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Resiratory SCE > Airway > Flashcards

Airway Flashcards

1
Q

Size of bronchioles affected bronchiolitis

A

<2mm

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2
Q

Types bronchiolitis

A

Proliferative
Constrictive

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3
Q

Mason bodies

A

Proliferation fibrin bands reactive bronchiolitis

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4
Q

Causes bronchiolitis

A

Proliferation - CoP, HP, TP, infection
Constrictive - viral

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5
Q

Lung function bronchiolitis

A

Reactive obs
Constrictive rest

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6
Q

HRCT bronchiolitis

A

Air trap
Mosaicism
Atelectasis

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7
Q

Inhaler choice

A

MDI

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8
Q

DPI con

A

Inhale fast and intensely

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9
Q

Older people

A

Spacer

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10
Q

Pulmonary rehab indication

A

MRC 3 or more in:
Copd
Non CF bre
ILD

Contra indication
MI 30d
Unable to mobilise eg PVD
AAA more than 5.5 less intense

Can repeat in 1y

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11
Q

Plum rehab contraindication

A

Cardiac disease
Msk
Cognitive impairment

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12
Q

Sats 88-92

A

Copd
Non cf bre
Kyphosis
Old tb
BMI over 40
Opioid or bz od

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13
Q

Oxygen mask colours

A

Blue 24% 2-3l
White 28% 4-6l
Yellow 35% 8-12l
Red 40% 10-15l
Green 60% 12-15l

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14
Q

Causes hypoxia

A

VQ mismatch
Alveolar hypoventilation
R to L shunt

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15
Q

Hypercapnia

A

Reduced ventilation eg drugs or airway obstruction or nm weak or CNS dep
Alveolar hypo so increased dead space

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16
Q

MART

A

Prevent and reliever

Eg
Budesonide formeterol
Beclometasone formeterol

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17
Q

NICE asthma

A

Low dose ICS and prn saba
Add LTRA
ICS LABA +- LTRA
Med dose ICS and LABA
High dose ICS + LABA

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18
Q

GINA asthma

A

Prn ics formeterol
Low dose ics
Low dose mart
Medium dose mart

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19
Q

Asthma non biological

A

Allergen avoid
Vaccination
Vitamin d
Stop smoking
Social and psych

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20
Q

Indication tertiary

A

Occupational
Frequent severe
Near fatal
Anaphylaxis
ABPA
NSAID
Side effect meds

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21
Q

Other add ons

A

Aza

Bronchial thermoplasty
reduce bronchial sm and works on nerve supply
Indication poor control ICS LABA, no smoke 1y, fev1>60%, no life threatening features, less than 3 exacerbations
Contra indication if metallic implant
SE- worse asthma, bleeding, ptx, abscess
Better symptoms
X No effect fev1, hyperinflation

Long term ics less than 7.5mg per day

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22
Q

Asthma -COPD

A

Airflow limitation and features both

Middle aged
Hx smoking
Triggers

BDR
Eo over 0.3
Raised feno

ICS and LABA
Can include lama
Ocs last resort

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23
Q

Genetic causes asthma

A

Adam 33
GPRA
Ormdl3

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24
Q

Pathology asthma

A

Eo bronchitis
Th2 lymphocyte and mast cell release cytokines
Small airway inflammation
Reversible small airway obstruction
Basement membrane thickening

Non Eo neutrophilic
Smooth muscle inflammation

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25
Q

Phenotypes of asthma

A

Allergic
Non allergic
Adult
Asthma-Copd
Obesity

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26
Q

Bronchodilator reversibility

A

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

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27
Q

Feno

A

IL4 and IL13 induced iNOS

Above 50 positive

False low
Steroid
Smoking
Alcohol
LTRA or PG

High
Tall
Men
Asthma
Rhinitis
Atopy
HIV
Pollution

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28
Q

Badly controlled asthma

A

Validated ACQ, ACT
Non validated RCP

Exacerbation inc itu
Night symptoms
Saba overuse

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29
Q

Asthma mx

A

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

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30
Q

Asthma definition

A

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

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31
Q

Monitoring

A

Adherence
Inhaler technique
Triggers
Review tax
Occupational asthma

Scores
ACQ/ ACT

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32
Q

Biological

A

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

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

Tezeplimab
Anti TSLP elk derived cytokine
3 exacerbations in 12m
No Eo but previous biologic
Rhinovirus, ABPA

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33
Q

Asthma exacerbation

A

Increased symptoms and reduced lung function

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34
Q

Cause asthma exacerbation

A

Infection
Pollution
Poor adherence to
Thunder

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35
Q

Risk factors asthma exacerbation

A

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

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36
Q

Risk factors near fatal asthma

A

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

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37
Q

Severity asthma

A

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

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38
Q

When to admit

A

Severe despite meds
Life threatening and above

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39
Q

Management acute asthma

A

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

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40
Q

ITU referral asthma

A

Severe onwards

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41
Q

Discharge asthma

A

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

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42
Q

Work related asthma

A

Work aggravated one arm

Occupational two types
1. Allergic
Immune sensitisation then latency react low dose allergen
Latency 24m

  1. 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

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43
Q

Vocal cord dysfunction

A

Hyperv
High o2 low pco2

FNE or bronch
Inspiratory limb stuttering

SALT or Botox vac

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44
Q

Pregnancy asthma prognosis

A

1/3 better same worse

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45
Q

Management asthma pregnancy

A

Chronic
Continue meds
No smoking obs
No provocation
LTRA no data

46
Q

Asthma labour

A

Regional better
PGE2 for induction
Pred to if hydrocortisone

47
Q

Allergic rhinitis mx

A

Ige sensitisation then mc degranulation

Mx
Allergen avoidance
Non sedative antihistamine
Nasal steroid 2w
Sodium crig and LTRA

