Asthma Flashcards
What are the 3 main questions to ask a patient attending an asthma review clinic?
- Have you had any problems sleep because of you asthma since the last check up?
- Have you had your usual asthma symptoms during the day?
- Has your asthma interfered with your normal daily activities?
Give the 2 main types of abnormal breathing on respiratory examination.
- Diminished breath sounds
2. Bronchial breathing
Recall the 4 types of added breath sounds
- Wheeze
- Crepitations
- Pleural rub
- Stridor
What are the 3 states in which bronchial breath sounds are heard?
- Consolidation
- Lobar collapse with a patent bronchus
- Lung cavity
What does a wheeze on clinical examination indicate?
Narrowing of the airways due to either bronchospasm or secretions in the small airways.
Recall the 2 categories of wheeze
- Sibilant (high pitch)
2. Sonorous (low pitch)
What is the pathophysiology of a sibilant and sonorous wheeze respectively?
- A sibilant wheeze is brought about by bronchospasm of the small airways.
- A sonorous wheeze is caused by narrowing of the small airways due to secretions.
Name a condition that is associated with a sibilant wheeze
Asthma
Name a condition associated with a sonorous wheeze
Chronic bronchitis
What causes crepitations?
Collapse of peripheral airways on expiration either due to interstitial fibrosis or the due to secretions/fluid
Give a cause of early inspiratory crepitations
Bronchiolitis
Give a cause of mid inspiratory crepitations
Pulmonary Oedema
Give 6 causes of late inspiratory crepitations
- Pulmonary fibrosis
- Pulmonary oedema
- COPD
- Resolving pneumonia
- Lung abscess
- Tuberculous lung cavity
Name a condition in which biphasic crepitations can be heard
Bronchiectasis
Define Bronchiectasis
Permanent dilation of the of the bronchi due to destruction of the elastic and muscular components of the bronchial wall.
What are the 4 main differentials for patients presenting with bronchiectasis?
- COPD
- Asthma
- Pneumonia
- Chronic sinusitis
Fine crepitations are heard in which 3 conditions?
- Bronchiolitis
- Pulmonary oedema
- Pulmonary fibrosis
Coarse crepitations are heard in which 5 conditions?
- COPD
- Resolving pneumonia
- Lung abscess
- Tuberculous lung cavities
- Bronchiectasis
Coarse crackles and wheeze are characteristic of which condition?
Cystic fibrosis
Give 3 potential causes of a pleural rub
- Consolidation
- Infarction
- Uremia
Why is it particularly important for patients with asthma to receive their flu vaccinations?
Influenza can cause further inflammation of the airways and lungs and thus can worsen the patient’s symptoms or even trigger acute asthma attacks.
Define Peak Expiratory Flow Rate
The maximal rate at which a person can exhale during a short maximal expiratory effort after a full inspiration.
What parameters are required in order to predict a patient’s peak flow rate?
Patient’s sex and height
Give 2 examples of long acting beta agonist (LABA)
- Salmeterol
2. Formoterol
Give an example of a long acting muscarinic antagonist (LAMA)
Tiotropium
How would you distinguish between obstructive and restrictive lung disease on spirometry testing?
Through consideration of the FEV1/ FVC ratio. If the ratio is decreased (<70%) then this is indicative of obstructive disease and conversely an increased ratio above normal levels may suggest restrictive lung disease
What additional drug can be given alongside a short acting beta-2 agonist?
Ipatropium Bromide
Define the A-a gradient
The difference between the partial pressure of oxygen inspired and the arterial oxygen partial pressure.
What is the normal value for an A-a gradient
10
An elevated A-a gradient can indicate what? (3)
- Right to left intrapulmonary shunt
- V/Q mismatch
- Alveolar hypoventilation
List the structures that make up the left border of the heart on CXR (4)
- Aortic knuckle
- Pulmonary outflow tract
- Left atrial appendage
- Left ventricle
List the structures that make the up the right border of the heart on CXR (3)
- SVC
- Right ventricle
- IVC
What is the most likely cause of a unilateral silent chest and wheeze?
Foreign body aspiration
What 4 features are suggestive of acute severe asthma?
- A peak flow reading 33-50% of best or predicted value
- RR > 25
- HR > 110
- Inability to complete sentences in one breath
