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Medicine, Year 3, Cardiovascular and Respiratory Medicine > Airways Disease > Flashcards

Airways Disease Flashcards

1
Q

What type of Hypersensitivity Reaction is Asthma? What antibodies mediate it?

A

Type 1 Hypersensitivity reaction, mediated by IgE antibodies

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2
Q

What is Atopy?

A

A genetic predisposition to develop asthma, atopic dermatitis and allergic rhinitis

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3
Q

Polymorphisms in which gene is associated with Asthma?

A

ADAM33

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4
Q

State some non-modifiable risk factors for developing Asthma

A
  • Maternal VitD deficiency during pregnancy
  • Premature birth
  • Low birth weight
  • Childhood exposure to tobacco smoke
  • Childhood bronchiolitis
  • Family history of astma
  • Atopic conditions
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5
Q

Is Asthma Obstructive or Restrictive? What might the FEV1, FVC and FEV1/FVC ratio be?

A

Obstructive
FEV1 reduced
FVC reduced but not as much
FEV1/FVC = < 0.7

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6
Q

What characteristic findings may be present in the sputum of an Asthmatic?

A 
Curshmann spirals (mucus plugs)
Charcot-Leyden crystals (broken down Eosinophils)
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7
Q

What finding in Spirometry might be diagnostic for Asthma?

A

FEV1/FVC < 80% of predicted

Is however responsive to bronchodilators, with a >12%/ >200 ml improvement after use

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8
Q

What does FeNO stand for? What is the premise of the FeNO test?

A

Fractional Exhaled Nitric Oxide

Nitric oxide is produced by 3 types of nitric oxide synthases (NOS). One of the types is inducible (iNOS) and levels tend to rise in inflammatory cells, particularly eosinophils. Levels of NO thus correlate to inflammation

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9
Q

What might be seen on CXR in patients with Asthma?

A

Hyperinflated chest, or signs of infection / pneumothorax

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10
Q

What might be visualised on a FBC in patients with Asthma?

A
  • Normal / raised Eosinophils

- Normal / raised Neutrophils

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11
Q

What are the PEFR values for patients with mild, moderate and severe asthma?

A

Mild >80% of PB
Moderate 50-80% of PB
Severe <50% of PB

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12
Q

What two classes of drugs may exacerbate Asthma?

A

Beta blockers

NSAIDs

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13
Q

What is the name of breathing exercises for patients with Asthma?

A

Butekyo breathing

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14
Q

What is the stepwise management of asthma according to NICE? 5 steps. How is this different to BTS?

A 
Step 1: SABA
Step 2: + ICS
Step 3: + LKTRA
Step 4: + LABA
Step 5: + Theophylline
Step 6: + Oral steroids

BTS, Swap Step 3 and 4 around (LABA > LKTRA)

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15
Q

What foods may be a trigger to patients with asthma?

A

Sulphites in preservatives and wine

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16
Q

What airborne irritants trigger asthma?

A

Air pollution, tobacco smoke, fumes, cold air, thunderstorms, mould, damp

17
Q

What animal / insect allergens trigger asthma?

A

Dust mites, pollen, animal dander, feathers

18
Q

What is Atelectasis?

A

Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange (usually unilateral)

19
Q

Outline how to use an Inhaler correctly

A
  • Take the cap off
  • Shake the inhaler well for 5-10 s
  • Pointing the mouthpiece away, press the canister to release a puff into the air
  • Breathe out gently and fully
  • Put the inhaler in mouth, with a tight seal
  • As you press the cannister, take a deep breath in
  • Hold your breath for as long as possible / 10 s
  • Breathe out gently
20
Q

Give examples of chemicals which can cause Occupational Asthma

A
  • Isocyanates
  • Platinum salts
  • Glutaldehyde
  • Flour
  • Epoxy resins
  • Proteolytic enzymes
  • Soldering flux resins
21
Q

What is the name of the fungus which is commonly a trigger of asthma?

