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Mattias - Respiratory > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Asthma triad

A

Reversible Airflow obstruction
Airway inflammation
Airway hyperresponsiveness

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2
Q

Which white blood cell is involved in Asthma

A

Eosinophils

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3
Q

Hallmarks of remodeling in asthma

A

Thickening of Basement membrane
Collagen deposition in Submucosa
Hypertrophy of Smooth muscle

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4
Q

How is Asthma diagnosed

A

History and Examination
Diurnal variation of peak flow rate
Reduced forced expiratory ratio
Reversibility of inh. salbutamol (>15%)

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5
Q

What is the Reduced forced expiratory ratio seen in asthma

A

FEV1/FVC <75%

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6
Q

When is asthma normaly worse (apart from triggering factors)

A

Morning

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7
Q

What is emphysema

A

Disrupted alveoli
Destroys the walls and creates bigger airpockets
Impair gas exchange

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8
Q

Parts of COPD

A

Emphysema

Chronic bronchitis

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9
Q

What white blood cell is associated with COPD

A

Neutrophil

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10
Q

What is Chronic bronchitis

A

Chronic neutrophilic inflammation
Mucus hypersecretion
Mucociliary dysfunction
Smooth muscle spasm and hypertrophy

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11
Q

What part of COPD is reversible

A

The chronic bronchitis is party reversible

Emphysema is NOT reversible

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12
Q

Clinical symptoms of COPD

A 
Chronic not episodic
Non-atopic
Daily productive cough
Progressive breathlessness
Frequent infective exacerbations
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13
Q

Breath sounds due to chronic bronchitis

A

Wheezing

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14
Q

Breath sounds due to Emphysema

A

Reduced breath sounds

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15
Q

Chronic cascade in COPD

A

Progressive airflow obstruction –> Impaired gas exchange –> Resp. failure –> Pulmonary hypertension –> Right sided heart failure –> Death

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16
Q

What is Tiotropium, other drug in same class

A

Long acting Muscarinic antagonist

Aclidinium

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17
Q

What is Olodaterol, other drug in same class

A

Long acting Beta agonist

Formoterol

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18
Q

What is Carbocisteine

A

Mucolytic drug

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19
Q

Restrictive thoracic disease. What is DPLD

A

Diffuse Parenchymal lung disease

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20
Q

Fluid in alveloar air space can be due to two mechanism, which?

A

Raised pulmonary venous pressure - ie LVF

Leaky pulmonary capillaries - sepsis, trauma, altitude sickness

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21
Q

Consolidation of Alveolar space can be due to

A

Infective pneumonia (viral, bacterial, fungal, parasites)
Infarction (PE, vasculitis)
Others - RA, Drugs, Cryptogenic

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22
Q

Drug induced alveolitis can be due to

A

Amiodarone
Bleomycin, Methotrexate
Gold

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23
Q

What type of reaction causes Farmer’s lung

A

Hypersensitivity type 3 reaction

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24
Q

What is Alveolitis

A

Inflammatory infiltrates of alveolar walls

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25
Q

Types of Dust-Disease

A

Fibrogenic ( Asbestosis, Silicosis)

Non-Fibrogenic (Siderosis/Iron, Stanosis/Tin, Baritosis/Barium)

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26
Q

What are the Clinical syndrome of DPLD

A 
SOB on exertion
Cough but no wheeze
Finger clubbing
Inspiratory lung crackles
Central cyanosis (If hypoxemic)
Pulmonary fibrosis occurs as end stage response to chronic inflammation
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27
Q

Forced expiratory volume ratio seen in DPLD

A

FEV1/FVC normal

Due to reduction in both FEV1 and FVC

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28
Q

Peak flow in DPLD

A

Normal

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29
Q

Clinical picture of DPLD and Raised Serum ACE and Ca indicates

A

Sarcoidosis

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30
Q

Where is the breathing rhythm generated

A

Medulla

Pre-Botzinger Complex

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31
Q

What two areas in the Pons controls breathing

A

Pneumotaxic area - Limits breathing (decrease tidal vol)

Apneustic area - Increases breathing

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32
Q

Ventral respiratory neurones in the medulla acts on __ to cause

A

Internal intercostals, abdominal

Forceful expiration

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33
Q

What is the Baroreceptors effect on respiration

A

Decreased blood pressure results in increased ventilatory rate

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34
Q

What reflex guards against hyperinflation

A

Hering-Breur reflex

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35
Q

Factors that increase ventilation during exercise

A

Joint receptor reflexes
Adrenaline release
Impulse from cerebral cortex
Increase in Temp, CO2 and H+

