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5 Human Diseases > Respiratory disease > Flashcards

Respiratory disease Flashcards

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1
Q

ventilation is one of the components that is needed to get adequate oxygen supply into the blood.

ventilation requires what 2 things?

A

airway patency

active muscles

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2
Q

what is airway patency?

A

how wide or narrow the airways are

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3
Q

what does active muscles mean in regards of ventilation?

A

ability of the muscles to move the ribcage in order for ventilation to take place

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4
Q

gas exchange is one of the components that is needed to get adequate oxygen supply into the blood

what does gas exchange require?

A

adequate number of alveoli

no fibrosis of alveolar wall

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5
Q

what can be a sign that ventilation is compromised in a patient clincally?

A

patient is anchoring arms by holding onto the dental chair so that the accessory muscles can assist in ventilation -> shows breathing is compromised

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6
Q

what happens if there is Inadequate ventilation due to airway patency or muscle action problems

A

oxygen levels fall and carbon dioxide levels rise in the alveoli

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7
Q

define type 2 respiratory failure

A

when ventilation is inadequate to deliver enough oxygen to the blood and remove the carbon dioxide

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8
Q

gas exchange failure can be due to what 3 things?

A

fibrosis - thick walls

emphysema - less aveoli

v-q mismatch - air and blood in same part of lungs for exchange to occur

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9
Q

what is emphysema?

A

destruction of alveoli, air sacs join up to form larger spaces with less surface area -> reduce gas exchange

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10
Q

gas exchange failure leads to what kind of respiratory failure?

A

type 1 respiratory failure

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11
Q

Symptoms of respiratory problems

Cough

Wheeze -> expiratory noise

Stridor -> inspiratory noise

Dyspnoea -> patient feels distressed or anxious by the effort of breathing
Pain

A
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12
Q
A
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13
Q

respiratory investigations

spirometry looks at the ability to ventilate the lungs

define these

tidal volume -

inspiratory capacity -

FVC

FEV 1

PEFR

A

Tidal volume - normal breathing volume in and out

Inspiratory capacity - take big breath in

FVC - breathing out after taking a big breath

FEV 1 second - how much gas can be removed from the lungs in 1 second

PEFR - peak expiratory flow rate (patients can measure this at home)

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14
Q

Asthma is ? of the airways to seemingly innocuous stimuli, causing a change in the ?? which ? the airway, restricting the airflow in and out - typically makes breathing ? more difficult - characteristic wheeze on ?

A

overreaction
bronchial wall
narrows
out
expiration

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15
Q

Asthma cellular response

Allergen triggers ? production

which causes a ???? interaction and causes degranulation of ??

which eventually leads to ?, smooth muscle ? and ??.

A

IgE

B cell T cell
mast cells

oedema
constriction
mucus secretion

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16
Q

asthma is treated by modulating some of the inflammatory mediators

how do drugs ending in mab or ib often work, use omalizumab as an example?

A

often monoclonal antibody or biologic drugs

anti-IgE drug which will prevent IgE production preventing mast cells from degranulating

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17
Q

name the 3 features of asthma that cause bronchial narrowing

A

Bronchial smooth muscle contraction

Bronchial mucosal oedema -> swelling of the airway

Excessive mucous secretion into the lumen -> filling the airway

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18
Q

remember airflow is related to the radius to the power of 8 so small changes in the radius of the airway will significantly impact airflow

A
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19
Q

explain each symptom of asthma

Cough, wheeze (expiratory), shortness of breath

Diurnal variation

Difficulty breathing out and lungs fill with air

A

Caused by irritation from high levels of mucus being produced in the airway

Asthma often worse in the morning and overnight

Measure by falling peak expiratory flow rate (PEFR) over a few days which shows reduced airway patency

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20
Q

why is asthma a biphasic response?

A

There’s a first acute asthma attack and recovery

Then a late asthmatic response some hours later

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21
Q

how is an acute response of asthma managed?

A

acute beta agonists to open the airways quickly

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22
Q

how is a late response of asthma prevented?

A

low dose corticosteroid

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23
Q

asthma

if an acute beta agonist and low dose corticosteroid arnt adequate for controlling a pt asthma what is done?

