencing Choice: Severity of the exacerbation, patient’s current medications, and baseline oxygen levels.

Question 16

What is the pathology of a neuromuscular weakness?

Scenario 3

Answer 16

Neuromuscular weakness following a stroke can affect the respiratory system by impairing the muscles involved in breathing and coughing, leading to complications such as aspiration and respiratory insufficiency.

Question 17

What is the pathophysiology of a neuromuscular weakness?

Scenario 3

Answer 17

Diaphragmatic Weakness: Damage to brain areas controlling the respiratory muscles can lead to reduced diaphragm function, causing shallow breathing and reduced lung volumes.

Weak Cough Reflex: Stroke-related weakness of the abdominal and intercostal muscles impairs the ability to clear mucus, leading to a buildup of secretions and risk of pneumonia.

Dysphagia and Aspiration: Difficulty swallowing may lead to aspiration of food or fluids, causing aspiration pneumonia.

Question 18

What is the prognosis of neuromuscular weakness?

Scenario 3

Answer 18

Recovery of respiratory function varies based on the severity of the stroke and the extent of neuromuscular involvement. Early rehabilitation can improve outcomes, but complications like pneumonia can increase mortality.

Question 19

What are signs and symptoms of neuromuscular weakness?

Scenario 3

Answer 19

Shallow breathing, weak cough, low oxygen levels, and possible wheezing or crackles on auscultation due to secretions. Signs of aspiration may include coughing during eating or drinking and recurrent chest infections.

Question 20

What are risk factors of neuromuscular weakness?

Answer 20

Older age, pre-existing respiratory conditions, immobility, and lack of early mobilisation post-stroke.

Question 21

What can you assess for neuromuscular weakness?

Scenario 3

Answer 21

Chest Auscultation: To listen for abnormal lung sounds.

Cough Strength: Ask the patient to perform a voluntary cough and assess its strength.

Oxygen Saturation: Use pulse oximetry to monitor oxygen levels.

Question 22

How does neuromuscular weakness clinically present?

Answer 22

Signs of respiratory distress, weak or ineffective cough, reduced lung sounds, and possible desaturation. Check for difficulty swallowing or signs of aspiration.

Question 23

What are interventions for neuromuscular weakness?

Answer 23

Positioning: Upright positioning to aid breathing and secretion clearance.

Assisted Cough Techniques: To help with mucus expulsion.

Use of Incentive Spirometry: To promote lung expansion.

Humidified Oxygen Therapy: Helps to keep secretions thin and easier to clear.

Factors Influencing Choice: Level of consciousness, ability to follow commands, and any concurrent swallowing difficulties.

Question 24

What is the pathology of pneumonia? Scenario 4

Answer 24

Pneumonia is an inflammatory condition of the lung parenchyma, typically caused by infection, which leads to alveolar filling with fluid or pus, reducing gas exchange.

Question 25

What is pathophysiology of pneumonia? Scenario 4

Answer 25

Infection and Inflammation: Pneumonia occurs when pathogens (bacteria, viruses, or fungi) invade the lung tissue, causing inflammation. This leads to alveolar filling with fluid, inflammatory cells, and debris, impairing gas exchange. Mucus Production: Increased mucus production may occur, which can block the airways and further impair ventilation. Ventilation-Perfusion Mismatch: The accumulation of fluid and cellular debris in the alveoli causes areas of the lung to become non-functional, leading to a mismatch in the distribution of air (ventilation) and blood flow (perfusion), resulting in hypoxemia.

Question 26

What is the prognosis for pneumonia? Scenario 4

Answer 26

With prompt and appropriate treatment, the prognosis is usually good. However, complications such as sepsis, respiratory failure, or abscess formation can increase mortality, especially in vulnerable populations, such as those recovering from surgery.

Question 27

What are the signs and symptoms of pneumonia? Scenario 4

Answer 27

Fever, productive cough with yellow or green sputum, dyspnoea, pleuritic chest pain, tachypnoea, and reduced oxygen saturation. Auscultation may reveal crackles, bronchial breath sounds, or dullness to percussion.

