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Year 3 > Week One - Acute Breathlessness > Flashcards

Week One - Acute Breathlessness Flashcards

1
Q

what are the signs and symptoms of allergies

A

urticarial (raised, itchy rash (hives)) or eczematous rash (dry, itchy and inflamed skin)
Asthma
Rhinitis
Conjunctivitis
Diarrhoea and vomiting
Anaphylaxis

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2
Q

how are allergies diagnosed

A
  • a careful, good history
  • family history
  • skin prick test
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3
Q

what is involved in a skin prick test

A

exposure to standardised allergen solution through forearm skin prick

a wheal >2mm larger than the negative (saline) control is a positive result

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4
Q

what is the treatment for allergies

A

avoidance

Topical treatments:

sodium cromoglicate (nasal spray/eye drops)

Topical steroids;

Emollient cream;

Bronchodilators
oral antihistamines or steroids

Desensitisation therapy

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5
Q

what does sodium cromoglicate do

A

stabilises mast cells to prevent degranulation

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6
Q

what do topical steroids do

A

reduce vessel permeability and cytokine synthesis

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7
Q

what does emollient cream do

A

reduces itching and water loss through damaged skin

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8
Q

when is desensitisation therapy used

A

in upper airway allergies if symptoms are not controlled on maximal medical therapy

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9
Q

what is the antibody in type I allergic reaction

A

IgE

fixed on mast cells and basophils via FceR

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10
Q

what is the antibody in type II allergic reaction

A

IgG/IgM

free

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11
Q

what is the antibody in type III allergic reaction

A

IgG/IgM

free

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12
Q

what is the antibody in type IV allergic reaction

A

T-helper cells
Th1

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13
Q

what is the other cell influence in type I,II, III allergic reactions

A

B cells stimulated by Th2 (CD4 cells)

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14
Q

what is the other cell influence in type IV allergic reactions

A

as there is no production of antibodies, Th1 cells are activated - effect on macrophages

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15
Q

what is the antigen in type I

A

always free and foreign

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16
Q

what Is the antigen in type II

A

always fixed and intrinsic to tissue on which reaction occurs

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17
Q

what is the antigen in type III

A

always free and can be exogenous or endogenous

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18
Q

what is the antigen in type IV

A

present by antigen presenting cells (MHCII)

