Respiratory Medicine Flashcards
What is the pathophysiology of asthma?
Type 1 hypersensitivity reaction
Sensitisation: IL-4, 13 > Th2 > IgE in mast cells
Excitation: degranulation of leukotrines, histamine, PGs
Causing: bronchoconstriction, mucosal oedema, mucus hypersecretion, denudation of epithelium
What are the four cardinal symptoms of asthma?
SOB, chest tightness, wheeze, cough + sputum
What areas should be covered when assessing asthma severity?
Daytime symptoms Nighttime symptoms Physical activity Exacerbations Number of sick days Use of reliever FEV1/FVC PEF
What are the spirometry findings in asthma?
FEV1/FVC 12% (400mL) increase post-BD
What are the management steps for chronic asthma?
- Identify + avoid triggers
- Reliever: SABA
+/- Preventor: inhaled corticosteroid (fluticasone)
+/- LABA: salmeterol
+/- LTRA: montelukast
What are the spirometry findings of COPD?
FEV1/FVC <12% (400mL) reversibility post-BD
FEV1 then used to grade severity
What are the GOLD criteria for COPD?
- Mild: FEV1 >80% predicted
- Moderate: FEV1 between 50-80% predicted
- Severe: FEV1 between 30-50% predicted
- FEV1 <30% predicted
What is the pathophysiology of COPD?
Smoking > airway injury > Chronic bronchitis (chronic inflammation) Emphysema (destruction of alveoli + fibrosis)
Which screening tools are available to assess the severity of CAP?
CURB-65 (easiest)
SMART-COP (endorsed by RAH)
Pneumonia Severity Index (most time consuming)
(used to determine need for hospitalisation)
What are the components of SMART-COP?
S - Systolic BP 25 T - HR >125 C - Confusion O - Oxygen sats <93% P - pH low (2) (3+ points = admit to hospital)
What is the only treatment proven to extend life in COPD?
Oxygen therapy
What are some causes of bronchiectasis?
CF, TB, lung abscess
What is the most common cause of haemoptysis?
Bronchiectasis
What causes restrictive lung disease?
Interstitial lung disease Space occupying lesion Pleural effusions Multiple sclerosis SCI
What is the most common sign in pulmonary embolism?
Tachycardia
What is a Ghon complex?
Calcified TB nodule + lymph nodes
What is the most common extrapulmonary location for TB to spread?
?Kidneys (according to DeJa Review)
What is Cheyne-Stokes Respiration and in which conditions can it occur?
Breathing that is progressively deeper then shallower an may result in periods of apnoea.
May occur in brainstem lesions, raised ICP, heart failure, pulmonary oedema and altitude sickness.
What is Kussmaul breathing and when may it occur?
Deep, laboured hyperventilation associated with metabolic acidosis (especially DKA) and kidney failure.
What are the clinical features of carbon dioxide retention?
Asterixis
Myoclonic jerks
Decreased conscious state
Tachypnoea
What is Type I respiratory failure?
= low oxygen with normal/low carbon dioxide
underlying problem is with the diffusion membrane, e.g. PE, pulmonary oedema, pneumonia, ARDS
What is Type II respiratory failure?
= low oxygen with high carbon dioxide
underlying problem is with decreased ventilation, e.g. COPD, asthma, suffocation
What are the causes of clubbing?
Bronchiectasis Non-small cell lung cancer Interstitial lung disease (e.g. pulmonary fibrosis, sarcoidosis) Lung abscess Cystic fibrosis
Which pneumonia-causing organism can be contracted from parrots, pigeons and other birds?
Chlamydia psittaci, causing psittacosis/ornithosis
