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CP3 Medicine > RESPIRATORY - Asthma, COPD > Flashcards

RESPIRATORY - Asthma, COPD Flashcards

1
Q

Functions of the respiratory system (5)

A 
Gas exchange
Homeostasis of the body 
Protection from inhaled pathogens 
Vocalisation 
Olfactory sense
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2
Q

FEV 1

A

Forced exp volume

Volume that has been exhaled at the end of the 1st s of forced expiration

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3
Q

Normal FEV1 value

A

> 80%

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4
Q

FVC

A

Forced vital capacity

Volume that has been exhaled after max exp, following a full insp

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5
Q

KCo

A

Diffusion capacity of lung per unit area for CO

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6
Q

TLco

A

Diffusion capacity of the total lung for CO

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7
Q

Obstructive pattern

A

Norm/Incr FVC

FEV1:FVC <0.7 (reduced)

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8
Q

Restrictive pattern

A

Reduced FVC (<80%)

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9
Q

What does decreased TLco/Kco indicate

A

Issue w/ gas exchange

hence rules out chest wall/diaphragm pathology

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10
Q

Def asthma

A

Chronic inflammatory condition of the airways, characterised by airway hypersensitivity

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11
Q

What % adults have asthma

A

5%

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12
Q

What % children have asthma

A

10%

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13
Q

Sx asthma (5)

A 
Wheeze 
SOB 
Morning dipping 
Subjective feeling chest tightness 
Nocturnal cough
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14
Q

O/E asthma

A

Widespread expiratory wheeze

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15
Q

Pulmonary function test results asthma

A

Decreased FEV1

Relieved by B2 agonists

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16
Q

Common precipitants asthma

A 
Enviro 
Viral infections 
Cold air
Emotion 
Dx (NSAIDS/B blockers) 
Atmospheric pollution 
Occupational pollutants
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17
Q

How is occupational asthma diagnosed

A

Using peak flows before /after work/ at weekends

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18
Q

Important Hx points asthma

A 
Known precipitants 
Diurnal variation 
Acid reflux Sx 
Atopy Hx 
Occupation 
Days off work/school 
Hx exaccerbations 
Did they req hospitalisation/ITU
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19
Q

Can asthma be diagnosed on clinical diagnosis aloone?

A

Yes

If B2 commenced and improvement of Sx

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20
Q

If poor response to bronchodilators, how is asthma diagnosed

A

Spirometry

FEV1:FVC < 0.7 +bronchodilator reversbility = diagnostic

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21
Q

What time of HS reaction is extrinsic asthma

A

T1HS

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22
Q

Clinical picture extrinsic asthma

A

Atopic indiv

w/ positive skin prick tests to common allergens

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23
Q

Clinical picture intrinsic asthma (4)

A

Middle aged indiv
With no causative agents ID’d
Generally > severe
+ quicker deteriorations in lung fct

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24
Q

Early phase of acute asthma attack

A

Bronchospasm b/c spasmogen production (Histamine, PG + LT)

SM contraction narrows airways

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25
Q

Late phase of acute asthma attack

A

Chemotaxins attract eosinophils +mononuclear cells

Infiltrate + mucosal oedema narrow airway

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26
Q

Which type of asthma is more likely to develop chronic asthma

A

Intrinsic astham

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27
Q

Changes in chronic asthma

A

Bronchoconstriction b/c incr responsiveness bronchial SM + hypersecretion mucus –> plugs

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28
Q

What 2 things ddoes the sputum contain in chronic asthma

A

Charcot-Leyden crystals

Curshman spirals

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29
Q

Effect on vascular system - chronic asthma

A

Pulmonary HTN

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30
Q

Features of life-threatening asthma attack (5)

A

-PEF <33% of best
-SpO2 <92%
-Silent chest, cyanosis or feeble respiratory effort
Bradycardia, hypotension or dysrhythmia
Exhaustion or confusion

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31
Q

ABG markers - life threatening asthma attack

A

Normal PaCO2 (b/c no longer hypoventilating)
Severe hypoxia <8
Low pH

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32
Q

What does raised PaCO2 indicate in acute asthma attack

A

Almost fatal

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33
Q

Mx life threatening asthma attack (8)

