Respiratory Flashcards
(126 cards)
1
Q
What are obstructive airway diseases characterized by?
A
Airflow obstruction or limitation causing difficulty during expiration
This includes the use of accessory muscles for expiration and slowed emptying of the lungs.
2
Q
What is the major obstructive airway disease in adults and children?
A
Asthma
Chronic obstructive pulmonary disease (COPD) is also prevalent in adults.
3
Q
What is the unifying symptom of obstructive airway diseases?
A
Dyspnoea (difficulty breathing or breathlessness)
This symptom is common across various obstructive airway diseases.
4
Q
What are some manifestations of obstructive airway diseases?
A
- Increased work of breathing
- Ventilation/perfusion mismatching
- Decreased forced expiratory volume in 1 second (FEV1)
- Decreased FEV1/forced vital capacity (FVC) ratio
5
Q
How many people worldwide are estimated to have asthma?
A
Over 300 million
Rates are higher in westernised societies than in developing countries.
6
Q
What percentage of the Australian population has asthma?
A
11%
This translates to more than 2.7 million people.
7
Q
Which populations have higher rates of asthma in Australia and New Zealand?
A
Indigenous populations
Māori and Pacific Islander adults in New Zealand and Indigenous people in Australia experience higher prevalence.
8
Q
What was the death rate for asthma in Australia in 2018?
A
1.3 deaths per 100,000 population
This is a reduction from 1.7 deaths per 100,000 in 2009.
9
Q
What is the annual economic cost of asthma to the Australian health system?
A
$770 million
This includes costs for hospitalisation, non-hospital services, and medications.
10
Q
What are the principal characteristics of asthma?
A
- Airway inflammation
- Airway hyperresponsiveness
- Mucus hypersecretion
- Airflow obstruction
11
Q
What mediators are associated with T H 2 asthma?
A
- IL-4
- IL-5
- IL-13
These are linked to CD4+ T cell predominance and airway eosinophilia.
12
Q
What triggers abnormal responses in asthma?
A
Inflammatory mediators such as allergens, irritants, pollution, exercise, cold air, or respiratory infections
These triggers lead to bronchoconstriction and airway obstruction.
13
Q
What is the hygiene hypothesis?
A
Living with low levels of infectious organisms can make the immune system prone to the development of allergy and asthma
This hypothesis explains the relationship between decreased infectious exposure and increased allergic conditions.
14
Q
What are the typical symptoms of asthma?
A
- Dyspnoea
- Wheezing
- Cough
Symptoms can vary in intensity and may fluctuate over time.
15
Q
What is bronchoconstriction?
A
Airway smooth muscle spasm leading to airflow obstruction
It is a key feature during an asthma attack.
16
Q
What are the typical arterial blood gas abnormalities seen in acute asthma?
A
- Hypoxaemia
- Hypocapnia
- Respiratory alkalosis
17
Q
What is status asthmaticus?
A
A severe asthma condition where bronchospasm worsens, potentially leading to respiratory failure
It is characterized by prolonged asthma exacerbation requiring urgent medical intervention.
18
Q
What happens during the early asthmatic response?
A
Mast cells degranulate and release mediators like histamine, causing bronchospasm, increased vascular permeability, and mucus secretion
This response occurs immediately after allergen exposure.
19
Q
What are the long-term changes associated with chronic asthma?
A
- Goblet cell hyperplasia
- Airway wall remodelling
- Subepithelial fibrosis
- Smooth muscle hypertrophy
20
Q
What is functional dead space in relation to air movement?
A
Functional dead space refers to little air being moved.
21
Q
What causes respiratory alkalosis?
A
Respiratory alkalosis is caused by hyperventilation, leading to a pH greater than 7.45.
22
Q
What is status asthmaticus?
A
Status asthmaticus is a severe asthmatic episode that does not respond to pharmacological control.
23
Q
What are the consequences of acute airway inflammation in asthma?
A
Acute airway inflammation leads to worsened bronchoconstriction, mucus plugging, edema, and cell infiltration.
24
Q
What happens to expiratory flow rates during a severe asthma episode?
A
Expiratory flow rates such as FEV1 and peak flow are markedly reduced.
25
What does hypoxaemia indicate in the context of status asthmaticus?
Hypoxaemia indicates worsening respiratory function and decreased effective ventilation.
