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Flashcards in Asthma and COPD Deck (44):
1

what is asthma

recurrent episodes of airway obstruction due to chronic inflammatory hypersensitivity and hyperresponsiveness of airways

2

symptoms of asthma and signs

wheeze (due to turbulent flow)
cough
SOB
atopy
family history of asthma, atopy
worse at night

3

kind of inflammation in asthma (cell)

eosinophilic inflammation leadig to bronchospasma and mucosal inflammation

4

diagnosis of asthma

FEV1/FVC salbutamol test

5

treatment of acute asthma attack

oxygen, nebulised salbutamol, tiotropium

6

asthma management

salbutamol (SABA) <3 times per week
otherwise manage with LABA, inhaled steroids/preventers (fluticasone, budesonide)

7

complications of asthma

acute attack
collagen deposition/fibrosis
smooth muscle cell hyperplasia, goblet cell hyperplasia

8

salbutamol side effects

tremor

9

steroid complications in asthma

appettie/weight gain, interrption of sleep
oral thrush, dysphonia (hoarse voice)

10

prednisolone side effects

weight gain/appetie
mood change
can raise blood sugar

11

pathology of COPD

chronic bronchial inflammation/obstruction
loss of cilia
mucus hypersecretion
loss of A-C units, gas exchange surface area, loss of elastic support for airways

12

what is tiotropium

a long acting anticholinergic used in COPD to reduce mucus, reduces exacerbations

13

treatments available for COPD

anticholinergics (tiotropiums)
SABA
inhaled steroids +- LABA
oxygen if PaO2<55

14

vaccinations for COPD patients

yearly influenza
5 yearly pneumococcal

15

what is pneumonia

infection of alveolar units leading to VQ mismatch, diffusion impairment and increased work of breathign

16

what is the rationale behind empiric antibiotics for community acquired pneumonia?

cover both typical and atypical organisms
outcomes are worse if we wait
usually start with penicillin and doxycyline

17

antibiotics for TB

INAH, rifampicin, pyrazinamide, ethambutol

18

findings on examination in asthma attack

tachypnoea
anxiety
wheeze
prolonged expiratory phase
cyanosis
use of accessory muscles

19

types of inflammation in COPD

neutrophilic, macrophages
proteinase-antiproteinase imbalance destroying alveolar connective tissue

20

changes in lung parenchyma in COPD

loss of alveolar-capillary membrane so loss of surface area for gas exchange
loss of elastic support
lose oxygenation capacity

21

mechanism of emphseama

protease/antiprotease imablance digest elastin and other structureal proteins in alveolar wall
macrophages and t cell inflammation

22

function of alpha1antitrypsin

degrade proteases in the lung and the liver

23

why might you use slow vitgal capacity in assessing COPD

forced vital cpacity can cause airway collapse, trapping air and giving an underestimate of vital capacity

24

what should the forced expiratory ratio be below to indicate obstruction

<0.7

25

what kind of inflammation is asthma?

eosinophilic

26

COPD goals of treatment

control symptoms
improve lung function
prevent exacerbations/deterioiration
smoking cessation

27

COPD treatment plan? side effeects?

mild: treat symptoms with short and long beta 2 agonist (salbutamol) but get tremor
more: add tiotropium/anticholinergic to lower SOB, but get anti-SLUD
severe: inhaled steroids (fluticasone) but get increased pneumonia risk

also pulmonary rehabilitation couse (8 week exercise class)
low dose theophylline may be antiinflammatory
VACCINES: influenza and twice pneumoccocal 5 years apart
HOME OXYGEN THERAPY

28

requirements for home oxygen therapy

PaO2<55mmHg
smoking cessation

29

what is lung volume reduction surgery

resection of emphysematous lung to decompress areas of functional lung

30

what is a COPD exacerbation and how should it be treated

change in patients baseline SOB, sputum amount/colour, coough beyond normal day-day variations with acute onset.
usually infectious, treat with doxycyline

31

what happens to pulmonary pressures as CO increases

it stays the same by recruiting pulmonary vessels

32

causes of pulmonary hypertension

increased Left atrial pressure
increased pulmonary flow (fluid overload, left to right shunt)
increased pulmonary vascular resistance (vasoconstriction in hypoxia etc)

33

consequences of pulmonary hypertension

right ventricular dilation/hypertrophy can lead to systemic venous pressure elevation

34

symptoms of pulmonary vascular disease

SOB
syncope
tiredness
ankle swelling
cough
pleuritic pain
haemoptysis

35

signs of pulmonary vascular disease

right ventriucular heave
loud P2
elevated JVP
ascites

36

what criteria dow e use to grade likeliness of PE

wells criteria

37

PE diagnosis

D-dimer: negative result excludes PE
CTPA
VQ scan

38

treatment for PE

supportive oxygen
anticoagulation (heparin and warfarin)

39

causes of clubbing

NSCLC, bronchiectasis, fibrosis, SBE, biliary cirrhosis

40

why do we do metabolic flap in resp exam

can be caused by hypercapnoea

41

what lobe are we listening to on the back and why?

the oblique fissure goes up high posteriorly so it is the lower lobe

42

what causes crackles physiologically? (2 things)

bubbling of air through secretions

sudden opening of small airways with equalisation of pressure (at end of inspiration)

43

percussion and breath soudns in pleural effusion?

decreased percussion and breath sounds

44

percussion and breath sounds in consolidation?

increased breath sounds and decreased percussion