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respiratory pathology 1 Flashcards

1
Q

examples of obstructive lung diseases

A

emphysema , asthma , chronic bronchitis

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2
Q

what are obstructive lung diseases

A

these are diseases that cause difficulty in air flow during expiration

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3
Q

common term for bronchitis and emphysema

A

chronic obstructive pulmonary disease

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4
Q

spirometry values for obstructive lung diseases

A

FEV1 reduced by a large extent
FVC is also reduced that is the final amount of air that is breathed out .

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5
Q

FEV-1 and FVC ratio

A

FEV1 is usually about 70-80% of FVC​

Normal FEV1 is about 3.5 – 4 litres​

Normal FVC is about 5 litres​

Normal ratio FEV1 : FVC is 0.7 – 0.8​

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6
Q

clinical tests for obstructive lung disease

A

PEFR
spirometry

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7
Q

summary of obstructive lung disease

A

There is AIRFLOW LIMITATION​

Peak Expiratory Flow Rate (PEFR) is reduced​

FEV1 is REDUCED​

FVC may be reduced​

FEV1 is less than 70% of FVC​

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8
Q

bronchial asthma

A

Generally considered to be REVERSIBLE airways obstruction​ either spontaneously or as a result of medical intervention​ ( both can be treated by medication )

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9
Q

COPD aetiology

A

smoking
dust particles from occupation
atmospheric particles in the inhaled air might lead to development of COPD
effect of age
more prevalent in adults

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10
Q

risk factors for development , progression and morbidity in COPD

A

individual and social factors
general external environment
early life risk factors
noxious exposures

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11
Q

definition of chronic bronchitis clinically

A

cough productive of sputum most days in at least 3 consecutive months for 2 or more years

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12
Q

morphological changes in chronic bronchitis

A

both the small and the large airways will be affected .

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13
Q

changes in the small airways in chronic bronchitis

A

Goblet cells appear​
Inflammation and fibrosis in long standing disease
the changes in the small airways are more pathological as the small airways are gaseous exchange sites

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14
Q

morphological changes in the large airways

A

Mucous gland hyperplasia​

Goblet cell hyperplasia​ (increase in number )

Inflammation and fibrosis is a minor component​

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15
Q

emphysema

A

destruction of the alveoli without fibrosis

which is an increase in the air spaces distal to the terminal bronchiole arising either from dilatation or from destruction of their walls and without obvious fibrosis.

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16
Q

forms of emphysema

A

centriacinar
panacinar
periacinar
scar
bullous emphysema

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17
Q

centriacinar emphysema

A

loss of alveoli tissue occurs in the middle bit of the acinus( the most common )

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18
Q

centriacinar emphysema

A

begins with bronchiolar dilatation then the alveolar tissue is lost

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19
Q

panacinar emphysema

A

at the base of the alveoli and there is much more destruction

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20
Q

bullous emphysema

A

has no physiological consequences

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21
Q

scar emphysema ( bullous )

A

just underneath the pleura
could be present in young people

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22
Q

pathogenesis of emphysema

A

smoking
lack of alpha -1 -antitrypsin
ageing

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23
Q

smoking and emphysema

A

there is alot of production of protease and less of antiprotease which is a protective mechanism against inflammatory cells .
therefore there is

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24
Q

alpha -1- antitrypsin deficiency causes emphysema

A

there is no production of antiproteases so there is destruction of the alveoli by the anti-inflammatory cells

