Respiratory Medicine Flashcards
How can the mast cells be stimulated if not directly from allergen?
Allergen stimulates cd4 lymphocyte ( th2 cells)
Interleukin 4 produced
Be cells stimulated to produce igE
Mast cells stimulated
What are symptoms of asthma?
Wheeze
Breathlessness
Cough
How is asthma assessed?
Peak flow readings- plotted by sex, age and heigh
What can be precipitants of asthma?
Allergens Irritants Exertion NSAIDs Emotion
What medications are used to treat asthma?
Inhaled b2 agonists
Inhaled steroids
Combination inhalers
Anti leukotrienes
What b2 antagonist is short acting?
Salbutamol
What b2 agonist is long acting ?
Salmeterol
What is an inhaled steroid?
Beclamethasone
What is a combination inhaler?
Seri tide
What is an anti leukotrienes?
Montelukast
How is moderate asthma defined?
Peak flow 50-75%
No features of acute
Resp and pulse rate normal
What defines acute severe asthma?
Peak flow 33-50%
Resp rate >25
Heart rate > 110
Inability to complete sentences in one breath
What defines unstable asthma?
Recent infections
Poor compliance
Symptoms- requiring more frequent inhaler or reduce exercise limit
Change of meds by gp
Dental aspects re. Asthma
Avoid NSAIDs
Oral candidiasis
Altered taste
Dry mouth
What IS COPD?
Airflow obstruction that is not fully reversible
Progressive
Often caused by smoking
What is FEV.?
Forced expired volume in 1 second
What is FVC
Vital capacity
What defines obstruction?
FEV/FVC = less than 0.7
What is the pathophysiology of COPD?
Emphysema- alveolar destruction
Bronchitis- airway inflammation, increased mucous
What are symptoms of COPD?
Breathlessness pop exertion
Wheeze- consistent
Chronic cough and sputum
Frequent infections due to stagnant mucous
What are pulmonary lung function test
Lung function
Spirometry
FEV1
FVC
What is the management of COPD?
Oral and inhaled therapies- tiotropion
Cease smoking
Exercise training
Home o2 if severe
Management of acute COPD
Stop tx
Give oxygen- not high flow unless desperate
Bronchodilator
Hospitalisation
What is relevant re. Dental tx and COPD?
Avoid NSAIDs
Avoid sedation
Assess ability to lie flat
What is pneumonia?
Infection of lung tissue
What are symptoms of pneumonia?
Cough with green sputum Breathlessness Fever Pleuritic chest pain Shadow on chest X-ray
Management of pneumonia?
Antibiotics
Hospitalisation re. IV fluid, o2
What does curb stand for ?
Confusion
Urea > 19
Resp rate >30
Bp 65
What does a higher curb score mean?
Higher the score the higher the mortality rate
What is pneumothorax
Leak of air into pleural space
Sudden onset of breathlessness and chest pain
Who is susceptible re. Pneumothorax?
Tall young people
Especially smokers
Chronic lung disease
What shows on chest X-rays?
Loss of lung markings
What is management of pneumothorax?
Aspirate
Chest drain
Surgery
What is sleep apnoea?
Collapse of upper airway during sleep
What is sleep apnoea associated with ?
Obesity
Large neck
Sedative meds
Smoking or alcohol before sleep
What are symptoms of sleep apnoea?
Snoring Daytime sleepiness Micro sleeps Irritability Headaches
Management of sleep apnoea?
Lifestyle
Cpap- continuous positive airways device
Mad- mandibular advancement device
What are causes of interstitial lung disease?
Allergens
Direct damage- asbestos
Auto immune
Symptoms of interstitial lung disease
Breathlessness
Cough
Management of interstitial lung disease?
Avoid sedation
Steroids
Remove underlying cause
What is cystic fibrosis?
Gene defect causing abnormal chloride ion channels
What can occur as a result of cystic fibrosis?
High viscosity mucous
Affects lung and pancreas
Affects male gonadal function
Childhood symptoms of cystic fibrosis?
Recurrent respiratory infections
Malabsorption
Pancreatic duct obstruction
Bowel obstruction
What are symptoms of cystic fibrosis in adults?
Diabetes
Male infertility
Osteoporosis
How is cystic fibrosis diagnosed?
Blood test at birth
Sweat test
What is management of cystic fibrosis?
Prophylactic ab cover Nutrition Physio Heart/ lung transplant Avoid sedation
What is DVT?
Deep vein thrombosis.
Clot formation in peripheral veins ( usually legs)
What is PE?
Pulmonary embolus
Clot migrates to lungs
What are predisposing factors to DVT and PE?
Obstruction to blood flow
Surgery
Increased coagulation of blood
Symptoms of DVT?
Painful lower leg
Dilated veins, hot red and swollen
Symptoms of PE?
Pleuritic chest pain
Breathlessness
Haemolysis
Collapse sudden death
Management of DVT and PE
Anticoagulation
Immediate- heparin
Long term- warfarin
What do mast cells produce to stimulate bronchoconstriction?
Leukotrienes and histamine
