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IHD Part 2 - BDS 3 > respiratory 1 2 and 3 > Flashcards

respiratory 1 2 and 3 Flashcards

1
Q

FEV1

A

forced expiratory vol in 1 sec

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2
Q

FVC

A

forced vital capacity over 6-12 secs

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3
Q

diagnose COPD

A

FEV1/FVC less than 70%

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4
Q

chronic bronchitis

A

3/12 productive cough for more than 2 consecutive yrs

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5
Q

symptoms of chronic COPD

A

SOBOE
Wheeze
Cough
Weight loss

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6
Q

symptoms of acute/exacerbation COPD

A

Acute sob/wheeze
Worsening sputum production
Fever
Drowsiness/CO2 narcosis

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7
Q

signs of COPD

A 
Cachexia
	Use of accessory muscles
	Pursed lips
	Cyanosis
	CO2 flap
	Drowsiness in CO2 narcosis
Hyper-expanded chest – barrel shaped
	Hyperesonant – percuss on the chest, sounds echo like
	Reduced breath sounds
	Wheeze
	Elevated JVP & peripheral oedema in late 	disease

if you have COPD likely to have other issues

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8
Q

what can be used to measure SOB

A

MRC breathlessness scale

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9
Q

treatment once diagnosis of COPD

A

prevention i.e. stop smoking
SABA/SAMA
then LABA (If asthma then also inhaled steroid) LAMA ifnot

asthmatic and not working, triple therapy LAMA/LABA and ICS
theophylline can be symptomatic relief
inhaled steroid not for use on its own

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10
Q

what increases risk of pneumonia

A

inhaled steroids

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11
Q

management of stable COPD

A 
address muscle deconditioning
improve QoL
non pharmacological intervention
smoking cessation
oral theophylline
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12
Q

prevention of COPD exacerbations

A 
seasonal influenza vaccination 
inhaled steoids
anticholinergics
mucolytics
pulmonary rehabilitation
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13
Q

hypoxic drive

A

body is used to CO2

usually the more CO2 , you breath more to reduce the CO2 but not a driver with some

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14
Q

types and causes of respiratory failure

A

I - pneumonia, asthma, fibrosing lung disease

2 - overdose trauma ,COPD, neuromuscular

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15
Q

asthma

A

tightening of smooth muscle

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16
Q

what to look for when diagnosing asthma

A 
recurrent episode of symptms
symtom varaibiloty 
wheeze
personal history of atophy
historical record of variable FEV1
  • see if there is a response to tx
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17
Q

symptoms of asthma

A 
Wheeze
Cough
Chest tightness
Dyspnea
Nocturnal duration
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18
Q

triggers for asthma

A 
Exertion
	Dust
	Change in temperature
	Emotional situations
	Occupation
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19
Q

signs of asthma

A

Eczema
Nasal polyps
Cushingoid
Wheeze

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20
Q

asthma treatment pyramid

A

regular preventer SABA - low dose ICS (B2 agonists)
add on - inhaled LABA and low dose ICS

additional- LABA not working increase ICS dose and try LAMA etc (or leukocyte receptor agonist)

high dose
- increase ICS, addition of 4th drug

oral steroids (monoclonal Ab) - maintain high ICS

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21
Q

method of delivery of inhaled drugs

A

metered dose inhaler (SABA/LABA/ICS)

spacer (10 puff salbutamol equiveland to nebuliser, 4 initials, 2 puff every 2 min max 10)

22
Q

types of lung cancer

A

non small vs small

23
Q

non small cell lung cancer subtypes

A

squamous cell
adenocarcinoma
adenocarcinoma in situ

can metasize

24
Q

lung cancer chest conditions

A

Sob – lobar collapse, effusion, lymphangitis
Chest pain – rib involvelement, chest wall invasion
Cough
Haemoptysis – usually due to endobronchial involvement

25
Q

paraneoplastic syndromes of lung cancer

A

High calcium (PTH release or bone involvement) – nausea, confusion, abdo pain & constipation
SIADH – confusion, fits, lethargy
Hypertrophic pulmonary osteoarthropathy
Lambert Eaton Syndrome - neuromuscular weakness