A 
15L O2 NRB mask 
Salbutamol 5mg via nebs (every 15-30 mins)
Ipratropium bromide 0.5mg via nebs 
PO prednisolone 50mg or IV HC 100mg 
No sedatives 
CXR 
Call ICU
\+ MgSO4
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34
Q

What must you do prior to discharge for an acute asthma attack patient

A

Check inhaler technique

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35
Q

Step 1 Mx asthma

A

salbutamol prn

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36
Q

Step 2 Mx asthma

A

+ ICS 200-800microg

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37
Q

Step 3 Mx asthma

A

+ LABA
If response - continue
If no response - stop and increase dose of ICS to 800microg/day

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38
Q

Step 4 Mx asthma

A

Persistent poor control
Can incr Inhal ICS up to 2000microg /day
Add 4th Dx e.g. LTRA, Theophylline etc

39
Q

Step 5 Mx asthma

A

Continuous or freq use of PO steroids
Maintain 2,000 microg ICS
Lowest dose daily oral steroid

40
Q

Inhaler technique

A

1 - Remove cap and shake inhaler to ensure consistency of dose
2 - Pt - breath fully out
3 - Pt - breath in slowly and steadily press down on the inhaler device
4 - On inhalation, pt should hold breath for count of 10
5 - pt - slowly breathe out, repeat dose + replace mouthpiece cover. Clean device if necess after use

41
Q

Role of Beta-agonists

A

Relax bronchial SM –> bronchodilation

42
Q

SE Beta-agonists

A

TachyC (Beta 1)

Tremor, cramps, hypokalaemia (Beta 2)

43
Q

How long does a SABA work for?

A

4-6hrs

44
Q

How long does a LABA work for?

A

> 12hrs

45
Q

SE ICS (main)

A

PO candidiasis

Pneumonia

46
Q

Advice for ICS

A

Rinse mouth afterwards

47
Q

SE - LTRA (3)

A

Thirst
GI disturbances
V rarely Churg Strauss

48
Q

SE Theophyilline

A 
Dose related b/c narrow therapeutic window 
headache 
Insomnia 
Nausea
TachyC
Arrhythmias
49
Q

Def COPD

A

A disease of progressive airflow limitation that is not fully reversible, associated w/ an abnormal inflammatory resposne to the lungs to noxious particles of (g), predominantly inhaled cigarette smoke

50
Q

Def Emphysema

A

Dilation of any part of respiratory acinus w/ destructive changes in the alveolar walls

51
Q

What is tissue destruction caused by in emphysema?

A

Increased secretion + activation of extracellular proteases by inflammatory cells
(which are stim’d by noxious particules)

52
Q

Centrilobar emphysema

A

changes Limited to central part of lobule directly around terminal bronchiole, w/ norm alveolar everywhere

53
Q

What is the most common type of emphysema

A

Centrilobar emphysema

54
Q

What is centrilobar emphysema assocated with

A

Smoking

55
Q

What is panacinar emphysema

A

Destruction + distention of whole lobule

56
Q

Who gets panacinar emphysema

A

a-1-antitripsin deficiency

57
Q

What is a bullae

A

Dilated air space >1cm

58
Q

Def chronic bronchitis

A

Daily cough + sputum for at least 3 months /yr for 2 years

59
Q

What is the primary abnormality seen in chronic bronchitis?

A

Abnormal amount of mucus, which –> plugging of airway lumen

60
Q

What index is used to show hypersecretion in chronic bronchitis?

A

Reid index
Ratio fland:wall thickness in the bronchus
(Incr in chronic bronchitis)

61
Q

What is bronchiolitis?

