Ella Kulman - Respiratory

Name a disease thats responsible for reversible airway obstruction

asthma

what intrinsic factors can affect pneumonia?

cold temperature, infection, stress, exercise, various pollutants

what can cause acute airway obstruction?

tumour or foreign bodies with distal collapse of the lung

what can COPD be sub-divided into?

1. chronic bronchitis
2. emphysema

is chronic bronchitis reversible?

no, its irreversible

what is the clinical diagnosis of chronic bronchitis?

persistent cough and sputum for 3+ months in 2 consecutive years

what can happen over time in a pt with chronic bronchitis?

pt may become hypercapnic, hypoxic and have progressive right sided heart failure (cor pulmonale) due to pulmonary vasoconstriction - there is fibrosis and tissue destruction

what is the pathology of emphysema?

irritants and chemicals trigger inflammatory mediators to release matrix destructive enzymes → elastin destruction and enlargement of alveolar air spaces → air trapping

what can cause chronic bronchitis?

often tobacco smoking and can be aggravated by pollution and infections

what can cause emphysema?

often tobacco smoking, can also be associated with alpha-1-antitrypsin deficiency and coal dust exposure

what is bronchiectasis?

permanent dilation of bronchi due to obstruction and inflammation, this leads to a build-up of excess mucus and predisposes someone to chest infections

what is idiopathic pulmonary fibrosis?

progressive fibrosis in the alveoli that limits the pts ability to respire

what is the name of the lung disorder group that reflects inhaled dust/toxins?

pneumoconiosis

pneumoconiosis: what might be the consequences of asbestos exposure?

-lung cancer
-persistent pleural effusion
-diffuse pleural fibrosis
-diffuse interstitial lung fibrosis

What happens to the FEV1, FVC and FEV1/FVC ratio in an obstructive lung disease?

FEV1 is decreased, FVC is normal, FEV1/FVC ratio is decreased

what happens to the FVC and FEV1/FVC ratio in a restrictive lung disease?

FVC reduced, FEV1/FVC ratio normal

give an example of an irreversible obstructive lung disease

COPD

what is the affect of COPD on residual volume and total lung capacity?

RV and TLC are increased

give an example of a restrictive lung disease

pulmonary fibrosis

what factors can commonly exacerbate asthma?

cold weather, exertion, fumes, often worse at night

what is a normal tidal volume?

500ml

what is the transfer coefficient?

the ability of O2 to diffuse across the alveolar membrane

what is the name of the test that can functionally assess respiratory function?

6 minute walk

what is consolidation on a CXR?

regions of the lung filled with liquid e.g. pulmonary oedema - the areas appear white/dense

what are the potential complications of bronchoscopy?

pneumonia and pneumothorax

give 2 early and 2 late stage symptoms of lung cancer

early → change in cough, wheeze, haemoptysis
later → weight loss, lethargy

if a chronically breathless pt is wheezing, what is the likely cause?

obstruction

give 2 examples of non-respiratory causes of breathlessness

heart disease, anaemia

what are the common affects of rheumatoid arthritis on the lung?

-pleural effusion
-fibrosing alveolitis
-airway disorders e.g. bronchiolitis, bronchiectasis

give an example of a disease where there is tissue damage due to chronic infection

COPD

give 2 examples of diseases where there is an excessive immune response

ARDS, asthma

what viruses can cause pneumonia?

adenoviruses, influenza A and B, measles, VZV

which influenza pathogen is commonly behind severe and extensive outbreaks and why?

influenza A - replicates a lot and mutations are common

How can influenza virus be transmitted?

aerosol → coughing and sneezing - inhale particles
droplet → hand to hand

what is the reproduction number?

average number of secondary cases generated from a primary case

what is the treatment for influenza?

supportive care - antivirals maybe to reduce risk of transmission

how would you describe the airways in asthma?

hyper-reactive → this leads to inflammation

why are airways hyper-reactive in asthmatics?

-inflammatory infiltrate
-eosinophils
-epithelium destruction gives easier access to bronchoconstrictors

what broad class of drugs are commonly used to alleviate symptoms in asthma?

bronchodilators

what broad class of drugs are commonly used to target inflammation in asthma?

steroids

what type of beta adrenergic receptors are found in the lungs?

beta 2

where are beta 1 adrenergic receptors found?

in the heart

where are anti-inflammatory steroids produced?

adrenal cortex

give 2 effects of hydrocortisone

-metabolic
-anti inflammatory

give some potential side effects of prolonged hydrocortisone use

-muscle wasting
-osteoporosis
-increased risk of infection

what are the main cells responsible for inflammation in asthma?

mast cells and eosinophils

what are the main cells responsible for inflammation in COPD?

neutrophils and macrophages

describe the mechanism behind aspirin induced asthma

aspirin inhibits COX → increase in arachidonic acid. this is shunted and there is increased leukotriene production = INFLAMMATION

what is the advantage of having inhaled medications in the management of asthma?

inhaled meds are more likely to reach the target sites and there is reduced chance of side effects

name some groups of people who might be at increased risk of pneumonia

-elderly
-children
-people with COPD
-immunocompromised
-nursing home residents

briefly describe the pathogenesis of pneumonia

-bacteria translocate to normally sterile distal airway
-resident host defence is overwhelmed
-macrophages, chemokines and neutrophils produce an inflammatory response

what symptoms might you see in someone with pneumonia?

