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MBCHB 1 > respiratory pathology > Flashcards

respiratory pathology 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
Q

features of COPD that are reversible

A

smooth muscle tone and inflammation will respond to pharmacological intervention

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26
Q

what happens to the alveoli in emphysema

A

there is the loss of the radial pull of the terminal alveoli which later on leads to the collapse of the alveoli during expiration

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27
Q

hypoxaemia in COPD

A

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​

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28
Q

changes in the pulmonary vessels

A

there is physiological vasoconstriction( remember shunt )
all vessels may constrict if there is hypoxaemia.

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29
Q

pulmonary hypertension

A

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​

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30
Q

chronic ( hypoxic ) cor pulmonale

A

this is hypertrophy of the right ventricle which results from disease affecting the function and or the structure of the lung

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31
Q

what is asthma

A

an obstructive respiratory disease that has no reliable diagnostic test and is mostly symptom based and is reversible

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32
Q

what are the main symptoms of asthma

A

coughing , wheezing , running out of breath and response to certain asthma medication which makes asthma reversible

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33
Q

causes of asthma

A

-Host (genes) response to environment​
-Physiology abnormal before symptoms (predisposition)​
-Host response to exposure important​
-It is a syndrome​

​

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34
Q

what are the types of asthma syndromes

A

infant onset
childhood onset
adult onset
excertional asthma
occupational asthma

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35
Q

main causes of asthma

A

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.

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36
Q

proof of causation in adults

A

breast -feeding
late weaning
allergens that are released post and ante- natal.
smoking

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37
Q

symptoms to look out for asthma in children

A

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 )

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38
Q

guidelines for diagnosis asthma in children

A

measure the FeNO level in children with a history suggestive of asthma
performing objective tests that may help support a diagnosis of asthma

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39
Q

treatment of suspected asthma for under fives

A

most likely to have recurrent LRTI
treated with low dose of inhaled corticosteroids and a review is done later on.

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40
Q

conditions that can cause isolated cough

A

Bronchitis​
Pertussis​
Habitual cough​
Foreign body​

41
Q

conditions that cause difficulty in breathing

A

Dysfunctional breathing​
Vocal cord dysfunction​

​

42
Q

conditions which cause isolated sounds in breathing

A

Bronchitis​
Laryngomalacia​
Tracheomalacia​
Snoring​

43
Q

what are the goals for the treatment for asthma in children

A

“minimal” symptoms during day and night ​
minimal need for reliever medication ​
no attacks (exacerbations) ​
no limitation of physical activity ​

44
Q

what to use with attacks that happen more than 2 days a week .

A

blue inhaler

45
Q

what to use when coughing and waking up more than once in a week

A

blue reliever inhaler

46
Q

questions for measuring control of asthma

A

SANE​
Short acting beta agonist/week​
Absence school/nursery​
Nocturnal symptoms/week​
Exertional symptoms/week​

47
Q

tests required for children

A

no tests are recommended

48
Q

treatment hierarchy for asthma

A

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
Q

restarting ICS

A

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
Q

as required therapy and maintenance and reliever inhaled corticosteroid

A

they only work in adults and are advocated by GINA , no evidence in children

51
Q

treatment of chronic asthma in children

A

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
Q

inhaled corticosteroids

A

very effective and very safe

53
Q

examples of inhaled corticosteroids

A

beclomethasone budesonide 1
ultrafine beclomethasone 2.5
fluticasone diproprionate 2
fluticasone fuorate 5

54
Q

effects of inhaled corticosteroids

A

1.height suppression by 1 cm
2.sometimes oral candidiasis
3.adrenocortical suppression caused by the increased use of exogenous steroids

55
Q

long acting beta agonist

A

should be used with ICS and is a fixed dose only
( flutiform)

