Formative Assessment Pointers Week 2 Flashcards
Normal expiration
Is a passive process, controlled by the gaps in firing of dorsal neurons within the medulla
Forceful expiration
Is an active process, controlled by the firing of ventral neurons in the medulla
Normal inspiration
Is an active process, controlled by the firing of dorsal neurons within the medulla
Theophylline
A methylxanthine drug with bronchodilator and anti-inflammatory action. Has many side effects and drug interactions.
Fexofenadine
A competitive H1 receptor antagonist used to treat allergic rhinitis.
Ipratropium
A short acting drug that blocks acetylcholine receptors non-selectively. Can be delivered intranasally to treat rhinorrhoea.
Tiotropium
An anticholinergic drug, selective for M3 receptors with a long half life.
Monteleukast
A cysteinyl leukotriene receptor antagonist used to treat asthma and allergice rhinitis.
Beclometasone
An inhaled corticosteroid. Used in combination with a beta-2 adrenoceptor agonist, particularly in frequent exacerbations of COPD.
Equals inspiratory reserve volume plus tidal volume plus expiratory reserve volume.
Vital Capacity
The volume of air in the lungs at the end of a normal, passive expiration
Functional Residual Capacity
A 59 year old man presents to his GP with a cough that he has been suffering from for at least six months. He tells you he brings up clear phlegm daily, but that it has occasionally been green and unpleasant when he gets a cold. He has come in today because he heard that long term coughs should be checked by a doctor. He smokes approximately 40 cigarettes a day, and has been smoking for over 30 years. He is much more breathless when walking around than he used to be.
Chronic Bronchitis
A 78 year old woman is admitted to hospital short of breath. She feels that even sitting talking to you is too much effort, and she is struggling to get up to the bathroom without help. She is generally unwell, with a temperature of 38.2, but no other investigations have been returned yet. She has a 50 pack-year smoking history. She has a cough, which she says is normal for her, but she is bringing up thick yellow sputum, which she does not normally. She takes regular inhaled medicines, but feels these are not helping her as they usually do.
Acute Exacerbation of COPD
A 35 year old woman visits her GP complaining of shortness of breath. She finds she feels her chest is tight and that she is struggling to breathe. This mostly affects her at home, and tends not to be as bad any other time. She is coughing at night, but this is non-productive. On examination she has a generalised wheeze, but no other abnormal findings. When you are discussing your thoughts, she mentions that her and her partner recently bought a kitten, and wonders if this is the cause of her problem.
Extrinsic Asthma
These chemoreceptors detect arterial oxygen partial pressure. When stimulated, they cause hyperventilation and increased cardiac output.
Peripheral Chemoreceptors
These chemoreceptors are found in the brainstem. They respond to CSF [H+].
Central Chemoreceptors in the Medulla
These chemoreceptors, when stimulated, can compensate for metabolic acidosis by triggering increased elimination of CO2
Peripheral Chemoreceptors
Chronic adaptation caused by hypoxia
Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic acidosis
Acute mountain sickness
Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness
Diabetic ketoacidosis
Hyperventilation with a severe metabolic acidosis.
An 18 year old man is admitted to hospital acutely short of breath. He cannot speak in full sentences and is audibly wheezing. He has been given a beta-2 adrenoceptor agonist and steroids, and his doctor wishes to give him a further inhaled drug
Nebulised ipratropium
A 68 year old man with long-standing COPD has been prescribed several medications. However, he is struggling to cope at home, and when he is examined you see is SaO2 is 82%.
Domicilary oxygen
A 22 year old woman has been using a reliever inhaler for some time, but is finding she is now wheezing and feels more breathless when she exercises.
Inhaled beclometasone
Results in increased pulmonary compliance, produces hyperinflated lungs and will show an obstructive defect on spirometry
Emphysema
Causes shortness of breath on exertion, a restrictive defect on spirometry and reduced pulmonary compliance but no sign of infection.
Pulmonary Fibrosis
Will show a low FVC, a low FEV1 and a low FEV1/FVC% on spirometry
Combined Restrictive-Obstructive Lung Disease
Rofumilast
A PDE4 inhibitor given orally for severe COPD
Sodium cromoglicate
Mast cell stabiliser used in asthma and allergic rhinitis
Prednisolone
An oral steroid used in severe or intractable rhinitis, acute asthma or an exacerbation of COPD
A 25 year old woman visits her GP. She is normally fit and well, but has been finding running increasingly difficult, particularly when it is cold. She complains of feeling short of breath and wheezing. There are no abnormal findings on examination and no significant past medical history
Intrinsic Asthma
A 68 year old man is admitted to hospital having become increasing short of breath over the past two days. He has had a cough for many months, but is now coughing up green sputum. He already takes tiotropium and salmeterol. He is a smoker, smoking 20 cigarettes per day for the past 40 years
Acute Infective exacerbation of COPD
A 12 year old boy is brought to the GP by his parents. He says he feels like he sometimes can’t get air in, and his mother is worried he has hayfever as it seems to be worse in the summer. He has a past history of eczema and his father has asthma and says he has allergies. On auscultation he has a generalised wheeze
Atopic Asthma
A 40 year old woman has been treated for asthma for several years, and has known allergies to various allergens including the house dust mite. She has been escalated through the available therapy and is still poorly controlled, with frequent exacerbations and hospital admissions. She already takes a beta-2 adrenoceptor agonist, an inhaled and an oral steroid and several add-on treatments. She is particularly worried about steroid side effects
Subcutaneous Omalizumab
A 66 year old man with a long-standing history of COPD is finding it increasingly difficult to breathe, despite being on several different medications. He tells his GP that he cannot cough as easily and struggles to expectorate sputum. He is already receiving physiotherapy
Oral carbocysteine
A 20 year old woman visits her GP complaining of occasional shortness of breath, brought on by exercise. She wheezes and has a night-time cough but no other symptoms. She takes no other medication, has no known allergies, and is otherwise fit and well
Salbutamol as required