26
What is the significance of a silent chest in asthma?
A silent chest (no audible air movement) is an ominous sign of impending death.
27
What is spirometry used for in asthma management?
Spirometry is used to diagnose asthma, monitor lung function, and assess airway obstruction.
28
List the key variables measured during spirometry.
* FEV1
* FVC
* FEV1/FVC ratio
* PEF
29
What are the findings in a mild asthma episode?
* Physical exhaustion: No
* Talks in: Sentences
* Pulse rate: < 100/min
* Wheeze intensity: Variable
* PEF: More than 75% predicted
30
What characterizes a severe and life-threatening asthma episode?
* Physical exhaustion: Yes
* Talks in: Words
* Pulse rate: More than 120/min
* Central cyanosis: Likely to be present
* PEF: Less than 50% predicted
31
What is the purpose of a written asthma action plan?
It helps individuals detect early signs of exacerbation and provides management instructions.
32
What are the goals of long-term asthma management?
* Achieve and maintain asthma control
* Maintain lung function and activity
* Prevent morbidity and mortality from asthma
33
Fill in the blank: Reliever medications provide _______ of symptoms by promoting rapid bronchodilation.
[acute relief]
34
What are examples of preventer medications for asthma?
* Beclomethasone dipropionate
* Budesonide
* Ciclesonide
* Fluticasone propionate
* Montelukast
35
What is mepolizumab used for in asthma treatment?
Mepolizumab targets IL-5 and reduces acute exacerbations in severe asthma.
36
What is the prevalence of asthma in children aged 0–14 years in Australia and New Zealand?
Asthma affects approximately 10% of children aged 0–14 years.
37
What are the three manifestations of childhood asthma?
* Transient wheezing
* Non-atopic wheezing
* IgE-mediated wheezing
38
What is the classification of childhood asthma?
* Infrequent intermittent
* Frequent intermittent
* Persistent (mild, moderate, severe)
39
What is the most common viral trigger for wheezing in infants and toddlers?
Respiratory syncytial virus.
40
What characterizes chronic obstructive pulmonary disease (COPD)?
COPD is characterized by irreversible obstruction of the airways.
41
What percentage of Australians over 40 years are affected by moderate to severe COPD?
7.5% of Australians over 40 years.
42
What are the economic costs associated with COPD in Australia?
$8 billion annually, including lost productivity and health system expenditure.
43
What is chronic obstructive pulmonary disease (COPD)?
A progressive chronic disease characterised by irreversible obstruction of the airways
## Footnote
COPD is Australia's fifth leading cause of death and third leading cause of disability.
44
What percentage of Australians over 40 years are affected by moderate to severe COPD?
7.5%
## Footnote
The prevalence rises to 29% in Australians over 75 years.
45
What is the estimated annual cost of COPD in Australia?
$8 billion
## Footnote
This includes lost productivity, health system expenditure, patient expenses, and welfare payments.
46
What are the main causes of airflow limitation in COPD?
Significant exposure to noxious particles or gases, primarily cigarette smoking
## Footnote
Airflow limitation is largely irreversible.
47
What two main diseases cause the airflow limitation in COPD?
* Chronic bronchitis
* Emphysema
48
What role do neutrophils, macrophages, and CD8+ T cells play in COPD?
They play a major role in airway inflammation and lung damage
## Footnote
Proinflammatory cytokines are also released in the COPD airway.
49
How is COPD diagnosed?
Using spirometry with a FEV1/FVC ratio of less than 70% following bronchodilator administration
## Footnote
A thorough smoking history is also important.
50
What is chronic bronchitis characterized by?
Hypersecretion of mucus and chronic productive cough for at least 3 months of the year for at least 2 consecutive years
## Footnote
It is almost always caused by cigarette smoking.
51
What are the typical clinical manifestations of chronic bronchitis?
* Common infections
* Mild dyspnoea late in course
* Classical productive cough
* Intermittent wheezing
* Cyanosis common
* Prolonged expiration always present
52
What distinguishes emphysema from chronic bronchitis?
Emphysema is characterized by permanent enlargement of gas-exchange airways and destruction of alveolar walls
## Footnote
Obstruction results from changes in lung tissues rather than mucus production.
53
What is the major mechanism of airflow limitation in emphysema?
Loss of elastic recoil
## Footnote
Cigarette smoking is the major cause of emphysema.