A

Inflammation in airways <2mm in diameter

+ macrophage + lymphoid cell infiltration

62
Q

What is the first pathological change in COPD

A

Bronchiolitis

63
Q

RF COPD (6)

A 
Cigarette smoke 
Occupational exposure to dusts 
A-1-antitrypsin deficiency 
Recurrent infections - childhood 
Low SE status 
Asthma/Atopy
64
Q

PS COPD (4)

A

Productive morning cough
Increased frequency LRTI
Slowly progressive dyspnoea + wheezing
Resp failure

65
Q

Signs COPD - severe dsiease

A 
Tachypnoea 
Cyanosis + flapping 
Hyperinflation
Intercostal recession insp
Lip pursing on exp 
Signs resp distress 
Raised JVP if cor pulmonale
Poor chest expansion 
Hyper-resonant throughout + loss cardiac/hepatic dullness 
Decr breath sounds 
Prolonged expiratory phase
Polyphonic wheeze
66
Q

Complications COPD (6)

A 
Acute exacerbations 
Polycythaemia 
Resp failure 
Cor pulmonale 
Pneumothorax
Lung carcinoma
67
Q

What are ‘Blue bloaters’

A

Pt w/ sever COPD who are insensitive to CO2

Rely on hypoxic drive

68
Q

How do Blue Bloaters ps

A

Not particularly breathless

But = cyanosed + oedematous

69
Q

ABG results Blue Bloaters

A

T2RF

70
Q

What treatment must be given with caution w/ Blue Bloaters

A

O2

71
Q

What are ‘Pink puffers’

A

Pt remains sensitive to CO2

72
Q

ABG features’Pink puffers’

A

Low CO2
Norm O2
But can –> T1RF

73
Q

Appearance of ‘Pink puffer’

A

Uses accessory mm to increase their ventilation
Breathless
Pt v thin due to large amount of kcal used to breath

74
Q

Does Pink Puffer or Blue bloater have > emphysema

A

Pink puffer

75
Q

When can diagnosis of COPD be clinical?

A

If typical Sx in >35y/o in presence of RF

76
Q

Ix for anyone suspected of COPD

A

Post-bronchodilator spirometry
CXR
FBC

77
Q

Post-bronchodilator spirometry - stage 1 (mild)

A

FEV1 80% predicted value

78
Q

Post-bronchodilator spirometry - stage 2 (mod)

A

FEV1 50-79% predicted

79
Q

Post-bronchodilator spirometry - stage 3 (severe)

A

FEV1 30-49% predicted

80
Q

Post-bronchodilator spirometry - stage 4 (v severe)

A

FEV1 <30% predicted

81
Q

CXR features COPD (5)

A 
Hyperinflation (>6ant/10post ribs)
Flattened hemidiaphragm
Large central pulm aa 
Reduced peripheral vascular markings 
Bullae
82
Q

Further Ix COPD (4)

A

Sputum culture
EC
ABG
DLCO

83
Q

Mx stable COPD (4)

A

Rx to resp specialist if any doubt on diagnosis
Pt education
Lifestyle advice
Medication

84
Q

Medicine pathway COPD if FEV1 >50:

A

1 - SABA prn or SAMA prn
2 - LABA or LAMA
3 - LABA + ICS
4 - LAMA + LABA + ICS

85
Q

Medicine pathway COPD if FEV1 <50:

A

1- SABA prn or SAMA prn
2 - LABA + ICS or LAMA
3 - LABA + LAMA + ICS

86
Q

Specialist Tx COPD (6)

A 
Pulmonary rehab 
PO aminophylline 
Mucolytics
Nutritional supplement 
LTOT 
Surgery
87
Q

Aims of pulmonary rehab in COPD

A

Increases exercise capacity
Decreases breathlessness
Improves QOL

88
Q

How often is pulmonary rehab

A

3 sessions/week for 6 weeks

89
Q

When is a patient w/ COPD started on aminophylline?

A

If still symptomatic after triple therapy

90
Q

Who gets LTOT in COPD>

A

If SPO2 <92% OA
FEV1 <30%
Cyanosis
Cor pulmonale

91
Q

Cause of acute exaccerbation COPD (2)

A

Virus
Bacteria
Pollutants

92
Q

If a patient is having acute COPD exaccerbations frequently, what changes need to be made to their current Mx

A

++ rescue meds (azithromycin)

93
Q

When to admit someone w/ acute exacc COPD (7)

A 
Severe breathlessness 
Rapid Sx onset
Acute confusion 
Cyanosis 
Low O2 sats 
worsenning peripheral oedema
94
Q

Outpt Mx acute exacc COPD (5)

A 
Incr SABA + spacer
30mg prednisolone 7-14 days 
PO ABx if purulent sputum/signs pneumonia 
Safety net
Follow up 6w

CP3 Medicine (29 decks)

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