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Sem 2 Case 2 > Case 2 > Flashcards

Case 2 Flashcards

Hello Orla

1
Q

What are the 4 Categorisations of asthma

A

Atopic
Non-atopic
Drug induced
Occupational

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2
Q

Atopic vs

Non-atopic

A

Atopic also known as extrinsic is a type 1 IgE mediated hypersensitivity reaction , DEFINITE EXTERNAL CAUSE
Non-atopic (intrinsic) - no causative agent can be identified

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3
Q

What is occupational asthma

A

 This form of asthma is stimulated by fumes, organic and chemical dusts, gases, and other chemicals.
 Minute quantities of chemicals are required to induce the attack, which usually occurs after repeated exposure.
 The underlying mechanisms vary according to stimulus and include type I hypersensitivity reactions, direct release of bronchoconstrictor substances, and hypersensitivity responses of unknown origin.

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4
Q

What is Drug-induced Asthma

A

 Several pharmacologic agents provoke asthma

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5
Q

What are two common Drug-induced Asthma

A

Aspirin (pain)

Propranolol (hypertension)

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6
Q

What does atopy mean

A

a group of disorders that appear to run in families

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7
Q

What are the 3 types off phases of atopic asthma

A

Immediate
Duel and late
Isolated

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8
Q

What is the Early Phase Reaction

A
  • In the airways, the scene for the reaction is set by initial sensitisation to inhaled allergens, which stimulate induction of Th2 cells.
  • Th2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce IgE and other antibodies.
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9
Q

What percentage of UK adults smoke

A

16%

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10
Q

COM-B framework

A

Capability
Motivation
Opportunity
Behaviour

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11
Q

What is tidal volume

A

Volume of air displaced between normal inspiration and expiration

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12
Q

Inspiratory reserve volume

A

is the extra volume of air that can be inspired over and above the normal tidal volume when the person inspires with full force (≈3000ml).

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13
Q

Expiratory reserve volume

A

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

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14
Q

Residual volume

A

volume of air remaining in the lungs after the most forceful expiration

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15
Q

What gives us maximum volume

A

Tidal
Inspiratory reserve
Expiratory reserve
Residual

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16
Q

Functional residual capacity

A

= expiratory reserve volume + residual volume

This is the amount of air that remains in the lungs at the end of normal expiration.

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17
Q

Vital capacity

A

= inspiratory reserve volume + tidal volume + expiratory reserve volume
This is the maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent.

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18
Q

What are the Methods of Studying Respiratory Abnormalities

4

A

Arterial Blood Gases
Peak Expiratory Flow Rate (PEFR)
Spirometry
Pulse Oximetry

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19
Q

Arterial Blood Gases

A

a blood test that measures
 The arterial oxygen tension
 The arterial carbon dioxide tension
 The acidity of the arterial blood

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20
Q

Pulse Oximetry

A

• They measure the difference in absorbance of light by oxygenated and deoxygenated blood to calculate its oxygen saturation (SaO2).

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21
Q

Peak Expiratory Flow Rate (PEFR)

A
  • This is the maximum rate at which a person can forcibly expel air form their lungs at any time
  • Normal values are dependent on height
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22
Q

Spirometry

A
  • Procedure: person inspires maximally to the total lung capacity and then exhales into the spirometer with the maximum expiratory effect as rapidly and as completely as possible.
  • FEV1 is expressed as a percentage of the FVC, i.e. how much of the FVC is exhaled by the end of the first second.
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23
Q

Types of Respiratory Failure

A
  • Type I: hypoxia WITHOUT hypercapnia.

* Type II: hypoxia WITH hypercapnia.

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24
Q

What is hypercapnia

A

too much co2

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25
Q

What is the rate of diffusion directly proportional to

A

partial pressure of that gas

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26
Q

What is Henry’s Law

A

Partial Pressure= (Concentration of Dissolved Gas)/(Solubility Coefficient)

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27
Q

What is the difference in hypoxia and hypoxaemia

A

Hypoxia is failure of oxygenation at the tissue level

Hypoxaemia is when PaO2 is below the normal range

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28
Q

How does pulse Oximetry work

A

Measures the difference in absorbable of light by oxygenated and deoxygenated blood to calculate the oxygen saturation (SaO2)

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29
Q

What is Spirometry

A

FEV1 expressed as a percentage of the FVC

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30
Q

What is the difference in Type 1 and 2 respiratory failure

A

Type I - hypoxia WITHOUT Hypercapnia

Type II - hypoxia WITH Hypercapnia

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31
Q

What are the respective pressures of Co2 and O2 in alveolar air

A

Alveolar Air has more Co2 and less O2

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32
Q

Why is a slow replacement of alveolar air important

A

It is important in preventing sudden changes in gas concentrations in the blood

33
Q

How many alveoli are there in the lungs

A

300 million

34
Q

What are the layers of the respiratory membranes

A 
Layer of fluid lining the alveolus 
Alveolar epithelium 
Epithelial basement membrane 
Thin interstitial space 
Capillary basement membrane 
Capillary endothelial membrane
35
Q

What is perfusion

A

The amount of blood that reaches the alveoli via the pulmonary capillaries

36
Q

What is ventilation

A

Aeration of the lungs

37
Q

If the blood flow is good what could be another factor to do with blood that makes it difficult to absorb air bitch

A

Blood flow going to different parts of the lungs

38
Q

In quantitative terms what is Va/Q

A

Ventilation perfusion ratio

39
Q

What does Va and Q stand for

A

Va is alveolar ventilation and Q is perfusion (blood flow to the lungs)