54
What is the relationship between COPD exacerbations and lung function?
Exacerbations are associated with accelerated decline in lung function and health status
## Footnote
They also increase the risk of future exacerbations.
55
What is the goal of COPD management?
To reduce the risk of exacerbation and minimize symptoms
## Footnote
This includes stopping smoking and using bronchodilators.
56
How does malnutrition affect individuals with COPD?
It adversely affects exercise tolerance, limits surfactant production, reduces immune responses, and increases morbidity and mortality
## Footnote
Malnutrition is a major concern due to increased energy expenditure and decreased intake.
57
What is cystic fibrosis?
The most common autosomal recessive inherited disease affecting Caucasians, caused by defective chloride transport
## Footnote
It results from a mutation in the CFTR gene.
58
What are the typical effects of cystic fibrosis on the lungs?
Mucus plugging, chronic inflammation, and chronic infection
## Footnote
These lead to respiratory failure in 90% of cases.
59
What is the prevalence of cystic fibrosis in Australia?
Approximately 1 in 2800 people is born with cystic fibrosis
## Footnote
About 1 in 25 is a carrier.
60
What is the clinical appearance of a patient with chronic bronchitis?
Often referred to as 'blue bloater'
## Footnote
This contrasts with emphysema patients, who are often termed 'pink puffers'.
61
What happens to respiratory muscles in advanced COPD?
They are put at a mechanical disadvantage due to air trapping
## Footnote
This can lead to hypoventilation and hypercapnia.
62
Fill in the blank: The most important cause of COPD is _______.
[cigarette smoking]
63
True or False: Chronic bronchitis is a reversible condition.
False
## Footnote
Chronic bronchitis is an irreversible condition of progressive decline.
64
What are the primary systems affected by cystic fibrosis?
Endocrine, gastrointestinal, renal, and reproductive systems
## Footnote
The most significant effects are on the lungs.
65
What is the typical lung disease presentation in cystic fibrosis?
Mucus plugging, chronic inflammation, and chronic infection
## Footnote
These features commonly lead to respiratory failure.
66
What causes mucus plugging in cystic fibrosis?
Increased production of mucus and altered chemical properties of the mucus
## Footnote
Defective chloride secretion and excess sodium absorption contribute.
67
What is the role of goblet cells in cystic fibrosis?
Increased number and size of mucus-secreting airway cells
## Footnote
This leads to excessive mucus production.
68
What is the composition of cystic fibrosis mucus?
Dehydrated and viscous due to defective chloride secretion
## Footnote
This results in thick and sticky mucus.
69
What is the impact of chronic inflammation in cystic fibrosis?
Contributes to long-term lung damage
## Footnote
Evidence suggests this process begins in infancy.
70
Which bacteria commonly colonize the airways of individuals with cystic fibrosis?
Staphylococcus aureus and Pseudomonas aeruginosa
## Footnote
P. aeruginosa colonizes approximately 70% of adults with cystic fibrosis by age 30.
71
What are the common respiratory symptoms of cystic fibrosis?
Persistent cough, dyspnoea, recurrent pulmonary infections
## Footnote
Lung function decreases with age.
72
What is meconium ileus?
Meconium blocking the bowel at birth
## Footnote
A classic gastrointestinal presentation of cystic fibrosis.
73
What percentage of individuals with cystic fibrosis experience pancreatic insufficiency?
Approximately 80%
## Footnote
This leads to malabsorption issues.
74
What is the definitive test for diagnosing cystic fibrosis?
Sweat test measuring sweat chloride concentration
## Footnote
A level above 60 mmol/L is indicative of cystic fibrosis.
75
What treatments are focused on pulmonary health in cystic fibrosis?
Mucus clearance techniques, bronchodilators, inhaled antibiotics
## Footnote
Treatments aim to manage chronic infections and improve lung function.
76
What is Ivacaftor?
The first CFTR modulator approved for cystic fibrosis
## Footnote
Targets the G551D mutation and improves lung function.
77
What characterizes bronchiectasis?
Abnormal permanent dilation and distortion of the bronchi
## Footnote
Results from chronic inflammation leading to destruction of bronchial walls.
78
What is the prevalence of bronchiectasis in adults in Australia and New Zealand?
Largely uncertain, likely underestimated
## Footnote
Due to lack of population studies and misdiagnosis.