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19
Q

what is the effector in type I

A

mast cells and basophils

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20
Q

what is the effector in Type II,III

A

complement

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21
Q

what is the effector in type IV

A

T cytotoxic cells or macrophages

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22
Q

where is site of reaction of Type I

A

surface of mast cells and basophils

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23
Q

where is the site of reaction in type II

A

surface of target tissues

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24
Q

where is the site of reaction in type III

A

circulation or tissue fluid

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25
where is the site of reaction in type IV
site of intruder
26
what are - hay fever - allergic rhinitis - angioedema - hives - anaphylactic shock examples of
type I allergic reactions
27
what are - autoimmune diseases e.g actue glomerulonephritis examples of
type III allergic reactions
28
what are - type I diabetes mellitus - Crohn's disease - MS examples of
type IV allergic reactions
29
what are - blood transfusion - glomerulonephritis - Grave's disease - penicillin allergy examples of
type II allergic reactions
30
what is the term used for acute allergic reactions producing life threatening features
anaphylaxis
31
what are these life threatening features
Hypotension and shock Severe bronchospasm which might cause wheeze and stridor Laryngeal oedema Angioedema Pruritus Urticaria Tachycardia
32
what are clinical signs of anaphylaxis
increased respiratory rate (e.g >30) Increased pulse (e.g >120) Decreased BP
33
what kind of diagnosis is it and why
it is a clinical diagnosis because there is no time for investigations
34
what increases the risk of anaphylaxis
increased risk of anaphylaxis in those with a family history of atopy, bronchial asthma and those on corticosteroid/ACEi/beta blocker therapy
35
what is the mechanism of anaphylaxis
exposure of susceptible individuals to allergen results in the production of IgE antibodies and the release of inflammatory mediators from mast cells
36
what does local histamine release cause
bronchoconstriction, vasodilation and increased vessel permeability
37
what does anaphylaxis require
previous exposure to the antigen here is a sensitisation reaction that occurs on first exposure and it is only on subsequent exposure to the allergen, that anaphylaxis occurs
38
what is the difference between Anaphylactoid reactions and anaphylaxis reactions
are clinically distinguishable from anaphylaxis, however they are not IgE mediated, and do not require prior exposure
39
how do anaphylactoid reactions happen
occur via direct stimulation of mast cells and can be caused by agents such as NSAIDS, opioids, blood transfusion and even exercise
40
what is the treatment of anaphylactoid reactions
initial ABC approach - secure the airway and obtain IV access. Give 100% oxygen. Lower the head of the bed to restore blood volume Consider intubation Adrenaline 0.5mg IM, repeated every 5 mins as required. Patients that do not respond to adrenaline should be quickly intubated - reduces need for cricothyroidotomy. antihistamine e.g 10mg chlorphenamine and corticosteroid e.g 200mg hydrocortisone IV Could give IV saline as appropriate for BP management For asthmatic wheeze - typically given inhaled B2 agonists
41
what are the possible conditions associated with breathlessness
pneumothorax Pneumonia Pericarditis PE Pulmonary oedema / heart failure Diabetic ketoacidosis Acute coronary syndromes Panic attack Asthma COPD
42
what are the possible conditions associated with chest pain
GORD Acute coronary syndrome Boney chest pain Myocarditis Hypertrophic cardiomyopathy Pneumothorax Pneumonia Panic attack Pericarditis Stable angina Musculoskeletal chest pain Sickle cell crisis PE
43
what is circumoral cyanosis
is when only your mouth or lips turn blue often occurs when blood vessels shrink
44
what is peripheral cyanosis
when only your hands, fingers, feet and or toes turn blue cold weather and rarely life threatening
45
what is central cyanosis
when other parts of the body are affected in addition to your hands and feet
46
what are the possible conditions associated with cyanosis
asthma Respiratory tract infection PE COPD Pulmonary hypertension Pneumonia Congestive heart failure Cardiac arrest Raynaud’s
47
what are the possible conditions associated with pain on inspiration
pneumonia Pleurisy Costochondritis Pneumothorax Pericarditis Chest injuries
48
what is stridor
Is a variable high pitched, turbulent respiratory sound that can be assessed during breathing
49
what is the most common cause of stridor
viral infection called croup
50
what can respiratory arrest be casued by
airway obstruction decreased respiratory effort respiratory muscle weakness
51
what is decreased respiratory effort
DRE reflects CNS impairment due to one of the following: - CNS disorder (stroke etc) - adverse medication - metabolic disorder
52
when may hypoventilation develop
if the brain stem is compressed
53
what are examples of drugs that decrease respiratory effort
opioids and sedative-hypnotics (barbiturates and alcohol)
54
gabapentin and pregabalin may causes serious breathing difficulties in which patients
patients using opioids or other drugs that depress the CNS, older patients or patients who have underlying respiratory impairment, such as COPD
55
when can respiratory muscle fatigue occur
If patients breathe for extended periods at a minute ventilation exceeding about 70% of their maximum voluntary ventilation
56
what are neuromuscular causes of respiratory muscle weakness
Neuromuscular causes include spinal cord injury, neuromuscular diseases (eg, myasthenia gravis, botulism, poliomyelitis, Guillain-Barré syndrome), and neuromuscular blocking drugs (eg. succinylcholine, rocuronium, vecuronium).
57
how is respiratory arrest diagnosed
clinical evaluation
58
when does treatment for Respiratory arrest begin
simultaneously with diagnosis the first consideration Is to exclude a foreign body obstructing the airway; if a foreign body is present, resistance to ventilation is marked during mouth to mask ventilation.
59
what is the treatment for respiratory arrest
clearing the airway mechanical ventilation
60
what is respiratory failure
when the blood doesn't have enough oxygen or too much C02
61
what is Type 1 respiratory failure
occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia
62
what is type 2 respiratory failure
occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body, leading to hypercapnia
63
what are some common causes of respiratory failure
acute MI related acute respiratory failure due to acute respiratory distress syndrome acute respiratory failure related to COVID19 acute exacerbation of COPD
64
what is the distinguishing characteristic of type 1 respiratory failure
is a partial pressure of oxygen <60mmHg with a normal or decreased partial pressure of carbon dioxide.
65
what could happen to the A-a gradient (alveolar-arterial gradient)
may be normal or increased
66
what is the formula for the A-a gradient
A-a gradient = PAO2 - PaO2, where; PAO2 = Alveolar partial pressure of oxygen PaO2 = Arterial partial pressure of oxygen
67
what is type 2 respiratory failure
defined as an increase in arterial carbon dioxide >45mmHg with a pH <7.35 due to respiratory pump failure and/or increased CO production
68
what is the respiratory pump comprised of
comprised of the chest wall, the pulmonary parenchyma, the muscles of respiration, as well as the central and peripheral nervous systems
69
what do patients present with
dyspnea, cough, hemoptysis, sputum production and wheezing
70
what is the gold standard for diagnosing respiratory failure
an ABG
71
LOOK UP MORE ON RESPIRATORY FAILURE AND ARREST XX
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Year 3 (63 decks)

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