40
Q

In terms of perfusion and ventilation explain the apex and the lower lobes of the lungs

A

Top the perfusion is decreased so Va/Q is too high so there is a moderate degree of dead space in the lung

At the lower lung there is slightly too little ventilation in relation to blood flow this Va/Q is reduced

41
Q

What happens during exercise in terms of surface area and physiological shunts

A

Increased surface area of ventilation/ perfusion ratio in the upper lung

42
Q

What nervous system at the start of exercise causes vasoconstriction

A

Sympathetic

43
Q

What is the shunt flow

A

This blood is shunted past the gas exchange areas and isn’t exposed to air

44
Q

What is venous admixture

A

Oxygenated blood from pulmonary veins to mix with shunt flow

45
Q

What is the maximum the PO2 can rise in mmHG in blood

A

95mm Hg due to the O2 pressure in the arterial blood

46
Q

What diffuses more rapidly Co2 and O2 and what does this entail when relating to pressure difference

A

Co2 defuses 20 times more rapidly thus a lesser conc gradient is needed

47
Q

What percentage of O2 is carried in the blood / dissolved in the blood

A

97% is in combination with Hb and 3% is dissolved in water of the plasma and blood

48
Q

What does Venus blood have

A

Large oxygen reserve which can be mobilised if tissue oxygen demands increase

49
Q

How does oxygen diffuse from the alveoli into the pulmonary blood as a result of

A

Partial pressure difference

50
Q

What nervous system causes vasoconstriction at the start of exercise

A

Sympathetic nervous system

51
Q

How do you make carbonic acid

A

H2O and Co2

52
Q

What does Haemoglobin act as

A

Acid-base buffer

53
Q

What maintains the pH of red blood cells

A

Chloride shift

54
Q

What is the Haldane effect

A

Binding of oxygen with Hb tends to displace carbon dioxide from the blood

55
Q

What is the Bohr effect

A

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

56
Q

Combination of O2 with Hb causes a (stronger acid or base)

A

Stronger acid

57
Q

What is Hypercapnia

A

Excess carbon dioxide in the body fluids

58
Q

What is the transport capacity for blood of Co2 vs O2

A

Blood has 3 times more capacity for Co2 than O2

59
Q

What is asthma

A

Inflammation of the air passages in the lungs and effects the sensitivity of the nerve endings in the airways so they become easily irritated.

60
Q

What are the different types of asthma

A

Atopic
Non-atopic
Drug induced
Occupational asthma

61
Q

What is the difference in atopic and non atopic asthma

A

Atopic is a definite external cause and is Type 1 mediated hypersensitivity reaction

Non-atopic is when no causative agent can be identified eg 007 or Jonny English

62
Q

What is less humid cold or warm air

A

Cold bitch

63
Q

What IL stimulates the production of IgE by B cells

A

Inter Luken 4

64
Q

What happens in airway remodelling in asthma

A

Hypertrophy and hyperplasia of bronchial smooth muscle - thus contracts too much and too easily

Epithelial destruction and metaplasia of goblet cells thus more mucus

Increased airway vascularity

65
Q

How can a mast cell be stimulated

A

Venoms eg bee sting
Cross linking of loaded IgE antibodies
Coding and morphine

66
Q

What is a curschmann spiral

A

Remember the mucus plug image that Jodie showed you

67
Q

What are the two classes of anti asthma drugs

A

Bronchodilators - revers the bronchospasm of the immediate phase
Anti-inflammatory agents - inhibit or prevent the inflammatory components of both phases

68
Q

What are bronchodilators and name some and the methods of action

A

Beta 2 adrenergic receptor agonists and they dilate the bronchi by direct action on the B2 adrenergic receptors of smooth muscle. They also inhibit the mediator release from mast cells and Tumour necrosis factor alpha release from monocytes .
They also increase mucus clearance by action on cilia.

Drugs are - salbutamol/Salmetrol

69
Q

What is the difference in salbutamol and salmetrol

A

Salbutamol is short acting and used for a as needed basis to control symptoms

Salmetrol is longer acting and given regularly twice daily and given to those who’s asthma is inadequately controlled by glucocorticoids

70
Q

Name an Xanthine drug

A

Theophylline

71
Q

What is the action of Xanthine drugs

A

Inhibitor of phosphodiesterase which results in an increase in cAMP causing muscle relaxation

72
Q

Mechanism of action of Xanthine drugs

A

Xanthine drugs are phosphodiesterase inhibitors.
Phosphodiesterase breaks down cAMP. cAMP inhibits myosin kinase which phosphorylates myosin and causes muscles to contract.
Therefore inhibiting phosphodiesterase increases the amount of cAMP and decreases the amount of myosin kinase causing muscle relaxation. This results in bronchodilation and is used to treat asthma

73
Q

What does a muscarinic receptor antagonists do

A

Blocks actions of Ach at receptors in parasympathetic nervous system

74
Q

What are glucocorticoids used for in asthma

A

Prevent progression of chronic asthma

Used as a prophylactic treatment for asthma

75
Q

What does glucocorticoids do bitch

A

Reduce production of cytokines and spas opens thus reducing bronchospasm

76
Q

What is the mechanism of glucocorticoid action

A

Enters cells
Binds to intracellular receptors in cytoplasms

Receptor complex moves to nucleus and binds to DNA in nucleus

Alters gene transcription

Reduced synthesis of IL-3

77
Q

What does IL-3 do mr poo hey Jordan x

A

Cytokine that regulates mast cell production

78
Q

What is the 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 personal susceptibility.

Sem 2 Case 2 (8 decks)

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