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36
Q

Where is the cough reflex centre

A

Medulla

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37
Q

Where are the Peripheral chemoreceptors located

A

Carotid bodies

Aortic bodies

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38
Q

Where are central chemoreceptors located. What do they sense

A

Near surface of medulla

Responds to [H+] in CSF

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39
Q

Hypoxic drive of respiration is stimulated when

A

pO2 falls to low levels <8.0 kPa

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40
Q

What is sensitivity of a test

A

% of sick who has a positive results
Sick/(positive results)
High sensitivity = low False negative results

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41
Q

What is specificity of a test

A

% many healthy people have a negative results
Healthy/(negative results)
High Specificity = low False positive results

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42
Q

What is positive predictive value

A

%of positive results who are sick
Positive sick/ all positive results
High value = low false positive

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43
Q

What is negative predictive value

A

% of negative results who aren’t sick
Negative healthy / all negative results
High value = low false negatives

44
Q

What is prevelance

A

% of people tested who are sick

45
Q

What enzymes can be found in blood from skeletal muscles

A 
Creatine Kinase
Asparte transaminase (AST)
46
Q

What enzymes can be found in blood from the heart

A

Troponin
Creatine Kinase
Asparte transaminase (AST)
Lactate Dehydrogenase (LDH)

47
Q

What enzymes can be found in blood from bones

A

alkaline phosphatase

48
Q

What enzymes can be found in blood from Liver

A

ALT
AST
ALK PHOS
Gamma GT

49
Q

What enzymes can be found in blood from Pancrease

A

Amylase

Lipase

50
Q

What drugs are given in a Bronchial challenge test

A

Methacholine
Histamine
Mannitol

51
Q

First line treatment of Asthma

A

Short-acting B2 agonist

52
Q

Mainteance monotherapy in asthma, first line

A

Inhaled Corticosteroid

Beclomethasone

53
Q

What is Cromoglycate. Acts on

A

Anti-inflammatory drug used only in asthma

Mast cell stabilizer

54
Q

Leukotrienes, prostaglandins and Thromboxanes are all derived from

A

Arachidonic acid

55
Q

Which Leukotriene receptor antagonists is used in ashtma

A

Montelukast

56
Q

Action of Leukotrienes in asthma

A

Edema
Increased mucus secretion/Decreased mucus transport
Eosinophilic influx
Epithelial cell damage
Contraction and proliferation of smooth muscle

57
Q

Which Anti-IgE monoclonal antibody is used in asthma

A

Omalizumab

58
Q

Which Anti-IL5 monoclonal antibody is used in asthma

A

Mepolizumab and Reslizumab

59
Q

How does Mepolizumab and Reslizumab act

A

Blocks the effects of the TH2 cytokine IL-5 which is responsible for eosinophilic inflammation in asthma

60
Q

Examples of Long acting beta2-agonists

A

BD - Salmeterol / Formoterol

OD - Indacaterol / Vilanterol / Olodaterol

61
Q

Which Muscarinic receptor mediates bronchoconstriction and mucus secretion

A

M3

62
Q

Example of Short acting muscarinic antagonist

A

Ipratropium

63
Q

Example of Long acting muscarining antagonist

A

Tiotropium, Glcopyrronium, Umeclidinium, Aclidinium

64
Q

Which Muscarininc antagonist is used in asthma regulary

A

Tiotropium

Only in severe asthma

65
Q

Acute COPD or Acute asthma, which muscarinic antagonist is used

A

High nebulised dose of Ipratropium

66
Q

What are the names of the Methylxanthines

A

Theophylline

Aminophylline

67
Q

MOA of Theophylline and Aminophylline

A 
Non selective phosphodiesterase inhibitor (raised cAMP, inhibits TNF-alpha, inhibits leukotriene production, anti-inflammatory effect)
Adenosine antagonist (side effect)
68
Q

