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Semester 2 Case Studies > Case 2 > Flashcards

Case 2 Flashcards

1
Q

what is bronchial asthma

A

a disease characterised by widespread narrowing of the peripheral airways varying in severity over short periods of time either spontaneously or in response to treatment

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2
Q

childhood asthma is:

A

extrinsic, atopic and mediated by antigens

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3
Q

adult asthma is:

A

intrinsic, idiosyncratic and mediated by neurological reflexes

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4
Q

some specific triggers of asthma are:

A
  • excreta of house dust mites
  • pollens
  • exercise or emotion
  • cold air
  • animal fur
  • respiratory tract infections
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5
Q

features of an asthmatic airway

A
  • hypertrophy and hyperplasia of smooth muscle
  • absence of ciliated epithelium
  • thickened basal membrane
  • mucus plug
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6
Q

what is there almost a complete loss of in airways of asthmatic patients

A

epithelium

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7
Q

first part of the role of a leucocyte:

A
  • allergen attaches to macrophage (antigen presenting cell)

- then activates CD4+, Th2 lymphocyte

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8
Q

the pathway from activated lymphocyte IL4

A
  • interleukin 4
  • b lymphocyte then differentiates into a plasma cell
  • secretes the IgE antibody
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9
Q

pathway from lymphocyte to IL5

A
  • IL5 activates eosinophils and mast cells with IgE antibody
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10
Q

allergen induced release of mediators from sensitised mast cells

A
  • the mast cell bears the IgE antibody
  • there is a release of early mediators including eosinophil chemotactic factor
  • released of later mediators (synthesised de novo)
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11
Q

allergen induced release of mediators from sensitised eosinophils

A
  • eosinophil bearing the IgE antibody
  • it releases the major basic protein
  • leads to epithelial desquamation
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12
Q

what are the pre-formed mediators of a mast cell

A
  • histamine
  • proteases
  • proteoglycans
  • chemotactic factors
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13
Q

what are the later mediators of a mast cell derived from membrane lipids

A
  • leukotrienes
  • prostaglandins
  • thromboxanes
  • prostacyclin
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14
Q

effect of histamine on bronchial asthma

A

contraction of airways smooth muscle, increases vascular permeability and increased bronchial secretions

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15
Q

effect of chemotactic factors on bronchial asthma

A
  • infiltration of airway wall by neutrophils and eosinophils
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16
Q

effects of leukotriene, C4, D4, E4 and prostaglandin D2

A
  • contraction of airways smooth ,muscle, increased permeability and increased bronchial secretions
  • major basic protein from eosinophils: epithelial desquamations
  • B-cell activating factor: much later mediator
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17
Q

efficacy

A

efficacy is the tendency of the drug to activate the receptor. drugs with maximum efficacy are termed as full agonists. antagonists on the other hand have zero efficacy. when they bind, they do not active the receptor they just simply block the activity of an agonist

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18
Q

is efficacy released to affinity

A

no. affinity tells us how tightly something binds, and both agonists and antagonists have affinity

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19
Q

what does the Functional Gaddum Equation do

A

describes the effect produced by agonist D in the precedes of a competitive antagonists 1

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20
Q

what is a partial agonist

A

is a drug that cannot fully activate a receptor, even when all the receptors in a system are occupied.

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21
Q

how do partial agonists differ from full agonists

A

they have lower efficacy. not related to potency.

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22
Q

what is a superagonist

A

simply a drug who’s efficacy exceeds that of a full agonist (natural)

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23
Q

what is conformational selection

A

when a receptor visits the active site in the presence of a full agonist, the agonist binds and ‘locks’ it in the active state.

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24
Q

action of antagonists

A

they bind equally as tight to the inactive and active states. this prevents activation by agonists because of competition but the ramifications are a bit deeper.