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25
features of COPD that are reversible
smooth muscle tone and inflammation will respond to pharmacological intervention
26
what happens to the alveoli in emphysema
there is the loss of the radial pull of the terminal alveoli which later on leads to the collapse of the alveoli during expiration
27
hypoxaemia in COPD
this is the state of leaving with less oxygen and more co2 Airway Obstruction​ on expiration Alveolar Hypoventilation​ - there is less carbon dioxide being taken out Reduced Respiratory Drive​ - the chemoreceptors are less sensitive to changes in hydrogen ion concentration Shunt - Only during severe acute infective exacerbation​
28
changes in the pulmonary vessels
there is physiological vasoconstriction( remember shunt ) all vessels may constrict if there is hypoxaemia.
29
pulmonary hypertension
normally pulmonary circulation is of low systolic pressure ; in pulmonary hypertension there is : 1.Pulmonary vasoconstriction ​ 2.Pulmonary arterioles​ 3.muscle hypertrophy and intimal fibrosis​ 4.Loss of capillary bed​ 5.Secondary polycythaemia – increased blood viscosity​ 6.Bronchopulmonary arterial anastamoses​
30
chronic ( hypoxic ) cor pulmonale
this is hypertrophy of the right ventricle which results from disease affecting the function and or the structure of the lung
31
what is asthma
an obstructive respiratory disease that has no reliable diagnostic test and is mostly symptom based and is reversible
32
what are the main symptoms of asthma
coughing , wheezing , running out of breath and response to certain asthma medication which makes asthma reversible
33
causes of asthma
-Host (genes) response to environment​ -Physiology abnormal before symptoms (predisposition)​ -Host response to exposure important​ -It is a syndrome​ ​
34
what are the types of asthma syndromes
infant onset childhood onset adult onset excertional asthma occupational asthma
35
main causes of asthma
genetic predisposition which lead to primary epithelial abnormality in the skin /airway /gut while epigenetics alter the disease that is they are a trigger of the disease.
36
proof of causation in adults
breast -feeding late weaning allergens that are released post and ante- natal. smoking
37
symptoms to look out for asthma in children
when there is genuine wheezing , cough and shortness of breath . when there is a problem with the upper respiratory tract when there is sucking in of ribs when there is response to corticosteroids ( that is the symptoms are reversed )
38
guidelines for diagnosis asthma in children
measure the FeNO level in children with a history suggestive of asthma performing objective tests that may help support a diagnosis of asthma
39
treatment of suspected asthma for under fives
most likely to have recurrent LRTI treated with low dose of inhaled corticosteroids and a review is done later on.
40
conditions that can cause isolated cough
Bronchitis​ Pertussis​ Habitual cough​ Foreign body​
41
conditions that cause difficulty in breathing
Dysfunctional breathing​ Vocal cord dysfunction​ ​
42
conditions which cause isolated sounds in breathing
Bronchitis​ Laryngomalacia​ Tracheomalacia​ Snoring​
43
what are the goals for the treatment for asthma in children
“minimal” symptoms during day and night ​ minimal need for reliever medication ​ no attacks (exacerbations) ​ no limitation of physical activity ​
44
what to use with attacks that happen more than 2 days a week .
blue inhaler
45
what to use when coughing and waking up more than once in a week
blue reliever inhaler
46
questions for measuring control of asthma
SANE​ Short acting beta agonist/week​ Absence school/nursery​ Nocturnal symptoms/week​ Exertional symptoms/week​
47
tests required for children
no tests are recommended
48
treatment hierarchy for asthma
1.Are the patient’s symptoms fully/partly/not controlled?​ 2.Are they taking their treatment (correctly)?​ 3.Have they had an attack recently?​ 4.How often are they using their reliever treatment?​ 5.What is their current treatment level?​
49
restarting ICS
start on low dose of ICS Then review after 2 months with no routine test to monitor progress required withdraw from medication for 2 months to monitor.
50
as required therapy and maintenance and reliever inhaled corticosteroid
they only work in adults and are advocated by GINA , no evidence in children
51
treatment of chronic asthma in children
start on low dose ICS if symptoms are uncontrolled introduce MART , if MART is working but not very effectively increase dose, then refer to specialist if MART therapy is not working then introduce low dose LTRA , add LABA
52
inhaled corticosteroids
very effective and very safe
53
examples of inhaled corticosteroids
beclomethasone budesonide 1 ultrafine beclomethasone 2.5 fluticasone diproprionate 2 fluticasone fuorate 5
54
effects of inhaled corticosteroids
1.height suppression by 1 cm 2.sometimes oral candidiasis 3.adrenocortical suppression caused by the increased use of exogenous steroids
55
long acting beta agonist
should be used with ICS and is a fixed dose only ( flutiform)
56
leukotriene receptor antagonist
montelukast , there is better adhere and there are granules for toddlers
57
side effects of leukotriene receptor antagonist
psychiatric side effects
58
comparison between the different medication for chronic asthma
laba , ics, tra
59
medication combination for chronic asthma that leads to increased FEV1
low or moderate ICS plus LABA
60
severe asthma
refer to specialist
61
chronic asthma treatment for under fives
ICS , LTRA , LABA
62
methods of asthma drug delivery in children
MDI or a spacer dry powder device breath actuated