56
Q

leukotriene receptor antagonist

A

montelukast , there is better adhere and there are granules for toddlers

57
Q

side effects of leukotriene receptor antagonist

A

psychiatric side effects

58
Q

comparison between the different medication for chronic asthma

A

laba , ics, tra

59
Q

medication combination for chronic asthma that leads to increased FEV1

A

low or moderate ICS plus LABA

60
Q

severe asthma

A

refer to specialist

61
Q

chronic asthma treatment for under fives

A

ICS , LTRA , LABA

62
Q

methods of asthma drug delivery in children

A

MDI or a spacer
dry powder device
breath actuated

63
Q

practices that promote 100 % drug delivery

A

washing the spacer device
shake the spacer device between puffs

64
Q

non medicinal management of asthma in children

A

stop tobacco exposure

65
Q

what are the treatment options for chronic asthma in children

A

laba
ltra
ics

66
Q

mild acute asthma treatment

A

SABA via spacer and prednisolone

67
Q

medication for moderate acute asthma

A

SABA via a nebuliser and prednisolone
SABA and ipratropium via nebuliser and prednisolone

68
Q

medication for severe acute asthma

A

IV salbutamol​
IV aminophylline​
IV magnesium (neb)
IV hydrocortisone​
Intubate and ventilate

69
Q

mode of intake of steroids in children with acute asthma

A

oral steroids

70
Q

mode of intake for steroids in children with chronic asthma

A

inhaled steroids

71
Q

presentation of asthma in adults

A

shortness of breath
wheezing
coughing

72
Q

onset of asthma in adults

A

marked at the beginning and the end of the day

73
Q

amount of people with asthma in the uk

A

5.4 million

74
Q

pathophysiology of asthma

A

narrowing of the airways, inflammation of the airways, increased airway sensitivity

75
Q

risk factors for asthma in adults

A

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
Q

examples of atopic diseases

A

hay fever
eczema
allergic rhinitis
asthma

77
Q

effects of maternal smoking during pregnancy on child resp system

A

FEV 1 decreases
asthma probability increases
airway responsiveness
this leads to switching on genes that can result in atopy ( epigenetics )

78
Q

how does occupation increase chance of cancer in adults

A

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
Q

diagnosis test for asthma in adults

A

measure Fe NO first followed by spirometry then bronchodilator reversibility if there is an obstruction form the spirometry

80
Q

Symptoms of asthma

A

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
Q

SYMPTOMS THAT ARE NOT PROBABLY ASTHMA

A

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
Q

localised airway obstruction diseases

A

Tumour​
Foreign body​

83
Q

investigations of asthma in adults

A

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
Q

ruling out other obstructive lung diseases

A

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
Q

assessment of acute asthma

A

Ability to speak​
Heart rate​
Respiratory rate​
PEF​
Oxygen saturation / Arterial blood gases​

​

86
Q

moderate asthma

A

Able to speak, complete sentences​
HR < 110​
RR < 25​
PEF 50 - 75% predicted or best​
SaO2 ≥ 92% (no need for ABG)​
PaO2 ≥ 8kPa​

87
Q

severe asthma

A

Inability to complete sentences in one breath​
HR ≥110​
RR ≥25​
PEF 33 - 50% predicted or best​
SaO2 ≥ 92% ​
PaO2 ≥ 8kPa​

88
Q

life threatening asthma

A

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
Q

near fatal asthma

A

Raised PaCO2​
Need for mechanical ventilation​ ( intubation and life support machine )

89
Q

complete control of asthma

A

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
Q

non pharmacological management of asthma in adults

A

​

Patient Education and Self management plans​
Exercise​
Smoking cessation​
Weight management​
Flu/Pneumococcal vaccinations​

91
Q

types of inhalers

A

metered dose inhalers which is used with spacers
dry powder inhaler

92
Q

reliever medication in adults

A

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
Q

pharmacological management

A

inhaled therapy
oral therapy
specialist treatments

94
Q

oral therapy

A

Leukotriene Receptor Antagonist​( montelukast )
Theophylline​- very adverse
Prednisolone- acute

95
Q

specialist options

A

Omalizumab (Anti- IgE)​

Mepolizumab (Anti-Interleukin-5)​

Bronchial thermoplasty

96
Q

mild asthma attack in adults

A

Increase inhaler use​
Oral Steroid​
Treat trigger​
Early follow up​ and Back up plan​ to check if the medication given is working

97
Q

severe asthma in adults

A

Nebulisers – Salbutamol/Ipratropium​

Oral/IV Steroid​

Magnesium​

Aminophylline​

Triggers – infection/allergen​

Complications – CXR​

Review​

Level 2/3 care​

98
Q
A

MBCHB 1 (23 decks)

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