A

increase corticosteroid to high dose and add long acting beta-adrenergic agonist

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24
Q

what is the clinical significance of aasthma being biphasic?

A

This is important to recognise as a patient sent home after management of the first response may then develop a more significant problem later
Ensure they get corticosteroids to prevent a late asthma response

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25
Beta adrenergic receptors Work by relaxing ??? - Reduce ? - Reduce resting ?? Protective -> take in ? of attack e.g. ? exercise Short acting -> '?' drug Long acting -> '?' drug (must use with inhaled steroid)
bronchial smooth muscle bronchostriciton bronchial tone anticipation before reliever preventer
26
Corticosteroids Work by reducing ??§, ?? and ?? which cause bronchial smooth muscle constriction - Immune and epithelial cell action
mucosal oedema mucus secretion inflammatory mediators
27
what are the issues with corticosteroids?
risk of adrenal suppression and osteoporosis though there is no evidence that this happens with the inhaled steroid doses
28
29
Coronary obstructive pulmonary disease is a mixture of what 2 things?
reversible airway obstruction - bronchiectasis irreversible lung disease - emphysema
30
in short what is bronchiectasis?
recurring damage to the airways caused by chronic infection.
31
Bronchiectasis aetiology -> recurring damage to the airways caused by chronic infection. increase in ? from the disease process and inflammation. This happens ? in the same places leading to ? and ??? and damage to the ?? on the outside. Airways are less ? and its difficult to ? mucus from them. the mucous excess is caught in the airways and acts as a focus for ?
mucous recurrently scarring thickened airway walls muscle layers responsive clear infection
32
what are the symptoms of bromchiectasis?
Productive cough often with green sputum
33
what is emphysema?
destruction of alveoli and dilation of others to fill the space (reduced SA for gas exchange)
34
how does emphysema lead to increase risk of cardiac failure?
increase in cardiac size as more work to pump blood round the body leading do cardiac failure being more likely
35
symptoms of COPD
Cough Mucus Fatigue Shortness of breath Dyspnoea - difficulty breathing Chest discomfort
36
causes of COPD
Asthma Pollution Age Smoking -> largest risk Chemical exposure Genetic - AAT deficiency Chronic bronchitis
37
complications of COPD?
Pneumonia Heart failure Acute respiratory distress syndrome ARDS Frailty depression
38
39
remember COPD risk assessment cant be based upon the medicine used (asthma can) as it is very specific to the patient
40
no drug based management of COPD 3
Smoking cessation Prevention of flu Pulmonary rehabilitation
41
inhlaed therapies for COPD are only given if non-drug based methods dont cause improvement name 3 inhaled drug therapies for COPD
Beta agonists if features suggest reversibility of airways Corticosteroids can be useful if significant inflammatory change Oxygen support if there is failure of the respiratory system
42
when may it be necessary to give COPD patients antibiotics?
if they have acute COPD exacerbation from infection
43
what is type 1 respiratory failure caused by?
alveolar effects (hypoxia - lack of oxygen reaching tissues) Reduced surface are for gas exchange Thickening of alveolar mucosal barrier from scarring of the alveolar surface
44
what is a person with type 1 respiratory failure called based on their clinical presentation?
Pink puffer -> hyperventilate to increase oxygen conc. Gradient to compensate
45
how is type 1 respiratory failure diagnosed?
arterial oxygenation below 8kPa on air, easier to measure oxygen saturation <90%
46
what is type 2 respiratory failure caused by?
poor ventilation (CO2 retention and hypoxia) Airway narrowing Restrictive lung defects - Muscle disease preventing ventilation
47
what is a person with type 2 respiratory failure called based on their clinical presentation
blue bloater Oxygen levels fall and CO2 levels rise, which is mirrored in the blood and the patient becomes oedematous and hypoxic
48
how is type 2 respiratory failure diagnosed?
if arterial CO2 is above 6.7kPa
49
how is respiratory failure managed?
Giving oxygen 24hrs a day increases chance of survival as low level hypoxia makes acute coronary events much more likely
50
