Respiratory Physiology Flashcards
Equation for the relationship between pH and protons
pH= -log[H+]
Equation for the relationship between pH and bicarbonate and partial co2.
pH= [HCO3-]/pCO2
Select the best option for each scenario provided.
a. Salbutamol
b. Tiotropium
c. Inhaled Beclomethasone
d. Prednisolone
e. Theophylline
An asthmatic patient on prn SABA and regular inhaled corticosteroid and has benefit from long acting beta agonist, but asthma control is still inadequate.
2. A 47-year old asthmatic currently on high dose inhaled corticosteroid, theophylline, a long acting beta agonist and daily prednisolone. The patient has been well controlled for the last 6 months. Which agents should be stepped down?
3. Patient has been started on propranolol and experience acute exacerbation COPD what agent is likely to potentiate exacerbation.
4. A 78-year-old male with COPD has developed dry mouth. Which agent is most likely to cause this.
5. A 55kg gentleman present with insomnia headache nausea and vomiting while on Erthromycin what agent is likely to have caused it.
- (e) Theophylline is what you would give because the treatment pathway goes: LTRA then if asthma is still uncontrolled LABA+ICS+SABA and stop LTRA. If symptoms are still not controlled a trial of PDE4 inhibitor to allow for bronchodilation but also down regulation immune system is necessary.
- (d) Prednisolone
- (a)
- (b) Anti-cholinergic effect.
- (e) Theophylline: Nausea, vomiting, tachycardia (purine analogue).
Select the best option for each scenario provided.
a. Salbutamol
b. Tiotropium
c. Inhaled Beclomethasone
d. Prednisolone
e. Theophylline
- Patient currently on LAMA+LABA who has had two acute exacerbation.
- 48-year-old female currently doing well on inhaled corticosteroid and formetorol but still experiencing breathlessness.
- 24-year-old with reversible FEVC1 currently on salbutamol but asthma is not well controlled. Which agent would be added.
- (c) ICS recommended.
- (b) Tiotropium added to improve symptoms of breathlessness.
- (c) Inhaled Beclomethasone
In hypercapnia what is the partial pressure of CO2.
> 6.1 kPa is hypercapnia.
In hypocapnia what is the partial pressure of CO2.
<4.9 kPa is hypocapnia.
What are the causes of respiratory acidosis.
Respiratory depression (toxins, opioids, CNS trauma), COPD, pneumonia.
What are the causes of respiratory alkalosis.
Hyperventilation (anxiety, pain).
In respiratory/metabolic acidosis what is the pH.
pH <7.35
In respiratory/metabolic alkalosis what is the pH.
pH>7.45.
What is the normal V/Q ratio in healthy adult.
V/Q= 0.8 indicating that perfusion> ventilation.
A patient with metabolic acidosis will have which ONE of the following arterial blood gas (ABG) pictures?
a pH 7.6 / pCO2 3.2 kPa / HCO3
b pH 7.2 / pCO2 8 kPa / HCO3
c pH 7.38 / pCO2 5 kPa / HCO3
d pH 7.3 / pCO2 3 kPa / HCO3
(b)
If V/Q ratio is below <0.8 what is the likely explanation.
Low ventilation caused by COPD or pneumonia due to inability to get enough air into the lungs.
If there is V/Q mismatch what is the likely explanation.
Block in the perfusion to the alveoli as a result of embolism/some sort of blockage
A 15 year old male has undergone reconstructive surgery to realign his previously fractured clavicle. His post-surgical pain relief includes morphine, delivered by a patient-controlled analgesia pump. His mother alerts the medical team that he has become drowsy and incoherent. An arterial blood gas analysis reveals the following:
Answer: Respiratory acidosis due to opioid induced respiratory depression.
(a) What is the NICE guidance for managing patient with no asthmatic feature or feature suggesting steroid responsiveness. (b) Second line for patient who has now had 1 severe or 2 moderate exacerbations within a year.
(a) What is the NICE guidance for patient who are exhibiting asthmatic features or features suggesting steroids responsiveness. (b) Second line for when patient day-to-day activity becomes affected or has had 1 or 2 moderate exacerbations within a year.
