Airway Flashcards

Question

Phenotypes of asthma

Answer 1

Allergic Non allergic Adult Asthma-Copd Obesity

Answer 2

Pefr increase 12% and increase 200 ml Pefr 20% diurnal variation

Answer 3

IL4 and IL13 induced iNOS Above 50 positive False low Steroid Smoking Alcohol LTRA or PG High Tall Men Asthma Rhinitis Atopy HIV Pollution

Answer 4

Validated ACQ, ACT Non validated RCP Exacerbation inc itu Night symptoms Saba overuse

Answer 5

Saba prn ICS low dose Nice add LTRA eg monteleukast ICS and LABA (better lung function, less exacerbation, decrease asthma) Med dose ics Then lama helps cont partial increase ics Other Theophylline Pde inhibitor so camp not broken down Better lung function and symptoms SE arrhythmia, drug int, GIT LTRA Reduce inflam and mucus Rhinitis and aspirin induced LAMA Block Ach on m3 so smooth muscle relaxation Reduce exacerbation, better lung function, less sob Low dose ocs Macrolide Thermoplasty

Answer 6

Symptoms - wheeze, sob, cough, chest tight Airway inflammation- feno above 50/ Eo above 0.3 Variable airflow obs - bdr 12% increase and 200ml, Pefr 20% diurnal variation, provocation 20% Obs fev1/fvc <0.7

Answer 7

Adherence Inhaler technique Triggers Review tax Occupational asthma Scores ACQ/ ACT

Answer 8

Omalizumab Allergic asthma or urticaria IGE 4 or more exacerbations and Eo 300-700 MEPOLIZUMAB Il5 Asthma and egpa 3 exac and 400 Eo or vv OR instead exac on pred over 5mg for 6m Benralizumab IL5 Eo 400 and 3 ex Egpa, Ocs and adult Resilizumab IL5 Eo 400 and 3 exac Dupilumab Anti il4a receptor blocker blocks il4 and il13 Eo 400, 4 exac, feno more than 25 Asthma and atopic dermatitis ** failed or not eligible for one of the others Tezeplimab Anti TSLP elk derived cytokine 3 exacerbations in 12m No Eo but previous biologic Rhinovirus, ABPA

Answer 9

Increased symptoms and reduced lung function

Answer 10

Infection Pollution Poor adherence to Thunder

Answer 11

Greatly Previous exacerbation 1 or more last year Moderately Poor control Overuse SABA Mildly Female Obese Older Reduced lung function Smoking Psych issues Food allergy GERD Worse lung function, raised Eo or feno

Answer 12

Previous near fatal ACQ >1.5 More than or equal to 3 meds B2 agonist use Ed attendance behavioural psych

Answer 13

Mild Moderate fev1 50-75%, Pefr more than 75% Severe fev1 33-50%, rr>25, hr >110, incomplete sentences Life threatening - Pefr <33%, sats <92%, pa02 <8, normal paco2, silent chest, cyanosis, poor Resp effort, arrhythmia, exhaustion, reduced gcs Near fatal Less than- raised paco2

Answer 14

Severe despite meds Life threatening and above

Answer 15

02 Salbutamol and Iprat nebs IV hydrocortisone or pred High dose ics or mart IV Mg for severe onwards Aminophylline not evidence based, SE arrhythmia Pred Reduce mortality Relapse Hospital admission B agonist requirement reduced

Answer 16

Severe onwards

Answer 17

Off nebs 24 hours Pefr more than 75% baseline Less than 25% variation Pefr CNS rv

Answer 18

Work aggravated one arm Occupational two types 1. Allergic Immune sensitisation then latency react low dose allergen Latency 24m 2. Irritant Presentation Rhinitis and urticaria Diagnosis Diary 4x a day for 3 weeks inc 3 consecutive days specific IgE, bronchial hyper triggers Eliminate mask not helpful Asthma meds Report SWORD