26
Q

signs of lung cancer

A 
Finger nail clubbing
Cachexia
Horner’s syndrome (wasting of muscles between thumb and finger)
Neck nodes
Chest signs
Palpable liver
SVCO (superior vena cava obstruction)
27
Q

diagnosis of lung cancer

A

tissue biopsy
bronchoscopy
throacoscopy
surgical

28
Q

treatment of lung cancer

A

RT or surgery for limited disease
chemo
immunotheray

29
Q

treatment of small cell lung cancer

A

cisplatin based chemotherapy
tend to present late however due to wide spread disease
if localised RT

30
Q

types of interstitial lung disease

A
  • interstitial lung disease
    diffuse parenchymal lung disease
    lung fibrosis
31
Q

how to classify interstitial lung disease

A

Idiopathic
Drug reaction
Extrinsic Allergic Alveolitis/Hypersensitivity Pneumonitis
Associated with rheumatological disease

32
Q

symptoms of intersistial lung disease

A 
Dyspnea
Cough
Constitutional symptoms
Onset of symptoms may identify aetiology
EAA – post exposure
IdiopathicPF – chronic
AIP – rapid onset
33
Q

signs associated with intersistial lung disease

A

Signs associated with CTD/RA
Nail clubbing
Sclerodactyly
Signs of steroid use
Chest – audible crackles; distribution may influence diagnosis
Chest - squeaks - suggest small airways disease

34
Q

idiopathic pulmonary fibrosis

A

Associated with clubbing
Mainly lower zone preponderance
Classically restrictive spirometry and reduced transfer factor
Diagnosis can be made from CT

35
Q

hypersensitivity pneumonitis

A

causes lots of cysts
triggered

tx - allergen avoidance
trial of corticoid steroid therapy

36
Q

sleep apnea

A

excessive daytime sleepiness with disordered nocturnal irregular breathing

37
Q

apnea

A

when you stop breathing for 10 secs

38
Q

hypopnea

A

reduction in nasal flow in 10 secs

39
Q

types of sleep apnea

A

obstructive (high BMI and wide neck collar)
central (CV disease)
mixed

40
Q

risk factors for obstructive SleepApnonea

A 
Obesity
>17inch collar
Men x2-3 likely
Age
Cranio-facial & upper airway abnormalities e.g short mandible, tonsillar/adenoid hypertrophy, wide craniofacial base
41
Q

sleep apnea symptoms

A 
excessive daytime sleepiness
impair conc
snoring
choking episodes during sleep
restless sleep
irritability
42
Q

diagnosis of SApnea

A

polysomnography and pulse oximetry

Central apnea
Cessation of nasal flow
Ceccessation of lung movement

Obstructive (movement of lung will try to happen, cessation of nasal flow as there is upper blockage)

43
Q

tx for SApnea

A

Weight loss/lifestyle change

Continuous Positive Airway Pressure (CPAP)

Mandibular Advancement Device (MAD)

Pharmocotherapy & surgery?

44
Q

short acting bronchodilators

A

relief of symptoms
used inCOPD and asthma
immediate bronchodialtion
increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muslce

45
Q

side effects of SABA

A 
Increased HR & palpitations
Tremor
Hypokalaemia
Headache
Nervousness
46
Q

LABA

A

alternative to increase steroid dose
selectivity for B2 adenoceptor in pulmonary tissue
not used in monotherapy in asthma

47
Q

anticholinergic agents and side effects

A

relief of symptoms
usually for COPD
block of muscarinic receptors M1-3

Possible effect on urinary retention
Dry mouth
Possible adverse cardiovascular effects

48
Q

inhaled steroids

A

prevents symptoms
reduces risk of exacerbations
reduces cytokines, bronchoconstriction and airwa inflammation

Side effect
- ORAL CANDIDA

49
Q

oral steroids w side effects

A

acute or chronic severe asthma

side effects
Weight gain
Hyperglycaemia
Skin change
Hypertension
Eye change
Mood change
Reduce bone mineral density
50
Q

theophyllines w side effects

A

acute/chronic asthma
tablets and IV

side effects
Nausea
Vomiting
Palpitations
Headaches
Dyspepsia
Arrhythmias
Confusion
51
Q

antileukotrines

A

chronic asthma tx

but only limited pt benefit

IHD Part 2 - BDS 3 (55 decks)

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