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25
Q

what is a partial agonists

A

molecule that binds tighter to the active state than the inactive, but does not select between the two states as much as a full agonist does. the efficacy of a partial agonist depends on the ratio of inactive/active

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26
Q

what kind of control are smooth muscle conducting airways under

A

autonomic control

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27
Q

innervation of the diaphragm

A

phrenic nerve, cervical plexus (C3-C5)

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28
Q

Innervation of intercostal muscles

A
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29
Q

innervation of intercostal muscles

A

T1-T12

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30
Q

innervation of abdominal muscles

A

thoracic and lumbar

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31
Q

automatic respiratory rhythm generation model

A
  • respiratory pacemaker in the medulla - will generate a respiratory rhythm in isolation, with no input
  • pacemaker -> ‘pattern generation’ -> output to pump muscles and upper airways
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32
Q

what is the pacemaker region

A

pre-botzinger

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33
Q

sensory inputs to the respiratory centres

A
  • peripheral chemoreceptors
  • carotid bodies and aortic arch
  • arterial stimulus
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34
Q

other sensory inputs to the respiratory centre

A

central chemoreceptors

- located on the surface of the medulla

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35
Q

sensory input from lungs, airways and chest wall

A
  • nose - trigeminal (V)
  • pharynx - glossopharyngeal (IX) and vagus (X)
  • lungs - vagus (X)
  • chest wall - spinal nerves
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36
Q

stretch receptors

A

predominantly in the trachea and main bronchi

- repsond to lung inflation

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37
Q

irritant receptors

A
  • naso-pharync, larynx, bronchi and trachea

- mechanical, chemical irritant stimuli and inflammatory mediators

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38
Q

C-fibres

A
  • receptors ‘free’ nerve endings
  • larynx, trachea, bronchi , lungs (J-receptors)
  • chemical irritant stimuli, inflammatory mediators and lung oedema (J-receptors)
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39
Q

normal range of values of blood gases while breathing air

A

Hb - 23.3-17.7 g/dl
pH - 7.37 - 7.45 units
PCO2 - 4.7-6.4 kPa
PO2 - over 10.7 kPa

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40
Q

calculated base excess values:

A

-2 to +2 mmol.l-1

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41
Q

acidosis

A

Respiratory: increased PCO2
Metabolic: decreased HCO3-

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42
Q

alkalosis

A

respiratory: deceased PCO2
metabolic: increased HC03-

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43
Q

Type 1 respiratory failure

A
  • hypoxaemic failure
  • low PaO2
  • normal or low PaC02
  • disturbance of the relationship of ventilation to perfusion
  • mismatch of regional perfusion and ventilation
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44
Q

type II respiratory failure

A
  • ventilatory failure
  • low Pa02 and raised PaC02
  • alveolar ventilation is reduced
  • if type I and II are present together this is known as mixed respiratory failure
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45
Q

which genes are associated with asthma

A
  • ADAM33 gene is associated with airway hyper-responsiveness and airway remodelling
  • PHF11 gene is associated with increased IgE production
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46
Q

effect of cold air and exercise

A
  • these both dry out the mucosa of the lung
  • makes the lining hypersomolar
  • causes mast cells to release histamine and prostaglandins, thus causing inflammation
47
Q

Peak Expiratory Flow

A
  • most useful test in asthma. patients should take two readings per day, to show the variability of the disease. in patients with suspected asthma, you should get them to take two weeks worth of measurements whilst at work, and 2 weeks whilst at home to prove the cause of the disease.
48
Q

spirometry

A

you can show the presence of asthma by demonstrating 15% improvement in FEV1 or PEF

49
Q

exercise tests

A

often used to diagnose asthma in children. run on a treadmill for max. 6mins and increase heart rate to over 160bpm. test peak flow before and after looking for a 15% difference

50
Q

four principles of motivation interviewing

A
  • express empathy
  • develop discrepancy
  • roll with resistance
  • supporting self efficacy
51
Q

what is self efficacy

A

a concept that refers to an individuals belief in their capacity to execute behaviours necessary to produce specific performance attainments. self efficacy effects every area of human endeavour. confidence in your own ability.

