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Block 1 - Prescribing > Respiratory > Flashcards

Flashcards in Respiratory Deck (19)
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1
Q

• The bronchioles continue to subdivide into..

A

– Terminal Bronchioles
– Respiratory Bronchioles
– Alveolar Ducts
– Alveoli

2
Q

Alveoli

A
  • Tiny, thin walled air sac at the end of bronchiole branches where gas exchange occurs.
  • Millions of alveoli in each lung
3
Q

The lungs

A
  • Two lungs lying each side of the midline in the thoracic cavity
  • The area between is the mediastinum occupied by the heart, great vessels, trachea, and right and left bronchi
4
Q

The Pleura

A

• Closed sac of serous membrane that covers each lung and separates them from other organs
• Consists of two layers
– Visceral Pleura (adhered to lung)
– Parietal Pleura (adhered to chest wall and diaphragm)
– Two layers separated by thin film of serous fluid secreted by the membrane to prevent friction when breathing

5
Q

Function - Respiratory system

A
Purpose – gas exchange
• Deoxygenated blood to oxygenated blood
Moving air – through the ducting system
Function
- Warms
- Humidifies
- Filters
6
Q

Lung volumes

A
Male = 6L
Female = 4.2L
Tidal volume = 400mL … single breath volume
Dead space = 150mL … no perfusion
Respiration rate = 12-20/min adults
7
Q

Cough - Common causes

A
  • Asthma – wheeze, often nocturnal, worse in mornings
  • COPD – (‘smokers’) usually produces sputum in mornings
  • Chronic heart failure
  • Interstitial lung disease
  • Drugs
8
Q

Cough - Ask about

A
  • Time of cough – when is it worse?
  • Duration – acute <3 weeks, sub-acute 3-8 weeks, chronic > 8 weeks
  • Relief with inhaler
  • Worse on lying down
  • Wakening
  • Sputum
  • Haemoptysis
9
Q

Sputum and haemoptysis - Types

A
  • serous: clear waters (acture pulmonary oedema), frothy pink (alveolar cell cancer)
  • mucold: clear, grey (chronic bronchitis/chronic obstructive pulmonary disease), white, viscid (asthma)
  • purulent: yellow (acute bronchopulmonary infection, asthma eosinophils), green (longer standing infection - pneumonia, bronchiectasis, cystic fribrosis, lung abscess)
  • rusty: rusty red, phneumococcal pneumonia
10
Q

Sputum and haemoptysis - ask about

A
• Colour
• Amount
• Taste or smell
• Solid material
• Haemoptysis
– Amount, fresh, in sputum?
– Coughed up vs.
• vomited/regurgitated
• from nasopharynx
11
Q

Breathlessness, shortness of breath,

dyspnoea

A
  • Dyspnoea – the sensation that unable to breath properly (subjective)
  • Shortness of breath, breathlessness – includes objective measures of difficulty in breathing
  • Orthopnoea – SoB on lying, usually associated with LVF
  • Paroxysmal nocturnal dyspnoea – wakes patient from sleep – usually LVF (in asthma – wheeziness often causes waking in early morning)
  • Exercise induced bronchoconstriction
  • Assessment of severity – MRC breathlessness scale
12
Q

Dysphonia define

A

hoarseness caused by damage to larynx or the nerve to larynx

13
Q

wheeze define

A

– high pitch whistling noise – air passing through narrowed airways

14
Q

stridor define

A

– high pitched, harsh noise caused by obstruction of

large airway – always needs investigation (unless viral croup!)

15
Q

Physical Assessment

A
IPPE
Introduction
Permission
Position
Exposure
IPPA
Inspection
Palpation
Percussion
Auscultation
16
Q

Red flag signs for cough - Non acute

consider investigation and referral

A
  • Haemoptysis
  • Breathlessness
  • Fever
  • Chest pain
  • Weight loss
17
Q

Red flag signs for cough - Signs of serious acute illness

urgent admission

A
  • Respiratory rate of more than 30 breaths per minute.
  • Tachycardia greater than 130 beats per minute.
  • Systolic blood pressure less than 90 mmHg, or diastolic blood pressure less than 60 mmHg (unless this is normal for them).
  • Oxygen saturation less than 92%, or central cyanosis (if the person has no history of chronic hypoxia).
  • Peak expiratory flow rate less than 33% of predicted.
  • Altered level of consciousness.
  • Use of accessory muscles of respiration (particularly if the person is becoming exhausted).
18
Q

Red flag signs – suspected lung cancer, aged 40 yrs plus: Do urgent CXR (<2 weeks), if unexplained:

A

• Persistent or recurrent chest infection.
• Finger clubbing.
• Supraclavicular lymphadenopathy or persistent cervical
lymphadenopathy.
• Chest signs consistent with lung cancer.
• Thrombocytosis

URGENT REFERRAL (<2wks)
• CXR abnormal
• Aged 40 and over with unexplained haemoptysis

19
Q

Red flag signs – suspected lung cancer, aged 40 yrs plus: Consider urgent CXR (<2weeks), if 2 or more in non-smoker, or if 1 in ever smoker:

A
  • Cough
  • Fatigue
  • Shortness of breath
  • Chest pain
  • Weight loss
  • Appetite loss