27/1

Question 1

asthma

• define
• age/ sex
• patho
• symptoms
• signs
• Ix

Answer 1

define
- inflammation of airways causing bronchoconstriction

age/ sex

• any gender
• extrinsic - young
• intrinsic- middle age, occupational, F

patho

• extrinsic - type 1 hypersensitivity
• • triggers&raquo_space; PGD2/ histamine/ LT release&raquo_space; bronchoconstriction
• • late - eosinophils/ mononuclear cells&raquo_space; mucosal oedema and airway hyperreactivity
• intrinsic/ late onset - quicker decrease in lung function, neutrophils IN in sputum
• chronic - bronconconstriction and increased mucus cuasing charcot-leyden crystals (eosinophil granules) and curshman spirals (mucus plugs)

symptoms

• chest tightness, wheeze, SOB, nocturnal cough, sx worse with exercise/ cold/ pets/ pollen
• triggers by NSAIDs, aspirin, beta blockers

signs

• wheeze on ausc
• PEF reduced
• reduced FEV1
• FV1/ FVC DE
• reversible with bronchodilators - improvementy of >12% and IN vol 200ml

Ix

• resp exam
• bloods - Hb, CRP, ESR, alpha 1
• spirometry, FeNO2 >40 ppb is positive

Question 2

asthma - Mx

Answer 2

SABA
SABA +ICS
SABA + ICS + LABA
SABA + IN ICS + LABA OR SABA + ICS + LABA + LTRA
specialist - MART

Question 3

asthma - Mx SE

• saba
• steroid
• laba
• ltra
• aminophyllie

Answer 3

saba e.g. salbutamol

• hypokalaemia
• somatic - tachycardia, tremors, cramps
• 4-6H

ics e.g. beclometason, budesonide, fluticasone

• rinse mouth after use
• oral thrush, puemonia

laba
- 12hrs

LTRA e.g. montelukast
- GI disturb, thirst, churgg-strauss

aminiphylline
- heaadaches, insomnia, nausea, tachycardia, arrhythmia

Question 4

asthma - acute

• symptoms
• mx

Answer 4

symptoms

• mod - PEF 50-75%, no sx severe, increased symptoms
• severe - HR >110, RR>25, PEF 33-50%, not complete sentences
• life threat - cyanosis, hypotension, bradycardia, silent chest, spO2<92%, low or normal pCO2, PEF<33%

Mx

• mod - neb SABA and ipratrobium bromide mix, steroid oral or IV for 5D, abx if infection
• severe - o2 94-98%, aminophylline iv, iv salb?
• life-threat - Iv mgSO4, HDU, intubation if severe
• SENIOR - aminophylline, iv salb, iv mag
• response to treatment - RR, resp effort, PEF, o2, chest ausc

Question 5

COPD

• define
• patho
• age/ sex
• RF
• symptoms
• signs
• Ix
• Mx - lifestyle
• Mx - stable
• Mx - unstable
• Mx - specialist

Answer 5

define/ patho

• emphysema - dialted alveoli, DE diffusion gradient
• bronchitis - increased secretions of goblet cells and increase mucus
• overall - air trapped in lungs and increased risk of infection e.g. pseudomonas

RF

• smoking
• pollution
• occupation e.g. coal
• alpha-1 antitrypsin

symptoms

• SOB
• cough with sputum
• chest tightness
• fatigue, wt loss, anorexia
• syncope
• depression

signs

• MRC dyspnoea scale - 1-5 - 1 with normal exercise, 2 uphill, 3 flat, 4 100m, 5 housebound
• polyphonic wheeze, widepsreaad

Ix

• resp exam
• bloods - Hb, LFT, CRP, ESR, ABG (t1RF)
• ECG
• CXR - hyperinflated chest, dilated pulmonary aa, flat hemidiaphragm, reduced peripheral markings
• raised JVP - cor pulmonale
• spirometry - 1 FEV>80%, 2 FEV 50-79%, 3 FEV30-49%, 4 FEV<30%
• DLCO

Mx - lifestyle
- wt loss, smoking cessation, diet, plan for acute

Mx - medical, if lifestyle fails

• stop smoking, diet, coal dust exposure limitation
• SABA
• asthma features - LABA + ICS&raquo_space; LABA + ICS + LAMA
• no asthama - LABA + LAMA

Mx - specialist

• pulmonary rehab - 3/wk for 6W - disability
• mucolytics - carbocysteine
• vacc - pneumonoccocal
• fail with triple therapy - aminophylline
• roflumilast - PDE4 inhibitor if on max therapy and regular exacerbations
• LTOT - sp02<90% and FEV1<30%/ cyanosis/ cor pulmonale/ polycythaemia - increase survival if used 15hr/day