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Respiratory Flashcards

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1
Q

What are the common obstructive airway diseases?

A

Chronic bronchitis
Emphysema
Asthma

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2
Q

What is the mechanism behind asthma?

A

Type 1 hypersensitivity in the airways to an allergen

Either specific IgE, stress, cold drugs or chemicals

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3
Q

What is the clinical definition of chornic bronchitis?

A

Cough productive of sputum most days in 3+ consecutive months for 2+ consecutive years
Exludes TB, bronchiestasis

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4
Q

What are the morphical changes in chronic bronchitis?

A 
Large airways
>Mucous gland hyperplasia
>Goblet gland hyperplasia
>Inflammation and fibrosis
Small airways
>Goblet cells appear
Inflammation and fibrosis in long term disease
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5
Q

What is emphysema?

A

Increase beyond the normal size of airspaces distal to terminal bronchiole
Either due to dilatation or destruction
And without obvious fibrosis

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6
Q

What are the types of emphysema?

A

Centriacinar
Panacinar
Periacinar
Scar

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7
Q

What is centriacinar emphysema?

A

Loss of respiratory bronchioles in proximal portion with sparing of distal alveoli
Typical in smokers

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8
Q

What is panacinar emphysema?

A

Loss of all portions of acinus, from bronchiole to alveoli

Typical in apla-1-antitrypsin deficiency

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9
Q

What is type 1 respiratory failure?

A

Where PaO2 is less than 8kPa

With PaCO2 normal or low

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10
Q

What is type 2 respiratory failure?

A

Where PaCO2 is greater than 6.5 kPa

With PaO2 usually being low

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11
Q

What are the four states associated with hypoxaemia?

A

Ventilation/perfusion imbalance
Diffusion impairment
Alveolar hypoventilation
Shunt

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12
Q

What are the pulmonary vascular changes in hypoxia?

A

Pulmonary arteriolar vasoconstriction
>Occurs in all vessels in hypoaemia
Due to protective mechanisms

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13
Q

What is cor pulmonale?

A

Hypertrophy of the right ventricle resulting from disease affecting the function and/or structure of lung

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14
Q

What is asthma?

A

A disease characterised by increased responsiveness of trachea/bronchi to various stimuli
Manifested by widespread narrowing of airways
Changes in severity either spontaneously or as a result of therapy

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15
Q

What is the prevalence of asthma?

A

10-15% of children (boys>girls)

5-10% adults (girls>boys)

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16
Q

What are the risk factors for asthma?

A

Inherited tendency to IgE response to allergens
>Asthma, eczema, hayfever, food allergy etc family history
>Maternal most influential (3x that of father)

Occupation
Obesity
Diet
Smoking (maternal during pregnancy)
Indoor pollution, maybe outdoor
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17
Q

How is obesity linked to asthma/airway problems?

A

Positively associated with:
>Asthma
Wheezing
>Airway hyperactivity

Also more breathless
>obesity pro-inflammatory

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18
Q

How do you diagnose asthma clinically?

A 
Wheeze (NO WHEEZE NO ASTHMA)
Short of breath, with severity
Chest tightness (/pain)
Cough - usually dry, paroxysmal
Sputum occasionally

Look for airflow obstruction + variability

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19
Q

What are the triggers for asthma?

A 
Exercise
Cold air
Smoke
Perfume
URTIs
Pets
Tree/grass pollen
Food
Aspirin
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20
Q

What signs on examination indicate it might not be asthma?

A 
Clubbing 
Cervical lymphadenopathy
Stridor
Assymetrical expansion
Dull percussion note
Crepitations
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21
Q

What tests can you do to confirm asthma?

A

Spiromitry
>If obstructed do full pulmonary function testing to exclude COPD
>If obstructed then check reversibility with B2 agonists/steroids

> If normal check peak flow monitoring
?If still okay, do bronchial provocation with nitric oxide

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22
Q

What are some useful investigations into asthma?

