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Flashcards in RESPIRATORY Deck (67)
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1

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

2

Aetiology of OSA

Muscle relaxation
Narrow pharynx
Obesity
Down syndrome - small nasal cavities obstruct

3

Symptoms and signs of OSA

heavy snoring
Typically un-refreshing sleep which leads to:
Daytime somnolence /sleepiness
Poor daytime concentration
Oxygen desaturation

4

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 }

5

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

6

Define Chronic Ventilatory failure

Respiratory failure with PaCO2 >6kPa

7

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)

8

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

9

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

10

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)

11

What is the microbiology of Pneumonia

strep. Pneumonia,
influenza
Leigonella
s.aureas
mycoplasma pneumonia
chlamydia psitacci

12

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


13

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

14

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


15

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

Hypogammagobulinanemia
-
allergic bronchopulmonary

aspergillios

crytogenic organising pneumonia




16

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




17

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


18

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

19

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

20

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

21

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



22

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

23

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

24

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




25

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)

26

What is the signs and symptoms of Interstitial pneumonitis response

Dysnopea
Cough
basal crackles
cyanosis
clubbing
abnormal CXR
Type 1 respiratory failure

27

What is the investigations for Interstitial pneumonitis response

chest x ray

pulmonary function tests - prove reduced gas transfer

spirometry (FVC <80% predicted)

Mediastonoscopy - remove lymph nodes

video assisted thoarcopic lung biopsy

28

What is the pathology of sacradosis

chronic response in which there is a granulomatous presentation of inflammatory cells causing a multi-system disorder - skin, lungs, lymph nodes


no necrosis/ceasiations
alveoli around the granulomas is normal
contains non caeseating epitheliod granulomas present in the lymph nodes

29

What is the signs and symptoms of sarcradosis

and the treatment

Dysnopea
Cough

Tender reddish bumps or patches on the skin - ertheyma nosdum

Red teary eyes/ blurred vision
swollen painful joints- acute arthralgia

enlarged hilar lymph nodes

abnormal CXR
Type 1 respiratory failure


Treatment:
NSAIDS
Skin lesions - topical steroids

30

What is the investigations for sarcradosis

serum calcium levels
chest x ray
angiotensin converting enzyme levels
Biopsy
Bronchoscopy (white patches)
Mediastinoscopy

Pulmonary function test
blood test
eye test
TB test
Bronchoscopy
ECG
CT scan

spirometry (FVC <80% predicted)