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
How can Aspirin induced Asthma arise?
NSAIDs/Aspirin inhibit COX-2 -> can aggravate asthma
26
What is the commonest cause of Bronchiolitis?
RSV (in 80% of cases)
27
What is the mechanism of action of Salbutamol?
↑cAMP --> PKA | Relaxes bronchial smooth muscle
28
What side-effects of Salbutamol?
Tremor Tachycardia Hypokalaemia
29
What corticosteroids are available for the treatment of asthma and what colours do they come in?
Beclometasone (Brown) Fluticasone (Red) - much more potent Budesonide (Brown)
30
Name some LABAs, and how are they different to SABAs
Salmeterol(slow onset of action), Formoterol (quicker acting) Prolonged action by lipid side chain (at least 12 hrs) Does not compromise SABA action
31
What is in Seretide?
Fluticasone + Salmeterol (cortico +LABA)
32
What is in Symbicort?
Budesonide & Formoterol (cortico + quick LABA) | Can be used for prevention & relief
33
What is in Fostair?
Beclometasone & Formoterol (cortico + quick LABA)
34
Name some Leukotriene antagonists
Montelukast, Zafirlukast Reduce Wheeze and Bronchoconstriction Reduce Eosinophil & basophil influx
35
Name some side-effects of Leukotriene antagonists
GI disturbances, Headache
36
Name some Xanthines and their mechanism of action
``` Theophylline, Aminophylline Inhibit phosphodiesterase (breaks down cAMP into AMP) ```
37
What are the problems and side-effects of using Xanthines?
Narrow therapeutic range Prescribe by brand Drug interactions important S/E - Nausea, Vomiting, Tachycardia, Convulsions, Coma
38
How does IV magnesium sulphate work?
↓[Ca] in blood
39
What are the risks associated with Omalizumab
IgE mAb | ↑risk of infection with any mAb
40
Name possible causes of an Acute ↑PaCO2
Severe acute asthma Severe pneumonia Exacerbations of COPD
41
Name some chronic causes of ↑PaCO2
COPD, Respiratory muscle weakness (neuromuscular disorders, thoracic skeletal deformities) Leads to renal retention of HCO3 and normalisation of pH
42
What is compensated Respiratory acidosis?
↑PaCO2, ↓PaO2, Normal pH In this case PaO2 drives respiration Giving O2 leads to hypoventilation
43
Name some causes of Respiratory Alkalosis
Hyperventilation ( Asthma, Pleurisy, PE)
44
What is compensated Respiratory alkalosis?
HCO3 is excreted by kidneys -> normalisation of pH
45
What can cause Metabolic Acidosis?
↓HCO3, ↓pH Acute Renal Failure Diabetic Ketoacidosis Lactic Acidosis
46
What can cause Metabolic Alkalosis?
↑HCO3, ↑pH | Often related to tubular K+ depletion