52
Q

what is the major basic protein secreted by

A

IgE activated eosinophils and stimulates epithelial desquamation

53
Q

what is the most common side effect of using the beta2 agonist inhaler

A

tremors

54
Q

what is the Henderson hasselbalch equation used for

A

to calculate blood pH and estimated HCO3- concentration

55
Q

what is the DRG inhibited by

A

signals from the pneumotacix centre

56
Q

what are the stimuli that the central chemoreceptors in the ventral side of the medulla respond to

A

H+ increase

57
Q

what is trans pulmonary pressure

A

measurement of the strength of the elastic forces in the lungs

58
Q

the cellular levels of what is measured to aid in the diagnosis of asthma

A

eosinophils

59
Q

how many people die from asthma every year

A

500,000

60
Q

what happens in extrinsic asthma

A

allergens bind to IgE causing a reaction

61
Q

what inhibits leukocyte infiltration

A

beclomethasone

62
Q

what kind of antagonist is Ipratropium

A

muscarinic receptor antagonist

63
Q

what is the risk ratio in meta analyses

A

the probability of an event occurring in the treatment group compared to the probability in the control

64
Q

allergic asthma

A
  1. when a person is first exposed to an allergen it interacts with B lymphocytes
  2. these cells respond to the allergen by making immunoglobulin E
  3. releases into the circulation
  4. the response also involves tissue mast cells which are present in the lungs
  5. these are a type of granulocyte secreting cells which are rich in inflammatory mediators
  6. mast cells also have Fce receptors on cell surface
  7. these receptors have a high affinity binding site for IgE
  8. the circulation IgE made by the B cells can bind to these receptors
  9. the interaction is irreversible to when mast cell is next exposed to the allergen, it reacts
  10. by binding to the Fc receptors, the allergen crosslinks them, causing them to activate and trigger the degranulation of the mast cell
65
Q

mediators released from mast cells

A
  • chemokine: attract inflammatory cells to the area

- bronchoconstrictors: contract the airways and limit airflow

66
Q

what do bronchodilators do

A

drugs that relax the smooth muscle, causing the lumen of the bronchiole to open. they are used as relievers to reverse bronchocontriction during an acute asthma attack

67
Q

beta2 adrenergic receptor agonists

A
  • bind to and activate the beta2 subtype of adrenoceptor

- their main effect on these receptors in smooth muscle cells is to evoke muscle relaxation

68
Q

where are beta2 adrenergic receptors found

A

on mucous glands in the bronchiole walls and on ciliated epithelial cells that line the lumen of the bronchioles

69
Q

what is the tidal volume

A

the volume of air displaced between normal inspiration and expiration, around 500ml

70
Q

what is the inspiratory reserve volume

A

the extra volume of air that can be inspired over and about the normal tidal volume the. a person inspires with full force, around 3000ml

71
Q

what is the expiratory reserve volume

A

maximum extra volume of air that can be expired by forceful expiration after the end of a normal tidal expiration, around 1100ml

72
Q

what is the residual volume

A

the volume of air remaining in the lungs after the most forceful expiration, around 1200ml

73
Q

what is the maximum volume

A

tidal volume + inspiratory reserve volume + expiratory reserve volume + residual volume

74
Q

equation of the inspiratory capacity

A

tidal volume + inspiratory reserve volume

75
Q

equation of the functional residual capacity

A

expiratory reserve volume + residual volume

76
Q

equation of the vital capacity

A

inspiratory reserve volume + tidal volume + expiratory reserve volume

77
Q

equation for the total lung capacity

A

inspiratory reserve volume + tidal volume + expiratory reserve volume + residual volume

78
Q

what is the rate of diffusion of a gas directly proportional to

A

the pressure caused by that gas alone, the partial pressure

79
Q

what is Henry’s Lae for partial pressure

A

the concentration of dissolved gas over the solubility coefficient

80
Q

what are the different layers In a respiratory membrane

A
  • layer of fluid lining the alveolus and containing surfactant
  • the alveolar epithelium composed of thin epithelial cells
  • an epithelial basement membrane
  • thin interstitial space
  • capillary endothelial membrane
81
Q

factors that affect rate of diffusion though the respiratory membrane

A
  • the thickness of the membrane
  • the surface area of the membrane
  • the diffusion coefficient of the gas in the substance of the membrane
  • the partial pressure difference of the gas between the two sides of the membrane
82
Q

what is the diffusion rate

A

(partial pressure difference x cross sectional area x solubility) / (distance x /molecular weight)