why must patients given oxygen with COPD be carefully monitored especially respiratory rate?
they rely on CO2 drive for their ventilation so it will reduce their need to breath
51
dental impact of COPD? 3
ability to attend appt. - O2 therapy candida risk from oral steroids (rinse and spacer) oral cancer risk as often smokers/ex-smokers
52
Cystic fibrosis is a ? disease where there is an inherited defect in ??? Mutation in the ? gene on chromosome ? Causes the production of excess ? mucus and affects all ?? (mainly lungs and pancreas) Lungs fill with sticky secretions. ? and ? also occur Preventing ? is a large part of ensuring survival
genetic cell chloride channels CFTR 7 sticky bodily secretions bronchiectasis emphysema infection
53
diagnosis of cystic fibrosis 4
Prenatal screening Perinatal testing - all children screened at 5 days with blood spot test Sweat test -> greater salt content in CF patients as more chloride CFTR gene testing -> specific mutation depends on ethnicity
54
symptoms of cystic fibrosis in children 4
Troublesome cough Repeated pulmonary (chest) infection -> staph Malnutrition -> from the lack of fat absorption and the inability of the pancreas to produce enzymes Prolonged diarrhoea and poor weight gain -> Due to high fat content being passed through the gut
55
cystic fibrosis can lead to what? 4
Liver dysfunction Prone to osteoporosis -> not absorbing fat soluble nutrients e.g. vit D Diabetes symptoms -> chronic pancreatic inflammation gradually destroys B cells Reduced fertility -> mainly men
56
one of the treatmnets for cystic fibrosis is physiotherapy, how does this help?
Help remove the mucus secretions out the lung (like a massage, done by parents)
57
what medication is given to treat lung problems associated with cystic fibrosis?
Bronchodilators to open airways Antibiotics to reduce chest infection frequency Steroids to reduce airway inflammation
58
what medication is given to treat the digestive system problems associated with cystic fibrosis?
Pancreatic enzyme replacement Nutritional supplements
59
CFTR modulators can be given to cystic fibrosis patients they change ?? regulation so there is a more normal response to stimuli Only suitable for F508del patients which is 90% of patients
chloride channel
60
how do stem cell treatments help cystic fibrosis patients?
Replace bad gene with new one Difficult as has to be given to stem cells (not stable 'adult' cells) so that all body cells have the new gene copy
61
how does exercise help cystic fibrosis patients?
Keep lung function optimal Build physical bulk and strength
62
transplantation is a treatment option for cystic fibrosis that has lead to end stage lung disease
also effects the heart so lung-heart transplant) 10 year survival Complications from the transplant suppression medicines
63
causes of lung cancer
- Smoking - Genetics - Other lung diseases Environmental: chemicals, radon, air pollution, radiation therapy
64
Lung tumours can be a ? mass or a ? mass that blocks the ? allowing a collection of ? and ? in the lung resulting in ? and ? of the whole lobe of the lung.
peripheral central bronchus fluid inection pneumonia occlusion
65
almost all lung tumours are benign or malignant?
malignant
66
what are the 2 main types of lung cancer?
Small cell Non-small cell (most common) - Squamous cell carcinoma - Large cell - Adenocarcinoma
67
signs and symptoms of lung cancer
Cough Haemoptysis -> blood stained sputum Pneumonia -> from bronchi blockage Metastasis -> bone, liver, brain Other - Dysphagia -> difficulty swallowing from central tumour at bronchus compressing the oesophagus - Superior vena cava compression -> from tumour within mediastinum -> oedema as blood doesn’t return to right heart from upper body. - Recurrent laryngeal nerve palsy -> persistent hoarseness from tumour in contact with laryngeal nerve -> may be first sign of lung cancer
68
Diagnosis of lung tumours When a tumour starts there is a long time before symptoms develop and diagnosis so metastasis can occur leading to bad patient outcomes
69
what is stage 1 lung cancer?
Stage 1: one tumour
70
what is stage 2 lung cancer?
Stage 2: multiple lesions but only on one side of the thorax
71
what is stage 3 lung cancer?
Stage 3: lesions on both sides of the thorax
72
what is stage 4 lung cancer?
Stage 4: metastatic lesions throughout the lung and symptoms of oedema, fluid or pneumonia
73