Answer 19

Hyperv High o2 low pco2 FNE or bronch Inspiratory limb stuttering SALT or Botox vac

Answer 20

1/3 better same worse

Answer 21

Chronic Continue meds No smoking obs No provocation LTRA no data Acute Regional preferred Prostaglandin F2a avoid Continuous monitoring Over 7.5mg pred over 2 weeks then IV hydrocortisone over labour

Answer 22

Ige sensitisation then mc degranulation Mx Allergen avoidance Non sedative antihistamine Nasal steroid 2w Sodium crig and LTRA

Answer 23

LTRA not evidence based

Answer 24

Fixed airway obstruction Sputum production Sob, cough, wheeze

Answer 25

Chronic inflammation so fibrosis small airway -Cells release cytokines -Airflow limitation - Air trap -Recurrent infection Alveolar wall destruction so less surface GE and loss elastic recoil Mucosal gland hyperplasia so cough and sputum PVR increased so increase re after load so even Impaired gas exchange

Answer 26

Obs fev1/fvc <0.7 Fev1 4 <33 V Severe 3 33-50 severe 2 50-80 moderate 1 >80 mild

Answer 27

Symptoms CT or cxr Obstruction with no BDR, TLC/FRC raised, raised RV air trapping, reduced TLCO

Answer 28

Smoking Environment fumes and smoke Genetics eg A1AT Seripina

Answer 29

Stop smoking PR Nutrition Vaccination Optimise inhalers Treat respiratory failure Pall care - opioid, fan, o2, NIV, mirtazapine

Answer 30

Triple therapy Stop smoking PR LTOT and NIV Lung volume reduction Lung tx

Answer 31

Group A 0-1 moderate exac, MRC o or 1 SABA or SAMA Group B MRC >=2 and o or 1 exac LABA+ LAMA Group E More than or equal to 2 exac LABA +LAMA -Eo more than 0.3 then triple - Eo more than 0.1 with exac then to triple - Eo low then Roflumast in fev1<50 OR azithro

Answer 32

Eo more than 0.3 Exacerbations more than 2py Asthma Atopy Pefr 20% variation FEV1 400ml variation Against Pneumonias Eo <100 Hx mtb Y ICS LABA N lABA lama If symptoms then triple

Answer 33

Theophylline pde inhibitor stops camp breakdown so bd Indication fev1 <50 and more than 2 exacerbations Y inspiratory muscle strength N arrhythmia, seizure, drug interaction and limited benefit Steroids Never Copd Carbocisteine Mucolytic Azithro More than 3 exac Ind non smokers Roflumilast PDE4 inh so increase cGMP so BD Add to LABA or LABA+ ICS Fev1<50% and 2 exacerbations on triple therapy Reduces exacerbation SE GIT, headache, depression CI reduced BMI

Answer 34

LAMA Less exacerbation Less sob LABA AND LAMA Lung function Health status Sob Reduce exacerbation

Answer 35

Bode 5-6 and not for bullectomy or LVR Increase BODE in 1yr Po2<8 Co2 >6.6 TLCO less than 20 Fev1 20-25 Max medical Post LVRS

Answer 36

Fev1<50 Bulla 1/3 hemithorax

Answer 37

Benefit ET Indication Optimum medical 6WT 140m MRC more than 2 Stopped smoking 6m PR done Fev1 20-30% DLCO >20 UL or LL Heterogenous No collateral ventilation with complete fissures RV >180, TLC0 > 20 RV/TLC >55 BMI >18 Previous thoracic sx CI Fev1<20 DLCO <20 Smoker Cancer Resp failure BRE SE Copd exac Pneumonia or valve migration Ptx

Answer 38

Worse symptoms Bronchospasm Mucosal oedema Sputum >>> airway resistance so expiration takes longer so dynamic hyper inflation 30% mortality itu and 15% level 1-2

