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Year 2 - Medicine > Week 210 - Asthma > Flashcards

Week 210 - Asthma Flashcards

1
Q

What is the definition of Asthma?

A

Chronic Inflammatory Disorder characterised by airway Hyper-responsiveness that is REVERSIBLE either spontaneously or with treatment

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2
Q

What are the FOUR most common symptoms of Asthma?

A

Wheeze
Breathlessness
Cough
Chest Tightness

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3
Q

What sort of diurnal variation does Asthma exhibit?

A

Peak flow lowest early morning

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4
Q

What pattern do you expect to find on spirometry?

A

FEV/FVC 12% FEV1 post-bronchodilator

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5
Q

What are the two types of Asthma?

A

Extrinsic - IgE mediated (Atopic, Occupational)

Intrinsic - non-immune (infection, cold, exercise, stress)

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6
Q

What occupational sensitisers exist?

A 
Isocyanates - industrial workers
Flour - Bakers/pastry makers
Colophony/Fluxes - Electronic workers
Latex - Lab/Hospital
Aldehydes - Chemical/Wood workers
Enzymes - Detergent manufacturers
Animals
Wood dusts - timber workers
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7
Q

What type hypersensitivity is Asthma?

A

Type 1 hypersensitivity (IgE mediated)

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8
Q

What are the four papillae of the tongue?

A

Vallate - biggest
Filiform - no taste buds (only one)
Fungiform
Foliate

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9
Q

What nerves innervate the posterior 1/3 of the tongue?

A

IX (glossopharyngeal)

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10
Q

What nerves innervate the posterior 2/3 of the tongue?

A

V3 and Corda Tympani (VII)

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11
Q

What is the innervation of the Intrinsic and Extrinsic muscles of the tongue?

A 
Intrinsic and Extrinsic = Hypoglossal nerve (XII)
Exception Palatoglossus (ext.) - vagus (X)
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12
Q

What does the Otic Ganglion Supply (directly under foramen ovale)?

A

Innervates the Parotid gland

via Auriculotemporal Nerve

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13
Q

What direction with the Tongue deviate in a UMN lesion?

A

Opposite side to lesion

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14
Q

What are the three major pairs of salivary glands?

A

Parotid (Stenson’s Duct)
Submandibular (Wharton’s Duct)
Sublingual (ducts of Rivinus)

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15
Q

Where does the Stenson’s Duct empty and what gland does it arise from?

A

From parotid

to Papilla opposite upper 2nd molar tooth

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16
Q

What is Frey’s Syndrome?

A

Post surgery to the parotid gland
Damage to auricotemporal nerve
Leads to gustatory sweating

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17
Q

Give two examples of BENIGN parotid neoplasms

A

Pleomorphic Adenoma

Warthin’s Tumour

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18
Q

Give two examples of MALIGNANT parotid neoplasms

A

Adenoid Cystic Carcinoma
Adenocarcinoma
Squamous cell carcinoma
Look for Facial Nerve Palsy

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19
Q

What do Eosinophils secrete?

A

Leukotrienes - smooth muscle contraction
ECP
MBP - epithelial damage, loss of tight junctions,stimulates Cl and water secretion
Eosinophil peroxidase

20
Q

What do Mast cells secrete?

A 
Histamine - bronchoconstriction, mucus secretion
Serotonin
Serine proteases (LT-C4) - bronchoconstriction
21
Q

What effect do IL-4 and Il-13 have on B cells?

A

Ig subclass switching (to class E) in B cells

22
Q

What is the “Late Phase Response” in Asthma?

A

Pt may respond to treatment initially but later the symptoms reoccur
Bronchodilators do not fully reverse the airway obstruction

23
Q

What effect does Sodium Cromoglycate have?

A

Mast Cell Stabiliser

24
Q

What is the mechanism of action of Mepoluzimab?

A

mAb towards IL-5

25
Q

How can Aspirin induced Asthma arise?

A

NSAIDs/Aspirin inhibit COX-2 -> can aggravate asthma

26
Q

What is the commonest cause of Bronchiolitis?

A

RSV (in 80% of cases)

27
Q

What is the mechanism of action of Salbutamol?

A

↑cAMP –> PKA

Relaxes bronchial smooth muscle

28
Q

What side-effects of Salbutamol?

A

Tremor
Tachycardia
Hypokalaemia

29
Q

What corticosteroids are available for the treatment of asthma and what colours do they come in?

A

Beclometasone (Brown)
Fluticasone (Red) - much more potent
Budesonide (Brown)

30
Q

Name some LABAs, and how are they different to SABAs

A

Salmeterol(slow onset of action), Formoterol (quicker acting)
Prolonged action by lipid side chain (at least 12 hrs)
Does not compromise SABA action

31
Q

What is in Seretide?

A

Fluticasone + Salmeterol (cortico +LABA)

32
Q

What is in Symbicort?

A

Budesonide & Formoterol (cortico + quick LABA)

Can be used for prevention & relief

33
Q

What is in Fostair?

A

Beclometasone & Formoterol (cortico + quick LABA)

34
Q

Name some Leukotriene antagonists

A

Montelukast, Zafirlukast
Reduce Wheeze and Bronchoconstriction
Reduce Eosinophil & basophil influx

35
Q

Name some side-effects of Leukotriene antagonists

A

GI disturbances, Headache

36
Q

Name some Xanthines and their mechanism of action

A 
Theophylline, Aminophylline
Inhibit phosphodiesterase (breaks down cAMP into AMP)
37
Q

What are the problems and side-effects of using Xanthines?

A

Narrow therapeutic range
Prescribe by brand
Drug interactions important
S/E - Nausea, Vomiting, Tachycardia, Convulsions, Coma

38
Q

How does IV magnesium sulphate work?

A

↓[Ca] in blood

39
Q

What are the risks associated with Omalizumab

A

IgE mAb

↑risk of infection with any mAb

40
Q

Name possible causes of an Acute ↑PaCO2

A

Severe acute asthma
Severe pneumonia
Exacerbations of COPD

41
Q

Name some chronic causes of ↑PaCO2

A

COPD, Respiratory muscle weakness (neuromuscular disorders, thoracic skeletal deformities)
Leads to renal retention of HCO3 and normalisation of pH

42
Q

What is compensated Respiratory acidosis?

A

↑PaCO2, ↓PaO2, Normal pH
In this case PaO2 drives respiration
Giving O2 leads to hypoventilation

43
Q

Name some causes of Respiratory Alkalosis

A

Hyperventilation ( Asthma, Pleurisy, PE)

44
Q

What is compensated Respiratory alkalosis?

A

HCO3 is excreted by kidneys -> normalisation of pH

45
Q

What can cause Metabolic Acidosis?

A

↓HCO3, ↓pH
Acute Renal Failure
Diabetic Ketoacidosis
Lactic Acidosis

46
Q

What can cause Metabolic Alkalosis?

A

↑HCO3, ↑pH

Often related to tubular K+ depletion

Year 2 - Medicine (25 decks)

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