48
Q

Aspirin induced asthma

A

LTRA not evidence based

49
Q

Copd definition

A

Fixed airway obstruction

Sputum production
Sob, cough, wheeze

50
Q

Copd pathophysiology

A

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

51
Q

Diagnosis Copd gold

A

Obs fev1/fvc <0.7

Fev1
<33 V Severe
33-50 severe
50-80 moderate
>80 mild

52
Q

Diagnosis COPD broad

A

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

53
Q

Risk factors Copd

A

Smoking
Environment fumes and smoke
Genetics eg A1AT Seripina

54
Q

Non pharmacological tx Copd

A

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

55
Q

COPD mortality benefit

A

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

56
Q

Pharmacological treatment Copd

A

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

57
Q

Indication ICS LABA Copd

A

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

58
Q

Add on therapy Copd

A

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

59
Q

Benefit bd in Copd

A

LAMA
Less exacerbation
Less sob

LABA AND LAMA
Lung function
Health status
Sob
Reduce exacerbation

60
Q

Lung transplant Copd

A

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

61
Q

Bullectomy

A

Fev1<50
Bulla 1/3 hemithorax

62
Q

Valves

A

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

63
Q

Copd exacerbation

A

Worse symptoms

Bronchospasm
Mucosal oedema
Sputum
»> airway resistance so expiration takes longer so dynamic hyper inflation

64
Q

Severity Copd exacerbation

A

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

65
Q

Decaf score

A

Dyspnoea
Eo
Consolidation cxr
Acidaemia with ph < 7.3
AF

Low 2%
Moderate 5%
High 15%

66
Q

Mortality benefit Copd exac

67
Q

Increased mortality exacerbation

A

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

68
Q

Lung volume reduction surgery

A

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

69
Q

Hypoxia challenge test Copd

A

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

70
Q

Follicular bronchiectasis

A

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

71
Q

Nicotine replacement

A

Bupropion
DA/sertraline/NA
Good weight loss
X epilepsy, CNS, etoh, pregnancy

Varencline
A4B2 partial agonist
Better quit
NV, depression

72
Q

Asthma provocation

A

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)

73
Q

Inspiratory loop flat

A

Extra thoracic
Goitre
Laryngeal tumour

74
Q

Anastomotic stricture

A

Biohasic Spirograph
2 compartment emptying

75
Q

ABPA

A

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

76
Q

EGPA

A

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

77
Q

Eosinophilia and loefflers

A

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

78
Q

Eosinophilic pneumonia

A

Induced sputum dcc

79
Q

Pred pregnancy

A

40mg for 5 days

<0.5% risk cleft palate

80
Q

Oral allergy

A

Skin kiwi

Birch or grass pollen

Itching
Swelling
Redness

Hot drink denatures enzymes

81
Q

NSAID angiodema

A

Urticaria
Asthma
Anaphylaxis

Send mast cell tryptase

82
Q

Non seasonal rhinitis

A

Fluticasone

83
Q

Predictor exac Copd

A

Past exacerbation

84
Q

LTOT indication

A

Pa02 less than 8

Pao2 less than 7.3 and
- peripheral oedema
- polyp
- phtn

2 bags on 3 occasions 3 weeks apart

85
Q

Echo features PH

A

MPAP more than 20

MPAP = (PASP x0.61) +2

TRV more than 2.6
RAP more than 5
TAPSE less than 18

86
Q

Copd mortality predictors

A

BMI
MRC
FEV1
6WT

Cod CV

87
Q

HIV smoking

A

30% increase risk Copd

Fluticasone and budesonide contraindicated protease inhibitor
Fostair safe

88
Q

Cyanide poisoning

A

Spontaneous ptx
GI
Cluster headache

N Pao2
Less oxyHB

89
Q

BODE

A

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

90
Q

BODE

A

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

91
Q

NIV in COPD

A

PH more than 7.35
Pco2 >7

92
Q

Surgical LVRS

A

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

93
Q

Prednisolone indications a Copd

A

Increased sob
All hospital

30 mg for 5 days

94
Q

Doxapram

A

Respiratory stimulant
Indication no NIV available

95
Q

Asthma ix

A

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

96
Q

Atopy

A

Ige RAST
Skin prick

97
Q

Death predictor asthma

A

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

98
Q

New GINA asthma guidelines

A

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

99
Q

PAP

A

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

100
Q

Aim asthma management

A

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

101
Q

Steroid use excess

A

Over 1 year
Over 4 exac py

102
Q

Discharge asthma

A

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

103
Q

Poor asthma control GINA

A

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

104
Q

Allergen immunotherapy

A

Grass pollen
Silver birch
House dust mite
Cat dander
Ragweed

105
Q

Risk pneumonia Copd

A

ICS
Eo < 2%

Smoker
Over 55
Previous pneumonia
BMI <25
Poor MRC grade
Severe airflow obstruction

106
Q

Effect Lvrs

A

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

107
Q

Lvrs open and valve

A

Better qol
Better et
Better lung function

108
Q

LVR

A

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

109
Q

NIV

A

Absolute contra indications
Facial deformity
Burns
Fixed upper airway obstruction

Relative
pH less than 7.15
Gcs less than 8
Confusion
Dementia

110
Q

A1AT

A

3% newly diagnosed Copd

Failure inhibit protease and neutrophil elastase

CT
Basal emphysema
Cirrhosis

Risk
HCC

Genetics
PiMZ normal
PiZS emphysema
PiZZ severe emphysema

Mx
Stop smoking
Etoh cessation
Copd and cirrhosis mx

Resiratory SCE (13 decks)

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