Respiratory - Chronic Conditions

Question 1

what type of hypersensitivity is asthma?

Answer 1

Type 1 (IgE mediated)

Question 2

risk factors for asthma?

Answer 2

FHx
atopy
allergen exposure
nasal polyps

Question 3

pathology of asthma?

Answer 3

• inflammation due to trigger
• mast cells and basophils degranulate
• increased mucus and responsiveness
• intermittent airway obstruction, mucus and hyper-reactivity

Question 4

clinical criteria for diagnosis of asthma?

Answer 4

atopic Hx
wheeze heard
diurnal variability
wheeze/SOB/chest tight/cough with no symptoms inbetween

Question 5

other features of asthma?

Answer 5

kids worse at night

precipitants of cold, exercise, Bb, NSAIDs

Question 6

investigations for asthma?

Answer 6

high probability - 6wks of Tx
spirometry with bronchodilator reversibility (<80% predicted)
bronchial challenge (allergic asthma)

Question 7

treatment for asthma?

Answer 7

1. SABA + ICS
2. add LABA
3. increase ICS or add LTRA

Question 8

treatment for asthma in kids?

Answer 8

1. SABA + ICS/LTRA if <5
2. • <5yrs LTRA / >5yrs LABA/LTRA
3. increase ICS or add LTRA/LABA

stop LABA if no response
use spacers

Question 9

e.g of 
SABA
LTRA
ICS
LABA

Answer 9

SABA - salbutamol (blue)
LTRA - montelukast
ICS - beclamethasone (brown)
LABA - salmeterol (purple)

Question 10

features of moderate acute asthma?

Answer 10

worsening symptoms

PEF >50-75% predicted

Question 11

features of acute severe asthma?

Answer 11

PEF 33-50%
RR ≥25
HR ≥110
inability to complete a sentence in one breath

Question 12

features of life threatening asthma?

Answer 12

PEF <33%
SpO2 <92%
altered consciousness
silent chest 
hypotension 
PaCO2 can be normal, PaO2

Question 13

features of acute severe asthma in kids?

Answer 13

SpO2 <92
PEF 33-50%
inability to complete a sentence in one breath
HR >140 for 1-5, >125 for >5
RR >40, >30

Question 14

features of life threatening asthma in kids?

Answer 14

SpO2 <92
PEF <33%
silent chest
confused
hypotension

Question 15

how many puffs of a SABA can be given to children in acute asthma?

Answer 15

one puff every 30-60secs

up to 10 puffs

Question 16

treatment of acute asthma?

Answer 16

Oxygen 
SABA
Steroids
Ipratropium bromide
IV Mag sulphate
IV Aminophylline
Anaesthetics and intensive care

Question 17

risk factors for COPD?

Answer 17

SMOKING
age
pollution

Question 18

two pathological features of COPD?

Answer 18

emphysema - enlarged air spaces and destroyed alveoli

chronic bronchitis - sputum + cough on most days for 3 successive months for 2 years

Question 19

features of COPD?

Answer 19

productive cough 
SOB
hyper resonant
wheeze
crackles
tachypnoea 
barrel chest

Question 20

investigations for COPD and results?

Answer 20

spirometry with bronchodilator:
mild >80, mod <80, severe <50

reduced FEV1/FVC ratio
reduced FEV1 and FVC (not as much)

Question 21

treatment for COPD?

Answer 21

1. SABA
2. SAMA
3. FEV1 >50 = LABA/LAMA
   FEV1 <50 = LABA + ICS/LAMA
4. LABA + LAMA + ICS
5. oxygen

Question 22

e.g of
SAMA
LAMA
LABA

Answer 22

SAMA = ipratropium 
LAMA = tiotropium 
LABA = salmeterol

Question 23

features of obstructive sleep apnoea?

Answer 23

snoring
daytime sleepiness
apnoea
orthopnea

Question 24

investigation and Tx of obstructive sleep apnoea?

Answer 24

polysomnography

weight loss
smoking cessation
CPAP

Question 25

treatment of exacerbation of COPD?

Answer 25

amoxicillin 2nd line: doxycycline prednisolone SABA SAMA

Question 26

what is bronchiectasis?

Answer 26

permanent dilation of bronchi due to destruction of the walls

Question 27

causes of bronchiectasis?

Answer 27

``` recurrent infection CF alpha 1 antitrypsin CTD tumour HIV ```

Question 28

investigations for bronchiectasis?

Answer 28

CXR high resolution CT find the cause

Question 29

features of bronchiectasis?

Answer 29

``` cough sputum SOB wheeze weight loss fever fatigue ```

Question 30

complications of bronchiectasis?

Answer 30

respiratory failure | cor pulmonale

Question 31

what is cor pulmonale?

Answer 31

high blood pressure in the pulmonary arteries | causes enlarged RHS of heart

Question 32

types of respiratory failure?

Answer 32

type 1 - hypoxia without hypercapnia | type 2 - hypoxia with

Question 33

features of hypoxia?

Answer 33

``` dyspnoea restless agitated confused cyanosis ```

Question 34

features of hypercapnia?

Answer 34

``` headache peripheral vasodilation tachycardia tremor confused drowsy papilloedema ```

Question 35

causes of type 1 RF?

Answer 35

asthma PE PO pneumonia

Question 36

causes of type 2 RF?

Answer 36

COPD | rising CO2 not matched by increased RR

Question 37

treatment of type 1 and type 2 RF?

Answer 37

1 - treat cause and oxygen 2 - treat cause and controlled oxygen ABG recheck

Question 38

what is the haldane effect?

Answer 38

deoxygenated Hb binds with a greater affinity to CO2

Question 39

why do COPD need controlled O2 therapy?

Answer 39

hypoxic vasoconstriction oxygen just increases blood flow does not increase ventilation

Question 40

when should asthma treatment be stepped up?

Answer 40

using SABA >3x a week

Question 41

what is FEV1?

Answer 41

amount expelled forcefully in one second | reduced in COPD

Question 42

what is FVC?

Answer 42

total air exhaled in one breath

Question 43

what is the spirometry pattern for restrictive lung disease? why?

Answer 43

FEV1/FVC normal both equally reduced (in obstructive, FVC reduced LESS than FEV1)