-productive cough
-sweats
-fever
-breathlessness
-pleuritic chest pain
myalgia/headache/arthralgia suggests atypical pneumonia

what investigations might you do in someone you suspect has pneumonia?

-CXR → look for air bronchogram in consolidated area
-FBC (look at WBCs)
-U+E
-LFT
-CRP
-microbiology → sputum culture, blood culture, serology etc

what is CURB65 used for?

way of assessing the severity of community acquired pneumonia - predicts mortality

name 2 bacteria that commonly cause pneumonia

-streptococcus pneumoniae
-haemophilus influenzae

describe s.pneumoniae

gram +ve cocci chain

describe haemophilus influenzae

gram -ve bacilli

what antibiotic would you give to someone with haemophilus influenzae?

co-amoxiclav or doxycycline

what can be a sign of effusion of CXR?

lots of consolidation

what is empyema?

pockets of pus that have collected in a body cavity e.g. in the lungs

give some signs of empyema

-WBC/CRP don't settle with antibiotics
-pain on deep inspiration
-pleural collection

what is the usual treatment for empyema?

drainage

name 3 groups of people who might be at risk of hospital acquired pneumonia

-elderly
-ventilator associated
-post op pts

what is bronchiolitis?

airway obstruction caused by inflammation of the bronchioles and increased mucus secretions

what can cause bronchiolitis and who is it most common in?

RSV (respiratory synctial virus), children

what is the difference between bronchitis and bronchiolitis?

bronchiolitis → inflammation of bronchioles
bronchitis → inflammation of bronchi epithelium due to irritants and chemicals

what investigations might you do in someone you suspect has infective bronchitis?

-CXR (often normal)
-viral and bacterial swabs

what is the usual cause of infective bronchitis?

mainly viral. acute bronchitis can be caused by adenoviruses

is pharyngitis normally caused by bacterial or viral infection?

viral e.g. rhinovirus, adenovirus etc

what bacteria might cause pharyngitis?

streptococcus pyogenes

what is the centor criteria used for?

determine the likelihood that a sore throat is bacterial

is sinusitis usually bacterial or viral?

viral

what are the symptoms of whooping cough in adults?

chronic cough, inspiratory 'whoop' posttussive vomiting

what causes croup?

parainfluenza virus

what is croup?

acute laryngotracheobronchitis - trachea, bronchi and larynx all affected

malignant bronchial tumours can be divided into 2 groups, what are they?

small cell and non small cell

which type of malignant bronchial tumour tends to have a worse prognosis?

small cell

give 5 environmental causes of lung cancer

-SMOKING
-asbestos exposure
-radon exposure
-coal tar exposure
-chromium exposure

the 5 year lung cancer survival rate is 8-10%, why is this?

people often present very late so treatment is much harder

what are the 3 main cell types that make up non small cell lung cancer?

squamus cell → 20%
adenocarcinoma → 40%
large cell

how does PET scanning work?

functional not anatomical - FDG is taken up rapidly by dividing cells, tumours therefore appear 'hot' on the scan

give symptoms of local disease lung cancer

-chest pain
-wheeze
-breathlessness
-cough
-haemoptysis
-recurrent chest infections

give symptoms of lung cancer that has metastasised

-bone pain, esp waking in the night
-headache
-seizures
-neurological defecit
-hepatic and/or abdo pain
-weight loss

name 5 places that lung cancer might metastasise to

-bone
-brain
-liver
-lymph nodes
-adrenal glands

what are paraneoplastic syndromes?

disorders triggered by an immune response to a neoplasm

give some examples of paraneoplastic syndromes

-finger clubbing
-anorexia
-weight loss
-hypercalcaemia
-hypernatraemia

what investigations might you do on someone to determine whether they have lung cancer?

-CXR
-CT scan
-bronchoscopy
-surgical and percutaneous biopsy
-bloods

what tests might you do on a pt to determine whether they're fit for operation?

-ECG
-lung function tests
-determine performance status

example of a malignant pleural tumour

mesothelioma

treatment for mesothelioma

-symptom control
-palliative chemotherapy or radiotherapy
-radical surgery (removal of tumour blood supply)

how does the treatment differ between local and systemic lung cancer?

local → surgery and radiotherapy
systemic → chemotherapy

give some side effects of radiotherapy

-fatigue
-anorexia
-cough
-oesophagitis
-systemic symptoms

give some side effects of chemotherapy

-alopecia
-nausea/vomiting
-peripheral neuropathy (nerve damage in extremities)
-constipation/diarrhoea

how might you diagnose pleural effusion?

-good hx
-imaging
-thoracentesis

what is a pneumothorax?

air in the pleural space which can lead to partial or complete lung collapse

what do carotid and aortic bodies detect?

chemoreceptors respond to increased CO2 and decreased O2

what is type 1 respiratory failure?

hypoxia → decreased PaO2

PaCO2 is normal/slightly low due to hyperventilation

what is type 2 respiratory failure?

hypoxia and hypercapnia → decreased PaO2 and increased PaCO2 (there is alveolar hypoventilation)

give signs of hypercapnia

-bounding pulse
-flapping tremor
-confusion

what can cause type 1 respiratory failure?

-airway obstruction
-failure of O2 to diffuse into the blood
-V/Q mismatch
-alveolar hypoventilation