Answer 39

Mild vas <5, hr < 94, rr<24, sats >94, crp <10 Moderate vas >5, rr>24, hr >95, sats <92, crp >10, po2<6\co2> 4.5 Severe decomp T2RF

Answer 40

Dyspnoea Eo Consolidation cxr Acidaemia with ph < 7.3 AF Low 2% Moderate 5% High 15%

Answer 41

Increased exac Severity exac Poor lung function Reduced bmi Com cancer and IHD

Answer 42

Vats or lobectomy Alveolar weakened so air sacs coalesced form Bullard so less as for gas exchange Indication Max medical Stopped smoking 6m PR done FEV1 30-50 6wt 140m SE Air leak Pneumonia MI VTE

Answer 43

Sats less than 95% MRC 3 or more Desat 84% 6WT If Type 1 failure then 2L If Hx T2RF HCT and If pao2 less than 6.6 then 2L o2 or increase by 2L

Answer 44

Primary Secondary due to CTD, HIV, cancer By lymphoid infiltrate

Answer 45

Act advised act Bupropion DA/sertraline/NA Good weight loss X epilepsy, CNS, etoh, pregnancy Varencline A4B2 partial agonist Better quit NV, depression Logistics Long acting patch and short acting eg gum Nicotine 1-2hr hl Don’t smoke on nrt Pregnant Don’t smoke Avoid nrt but short acting better

Answer 46

Normal spiro not for BDR Direct vs indirect provocation Direct histamine or methacholine Indirect mannitol Positive if fev1 20% drop Pc20 less than or equal 8g/ml (normal more than 16)

Answer 47

Extra thoracic Goitre Laryngeal tumour

Answer 48

Biohasic Spirograph 2 compartment emptying

Answer 49

Hypersensitivity to aspergillosis fumigates Dx CT changes - thick walled bronchi, mucus plug, central BrE, areas confluence Ige more than 1000 RAST aspergillus Ige aspergillus Poorly controlled asthma Monitor Ige titres

Answer 50

Small and medium sized necrotising vasculitis Eo more than 10% above cutoff Poorly controlled asthma Nasal polyps Mononeuritis Infiltrates cxr PANCA 30-70% I’ve methylpred then cyclophosphamide or ritux Mtx or aza or MMf Biological mepo or benra

Answer 51

Loefflers Increased Eo with pulmonary infiltrates Asthma and atopy ABPA RA, sjogren, IgG4 Vasculitis eg egpa Acute Eo pn COP NSAID, NF, phenytoin, sulfasalazine, doxycycline, below Helminth eg schisto, ascaris, stronyloides, toxo

Answer 52

Induced sputum dcc

Answer 53

40mg for 5 days <0.5% risk cleft palate

Answer 54

Skin kiwi Birch or grass pollen Itching Swelling Redness Hot drink denatures enzymes

Answer 55

Urticaria Asthma Anaphylaxis Send mast cell tryptase

Answer 56

Fluticasone

Answer 57

Past exacerbation

Answer 58

Pa02 less than 8 Pao2 less than 7.3 and - peripheral oedema - polyp - phtn 2 bags on 3 occasions 3 weeks apart

Answer 59

MPAP more than 20 MPAP = (PASP x0.61) +2 TRV more than 2.6 RAP more than 5 TAPSE less than 18

Answer 60

BMI MRC FEV1 6WT Cod CV

Answer 61

30% increase risk Copd Fluticasone and budesonide contraindicated protease inhibitor Fostair safe - Beclometasone

Answer 62

Spontaneous ptx GI Cluster headache N Pao2 Less oxyHB

Answer 63

FEV1 6WT MRC BMI Survival 0-2 - 80% 3-4 - 67% 5-6 - 57% 7-10 - 18%

Answer 64

Survival 0-2 - 80% 3-4 - 67% 5-6 - 57% 7-10 - 18%

Answer 65

PH less than 7.35 Pco2 >6.5

Answer 66

UL Heterogenous emphysema RV/TLC >60 tLCO>20 BMI>18 Apical dx w Collateral ventilation Low ET LL predominant emphysema with collateral ventilation

