Resp Flashcards
what are 6 environmental triggers of asthma?
viral/bacterial infection allergen exposure food additives chemicals irritants aspirin
what are 3 risk factors for asthma?
FHx
Atopic Hx
nasal polyposis
what are 5 presentations of asthma?
episodic SOB dry cough expiratory wheeze and chest tightness nasal polyposis diurnal PEFR variation
what are 4 investigations of Asthma?
FEV1/FVC ratio - <70% predicted and bronchodilator reversibility
factional exhaled NO - >40 ppb
Peak expiratory flow rate - less than expected in gender and height matched person
skin prick allergy testing
what are 3 differentials for asthma?
cystic fibrosis
pulmonary oedema
COPD
what are the 2 different types of asthma?
Eosinophilic - most common (70%)
non-eosinophilic
what is atopy?
when an individual readily develops IgE against common environmental antigens
what is non-eosinophilic asthma triggered by?
exercise, cold air, stress, smoking, obesity, menstrual cycle
what is eosinophilic asthma triggered by?
allergens
what drug class should you never give to asthmatics?
BETA BLOCKERS
what 4 immune cells are present in asthma?
mast cells
eosinophils
dendritic cells
lymphocytes
what are 4 features of an asthma attack?
reduced chest expansion
prolonged expiratory tume
bilateral expiratory polyphonic wheeze
tachypnoea
what are 4 features of uncontrolled asthma?
PEFR less than 50%
RR < 25
pulse <110
normal speech
what are 3 features of a severe asthma attack?
inability to complete sentences
pulse >110
RR >25
PEFR 33-50%
what are 5 features of a life threatening asthma attack?
silent chest confusion and exhaustion cyanosis bradycardia PEFR <33%
what is the management for an asthma attack?
O2 therapy
salbutamol
nebulised ipratropium bromide
prednisolone/hydrocortisone IV
when in the day is asthma worst?
worse at night and early morning
DIURNAL
how is asthma diagnosed with peak flow?
a greater than 15% increase in FEV1 or PEFR following bronchodilator inhalation
how do B2 agonists work?
binds to B2 receptor coupled with Gs protein
=> adenyl cyclase converts ATP to cyclic AMP =>
increases in cyclic AMP leads to bronchodilation
what are the 4 main treatments of asthma?
SABAs - salbutamol and terbutaline
LABAs - salmeterol, formoterol
muscarinic antagonists - ipratropium (short), tiotropium (long)
inhaled corticosteroids - prednisolone, beclomatasone, budesonide
leukotriene receptor antagonists (LTRA) - bronchodilator, montelukast
how do muscarinic antagonists work?
act on M3 receptors
prevent Ach from binding => no smooth muscle contraction
what are 6 side effects of corticosteroids?
susceptibility to infection osteoporosis and muscle wasting cataracts diabetes skin thinning and bruising growth retardation
what are 2 steroid sparing agents that can be used in asthma?
methotrexate
ciclosporin
what is the medication regime for asthma mild to severe?
SABA
SABA + ICS
SABA + ICS + lLTRA
SABA + ICS + ILTRA/LABA + MART
what are 3 complications of asthma?
severe exacerbation
airway remodelling
candida due to inhaled corticosteroids
what is the most common causative agent for CA pneumonia?
streptococcus pneumonia
what are 5 manifestations of pneumonia?
cough +/- sputum SOB pleuritic chest pain rigors/night sweats and fever abnormal auscultatory findings
what are 4 investigations of pneumonia?
CXR - new shadowing - gold
CRP - raised
FBC - raised WBCs
sputum culture
what assessment tool is used to assess pneumonia severity?
CURB65
what is the CURB65 score?
Confusion Urea ≥7mmol/L Respiratory rate≥ 30/min Blood pressure; low systolic < 90mm/Hg or diastolic ≤60mm/Hg Age ≥ 65
what are 3 risk factors for CA pneumonia?
> 65 years
resident in healthcare setting
COPD
what are 3 complications of pneumonia?
septic shock
ARDS
antibiotic associated C. Diff
what is COPD?
a progressive disease state characterised by airflow limitation that is not fully reversible. Contains both emphysema and chronic bronchitis
what are 4 causes of COPD?
smoking - 40-70%
air pollution
occupational exposure
alpha-1 Antitrypsin deficiency
what are 3 risk factors for COPD?
smoking
older age
genetics - alpha-1 antitrypsin
why is there increased mucous secretion in COPD?
increased goblet cell size and number
what are 5 manifestations of COPD?
productive cough and SOB
pursed lips - increased resprate and barrel chest
cyanosis
expiratory wheeze
what FEV1/FVC ratio is needed for an obstructive lung disease?