83
Q

what is the diffusing capacity for oxygen in a man

A

21ml/min/mmHg

84
Q

what is ventilation

A

aeration of the lungs

85
Q

what is perfusion

A

blood flow to the lungs

86
Q

how is the ventilation/perfusion ratio expressed

A

Va/Q

87
Q

normal venous blood gases

A

PO2 - 40mmHg

PCO2 - 45mmHg

88
Q

alveolar blood gas values

A

PO2 - 104mmHg

PCO2 - 40mmHg

89
Q

what causes vasoconstriction at the start of exercise

A

sympathetic nervous system

90
Q

conditions when exercise starts and continues

A

starts of as anaerobic and then with sufficient oxygen levels the condition become aerobic

91
Q

what is the shunt flow

A

the small amount of blood in the bronchial circulation, that supplies the lungs with blood and isn’t exposed to air

92
Q

what is the upper limit to which PO2 can rise in tissues

A

95mmHg

93
Q

carbon dioxide can diffuse how much more rapidly than oxygen

A

20 times

94
Q

how much oxygen is carried in chemical combination with haemoglobin in arterial blood

A

97%

95
Q

which part of haemoglobin does oxygen combine with

A

haem

96
Q

how is carbon dioxide usually transported

A

as carbonic acid

97
Q

what is the Bohr effect

A

an increase in carbon dioxide in the blood causes oxygen to be displaced from the haemoglobin

98
Q

what is hypercapnia

A

excess carbon dioxide in the body fluids

99
Q

what happens if the base excess is out of the normal range

A

the condition is metabolic and not respiratory

100
Q

three characteristics of asthma

A
  • airflow limitation
  • bronchial hyper-responsivness
  • inflammation of the bronchi
101
Q

how does aspirin trigger asthma

A

inhibits the cyclooxyrgenase pathway of arachidonic acid metabolism without affecting the lipoxgenase route, thus tipping the balance toward elaboration of the bronchoconstrictor leukotriene

102
Q

how does propranolol trigger an asthma attack

A

it is a sympatholytic non-selective beta blocker. it inhibits postganglionic functioning of the sympathetic nervous system. in this case it is achieved through blocking beta adrenergic receptors.

103
Q

early phase reaction of asthma

A
  • the initial sensitisation to inhaled allergens stimulates the induction of the Th2 cells
  • Th2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce IgE and other antibodies.
104
Q

how long does the sensitisation phase take

A

10-15 of IgE loading

105
Q

what do mast cells secrete during degranulation

A

histamine, proteases, neutrophil chemotactic factor and eosinophil chemotactic factor

106
Q

why are cytokines secondary mediators

A

they are not preformed

107
Q

what is eotaxin

A

produced by airway epithelial cells, potent chemoattractant and activator of eosinophils

108
Q

what are spiral shaped mucus plugs called

A

Curschmann Spirale

109
Q

how many hospital addmitances are due to non-adherence

A

10-25%

110
Q

when is it likely that a patient with adhere to treatment

A

when they understand what they are being asked to do and why

111
Q

when are patients most likely to adhere to a drug PtII

A

when they remember what they are being asked to do if they are to act on it later and also satisfaction with the doctor and the consultation makes adherence more likely

112
Q

systemic biases in risk perception

A
  • compression: overestimate low risks, underestimate high ones
  • miscalibration: overestimate accuracy of own knowledge
  • availability: overestimate notorious risks
  • optimism: underestimate a person’s susceptibility
113
Q

what is theory of planned behaviour affected by

A
  • attitude towards a behaviour
  • subjective norm
  • perceived behavioural control
114
Q

if an inhaler is used correctly how much of the dose will be deposited in the lung

A

10%

Semester 2 Case Studies (11 decks)

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