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Cardioresp > Airways disease > Flashcards

Airways disease Flashcards

1
Q

Asthma symptoms?

A

SOB
Chest tightness
Cough
Expiratory wheeze

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2
Q

Triggers for asthma symptoms?

A

Allergen exposure
Cold
Smoke

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3
Q

What is asthma?

A

Chronic inflammation of airways characterised by intermittent obstruction and hyper-reactivity

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4
Q

Inflammatory reaction type in asthma?

A

Th2 response - characterised by CD4+ cells

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5
Q

What do CD4+ cells secrete?

A

IL4, IL5, IL13 and TNFa

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6
Q

What does IL-4 do?

A

Stimulates B lymphocytes - IgE production - mast cell degranulation - histamine release

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7
Q

What does IL-5 do?

A

Stimulate eosinophils

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8
Q

What does IL-13 do?

A

Stimulate mucus production

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9
Q

What does IL-1 do?

A

Acute inflammation and fever

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10
Q

What is the anti-inflammatory cytokine

A

IL-10 - inhibits IL-1

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11
Q

What does IL-2 do?

A

Activation and proliferation of T cells

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12
Q

What does TNFa do?

A

Fever + attract neutrophils

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13
Q

Investigations for asthma?

A 
Spirometry
Peak flow
CXR
Exhaled NO
Sputum eosinophilia
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14
Q

What would spirometry results be for asthma?

A

Obstructive pattern - FEV1/FVC <80%, FEV1 should drop by at least 20%, FVC would be normal

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15
Q

Classification of asthma?

A

Mild intermittent
Mild persistent
Moderate persistent
Severe persistent

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16
Q

Mild intermittent asthma?

A

Symptoms less than twice a week

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17
Q

Mild persistent asthma?

A

Symptoms more than twice a week but less than once a day

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18
Q

Moderate persistent asthma?

A

Daily symptoms +use of SABA

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19
Q

Severe persistent?

A

Continuous symptoms, frequent exacerbations, limited physical activity

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20
Q

Step one of asthma control?

A

SABA - salbutamol

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21
Q

Step two of asthma control?

A

SABA + low dose inhaled corticosteroid

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22
Q

Step three of asthma control?

A

SABA + ICS + LABA - salmeterol

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23
Q

Step four of asthma control?

A

SABA + ICS + LABA + theophylline or monteleukast or up steroid dose

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24
Q

Step five of asthma control?

A

SABA + med dose ICS + LABA + theo/monte + oral steroid or high dose ICS

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25
Q

Treatment for asthma exacerbation?

A 
Oxygen
Salbutamol
Ipratropium
Hydrocortisone
Magnesium sulfate
Theophylline
Salbutamol IV
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26
Q

Peak of action of salbutamol?

A

15 minutes

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27
Q

Asthma vs COPD?

A

Reversibility in asthma non in COPD

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28
Q

What is theophylline?

A

Phosphodiesterase inhibitor

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29
Q

What is monteleukast?

A

Leukotriene receptor antagonist

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30
Q

Causes of COPD?

A 
GASES
Genetic - alpha-1 antitrypsin deficiency
Air pollution
Smoking
Exposure through occupation
Second-hand smoke exposure
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31
Q

What is alpha-1 antitrypsin?

A

A proteinase inhibitor produced in the liver which inhibits enzymes such as neutrophil elastase which breaks down alveolar wall connective tissue

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32
Q

What does GOLD assess?

A

Severity of airflow limitation and exacerbation history

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33
Q

GOLD stage 1?

A

Mild COPD - FEV1 >80% of predicted

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34
Q

GOLD stage 2?

A

Moderate COPD - FEV1 <80% of predicted

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35
Q

GOLD stage 3?

A

Severe COPD - FEV1 <50% of predicted

36
Q

GOLD stage 4?

A

Very severe COPD - FEV1 <30% of predicted

37
Q

How is exacerbation/risk assessed?

A

Number of exacerbations requiring steroids + hospital admissions and CAT score - COPD assessment test

38
Q

Complications of COPD?

A 
CLIPPR
Cor pulmonale
Lung cancer
Infection
Pneumothorax
Polycythaemia
Respiratory failure
39
Q

What is bronchiectasis?

A

Permanent dilation of bronchi due to the destruction of the bronchial wall

40
Q

Why does bronchiectasis occur?

A

Most commonly - recurrent infections or secondary to HIV, cystic fibrosis, ciliary dyskinesia, or alpha-1 antitrypsin deficiency

41
Q

CT findings in bronchiectasis?

A

Thickened, dilated airways w or w/out fluid levels, varicose constrictions, cysts

42
Q

Symptoms of bronchiectasis?

A 
Purulent sputum
Persistent cough
Fever
Clubbing
Crepitations
Coarse inspiratory crackles
43
Q

Complications of bronchiectasis

A

Massive haemoptysis

44
Q

What is Kartagener’s syndrome

A

Cilia become immobile

45
Q

What is type 1 respiratory failure?

A

<8kPa PaO2 with normal or low CO2 - Damage to lung tissue - V/Q mismatch in part of the lung

46
Q

Why do they not get hypercapnic in type 1 respiratory failure?

A

Less lung tissue is required to excrete CO2 than oxygenate the blood

47
Q

Causes of type 1 respiratory failure?