<0.7
what FEV1/FVC ratio is needed for a restrictive lung disease?
> 0.7
what are 3 investigations for COPD?
spirometry - <0.7 => non reversible
CXR - rule out pathology, hyper inflated lungs and flat diaphragm
FBC
what is needed for a COPD diagnosis (bronchitis)?
daily productive cough lasting at least 3 months of the year for at least 2 years in a row
what are 3 differentials for COPD?
Asthma
congestive HF
TB
what is alpha-1 Antitrypsin Deficiency?
rare genetic condition causing lung and liver problems
early onset COPD/cirrhosis even without smoking/drinking Hx
autosomal co-dominant
what is the pharmacological treatment for COPD?
bronchodilators - SABA => Salbutamol - SAMA => ipratropium - LABA => Salmeterol - LAMA => tiotropium Inhaled corticosteroids
order => SABA/SAMA, LABA + LAMA, ICS
What are the 4 stages of COPD?
1 - FEV1 >80% predicted
2 - FEV1 50-79%
3 - FEV1 30-49%
4 - FEV <30%
what are 3 complications of COPD?
Cor pulmonale
resp failure
pneumothorax
What is cystic fibrosis?
a severely life-shortening genetic disease resulting from abnormalities in the cystic fibrosis transmembrane conductance regulator (CFTR), a chloride channel found in cells lining the lungs, intestines, pancreatic ducts, sweat glands, and reproductive organs.
what is the prevalence of CF?
1 in 2500 live births
what is the inheritance pattern for CF?
Autosomal recessive on chromosome 7
there are mutations in the CF transmembrane conductance regulator
what are 3 risk factors for CF?
FHx
known carrier parents
Caucasian ethnicity
how does CF affect the pancreas?
blockage of exocrine ducts, early activation of pancreatic enzymes, autodestruction of exocrine pancreas
how does CF affect the intestine?
bulky stools and intestine blockages
how does CF affect the lungs?
mucus retention. Chronic infection, inflammation and lung destruction (fibrosis)
what are 5 manifestations of CF?
failure to pass meconium/steatorrhoea failure to thrive despite a voracious appetite wet sounding cough recurrent chest infections chronic sinusitis
what is a GU abnormality that is common in those with CF?
males lacking a vas deference
what are 3 investigations of CF?
sweat test - GOLD - >60mmol/L
genetic testing
Guthrie heel prick test - immunoreactive trypsinogen test
what are 3 differentials for CF?
asthma
primary immunodeficiency
coeliac disease
what is the treatment for CF?
prophylactic antibiotics - flucloxacillin education chest physio flu vaccine B2 agonists and ICS - symptom relief mucolytics - Dornase alfa pancreatic enzyme replacement immunomodulators - azathioprine
what are 3 complications of CF?
pneumothorax
chronic respiratory acidosis
acute respiratory failure
what is the average age of survival of a CF patient?
40
what is HA pneumonia?
an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital
what is the most common early onset HA pneumonia?
pseudomonas aeruginosa
< 5 days after admission
what is the most common late onset HA pneumonia?
S. Aureus
> 5 days after admission
what are 3 risk factors for HA pneumonia?
poor infection control/hand hygiene
intubation and mechanical ventilation
decreased consciousness
what extra tests do you have to do in HA pneumonia?
sputum culture
nasopharyngeal swap
tracheal aspirate samples
BEFORE antibiotics
what are 3 complications of CA pneumonia?
empyema
lung abcess
sepsis
what is the most deadly cancer in the UK?
Lung cancer
what are 3 risk factors for lung cancer?
smoking
radon gas
occupational exposure
what are the 3 different types of primary lung cancer?
small cell
non-small cell
carcinoid tumour
what are some features of small cell lung cancer?
more aggressive neuroendocrine tumour high grade associated with smoking CHEMO
what are some features of non-small cell lung cancer?
85% of primary lung carcinomas
squamous cell, adenocarcinoma, large cell
resection + chemo
what are some features of carcinoid tumours?
neuroendocrine tumour
malignant potential
surgery
what are 5 manifestations of local lung cancer?
SOB persistent cough/new change haemoptysis hoarse voice pleuritic chest pain recurrent chest infections
what are 4 systemic manifestations of lung cancer?
weight loss
fatigue
bone pain
finger clubbing
what are 4 paraneoplastic syndromes?
SIADH
secretion of ACTH, PTH and other hormones
Hypertrophic pulmonary osteoarthropathy
myasthenic syndrome
what are 3 manifestations of hypertrophic pulmonary oseteoarthropathy?
digital clubbing
periostitis
painful arthropathy
what are 3 investigations of lung cancer?
CXR
CT chest, liver, adrenals
sputum cytology
what is the prognosis for lung cancer?
10% at 10 years