79
What are common symptoms of bronchiectasis?
Recurrent respiratory infections, purulent sputum, haemoptysis
## Footnote
Individuals may also experience significant respiratory morbidity.
80
How do restrictive airway diseases differ from obstructive airway diseases?
Restrictive diseases have decreased lung compliance and increased work of breathing
## Footnote
Obstructive diseases typically involve airflow limitation.
81
What is acute respiratory distress syndrome (ARDS)?
A life-threatening condition characterized by acute lung inflammation
## Footnote
It can lead to diffuse alveolar capillary injury.
82
What are common predisposing factors for ARDS?
Sepsis and multiple trauma
## Footnote
Other causes include pneumonia and drug overdose.
83
What is the hallmark of ARDS?
Lung inflammation
## Footnote
This includes activation of the inflammatory response and increased capillary permeability.
84
What are the classic symptoms of ARDS?
Marked dyspnoea, rapid shallow breathing, hypoxaemia
## Footnote
Symptoms develop acutely, usually within 24 hours of the initial insult.
85
What is acute respiratory distress syndrome?
A condition that develops acutely after an initial insult, usually within 24 hours, characterized by marked dyspnoea, rapid shallow breathing, and hypoxaemia unresponsive to oxygen therapy
## Footnote
Also known as refractory hypoxaemia.
86
What are the classic signs and symptoms of acute respiratory distress syndrome?
* Marked dyspnoea
* Rapid shallow breathing
* Inspiratory crackles
* Respiratory alkalosis
* Decreased lung compliance
* Hypoxaemia unresponsive to oxygen therapy
* Diffuse alveolar infiltrates on chest x-rays
## Footnote
Without evidence of cardiac disease.
87
What is the primary treatment for acute respiratory distress syndrome?
Supportive care to maintain adequate tissue oxygenation, minimize acute lung injury, and avoid further pulmonary complications
## Footnote
Most individuals require mechanical ventilation.
88
What gases are toxic to the pulmonary system?
* Smoke
* Ammonia
* Hydrogen chloride
* Sulfur dioxide
* Chlorine
* Nitrogen dioxide
## Footnote
Inhalation of these gases can lead to severe inflammation and pulmonary oedema.
89
What are the initial symptoms of inhalation of toxic gases?
* Burning of the eyes, nose, and throat
* Coughing
* Chest tightness
* Dyspnoea
## Footnote
Hypoxaemia is also common.
90
What is pneumoconiosis?
Any change in the lung caused by inhalation of inorganic dust particles, typically in the workplace
## Footnote
It often leads to progressive fibrosis of lung tissue.
91
What are the three most important dust-related diseases from occupational exposure in Australia?
* Asbestosis
* Silicosis
* Coal worker’s pneumoconiosis
## Footnote
There is a resurgence of coal worker’s pneumoconiosis.
92
What is the primary route of lower respiratory tract infection?
Aspiration of oropharyngeal secretions
## Footnote
The nasopharynx and oropharynx serve as the first line of defence.
93
What are common microorganisms causing community-acquired pneumonia?
* Streptococcus pneumoniae
* Mycoplasma pneumoniae
* Haemophilus influenzae
* Oral anaerobic bacteria
* Influenza viruses
* Legionella pneumophila
* Chlamydia pneumoniae
* Moraxella catarrhalis
## Footnote
These microorganisms differ from those causing healthcare-acquired pneumonia.
94
What is tuberculosis (TB)?
An infection caused by Mycobacterium tuberculosis, primarily affecting the lungs but may invade other body systems
## Footnote
It is the leading cause of death from a curable infectious disease worldwide.
95
What are the common clinical features of active tuberculosis?
* Chronic cough
* Sputum production
* Loss of appetite
* Weight loss
* Fever
* Night sweats
* Chest pain
* Haemoptysis
## Footnote
Individuals with latent infection are usually asymptomatic.
96
How is tuberculosis diagnosed?
* Positive tuberculin skin test
* Sputum analysis
* Chest x-rays
## Footnote
The tuberculin skin test has a high rate of false positives.
97
What is the difference between community-acquired pneumonia and healthcare-acquired pneumonia?
Community-acquired pneumonia is typically caused by different microorganisms than healthcare-acquired pneumonia, which has a higher mortality rate
## Footnote
Immunocompromised individuals are more susceptible to opportunistic infections.
