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Resp Path 2009
Dr Amy Johnston P&P 1 notes 2009
| Question | Answer |
|---|---|
| What are the readings expected in Acute Respiratory Failure? | PaO2 <60mmHg + PaCO2 >50mmHg + pH <7.3 on room air |
| What are the categories of Acute Respiratory Failure? | 1. Failure of respiration or oxygenation, 2. Failure to ventilate or 3. Both |
| What are some of the physiological aetiologies of Acute Respiratory Failure? | Neuromuscular; chest skeletal system; chest trauma; shock; pulmonary oedema; obesity |
| What are some of the respiratory conditions which can lead to Acute Respiratory Failure? | Asthma; pneumonia; emphysema; ARDS |
| What is ARDS? | Acute (Adult) Respiratory Distress Syndrome |
| What are the clinical signs of respiratory failure? | They include: hypoxia, hypercapnia, headache, dizziness, confusion, tachycardia, dyspnoea, tremors, hyper, then hypotension |
| What are the early signs of respiratory failure? | Rapid shallow breathing; increased use of accessory breathing muscles |
| What are the late signs of respiratory failure? | Cyanosis; nasal flaring; intercostal retractions; cool clammy skin; dysrhythmias; loss of consciousness; decreased capillary refill |
| What is the treatment for respiratory failure? | Maintain mechanical ventilation support; deal with the patient's distress; treat the underlying cause. |
| What is the V/Q ratio? | The ventilation / perfusion ratio. The ratio of alveolar ventilation in L/min expressed over pulmonary perfusion of blood in L/min. |
| What is a normal V/Q ratio? | 4L/min (air) over 5L/min (blood) |
| What is a low V/Q ratio and what does it signify? | Where the amount of air reaching the point of gas exchange is reduced. Eg 2 L/min (air) over 5 L/min (blood) |
| What is a high V/Q ratio and what does it signify? | Where the amount of blood reaching the point of gas exchange is reduced. Eg 4L/min (air) over 3 L/min (blood) |
| What is shunting in relation to V/Q? | 'Where there is a passage of blood from a pulmonary artery to a vein through non ventilated portions of the lung.' |
| What is cor pulmonale? | enlargement of the right ventricle of the heart due to disease of the lungs or of the pulmonary blood vessels wordnet.princeton.edu/perl/webwn |
| What happens to blood flow in areas of the lung with low oxygen saturation? | There is vasoconstriction, and blood is transported to other more highly oxygen rich areas of the lung. |
| What happens when large areas of the lung have low perfusion and poor oxygen saturation? | Arterioles continue to constrict, increasing resistance. Pulmonary artery pressure increases and causes hypertrophy of right ventricular myocardium. |
| What is a usual pulmonary pressure reading? | 25 / 8 mmHg (it has low pressure because it does not need to travel far or against gravity) |
| Greater than what systolic pressure is pulmonary hypertension? | >30mmHg |
| What causes primary pulmonary hypertension? | Unknown - it is an idiopathic disease. |
| What causes secondary pulmonary hypertension? | A known underlying disease process. Increased resistance because of increased pulmonary blood flow; increased resistance to flow; increased left atrial pressure |
| How does pulmonary oedema cause air to be trapped in the bronchioles? | During inspiration the air is able to move past the blockage with is angled in the direction of inspiration. However at expiration air is trapped under its 'lip' and pushes it up to form a plug. |
| What are some of the signs and symptoms of pulmonary hypertension? | Exercise intolerance; syncope (passing out); chest pain with excercise; dyspnoea; fatigue; haemoptysis; pulmonary oedema |
| What are the 2 elements required by the airways for facilitating good gas exchange? | Diameter of airways & airway tissue resistance |
| What is the lung paranchyma? | The part of the lungs beyond the airways at which gas exchange takes place |
| What is Restrictive Lung Disease? | It is any disorder in which the ability of the lungs to expand is impaired. |
| What are some conditions which can cause restrictive lung disease due to changes in lung parenchyma? | Pneumonia, lupus, vascular disease, pulmonary oedema & pulmonary embolism |
| What are some of the conditions affecting the pleura which can cause restrictive lung disease? | Pleural effusion, haemothorax, pneumothorax |
| What are some conditions affecting the chest wall which can cause restrictive lung disease? | Obesity, kyphoscoliosis |