Answer 67

Increased sob All hospital 30 mg for 5 days

Answer 68

Respiratory stimulant Indication no NIV available

Answer 69

Feno above 50 positive; 20% people with asthma negative and vv Eo raises Obs spiro BDR 12% and 200mL increase Pefr 20% diurnal variation Bronchial prov indication fall fev1 by 20% + Pc20 of 8g/ml or less positive Direct methacholine and histamine : FN 10% Indirect mannitol : less sensitive

Answer 70

Ige RAST Skin prick

Answer 71

Exactly 1y ICU admission No use pred Overuse saba No action plan

Answer 72

Prn AIR Low dose mart Moderate mart — check feno and Eo - low LTRA or LAMA — high Eo and feno — High dose mart and refer biologic

Answer 73

Pef <80 % 4x ICS <60% oral pred <50% medical review

Answer 74

No day symptoms No night sx No rescue Asthma attack No Limitation activity Normal lung function Minimal side effect meds

Answer 75

Over 1 year Over 4 exac py

Answer 76

Less than 25% variation Pefr Pefr am 75% best No night symptoms Off nebs 24h

Answer 77

Saba Inadequate ICS Obese gord rhinitis Food allergy Depression Smoker Poor Fev1< 60% High Eo and feno despite treatment

Answer 78

Grass pollen Silver birch House dust mite Cat dander Ragweed

Answer 79

ICS Eo < 2% Smoker Over 55 Previous pneumonia BMI <25 Poor MRC grade Severe airflow obstruction

Answer 80

Reduce air trapping so better oxygenation and less sob Better et Better qol Prolonged survival

Answer 81

Better qol Better et Better lung function

Answer 82

MRC 3 or up Pr 12m Non smoker 4m 6wt 14om Fev1<50% RV >150% RV/TLC >55% DLCO>20% Pco2<7 BMI over 18

Answer 83

Absolute contra indications Facial deformity Burns Fixed upper airway obstruction Relative pH less than 7.15 Gcs less than 8 Confusion Dementia

Answer 84

3% newly diagnosed Copd Failure inhibit protease and neutrophil elastase Copd basal Liver failure Paniculitis CT Basal emphysema Cirrhosis Risk HCC Genetics PiMZ normal PiZS emphysema more apical PiZZ severe emphysema basal Mx Stop smoking Etoh cessation Copd and cirrhosis mx

Answer 85

Ct emphysema w symptoms and risk factors Fev1 less than 80% but ratio post bd more than 0.7 10% cohort non smokers 30% progress to Copd esp lower fev1 or older or smokers

Answer 86

Bulbar weakness 24/7 NIV dependance Upper airway lesion Unable to tolerate despite mask Pt preference

Answer 87

Panlobular LL A1AT Paraseptal peripheral Centrilobular UL

Answer 88

Congenital tracheomalacia larger than 3cm Tracheal diverticulum Recurrent LRTI Cx Infection BrE Emphysema Fibrosis

Answer 89

Amyloid Papillomatosis

Answer 90

GPA Amyloid Trauma eg intubation Infection Polychondritis

Answer 91

Dyspnoea MRC Eosinophilia Consolidation cxr Acidaemia AF

Answer 92

Hypoxia so pulm VC This area isn’t ventilated to maintain VQ matching Increase oxygen then VD but not ventilated so increase co2 High flow o2 reduces tidal volume and RR Worsening alveolar hypoventilation

Answer 93

Analeptic agent with K channel inhibition If NIV isn’t available

Answer 94

Life threatening

Answer 95

By weight Stop smoking Review 16w

Answer 96

Post viral flu or mycoplasma or pertussis after 3-8w Gefapixant is P2X3 inhx se taste Morphine ILO PPI and SALT