What is Roflumilast

A

PDE4 (phosphodiesterase 4) inhibitor
Anti-inflammatory action
Rarely used

69
Q

Examples of Mucolytics

A

Carbocisteine
Edosteine
Rarely used

70
Q

Which corticosteroid can be used IV in acute asthma

A

Hydrocortisone

71
Q

MMRC breathless score

A

0-4
0 - only on strenuous exercise
1 - SOB on hurrying or slight hill
2 - I walk slower than others my age due to SOB
3 - SOB after 100m walking
4 - SOB on dressing or getting out the door

72
Q

Mild to moderate COPD exacerbation antibiotic treatment

A

Amoxycillin

Doxycycline

73
Q

White blood cells can be divided into (2)

A

Granulocytes

Agranulocytes

74
Q

Granulocytes are

A

Neutrophils
Eosinophils
Basophils

75
Q

Agranulocytes are

A

Lymphocytes

Monocytes

76
Q

Microcytic RBC and anemia can mean a deficiency in

A

Iron

77
Q

Macrocytic RBC and anemia can mean a deficiency in

A

Vitamin B12/Folate

78
Q

Macrocytic RBC w/o anemia is associated with

A

Alcohol excess
Liver disease
Hypothyroidism

79
Q

Name all Leukocytes in order of normal concentration, highest first

A 
Neutrophils
Lymphocytes
Monocytes 
Eosinophils
Basophils
80
Q

Primary hemostasis is

A

Formation of platelet plug

81
Q

Secondary hemostasis is

A

Formation of fibrin clot

82
Q

Prothrombin time assess which coagulation factors

A

2, 5, 7 and 10

83
Q

Activated partial thromboplastin time, aPTT, assess which coagulation factors

A

2, 5, 8, 9, 10, 11, 12

84
Q

What is metabolic acidosis

A

Increase [H+] due to Decreased HCO3-

85
Q

Potassium deficiency cause what acid-base disorder

A

Metabolik Alkalosis

86
Q

M2 muscarinic receptor action in the airways

A

At Postganglionic neurone terminals

Act as inhibitory autoreceptor reducing relase of ACh

87
Q

Muscarinic receptor antagonists acts on which division of the nerveous system

A

Parasympathetic

88
Q

Ipratropium is, acts on

A

Short acting Muscarinic antagonists

non-selective, acts on M1, M2, and M3

89
Q

Difference between Allergic and Non-allergic rhinitis

A

Allergic involves IgE

Non-allergic does not involve IgE

90
Q

What receptors does anti-histamine act on

A

Anti-histamines are H1 receptor antagonists

91
Q

Examples of anti-histamines

A

Loratidine
Fexofenadine
Cetirizine
Azelastine (nasal spray)

92
Q

How many generations of anti-histamines are there, benefit

A

1st and 2nd generation

2nd does not cross blood-brain barrier = no sedation

93
Q

What is Ipratropium

A

Anti-cholinergic nasal spray used in rhinorrhea

Acts as a Muscarinic receptor antagonist

94
Q

What type of drug is Montelukast

A

Cysteinyl Leukotriene Receptor Antagonists

CysLT1 receptor antagonists

95
Q

What is Oxymetazoline

A

Selective alpha-1-adrenoreceptor agonist

Intranasally given in allergic rhinitis

96
Q

Difference between SaO2 and SpO2

A

SaO2 is oxygen saturation in arterial blood
SpO2 is oxygen saturation measured by pulse oximeter
The p stands for percutaneous

97
Q

What is FiO2

A

Fraction of Inspired Oxygen

98
Q

Why do patients retain CO2

A

V/Q mismatch, good perfusion but poor ventilation. Especially with high oxygen
Haldane effect - Oxygen take CO2 spots on Hb

99
Q

Signs of Hypoxyemia

A 
Altered mental state
Cyanosis
Dyspnea
Tachypnea
Arrhythmias
100
Q

At what level of PO2 does Hyperventilation increase dramatically

A

<5.3 kPa

101
Q

At what PO2 does a patient lose consciousness

A

About 4.3 kPa

102
Q

What is shunting (Respiratory)

A

Perfusion without ventilation

103
Q

What is Dead Space (Respiratory)

A

Ventilation without Perfusion

104
Q

Is Lung apex more like a shunt or Dead space

A

Dead space

Good ventilation but poor Perfusion

105
Q

Formula for Delivery of Oxygen

A

CO x (( 1.3 x Hb x SaO2) + 0.003 x PaO2)

106
Q

Week 2 done

A

yes

Mattias - Respiratory (2 decks)

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