3. Respirology Flashcards
Respiratory drugs
Function of bronchodilators Function of mast cell stabilisers and leukotriene inhibitors Function of B-agonist Function of anticholinergics Action of corticosteroids Types of respiratory stimulants (2) Action of theophylline
Improve airway patency
Prevent mast cell degranulation
Bronchodilator - treat/prevent acute bronchial constriction. Long/short acting
Bronchodilator - inhibit muscarinic nerve transmission of autonomic nerves –> bronchial dilation and reduced mucus secretion
Reduce bronchial wall inflammation
Oxygen greater than air concentration and theophylline
Improves gas exchange, relaxes bronchial smooth muscle, increases heart muscle contractility and efficiency, increase BP, renal blood flow and anti-inflammatory effects
General respiratory disease signs and symptoms (10) Respiratory investigations (4)
Cough (dry, sputum, blood), wheeze (expiration), stridor (inspiration), SoB, pain, chest movement with respiration, respiratory rate (12-15bpm), air entry (symmetrical/reduced), vocal resonance (resonant/dull), percussion notes
Sputum exam, CXR, pulmonary function (PEFR, FEV, FEV1/VC), VQ scan
Asthma
Definition Characterised by Triad of (3) Signs and symptoms (5) Triggers (5) Treatment stages (5)
Bronchial hyper reactivity. Common long-term inflammatory disease of lung airways.
Variable and recurring symptoms, reversible airflow obstruction and bronchospasm.
Airway smooth muscle construction, mucosa (wall) inflammation and increased mucus production
SoB, wheeze, chest tightness, cough, use of accessory muscles
Infection, environmental, cold air, atopy, exercise
- Occasional B-agonist
- Low-dose inhaled steroid/Na chromoglycate/nedocromil
- High-dose inhaled steroid
- Long-acting B-agonist, theophylline, anti-muscarinic drug
- Oral steroid
COPD
Definition
Combination of
Aetiology/cause (3)
How can COPD lead to respiratory failure (2)
How can occupational lung disease lead to respiratory failure (2)
Management (4)
Acute/chronic COPD treatment
Mixed reversible airway obstruction and destructive lung disease
Asthma and emphysema (leads to poor ventilation)
Smoking, environmental, hereditary (emphysema)
From reduced surface area for gas exchange, thickening alveolar mucosa barrier
From fibrosis (dust) or tumours (asbestos)
Stop smoking, long-acting bronchodilator, inhaled steroids (if FEV < 50%), oxygen support
Acute - oxygen until medical help arrives
Chronic - home oxygen therapy
Respiratory failure
Type 1 description
Type 1 due to (4)
Type 2 description
Type 2 due to (4)
Normal breathing features vs COPD breathing features
Type 1 - hypoxaemia - PaO2 < 8kPa/60mmHg
Due to high altitude, VQ mismatch, diffusion abnormality, alveolar hypoventilation
Type 2 - hypoxaemia and hypercapnia (PaCO2 > 6.7kPa/50mmHg). Rely on low oxygen concentration to breathe
Due to increased airway resistance (COPD), airway narrowing/blockage, ventilation problems in muscles, NM problems. Involves reduced compliance, airway obstruction and muscle dysfunction
Normal breathing - CO2 drive controls ventilation. In COPD - CO2 tolerance and hypoxia drives ventilation
Cystic fibrosis
Aetiology (genes) and cell defect caused Effects of cell defect Organs most affected (2) Investigations (2) Signs and symptoms (8) Treatment (4) Medications used (6)
Inherited CFTR gene causes defect in cell chloride channels
Excess production of sticky, solid mucus –> bacteria trap
Lungs and pancreas
Perinatal test (blood), sweat test (CF salt in saliva > normal)
Troublesome cough, repeated chest infections, prolonged diarrhoea, poor weight gain, liver dysfunction, prone to osteoporosis, diabetes symptoms, reduced (male) fertility
Physiotherapy, medication, exercise, transplant
Bronchodilators, steroids, antibiotics, DNase (breaks down mucus), pancreatic enzyme replacement, nutritional support
Lung tumours
Effects (7)
Common metastases sites (3)
% smoking related
ESLD cause
Cough, haemoptysis, pneumonia, metastases, dysphagia, SVC obstruction, recurrent laryngeal nerve palsy
Bone, liver, brain
40%
Extensive fibrosis of lung tissue
Sleep apnoea
Definition Types (2) Investigations Increased risk of OSA treatment (2)
Airway obstruction in sleep, >10 second drop in airway muscle tone
OSA or central
AHI (apnoea/hypopnea index - score of <10 indicates few problems)
MI
CPAP, mandibular advancement devices if tongue falls back due to relaxing muscles
URTIs
Main causative agent
Group A strep virulence factors (3)
Strep throat complications (4)
Types of bronchitis (2)
Symptom/causes of bronchitis (3)
Treatment of bronchitis (3)
S. pyogenes
Pyrogenic exotoxins, streptolysins, hyaluronidase
Abscess, scarlet fever, otitis media, sinusitis
Acute, chronic
Productive cough due to smoking, air pollution, infection, allergies
Decongestants, NSAIDs, antibiotics
Pneumonia
Definition of pneumonia Signs and symptoms (8) Investigations (2) and management (2) Main type of atypical pneumonia Signs and symptoms Treatment Action of pneumolysin (4)
Lung/alveolar inflammation from infection
Fever, riggers, malaise, SoB, rapid shallow breathing, cyanosis, cough producing purulent sputum, consolidation of lungs
CXR, clinical exam. Hospitalisation, IV antibiotics
Legionnaires disease
Flu-like –> severe pneumonia
Macrolide
Inhibits ciliated cell activity - cytotoxic for alveolar and endothelial cells. Activates classical complement –> lung inflammation. Reduces PMN effectiveness and stimulates monocytes to produce cytokines
Oral implications of smoking (4)
Cancer, periodontal disease, staining, keratosis