63
practices that promote 100 % drug delivery
washing the spacer device shake the spacer device between puffs
64
non medicinal management of asthma in children
stop tobacco exposure
65
what are the treatment options for chronic asthma in children
laba ltra ics
66
mild acute asthma treatment
SABA via spacer and prednisolone
67
medication for moderate acute asthma
SABA via a nebuliser and prednisolone SABA and ipratropium via nebuliser and prednisolone
68
medication for severe acute asthma
IV salbutamol​ IV aminophylline​ IV magnesium (neb) IV hydrocortisone​ Intubate and ventilate
69
mode of intake of steroids in children with acute asthma
oral steroids
70
mode of intake for steroids in children with chronic asthma
inhaled steroids
71
presentation of asthma in adults
shortness of breath wheezing coughing
72
onset of asthma in adults
marked at the beginning and the end of the day
73
amount of people with asthma in the uk
5.4 million
74
pathophysiology of asthma
narrowing of the airways, inflammation of the airways, increased airway sensitivity
75
risk factors for asthma in adults
smoking during pregnancy genetic basis of asthma disease in the family genetic predisposition of atopic diseases such as asthma , eczema , rhinitis and hay fever . maternal atopy has a greater chance of causing asthma than paternal influence environmental exposure
76
examples of atopic diseases
hay fever eczema allergic rhinitis asthma
77
effects of maternal smoking during pregnancy on child resp system
FEV 1 decreases asthma probability increases airway responsiveness this leads to switching on genes that can result in atopy ( epigenetics )
78
how does occupation increase chance of cancer in adults
Isocyanates twin pack paints​ Colophony welding solder flux​ Laboratory animals rodent urinary proteins​ Grains wheat proteins, grain mites​ Enzymes subtilisin, amylase​ Drugs antibiotics, salbutamol​ Crustaceans prawns, crabs​
79
diagnosis test for asthma in adults
measure Fe NO first followed by spirometry then bronchodilator reversibility if there is an obstruction form the spirometry
80
Symptoms of asthma
the symptoms are variable depending on the season and whether it is day or night and exposure to certain trigger. wheezing shortness of breath on different severity tightness of chest dry cough occasional sputum
81
SYMPTOMS THAT ARE NOT PROBABLY ASTHMA
Finger clubbing, cervical lymphadenopathy​ Stridor​( wheeze on inspiration) Asymmetrical expansion, dull percussion note (collapse/ effusion)​ Crepitations-crackles that is (bronchiectasis, Cystic Fibrosis, ILD interstitial liver disease , LVF liver function test )
82
localised airway obstruction diseases
Tumour​ Foreign body​
83
investigations of asthma in adults
evidence of airflow obstruction where the FEV1 test is less than 70% or where there is reversibility and variability of airway flow ( however , the spirometry test results may come out as normal especially when the person is not under an asthma attack)
84
ruling out other obstructive lung diseases
1.spirometry - spirometry test less than 70% 2.PEFR test is done to rule out COPD and emphysema 3.carbon monoxide gas transfer ( tlco for gas transfer and kco for tissue destruction) 4.use of bronchodilator for example inhaled salbutamol then nebulised salbutamol 5.reversibility with the use of oral corticosteroids which separates COPD form asthma
85
assessment of acute asthma
Ability to speak​ Heart rate​ Respiratory rate​ PEF​ Oxygen saturation / Arterial blood gases​ ​
86
moderate asthma
Able to speak, complete sentences​ HR < 110​ RR < 25​ PEF 50 - 75% predicted or best​ SaO2 ≥ 92% (no need for ABG)​ PaO2 ≥ 8kPa​
87
severe asthma
Inability to complete sentences in one breath​ HR ≥110​ RR ≥25​ PEF 33 - 50% predicted or best​ SaO2 ≥ 92% ​ PaO2 ≥ 8kPa​
88
life threatening asthma
any of these ; Grunting​ Impaired consciousness, confusion, exhaustion​ Bradycardia/ arrhythmia/ hypotension​ PEF < 33% predicted or best​ Cyanosis​ Silent chest​ Poor respiratory effort​ SaO2 < 92% (definitely needs blood gas!)​ PaO2 < 8kPa​ PaCO2 normal (4.6 - 6.0kPa)​ ​
89
near fatal asthma
Raised PaCO2​ Need for mechanical ventilation​ ( intubation and life support machine )
89
complete control of asthma
no daytime symptoms ​ no night time wakening ​ no need for rescue medication ​ no asthma attacks ​ no limitations on activity including exercise & normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)​ minimal side effects from medication.​
90
non pharmacological management of asthma in adults
​ Patient Education and Self management plans​ Exercise​ Smoking cessation​ Weight management​ Flu/Pneumococcal vaccinations​
91
types of inhalers
metered dose inhalers which is used with spacers dry powder inhaler
92
reliever medication in adults
short acting beta agonists example salbutamol which is present in the dry powder inhaler and the metered dose inhaler and terbutaline which is present in the dry powder inhaler only
93
pharmacological management
inhaled therapy oral therapy specialist treatments
94
oral therapy
Leukotriene Receptor Antagonist​( montelukast ) Theophylline​- very adverse Prednisolone- acute
95
specialist options
Omalizumab (Anti- IgE)​ Mepolizumab (Anti-Interleukin-5)​ Bronchial thermoplasty
96
mild asthma attack in adults
Increase inhaler use​ Oral Steroid​ Treat trigger​ Early follow up​ and Back up plan​ to check if the medication given is working
97
severe asthma in adults
Nebulisers – Salbutamol/Ipratropium​ Oral/IV Steroid​ Magnesium​ Aminophylline​ Triggers – infection/allergen​ Complications – CXR​ Review​ Level 2/3 care​
98

MBCHB 1 (62 decks)

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