A 
Pneumonia
PE
Pulmonary oedema
Fibrosing alveolitis
Acute asthma
48
Q

Symptoms of respiratory failure

A

Agitation
Breathlessness
Confusion
Drowsiness+fatigue

49
Q

What is type 2 respiratory failure?

A

<8kPa PaO2 + >6.7kPa PaCO2 - ventilatory failure due to reduced effort or increased resistance

50
Q

Causes of type 2 respiratory failure?

A 
COPD
Cerebrovascular disease
Opiate/benzos
Myasthenia gravis
Motor neuron disease
51
Q

Complications of respiratory failure?

A

Infection
Heart failure
Arrhythmia
Pericarditis

52
Q

Treatment of respiratory failure

A

Oxygen replacement therapy
Non invasive ventilation
Treat underlying cause

53
Q

What is obstructive sleep apnoea?

A

Intermittent closure/collapse of pharyngeal airway causing apnoeic episodes during sleep

54
Q

Risk factors for OSA?

A 
Obesity
Male
Older age
Opiate/benzo use
Neurological disorders
Increased soft tissue around airway
Structurally narrow airway
55
Q

What stage of sleep does OSA effect?

A

REM

56
Q

Symptoms of OSA?

A 
Snoring
Restless sleep
Morning headache
Episodic gasping
Apnoea episodes
Decreased libido
Poor cognitive performance
57
Q

What questionnaire for OSA?

A

Epworth sleepiness score

58
Q

How does modafinil work?

A

Dopamine reuptake inhibitor - reduces sleepiness

59
Q

Treatment of OSA?

A

Weight reduction
CPAP
Modafinil

60
Q

Most common pathogen found in bronchiectasis patients

A

Haemophilus influenza

61
Q

Causes of restrictive lung disease?

A

Interstitial lung disease, sarcoidosis, obesity, scoliosis, neuromuscular disease

62
Q

Upper zone pulmonary fibrosis causes?

A

TOP of the CHARTS
Coal workers pneumoconiosis
Hypersensitivity pneumonitis + Histiocytosis
Ankylosing spondylitis + Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis + Sarcoidosis

63
Q

Lower zone fibrosis causes?

A 
ACID = LOW pH
Asbestosis
Connective tissue disorders
Idiopathic fibrosis
Drug induced = amiodarone, methotrexate
64
Q

Fibrosis symptoms?

A 
Exertional dyspnoea
Cough
Chest tightness
Wheeze
Cyanosis
Barrel chest
Clubbing
65
Q

What is pneumoconiosis?

A

Chronic lung disease caused by exposure to a dust or metal

66
Q

Main types of pneumoconiosis?

A

Silicosis, berylliosis, coal miners, asbestosis

67
Q

What is silicosis?

A

Exposure to silica, triggers macrophage fibrogenic response, can lead to TB

68
Q

What is coal miner lung?

A

Exposure to coal dust, macrophage activation and fibrogenic response

69
Q

What is berylliosis?

A

Exposure to beryllium, binds to T cells and alters their interactions

70
Q

What is caplan’s syndrome?

A

Pneumoconiosis + rheumatoid = big nodules

71
Q

What is asbestosis?

A

Exposure to asbestos fibres, damage through macrophage activation, associated with plural plaques, pleural thickening and pleural effusions

72
Q

Risk factors for idiopathic pulmonary fibrosis?

A 
Cigarette smoking
Dust exposure
GORD
Diabetes
Infection
73
Q

Symptoms of IPF?

A 
Exertional dyspnoea 
Cough
Crackles
Weight loss
Fatigue
Clubbing
74
Q

Investigations in IPF?

A

CXR
HR-CT
PFT

75
Q

CXR findings in IPF?

A

Basilar, peripheral, bilateral, asymmetrical, reticular opacities

76
Q

HRCT findings in IPF?

A

Sub-pleural, basilar predominant reticular abnormalities
Honeycombing
Traction bronchiectasis
Ground glass opacities present but not extensive

77
Q

HRCT findings that would doubt IPF diagnosis?

A 
Upper/mid lung predominance
Peribronchovascular dominance
Extensive ground glass opacities
Micronodules
Cysts
Air trapping 
Consolidation
78
Q

If diagnosis of IPF cannot be made from history and imaging?

A

Bronchoalveolar lavage

Biopsy

79
Q

Treatment of IPF?

A 
Pirfenidone
Nintedanib
Pulmonary rehabilitation
Oxygen therapy
Smoking cessation
Lung transplant
80
Q

What is pirfenidone?

A

Inhibits collagen synthesis
Down regulates profibrotic cytokines
Decreases fibroblast proliferation

81
Q

What is nintedanib?

A

Tyrosine kinase receptor blocker

82
Q

What is transfer factor?

A

Describes rate at which a gas with diffuse from alveoli to blood

83
Q

Causes of raised total gas transfer?

A 
Asthma
Pulmonary haemorrhage
L-R cardiac shunts
Polycythemia
Hyperkinetic states
Male gender
Exercise
84
Q

Causes of low total gas transfer?

A 
Pulmonary fibrosis
Pneumonia
PE
Pulmonary oedema
Emphysema
Low cardiac output
Anaemia
85
Q

What is KCO?

A

Transfer coefficient - rate of gas transfer corrected for lung volume
Increases with age

86
Q

Increased KCO with normal total gas transfer?

A

Neuromuscular weakness
Scoliosis/kyphosis
Ankylosing spondylitis
Pneumonectomy/lobectomy

Cardioresp (8 decks)

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