these Flashcards
Budd-Chiari syndrome
Hepatic vein obstruction - triad: severe abdominal pain, ascites and tender hepatomegaly
Shifting dullness
Ascites
Helper T cells
Recognise antigens presented by MHC II molecules, CD4+
T cells develop in
Thymus
First antibody to be released in infection
IgM
Interferon y
Cytokine released from Th1 cells and activates macrophages
B Cells
Responsible for antibody productio
IgA
Provides protection on mucous membranes, breast milk
Cytotoxic T cells
Recognise antigens presented by MHC class I molecules, CD8
Opsonisation
Making a foreign cell more susceptible to phagocytosis
Obstructive spirometry
FEV1/ FVC < 0.7
COPD FEV1 >80
Mild
COPD FEV1 50 -80%
Mod
COPD FEV1 30-50
Severe
COPD FEV1 <30%`
V. severe oopsie nono breathing well
Dyspnoea scale
Breathless when 1 - strenuous exercise 2 - speed walk or hill 3 - normal walk 4 - 100 m 5 - putting on socks type vibe
COPD management
SAVIM
- smoking cessation
- active lifestyle
- vaccination
- initial pharmacotherapy
- manage comorbidities
Greater effect on exacerbations - LABA or LAMA?
LAMA
ICS in COPD what does tommy fardon want you to remember
ICS/LAMA/LABA triple therapy if eosinophils are >300 cells per microL
Oral glucocorticoids in COPD
Na
Reasons you wouldn’t prescribe a silly COPD triple therapy
Repeated pneumonia, Low blood eosinophils <100 cells/microL, Mycobacterial infection history
A on the cheeky gold square
Bronchodilator
0-1 exacerbations a year, CAT less than 10 mMRC 0-1
B GOLD square
LABA or LAMA
0-1 exacerbations a year 0-1 mMRC, CAT 10 or more
D GOLD square
LAMA or LAMA/LABA or ICS/LABA
CAT 10 or more, mMRC 2 or more, 2+ exacerbations or 1 hospitalisation
C GOLD square
LAMA
2 or more exacerbations a year/ 1 hospitalisation, mMRC 0-1 CAT less than 10
COPD surgical management
Lung volume reduction, bullectomy, transplantation, bronchoscopic interventions - lung coils, vapor ablation
Only option for patients with pulmonary hypertension
Lung transplantation
Long term oxygen therapy offered when
Patient has stopped smoking for 3 months, SaO2 < 92, COPD management optimised w/ no improvement and ABG taken
Chronic t2 respiratory failure
Metabolic compensation for chronic respiratory acidosis
Acute on chronic t2 respiratory failure
Chronic T2 respiratory failure shifted to acidaemia as pCO2 rises
Releases from postganglionic fibres causing airways smooth muscle to relaxxxx
NO and VIP
Which receptors mediate ASM contraction and mucus secretion?
M3 receptors
Chronic asthma pathology
1 - Increased ASM mass 2 - Accumulation of interstitial fluid 3 - Increased secretion of mucus 4 - Epithelial damage (exposed nerve endings) 5 - Sub-epithelial fibrosis
Asthma management summary
SABA and ICS Still bad? LABA i.e. formetarol Still bad? No LABA response or isnt enough stop it and increase ICS, trial methylxanthines/LAMA/leukotriene receptor antagonist
Montelukast
Leukotriene receptor antagonist
Asthma exacerbation
If infection signs - antimicrobials
Oral steroids and increase ICS
Type of response in mild to moderate asthma
Th2
Type of response in severe asthma
Th1 and Th2
Aspergillosis
Life-threatening fungal infection that generally only occurs in very immunosuppressed patient
Allergic Broncho-pulmonary aspergillosis
Allergic response to apergillus
Childhood onset, asthma, eczema and rhinitis
Allergic asthma
Asthma, females, adult onset, steroid resistant, prednisolone treated, anti-allergy not effective
Eosinophilic asthma
Treatment of eosinophilic asthma
Mepolizumab or benralizumab - anti Il-5 s
Hydrostatic pressure
Pressure pushing fluid out of capillaries
Oncotic pressure
Pressure pushing fluid into capillaries
Most likely bronchiolitis cause
Respiratory synctial virus
Most common cause of croup
Parainfluenza virus