A 
Chest X ray 
>Check for hyperinflaton/hyperlucent
Skin prick testing
Total/specific IgE
Full blood count (for eosinophillia)
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23
Q

What indicated acute severe asthma?

A 
Ability to speak inhibted
Heart rate >110
Resp rate >25
PEF
Oxygen sats down
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24
Q

What is a moderate asthma attack?

A

Increasing symptoms, however still able to speak and stats not as high as severe

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25
What indicates life-threatening asthma?
``` Grunting Impaired conciousness, confusion / exhaustion Bradycardic OR HR >130 Hypoventilating Cyanosis ``` Raised PaCO2 is near fatal
26
What are the differentials of asthma?
``` Viral induced wheeze CF Immune deficincy Foreign body Possibly aspiration ```
27
How do you treat episodic wheeze with a cold?
Salbutamol
28
What are the differentials for an isolated cough in children?
Brocnhitis (2-3 years) Pertussis Habitual cogh (8-12 years) Tracheomalacia (life long)
29
What are the clinical features of bacterial bronchitis?
``` Recurrent wet cough Tractor (darth vader sounding) Palpable fremitis Often first born + very well child Self limiting ```
30
What is the natural history of bacterial bronchitis?
Follows URTI Lasts 4 weeks First winter bad, progressively better. 3rd is often fine Often caused by pneumococcus
31
What is pertussis?
``` Coughing fits (whoping cough) Often with vomiting, colour change + petechiae Vaccination available ```
32
What are the common URTIs?
``` Coryza (common cold) Sore throat syndrome Acute laryngotracheobronchitis (croup) Laryngitis Sinusitis Acute epiglottitis ```
33
What two organisms cause acute epiglottitis?
Group A beta-haemolytic streptococci | H. Influenzae (type B)
34
What are the LRTIs?
Bronchitis Bronchiolitis Pneumonia +complications
35
What are the respiratory tract defence mechanisms?
Macrophage-mucociliary escalator system General immune system Respiratory tract secretions
36
What makes up the macrophage--mucociliary escalator system?
Alveolar macrophages Mucociliary escalator Cough reflex
37
What are the aetiological calssifications of pneumonia?
``` Community Acquired Pneumonia Hospital Acquired (Nosocomial) Pneumonia Pneumonia in the Immunocompromised Atypical Pneumonia Aspiration Pneumonia Recurrent Pneumonia ```
38
What are the patterns of pneumonia?
Bronchopneumonia Segmental Lobar Hypostatic Aspiration Obstructive, Retention, Endogenous Lipid
39
What is the bronchopneumonia pattern?
Often bilateral basal opacification | Due to focal nature of consolidation
40
What are the possible complications of pneumonia?
``` Pleurisy, Pleural Effusion and Empyema Lung Abscess Bronchiectasis Constrictive bronchiolitis Pneumonia is still a potentially fatal disease ```
41
What can cause lung abcesses?
Tumours - leading to obstructed bronchus Asipiration Particular organisms - Staph A, some pneumococci Necrotic lung (sencondary to infection)
42
What is bronchiectasis?
``` Pathological dilatation of bronchi due to >Severe infection >Recurrent infections >Proximal bronchial obstruction >Lung parenchymal destruction ```
43
What is the clinical picture of bronchiectasis?
``` Cough Abundent foul sputum!!! Haemoptysis Signs of chronic infection Coarse crackles Clubbing ```
44
How do you treat bronchiectasis?
Postural drainage Antibiotics Surgery
45
What are the causes of aspirational pneumonia?
``` Vomiting Oesophageal Lesion Obstetric Anaesthesia Neuromuscular Disorders Sedation ```
46
What are opportunistic infections?
Infection via organism not usually capable of producing disease However able to in patients with existing lung disease