| What are some of the neuromuscular conditions which can cause restrictive lung disease? | Quadriplegia, myasthenia gravis, muscular dystrophy, polio |
| What breath measurements are characteristic of restrictive lung disease? | Reduced: Total Lung Capacity, Vital Capacity, Functional Residual Capacity, Residual Volume |
| What is the cough of a person with viral pneumonia like compared to one with bacterial pneumonia? | Viral: nonproductive Bacterial: productive |
| What is the fever of a person with viral pneumonia like compared to one with bacterial pneumonia? | Viral: low-gradeBacterial: higher temps |
| What is the white blood cell count of a person with viral pneumonia like compared to one with bacterial pneumonia? | Viral: normalBacterial: elevated |
| What is the consolidation of a person with viral pneumonia like compared to one with bacterial pneumonia? | Viral: no consolidationBacterial: yes, with dull & e->a |
| What is the V/Q change of a person with viral pneumonia like compared to one with bacterial pneumonia? | Viral: minimalBacterial: low V/Q & shunting |
| What is the X-ray of a person with viral pneumonia like compared to one with bacterial pneumonia? | Viral: minimal changesBacterial: |
| What is the severity of viral pneumonia like compared to bacterial pneumonia? | Viral: less severeBacterial: more severe |
| Can antibiotics be used to treat pneumonia? | Only if it is bacterial. They do nothing for viral pneumonias. |
| What is the treatment for community acquired bacterial pneumonia where the patient is <50yo and has no comorbidity? | Empiric treatment with macrolide. |
| What is the treatment for community acquired bacterial pneumonia where the patient is >50yo and has comorbidity/ies? | Septra, Augmentin, Fluoroquinolone, 2nd generation Cephalosporin |
| Why is TB such a killer? | Very high antibiotic noncompliance which has lead to very high resistance. |
| How is tuberculosis transmitted? | Airborne, by UV-sensitive microbacterium |
| What is the pathophysiology of tuberculosis? | Lung tissue is destroyed leading to calcification and cavities. It can spread to other organs. |
| What is a 'Ghon tubercle'? | The pulmonary lesion of primary tuberculosis. Also called Ghon's focus, Ghon's primary lesion. |
| What is the treatment for tuberculosis? | Multidrug therapies are required due to high resistance. |
| What happens to the alveoli in ARDS? | Atelectasis (alveolar collapse) due to damage done to the alveolar capillary membrane. |
| What are some of the aetiologies for ARDS? | Tissue trauma; aspiration of stomache contents; indirect damage such as shock; inflammation |
| What is the pathophysiology of ARDS? | 1. Leaky capillaries -> pulmonary oedema 2. Deacreased surfactant -> atelectasis 3. Injury -> fibrosis |
| What is surfactant? | It is a phospholipid which is secreted onto the surface of the alveoli by Type 2 alveolar cells to reduce surface tension. |
| What is hyaline membrane disease of the newborn? | It is where babies are born without (or without enough) surfactant. At expiration, alveloi collapse and on inspiration fill with fibrin rich fluid -> hyaline membrane formation |
| When does the foetus produce surfactant? | At between 28 - 30 weeks. |
| What % of neonates born at <30 weeks develop Hyaline Membrane Disease? | 60% |
| What are some contributing factors other than pre-term birth which can lead to hyaline membrane disease? | Maternal diabetes; caesarian without labour; perinatal asphixia; second twin |
| What treatment is there for hyaline membrane disease? | Prophylactic corticosteroids |
| What is the pathophysiology of pneumothorax? | A positive pressure exists in the thoracic cavity instead of the negative pressure required for pulmonary ventilation. |
| What are some of the physical effects of pneumothorax? | Tracheal shift; cardiac compression; lung deflation. |
| Define haemothorax. | Blood in the pleural space |
| Define pneumothorax. | Air or gas in the pleural space |
| Define empyema. | Pus in the pleural space (as with TB or pleurisy) |
| What is transudate and what does it cause in the pleural space? | It is the serous fluid, low in protein. It increases BP, causes systemic oedema & impairs lymphatic drainage |
| What is exudate and what does it cause in the pleural space? | It is a protein rich fluid. It follows inflammation & its increased capillary permeability (eg pneumonia) |
| What is the treatment for pneumothorax, haemothorax and empyema? | Drainage and treatment of the cause of the problem. |
| What is sleep apnoea? | The cessation of breathing while sleeping. |
