3. Respirology Flashcards Preview

1. BDS2 BAMS Revision > 3. Respirology > Flashcards

Flashcards in 3. Respirology Deck (11):
1

Respiratory drugs

Function of bronchodilators
Function of mast cell stabilisers and leukotriene inhibitors
Function of B-agonist
Function of anticholinergics
Action of corticosteroids
Types of respiratory stimulants (2)
Action of theophylline

Improve airway patency

Prevent mast cell degranulation

Bronchodilator - treat/prevent acute bronchial constriction. Long/short acting

Bronchodilator - inhibit muscarinic nerve transmission of autonomic nerves --> bronchial dilation and reduced mucus secretion

Reduce bronchial wall inflammation

Oxygen greater than air concentration and theophylline

Improves gas exchange, relaxes bronchial smooth muscle, increases heart muscle contractility and efficiency, increase BP, renal blood flow and anti-inflammatory effects

2

General respiratory disease signs and symptoms (10)
Respiratory investigations (4)

Cough (dry, sputum, blood), wheeze (expiration), stridor (inspiration), SoB, pain, chest movement with respiration, respiratory rate (12-15bpm), air entry (symmetrical/reduced), vocal resonance (resonant/dull), percussion notes

Sputum exam, CXR, pulmonary function (PEFR, FEV, FEV1/VC), VQ scan

3

Asthma

Definition
Characterised by
Triad of (3)
Signs and symptoms (5)
Triggers (5)
Treatment stages (5)

Bronchial hyper reactivity. Common long-term inflammatory disease of lung airways.

Variable and recurring symptoms, reversible airflow obstruction and bronchospasm.

Airway smooth muscle construction, mucosa (wall) inflammation and increased mucus production

SoB, wheeze, chest tightness, cough, use of accessory muscles

Infection, environmental, cold air, atopy, exercise

1. Occasional B-agonist
2. Low-dose inhaled steroid/Na chromoglycate/nedocromil
3. High-dose inhaled steroid
4. Long-acting B-agonist, theophylline, anti-muscarinic drug
5. Oral steroid

4

COPD

Definition
Combination of
Aetiology/cause (3)
How can COPD lead to respiratory failure (2)
How can occupational lung disease lead to respiratory failure (2)
Management (4)
Acute/chronic COPD treatment

Mixed reversible airway obstruction and destructive lung disease

Asthma and emphysema (leads to poor ventilation)

Smoking, environmental, hereditary (emphysema)

From reduced surface area for gas exchange, thickening alveolar mucosa barrier

From fibrosis (dust) or tumours (asbestos)

Stop smoking, long-acting bronchodilator, inhaled steroids (if FEV < 50%), oxygen support

Acute - oxygen until medical help arrives
Chronic - home oxygen therapy

5

Respiratory failure

Type 1 description
Type 1 due to (4)
Type 2 description
Type 2 due to (4)

Normal breathing features vs COPD breathing features

Type 1 - hypoxaemia - PaO2 < 8kPa/60mmHg

Due to high altitude, VQ mismatch, diffusion abnormality, alveolar hypoventilation

Type 2 - hypoxaemia and hypercapnia (PaCO2 > 6.7kPa/50mmHg). Rely on low oxygen concentration to breathe

Due to increased airway resistance (COPD), airway narrowing/blockage, ventilation problems in muscles, NM problems. Involves reduced compliance, airway obstruction and muscle dysfunction

Normal breathing - CO2 drive controls ventilation. In COPD - CO2 tolerance and hypoxia drives ventilation

6

Cystic fibrosis

Aetiology (genes) and cell defect caused
Effects of cell defect
Organs most affected (2)
Investigations (2)
Signs and symptoms (8)
Treatment (4)
Medications used (6)

Inherited CFTR gene causes defect in cell chloride channels

Excess production of sticky, solid mucus --> bacteria trap

Lungs and pancreas

Perinatal test (blood), sweat test (CF salt in saliva > normal)

Troublesome cough, repeated chest infections, prolonged diarrhoea, poor weight gain, liver dysfunction, prone to osteoporosis, diabetes symptoms, reduced (male) fertility

Physiotherapy, medication, exercise, transplant

Bronchodilators, steroids, antibiotics, DNase (breaks down mucus), pancreatic enzyme replacement, nutritional support

7

Lung tumours

Effects (7)
Common metastases sites (3)
% smoking related

ESLD cause

Cough, haemoptysis, pneumonia, metastases, dysphagia, SVC obstruction, recurrent laryngeal nerve palsy

Bone, liver, brain

40%

Extensive fibrosis of lung tissue

8

Sleep apnoea

Definition
Types (2)
Investigations
Increased risk of
OSA treatment (2)

Airway obstruction in sleep, >10 second drop in airway muscle tone

OSA or central

AHI (apnoea/hypopnea index - score of <10 indicates few problems)

MI

CPAP, mandibular advancement devices if tongue falls back due to relaxing muscles

9

URTIs

Main causative agent
Group A strep virulence factors (3)
Strep throat complications (4)

Types of bronchitis (2)
Symptom/causes of bronchitis (3)
Treatment of bronchitis (3)

S. pyogenes

Pyrogenic exotoxins, streptolysins, hyaluronidase

Abscess, scarlet fever, otitis media, sinusitis

Acute, chronic

Productive cough due to smoking, air pollution, infection, allergies

Decongestants, NSAIDs, antibiotics

10

Pneumonia

Definition of pneumonia
Signs and symptoms (8)
Investigations (2) and management (2)
Main type of atypical pneumonia
Signs and symptoms
Treatment
Action of pneumolysin (4)

Lung/alveolar inflammation from infection

Fever, riggers, malaise, SoB, rapid shallow breathing, cyanosis, cough producing purulent sputum, consolidation of lungs

CXR, clinical exam. Hospitalisation, IV antibiotics

Legionnaires disease

Flu-like --> severe pneumonia

Macrolide

Inhibits ciliated cell activity - cytotoxic for alveolar and endothelial cells. Activates classical complement --> lung inflammation. Reduces PMN effectiveness and stimulates monocytes to produce cytokines

11

Oral implications of smoking (4)

Cancer, periodontal disease, staining, keratosis