47
What are examples of opportunistic infections?
Low grade bacterial pathogens CMV Pneumocystis jirovecii Other fungi and yeasts
48
Why do you get hypoxaemia in pneumonia?
Ventilation mismatch due to bronchitis | Shunt in severe bronchipneumonia - leads to no ventilation of abnormal alveoli
49
What is a shunt?
Blood passing from right to left side of heart without contacting ventilated alveoli Lung shunts respond poorly to increased fractional oxygen intake
50
What can cause pathological shunt?
AV malformations, congenital heart disease and PULMONARY DISEASE
51
What are the causes of COPD (Emphysema + chronic bronchitis)?
``` Smoking (85%) Chronic asthma Passive smoking Maternal smoking Air pollution Occupation (Dusts, vapours/fumes: coal mining, concrete, farming, plastics, textiles etc) Rare: alpha1-antitrypsin deficiency ```
52
What are the clinical features of COPD?
``` Cough Sputum Dyspnoea Wheeze Weight loss ``` ``` Tachypnoea Prolonged expiratory pahse Hyperinflation (barrel chest) Cynaosis Inspiratory crackles Cor pulmonale ```
53
What indicates emphysema?
``` Emphysema (pink puffers) >Increased alveolar ventilation - pink but breathless >Normal PaO2 Normal/low PaCO2 T1 respiratory failure ```
54
What indicates chronic bronchitis?
Chronic bronchitis (blue bloaters) >Decreased alveolar ventilation - cyanosed not breathless >Decreased PaO2 + increased PaCO2 >Type 2 respiratory failure + cor pulmonale
55
How do you investigate COPD?
CXR (look for hyperinflation, prominent pulmonary arteries + peripheral oligaemia) ECG (R Atrial hypertrophy) Spirometry
56
What are the causes of lung cancer?
``` Tobacco Asbestos Environmental causes Radiation Pulmonary fibrosis ```
57
What are the four main types of cancer in the lungs?
Adenocarcinoma Squamous cell carcinoma Small cell carcinoma Large cell carcinoma
58
What genes cause adenocarcinoma of the lungs?
KRAS (35%) = smoking induced EGFR = 15% (not smoking) BRAF, HER2, ALK
59
Why is a primary lung cancer often fatal?
Symptoms don't show until late in disease | By that time often too late to cure
60
What are the local effects of lung cancer?
``` Bronchial obstruction (through collapse or otherwise) Pleural issues of inflammation/malignancy ```
61
``` What are the effects of a cancer invading the following nerves? Phrenic L recurrent laryngeal Brachial plexus Cervical sympathetic ```
Phrenic - Diapragmatic paralysis L recurrent laryngeal - Hoarse, bovine cough Brachial plexus - Pancoast T1 damage Cervical sympathetic - Horners syndrome
62
Where can a lung cancer locally spread to?
Chest wall Nerves Mediastinum Lymph nodes
63
Where can a lung cancer distally spread to?
``` Liver Adrenals Bone Brain Skin ```
64
What hormones does a small cell cancer affect?
ACTH | siADH
65
What hormones does a squamous cell lung cancer affect?
PTH
66
What non-metastatic effects do you get from lung cancer?
``` Finger clubbing Hypertrophic pulmonary osteoarthropathy Endocrine disruption Acanthosis nigricans Nehprotic syndrome ```
67
How do you investigate lung cancer?
CXR Bronchoscopy FNA Pleural effusion Maybe CT, MRI etc
68
What is the prognosis of lung cancer?
``` 7% 5 year survival Mostly dependant on stage If operable then better: >Stage 1 60% >Stage 2 35% ```
69
What is the prognosis of small cell carcinoma of lungs?
4% - median survival is 9 months
70
What are the two main thromboembolic diseases?
DVT | PE - pulmonary embolism
71
What is virchows triad?
Decreased blood flow Abnormal vessels Hypercoagulable state >States risk factors for thromboembolic disease
72
What causes decreased blood flow?
``` Immobility Travel Bed bound Obesity Heart failure ```

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