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AB 4th Year Gen Med > Respiratory - Chronic Conditions > Flashcards

Respiratory - Chronic Conditions Flashcards

1
Q

what type of hypersensitivity is asthma?

A

Type 1 (IgE mediated)

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2
Q

risk factors for asthma?

A

FHx
atopy
allergen exposure
nasal polyps

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3
Q

pathology of asthma?

A
  • inflammation due to trigger
  • mast cells and basophils degranulate
  • increased mucus and responsiveness
  • intermittent airway obstruction, mucus and hyper-reactivity
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4
Q

clinical criteria for diagnosis of asthma?

A

atopic Hx
wheeze heard
diurnal variability
wheeze/SOB/chest tight/cough with no symptoms inbetween

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5
Q

other features of asthma?

A

kids worse at night

precipitants of cold, exercise, Bb, NSAIDs

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6
Q

investigations for asthma?

A 
high probability - 6wks of Tx
spirometry with bronchodilator reversibility (<80% predicted)
bronchial challenge (allergic asthma)
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7
Q

treatment for asthma?

A
  1. SABA + ICS
  2. add LABA
  3. increase ICS or add LTRA
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8
Q

treatment for asthma in kids?

A
  1. SABA + ICS/LTRA if <5
    • <5yrs LTRA / >5yrs LABA/LTRA
  3. increase ICS or add LTRA/LABA

stop LABA if no response
use spacers

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9
Q 
e.g of 
SABA
LTRA
ICS
LABA
A

SABA - salbutamol (blue)
LTRA - montelukast
ICS - beclamethasone (brown)
LABA - salmeterol (purple)

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10
Q

features of moderate acute asthma?

A

worsening symptoms

PEF >50-75% predicted

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11
Q

features of acute severe asthma?

A

PEF 33-50%
RR ≥25
HR ≥110
inability to complete a sentence in one breath

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12
Q

features of life threatening asthma?

A 
PEF <33%
SpO2 <92%
altered consciousness
silent chest 
hypotension 
PaCO2 can be normal, PaO2
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13
Q

features of acute severe asthma in kids?

A 
SpO2 <92
PEF 33-50%
inability to complete a sentence in one breath
HR >140 for 1-5, >125 for >5
RR >40, >30
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14
Q

features of life threatening asthma in kids?

A 
SpO2 <92
PEF <33%
silent chest
confused
hypotension
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15
Q

how many puffs of a SABA can be given to children in acute asthma?

A

one puff every 30-60secs

up to 10 puffs

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16
Q

treatment of acute asthma?

A 
Oxygen 
SABA
Steroids
Ipratropium bromide
IV Mag sulphate
IV Aminophylline
Anaesthetics and intensive care
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17
Q

risk factors for COPD?

A

SMOKING
age
pollution

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18
Q

two pathological features of COPD?

A

emphysema - enlarged air spaces and destroyed alveoli

chronic bronchitis - sputum + cough on most days for 3 successive months for 2 years

19
Q

features of COPD?

A 
productive cough 
SOB
hyper resonant
wheeze
crackles
tachypnoea 
barrel chest
20
Q

investigations for COPD and results?

A

spirometry with bronchodilator:
mild >80, mod <80, severe <50

reduced FEV1/FVC ratio
reduced FEV1 and FVC (not as much)

21
Q

treatment for COPD?

A
  1. SABA
  2. SAMA
  3. FEV1 >50 = LABA/LAMA
    FEV1 <50 = LABA + ICS/LAMA
  4. LABA + LAMA + ICS
  5. oxygen
22
Q

e.g of
SAMA
LAMA
LABA

A 
SAMA = ipratropium 
LAMA = tiotropium 
LABA = salmeterol
23
Q

features of obstructive sleep apnoea?

A

snoring
daytime sleepiness
apnoea
orthopnea

24
Q

investigation and Tx of obstructive sleep apnoea?

A

polysomnography

weight loss
smoking cessation
CPAP

25
Q

treatment of exacerbation of COPD?

A

amoxicillin
2nd line: doxycycline

prednisolone
SABA
SAMA

26
Q

what is bronchiectasis?

A

permanent dilation of bronchi due to destruction of the walls

27
Q

causes of bronchiectasis?

A 
recurrent infection 
CF
alpha 1 antitrypsin 
CTD
tumour
HIV
28
Q

investigations for bronchiectasis?

A

CXR
high resolution CT
find the cause

29
Q

features of bronchiectasis?

A 
cough 
sputum 
SOB
wheeze
weight loss
fever
fatigue
30
Q

complications of bronchiectasis?

A

respiratory failure

cor pulmonale

31
Q

what is cor pulmonale?

A

high blood pressure in the pulmonary arteries

causes enlarged RHS of heart

32
Q

types of respiratory failure?

A

type 1 - hypoxia without hypercapnia

type 2 - hypoxia with

33
Q

features of hypoxia?

A 
dyspnoea
restless
agitated
confused
cyanosis
34
Q

features of hypercapnia?

A 
headache
peripheral vasodilation
tachycardia
tremor
confused
drowsy
papilloedema
35
Q

causes of type 1 RF?

A

asthma
PE
PO
pneumonia

36
Q

causes of type 2 RF?

A

COPD

rising CO2 not matched by increased RR

37
Q

treatment of type 1 and type 2 RF?

A

1 - treat cause and oxygen
2 - treat cause and controlled oxygen
ABG recheck

38
Q

what is the haldane effect?

A

deoxygenated Hb binds with a greater affinity to CO2

39
Q

why do COPD need controlled O2 therapy?

A

hypoxic vasoconstriction
oxygen just increases blood flow
does not increase ventilation

40
Q

when should asthma treatment be stepped up?

A

using SABA >3x a week

41
Q

what is FEV1?

A

amount expelled forcefully in one second

reduced in COPD

42
Q

what is FVC?

A

total air exhaled in one breath

43
Q

what is the spirometry pattern for restrictive lung disease? why?

A

FEV1/FVC normal

both equally reduced (in obstructive, FVC reduced LESS than FEV1)

AB 4th Year Gen Med (27 decks)

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