Diseases Flashcards
(20 cards)
Differences between COPD (emphysema) and chronic bronchitis
COPD - alveolar destruction, irreversible
CB - chronic neutrophilic inflammation, altered lung microbiome, smooth muscle spasm and hypertrophy, partially reversible
Diagnosis of COPD
Reduced FEV1/FVC ratio on spirometry, less than 0.7
COPD symptoms
Dyspnoea, productive cough, decreased exercise tolerance and SOB on exertion, wheeze (if CB), difficulty exhaling due to trapped air remaining in lungs
COPD signs
Raised resp rate Hyperexpanded chest Prolonged expiratory time, with pursed lips Use of accessory resp muscles Quiet breath and heart sounds Possible basal crepitations
Pathophysiology of COPD (include cell types and cytokines)
Inflammatory response in lungs.
CD8+ve cells and alveolar macrophages attracted, release cytokines (Leukotriene B4, IL-8, TNF alpha, oxygen radicals).
Neutrophils attracted, release proteases (elastases, collagenases), damaging the alveoli and resulting in progressive airflow limitation.
Investigations for COPD
Assess symptoms
Assess degree of airflow limitation with spirometry
Assess risk of exacerbations and co-morbidities
COPD Treatment
Non-pharma - stop smoking, physical activity
Pharma - start with SAMA/SABA (ipatropium/salbutamol), then move to inhaled LAMA/LABA (tiotropium/formoterol). If symptoms still persist (severe COPD) then combo therapy of LABA and an inhaled corticosteroid (symbicort - mixture of budesonide and formoterol).
Other ICSs include beclometasone and fluticasone
3 components of the Asthma triangle
Airway hyperresponsiveness (twitchy airways) Airway inflammation Reversible airflow obstruction
Immune cell involved in asthma attacks? What does it release?
Eosinophils.
Release granules - histamine, prostaglandin, leukotrienes, platelet activating factor
Hallmarks of irreversible change of alveolar architecture seen in chronic asthma?
Thickening of the basement membrane.
Collagen deposition in the submucosa.
Hypertrophy of smooth muscle.
What’s the difference between atopic and non-atopic asthma?
Atopic - development of a Type I hypersensitivity reaciton. As well as the milder Th1 (cell-mediated) immune response involving IgG and macrophages, a more severe Th2 (antibody-mediated) Th2 response, involving IgE produced by B cells. IgE-antibody complexes form that bind to mast cells, basophils and macrophages.
Non-atopic - not in response to an allergen, mild Th1-mediated immune response involving IgG and macrophages.
Asthma Treatment
mild intermittent - SABA (salbutamol)
Regular preventer therapy - ICS (beclometasone dipropionate, fluticasone, budesonide)
Add-on therapy - consider LABA (salmeterol). No response? Stop LABA treatment and increase ICS dose
Addition of 4th drug if poorly controlled - leukotriene receptor antagonist (montelukast), or xanthine (theophylline, aminophylline)
Still bad? Monitor use of steroids, could lead to osteoporosis.
Use prednisolone if necessary (oral corticosteroid)
Key asthma symptoms
Wheeze
Cough
Shortness of breath
Chest tightness
Most common causes of pneumonia?
Strep. pneumoniae - 36%
Unknown - 45%
Viruses - 13%
(Influenza A and B - 8%)
Haemophilus influenzae - 10%
Bacterium associated with birds that can cause pneumonia?
Chlamydophila psittaci (Psittacosis)
Signs & Symptoms of pneumonia?
Signs - fever, tachypnoea, crackles, pleural rub, cyanosis, hypotension
Symptoms - malaise, anorexia, sweats, cough, headaches, confusion etc.
Investigations for pneumonia?
blood culture serology ABGs FBC Urea LFTs CXR
What does CURB65 stand for?
C - confusion U - urea R - resp rate B - blood pressure over 65?
Treatment for mild and severe pneumonia?
Mild (0-2 CURB65 score) - amoxicillin 1g IV/PO
Severe (3-5) - co-amoxiclav 1.2g IV and doxycylcine 100 mg (if in ICU, replace doxy with clarythromycin 500mg IV)
3 types of atypical pneumonia? Treatments for each?
HAP - amoxicillin, metronidazole, gentamicin
aspiration pneumonia - metronidazole
Legionella - fluoroquinolone (levofloxacin), macrolide (clindamycin/azithromycin), penicillin (amoxicillin/doxy)