Treatment of lung cancer Dependant on ? ? (genetic mutations of the lesion) help decide what treatment is best In locally advanced unresectable non-small cell lung cancer the treatment is ?? with the aim of prolonging life expectancy not ? the disease In some peripheral solitary lesions ? of the infected lobe can be curable
stage biomarkers chemoradiation therapy curing removal
74
what is obstructive sleep apnoea?
airway obstruction whilst asleep preventing normal breathing for 10seconds or more.
75
symptoms of obstructive sleep apnoea
Drowsiness during the day as cant sleep -> car accidents Snore
76
Problems associated with obstructive sleep apnoea Its a multisystem problem but manifests as an ? problem Affects the ? -> cognitive function etc. ? systems -> cardiovascular disease and insulin resistance (diabetes) increased risk of ??? such as MI as hypoxia occurs during sleep apnoea
airway brain control acute cardiac events
77
The number of times a obstructive sleep apnoea patient suffers obstruction during the night is key to their long term survival and need for treatment
78
how do mandibular advancement appliances help obstructive sleep apnoea?
Aims to move the tongue away from the pharynx. Move the mandible forward pulling the tongue with it
79
how does CPAP help obstructive sleep apnoea?
continuous positive airway pressure Mask is worn to maintain pressure in the airways to blow apart the tongue and pharynx maintaining patency
80
how does positional therapy help obstructive sleep apnoea?
An alternative if obstruction only occurs when the patient sleeps on their back. Devices to encourage to sleep on side.
81
what drugs improve ventilation through improving airway patency?
Bronchodilators -> relax the smooth muscle - B2 agonist and anticholinergic Anti-inflammatory -> reduce mucosal oedema and mucus production - Corticosteroids
82
what drugs improve ventilation through preventing mast cell degranulation?
Reduce inflammatory mediators released into the airway wall that cause narrowing of the airways - Chromoglycate - Leukotriene receptor antagonists
83
drugs that impair ventilation ?? -> Narrow airways by increasing airway smooth muscle constriction ?? - Benzodiazepines -> reduce ?? by causing muscle relaxation - Opioids -> reduce the ? for the patient to ?
B blockers respiratory depressants ventilation rate stimulus breath
84
what drug is used to improve gas exchange?
Oxygen -> higher conc. In alveolus = more oxygen diffuses into blood Remember oxygen is a drug so must be prescribed
85
what is the problem with a metered dose inhaler MDI?
fires a jet of drug into the oropharynx to be captured by the air being breathed in but a lot of the drug will be deposited around the oropharynx and may lead to local immunosuppression (especially corticosteroids) and candidiasis
86
inhaled drug delivery what is a breath activated device?
Pics up the drug as the air moves across the device and carries it into the airway Spinhaler, turbohaler
87
name two aids to inhaled drug delivery
Nebuliser - liquid version of the drug - The compressor blows air through the tube causing the drug to bubble and be breathed into the airway Spacer - useful for patients with a MDI - Don’t need to coordinate activating the inhaler and the breath so effectively - Activate device into chamber then take breath from chamber
88
B agonist Relieve the symptoms of asthma by ?
relaxing the airway
89
short acting B agonists ? onset administration ? use?
quick inhaled, oral, intravenous Treats acute bronchial constriction
90
long acting B agonist ? onset administration ? use ?
slow inhaled prevents acute bronchial constriction Always used with an inhaled steroid to reduce chance of acute coronary syndrome
91
what do anticholinergics do?
Cause relaxation of the smooth muscle and opening of the airways Used with b agonists for bronchial dilation and mucus secretion reduction
92
what do corticosteroids do?
Reduce inflammation in the bronchial walls
93
how do mast cell stabilisers treat asthma?
Prevent the release of chemical mediators in the bronchiole wall which initiate asthma
94
how do leukotrine inhibitors treat asthma
Prevent the release of chemical mediators in the bronchiole wall which initiate asthma
95
how do biological medicines treat asthma?
Target specific immune modulators within the inflammatory process
96

5 Human Diseases (16 decks)

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