| What are the three types of sleep apnoea and their frequency? | Obstructive (most common), Central (rare) & Mixed |
| What is Obstructive sleep apnoea? | The pauses in breathing occur because there is a collapse or obstruction of the upper airway (throat) + decreased O2 saturation in blood -> waking up to breathe |
| What is Central sleep apnoea? | The waking up to breathe is the same as obstructive sleep apnoea, but the person stops breathing because of loss of neurological inspiratory drive. |
| What are the signs and symptoms of sleep apnoea? | Heavy snoring; falling asleep at unusual times; poor sleep quality; excessive fatigue |
| What is sleep apnoea linked with? | High BP and increased chance of heart disease, stroke & arrhythmias |
| What is asthma? | A reversible obstructive airways disease, usually associated with increased airway responsiveness |
| What are the 2 pathophysiological components of an asthma attack? | Bronchoconstriction + inflammation |
| What are the general symptoms for asthma? | Wheezing, dyspnoea, cough, hyperinflation |
| What is the pathophysiology of asthmatic inflammation? | Degranulation of mast cells, causing release of inflammatory chemicals -> mucous secretion + smooth muscle contraction |
| What is the pathophysiology of asthmatic bronchoconstriction? | Direct stimulation of the smooth muscles surrounding airways + fluid buildup in the inner lumen -> decrease diametre and impaired patency |
| Are intrinsic and extrinsic asthma similar in their aetiology? | No. Extrinsic asthma is usually an allergic activation of IgE (Immunoglobulin E) and intrinsic is not. |
| Are intrinsic and extrinsic asthma similar in their signs and symptoms? | Yes. Both involve mast cell degranulation and the initiation of inflammation |
| How is asthma diagnosed? | PEFR (Peak expiratory flow rate) >80L/min = onstruction. Also a FEV1:FVC ratio which changes after use of a bronchodilator. |
| Can asthma induce alkalosis or acidosis? | It can sometimes cause alkalosis |
| What % of bronchitis is viral? | 80% |
| What are 4 common changes to the bronchial wall you would expect to see in asthmatics? | 1. Hypertrophied smooth muscle 2. Oedema 3. hypertrophed mucous glands 4. mucous in the lumen |
| What happens to the mucous membrane in the bronchii when bronchitis becomes chronic? | There is scarring and fibrosis. |
| What are some of the consequences of bronchitis (especially chronic bronchitis)? | Decreased alveolar ventilation -> hypoxaemia, hypercapnia and compensatory polycythaemia. Pulmonary vasoconstriction, hypertension and right ventricular hypertrophy -> right side heart failure |
| What are chronic bronchitis sufferers also known as? | Type B COPD sufferers or 'blue puffers / bloaters' |
| What test is needed to differentiate bronchitis from pneumonia? | Chest radiogram |
| What is one of the consequences of the loss of ciliated epithelium in chronic bronchitis? | Increased access into the airways by airborne particulates -> increased inflammation |
| What is croup? | An inflammatory disease of the larynx in children aged 6 months to 3 years |
| What vaccination is available to prevent epiglottitis? | Hib - Haemophilius influenza type b - prevents this potentially fatal disease |
| What is stridor? | Associated with croup, it is a high pitched barking cough |
| What treatments are given for viral croup? | Oxygen therapy; pulse oximetry; nebulaized adrenaline; endotracheal intubation for respiratory failure |
| What are some of the signs and symptoms of epiglottitis? | Drooling, dysphagia, rapid onset of fever, dysphonia, inspiratory stridor and retractions |
| What are emphysema patients also known as? | Type A COPD sufferers or 'pink puffers' |
| What occurs to the alveoli in Emphysema? | There is widespread destruction of the walls of the alveoli; bullae formation of dital air sacs and consequent narrowing of bronchiole lumen |
| What are some signs and symptoms of emphysema? | Increased residual volume; dysrhythmias; decreased breathing sounds; hyperresonance of chest; development of barrel chest |
| What is cystic fibrosis? | It is a genetic disorder leading to massive production of mucous in lungs, endocrine organs and GI tract. |
| What are the pulmonary signs and symptoms of cystic fibrosis? | History of cough; thick mucous; often pulmonary infections; dyspnoea; tachypnoea; sternal retractions; basilar crackles; hyperresonant barrel chest |
Created by:
Kbel
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