98
What is the treatment for bacterial pneumonia?
Antibiotics selected based on likely causative microorganism
## Footnote
Resistant strains of pneumococcus are on the rise.
99
What is the pathophysiology of pneumonia?
Infection leads to alveolar inflammation, activation of macrophages and neutrophils, and accumulation of exudate in the alveoli
## Footnote
This results in dyspnoea and hypoxaemia.
100
What is the role of alveolar macrophages in the pulmonary defense mechanism?
They engulf bacteria and prevent their spread without significant inflammatory response
## Footnote
If overwhelmed, this can lead to a full-scale immune response.
101
What are the clinical manifestations of pneumonia?
* Fever
* Chills
* Productive or dry cough
* Malaise
* Pleural pain
* Dyspnoea
* Haemoptysis
## Footnote
Often preceded by an upper respiratory infection.
102
What is the impact of viral pneumonia in children and older adults?
It is the primary cause of pneumonia and can be severe but is usually mild and self-limiting
## Footnote
It can lead to secondary bacterial infections.
103
What are common symptoms of tuberculosis?
Chronic cough, sputum production, loss of appetite, weight loss, fever, night sweats, chest pain and haemoptysis
## Footnote
Individuals with latent infection are usually asymptomatic but remain at risk of reactivation
104
How is tuberculosis typically diagnosed?
Positive tuberculin skin test, sputum analysis, and chest x-rays
## Footnote
Newer diagnostic tests like interferon gamma release assay (QuantiFERON-TB Gold) are also recommended
105
What is the recommended treatment for tuberculosis?
Combination of drugs including isoniazid, rifampicin, pyrazinamide and ethambutol
## Footnote
Treatment usually continues for 6 months
106
What is DOTS in relation to tuberculosis control?
Directly observed therapy short courses involving five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems, and direct observation of treatment
107
What defines acute bronchitis?
Acute infection or inflammation of the airways or bronchi, usually self-limiting and primarily caused by viruses
108
What are the main differences between acute bronchitis and chronic bronchitis?
Acute bronchitis is self-limiting and caused by viruses, while chronic bronchitis is irreversible and mainly caused by smoking
109
What are common symptoms of acute bronchitis?
Fever, cough, chills, malaise, non-productive cough, chest pain
## Footnote
Cough often occurs in paroxysms and may be aggravated by cold, dry or dusty air
110
What is the typical treatment for acute bronchitis?
Rest, aspirin, humidity, cough suppressant (e.g., codeine)
111
What is the main cause of influenza?
Influenza is caused by the influenza virus, which can infect all age groups
112
What are the three main strains of influenza virus?
Type A, type B, and type C
113
What is antigenic drift?
Minor changes in the genetic sequence of the virus that render it less recognisable to the immune system
114
What is antigenic shift?
Major genetic changes in the virus often due to coinfection, leading to new strains that the immune system cannot recognize
115
What are the classic signs and symptoms of influenza?
Cough, fever, generalized myalgia, headache, sore throat
116
What is the primary method for diagnosing influenza?
Nasal and mouth swabs, along with clinical symptoms and known contact with an infected individual
117
What virus causes COVID-19?
Severe acute respiratory syndrome coronavirus (SARS-CoV-2)
118
When was COVID-19 first detected?
December 2019
119
What receptor does SARS-CoV-2 bind to in human cells?
Angiotensin-converting enzyme (ACE2) receptor
120
What are the phases of COVID-19 infection?
Asymptomatic viral infection, symptomatic phase with fever and malaise, severe infection leading to ARDS
121
What are common clinical manifestations of COVID-19?
Fever, cough, shortness of breath, fatigue, headache, nausea, vomiting, rhinorrhoea
122
What tests are commonly used to diagnose COVID-19?
Polymerase chain reaction (PCR) test and rapid antigen reaction test (RAT)
123
What treatments were used for COVID-19 before vaccines?
Supportive care, supplemental oxygen, antipyretics, fluid supplementation
124
What types of vaccines have been developed for COVID-19?
Adenovirus vector vaccines, mRNA vaccines, and subunit vaccines
125
What is long COVID?
Symptoms persisting longer than 12 weeks after initial infection
126
What is the role of vaccines in the COVID-19 pandemic?
Trigger immune response, reduce severity and mortality of infection