Question 28

What are the risk factors of pneumonia? Scenario 4

Answer 28

Recent surgery (especially abdominal or thoracic), advanced age, smoking, chronic illnesses (COPD, diabetes), immobility, and weakened immune system.

Question 29

How would you assess Pneumonia? Scenario 4

Answer 29

Lung Auscultation: Listen for crackles, bronchial breath sounds, and areas of diminished breath sounds. Sputum Production: Assess the colour, consistency, and amount of sputum. Oxygen Saturation: To check for hypoxia. Temperature: Monitor for fever, which can indicate ongoing infection.

Question 30

How does pneumonia clinically present? Scenario 4

Answer 30

The patient may present with increased respiratory rate, use of accessory muscles, and possible signs of hypoxia (e.g., cyanosis). They may also have a productive cough and appear febrile.

Question 31

What is a treatment for post abdominal surgery pneumonia?

Answer 31

Positioning: Encourage upright positioning to facilitate lung expansion and secretion clearance. Chest Physiotherapy: Techniques like percussion, vibration, and postural drainage to mobilise secretions. Incentive Spirometry: To encourage deep breathing and lung expansion, preventing atelectasis. Hydration: To help thin mucus, making it easier to clear. Factors Influencing Choice: Patient's post-op pain level, ability to participate in physiotherapy, and presence of comorbidities.

Question 32

What is bronchiectasis? Scenario 5

Answer 32

Bronchiectasis is a chronic lung condition characterised by the permanent dilation and thickening of the bronchial walls due to chronic inflammation and recurrent infections.

Question 33

What is the pathophysiology of bronchiectasis? Scenario 5

Answer 33

Chronic Inflammation and Infection: Repeated episodes of inflammation and infection cause damage to the bronchial walls, leading to their dilation. The cilia are also damaged, impairing the mucociliary clearance mechanism, resulting in mucus accumulation. Mucus Stasis: The buildup of thick, sticky mucus creates an environment conducive to chronic bacterial colonization, leading to a cycle of infection and further airway damage. Airway Remodeling: Over time, the bronchial walls become thickened and scarred, contributing to airflow obstruction and reduced lung function.

Question 34

What is the prognosis of bronchiectasis? Scenario 5

Answer 34

While bronchiectasis is a chronic, progressive condition, regular treatment can help manage symptoms, improve quality of life, and reduce the frequency of infections. Severe cases may lead to respiratory failure.

Question 35

What are the signs and symptoms of bronchiectasis? Scenario 5

Answer 35

Chronic productive cough, frequent lung infections, breathlessness, wheezing, fatigue, and sometimes hemoptysis (coughing up blood). Patients may produce large volumes of thick, purulent sputum daily.

Question 36

What are risk factors of bronchiectasis? Scenario 5

Answer 36

Prior lung infections (e.g., tuberculosis, pneumonia), cystic fibrosis, primary ciliary dyskinesia, immune deficiencies, and exposure to environmental toxins.

Question 37

How does bronchiectasis clinically present? Scenario 5

Answer 37

Patients typically present with a chronic, productive cough and frequent episodes of chest infections. Auscultation may reveal crackles, wheezes, and sometimes coarse breath sounds.

Question 38

What can you assess in bronchiectasis? Scenario 5

Answer 38

Lung Auscultation: Listen for crackles, wheezes, and other abnormal sounds. Sputum Assessment: Evaluate the colour, consistency, and quantity of sputum. Chest X-Ray/CT Scan: Imaging may be needed to confirm diagnosis and assess the extent of bronchial dilation.

Question 39

What interventions can you use for bronchiectasis? Scenario 5

Answer 39

Airway Clearance Techniques: ACBT, postural drainage, and oscillatory positive expiratory pressure (PEP) devices like flutter or Acapella. Humidification: To help thin and loosen mucus. Antibiotics: If there is an active infection, antibiotics may be prescribed based on sputum culture results. Pulmonary Rehabilitation: To improve respiratory muscle strength and overall endurance. Factors Influencing Choice: Patient’s ability to participate in therapy, severity of symptoms, and frequency of infections.