A

Aspergillus

22
Q

ASTHMA

  1. What is it?
  2. How may asthmatics present?
  3. What are some differential diagnoses?
  4. What are some simple bedside tests?
  5. What is the first-line, gold standard investigation and results?
  6. What are other investigations to order?
  7. What is FEV1, FVC and TLCO in asthma?
  8. What is the NICE Stepwise management for asthma?
  9. What are other aspects of management for asthmatics?
  10. What are asthmatics sensitive to, drugs-wise?
A
  1. A Type 1, IgE mediated hypersensitivity reaction, and chronic inflammatory condition causing episodic bronchoconstriction
  2. Episodic symptoms of SOB, wheeze, dry cough, with diurnal variability, worse at night. History of atopy and family history
  3. Viral induced wheeze, COPD (if productive cough), extrinsic allergic alveolitis
  4. PEFR (mild, moderate, severe), FBC (eosinophilia, neutrophilia), ABG (respiratory acidosis), CXR (hyperexpansion, signs of infection)
  5. Spirometry with bronchodilator reversibility (FEV1/FEV <0.7, FEV1 improvement by 12%), FeNO (inflammatory cells secrete NO, >40 ppb)
  6. Methacholine or histamine challenge, peak flow variability diaries
  7. FEV1 = reduced, FVC = reduced, TLCO = increased
8.
SABA
SABA + ICS
SABA + ICS + LKTRa
SABA + ICS + LABA (+ maybe LKTRa depending on response to LABA)
SABA + LKTRa + MART (ICS + LABA)
  1. Yearly influenza flu-jab, yearly asthma review, advice exercise and reduce smoking
  2. Aspirin and beta-blockers
23
Q

ALPHA-1 ANTITRYPSIN DEFICIENCY

  1. What is it?
  2. Where is the gene for A1AT found?
  3. Where are the different genotypes?
  4. What is the normal role for A1AT?
  5. On CXR what is usually seen?
  6. Is it an obstructive or restrictive picture?
  7. What does A1AT deficiency give you an increased risk of?
  8. What are some investigations?
  9. What is the management?
  10. What is the earliest it can be diagnosed?
  11. What patients are classically seen affected by it?
A
  1. An inherited condition of lacking protease inhibitor, which is usually produced by liver and protects against neutrophil elastase
  2. Chromosome 14
  3. PiMM = Normal, PiSS = 50% normal, PiZZ = 10% normal (show symptoms)
  4. Protects against neutrophil elastase, will now cause emphysema
  5. Lower lobe emphysema
  6. OBSTRUCTIVE, LIKE COPD
  7. Hepatocellular carcinoma, liver cirrhosis, cholestasis
  8. A1AT levels, spirometry (obstructive picture)
  9. Smoking cessation, bronchodilators, physio, lung volume reduction surgery, lung transplant
  10. Pre-nataly via amniocentesis
  11. Classically young non-smokers
24
Q

COPD

  1. What are the two main types of COPD?
  2. What are the risk factors of COPD?
  3. What are the features of COPD?
  4. What are findings on Spirometry? FEV1, FVC, TLCO?
  5. What are bedside investigations for COPD?
  6. What are blood tests for COPD?
  7. What imaging tests for COPD?
  8. What special tests for COPD?
  9. What are common causes of a COPD exacerbation?
  10. What is a mild, moderate, severe and very severe PEFR for COPD?
  11. Stepwise management for COPD?
  12. What is defined as features of steroid responsiveness?
    13.
A
  1. Emphysema and Chronic Bronchitis
  2. Smoking, A1AT
  3. SOB on exertion, productive cough, fatigue
  4. FEV1/FVC <0.7, TLCO reduced
  5. BMI, ECG, Sputum culture if COPD exacerbation
  6. FBC: Polycythaemia, U&Es for baseline, CRP high if exacerbation, ABG for T2 respiratory failure
  7. CXR: hyperinflation, flattened hemidiaphragm
  8. Spirometry: Obstructive picture, TLCO: raised, A1AT: May be positive
  9. H. influenzae, strep pneumoniae
  10. Mild: >80%, Moderate: 50-79%, Severe: 30-49%, V severe: <29%
    • SAMA or SABA
    • If asthmatic features, add LAMA + ICS
    • If no asthmatic features, add LAMA + LABA
    • LAMA + LABA + ICS
  12. Eosinophillia, FEV1 variation >400ml, PEFR variation >20%, previous diagnosis of asthma or atopy

Medicine, Year 3, Cardiovascular and Respiratory Medicine (19 decks)

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