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Year 3 > Week One - Acute Breathlessness > Flashcards

Week One - Acute Breathlessness Flashcards

1
Q

what are the signs and symptoms of allergies

A

urticarial (raised, itchy rash (hives)) or eczematous rash (dry, itchy and inflamed skin)
Asthma
Rhinitis
Conjunctivitis
Diarrhoea and vomiting
Anaphylaxis

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2
Q

how are allergies diagnosed

A
  • a careful, good history
  • family history
  • skin prick test
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3
Q

what is involved in a skin prick test

A

exposure to standardised allergen solution through forearm skin prick

a wheal >2mm larger than the negative (saline) control is a positive result

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4
Q

what is the treatment for allergies

A

avoidance

Topical treatments:

sodium cromoglicate (nasal spray/eye drops)

Topical steroids;

Emollient cream;

Bronchodilators
oral antihistamines or steroids

Desensitisation therapy

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5
Q

what does sodium cromoglicate do

A

stabilises mast cells to prevent degranulation

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6
Q

what do topical steroids do

A

reduce vessel permeability and cytokine synthesis

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7
Q

what does emollient cream do

A

reduces itching and water loss through damaged skin

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8
Q

when is desensitisation therapy used

A

in upper airway allergies if symptoms are not controlled on maximal medical therapy

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9
Q

what is the antibody in type I allergic reaction

A

IgE

fixed on mast cells and basophils via FceR

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10
Q

what is the antibody in type II allergic reaction

A

IgG/IgM

free

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11
Q

what is the antibody in type III allergic reaction

A

IgG/IgM

free

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12
Q

what is the antibody in type IV allergic reaction

A

T-helper cells
Th1

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13
Q

what is the other cell influence in type I,II, III allergic reactions

A

B cells stimulated by Th2 (CD4 cells)

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14
Q

what is the other cell influence in type IV allergic reactions

A

as there is no production of antibodies, Th1 cells are activated - effect on macrophages

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15
Q

what is the antigen in type I

A

always free and foreign

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16
Q

what Is the antigen in type II

A

always fixed and intrinsic to tissue on which reaction occurs

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17
Q

what is the antigen in type III

A

always free and can be exogenous or endogenous

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18
Q

what is the antigen in type IV

A

present by antigen presenting cells (MHCII)

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19
Q

what is the effector in type I

A

mast cells and basophils

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20
Q

what is the effector in Type II,III

A

complement

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21
Q

what is the effector in type IV

A

T cytotoxic cells or macrophages

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22
Q

where is site of reaction of Type I

A

surface of mast cells and basophils

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23
Q

where is the site of reaction in type II

A

surface of target tissues

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24
Q

where is the site of reaction in type III

A

circulation or tissue fluid

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25
Q

where is the site of reaction in type IV

A

site of intruder

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26
Q

what are
- hay fever
- allergic rhinitis
- angioedema
- hives
- anaphylactic shock

examples of

A

type I allergic reactions

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27
Q

what are
- autoimmune diseases
e.g actue glomerulonephritis

examples of

A

type III allergic reactions

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28
Q

what are
- type I diabetes mellitus
- Crohn’s disease
- MS

examples of

A

type IV allergic reactions

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29
Q

what are
- blood transfusion
- glomerulonephritis
- Grave’s disease
- penicillin allergy

examples of

A

type II allergic reactions

30
Q

what is the term used for acute allergic reactions producing life threatening features

A

anaphylaxis

31
Q

what are these life threatening features

A

Hypotension and shock
Severe bronchospasm which might cause wheeze and stridor
Laryngeal oedema
Angioedema
Pruritus
Urticaria
Tachycardia

32
Q

what are clinical signs of anaphylaxis

A

increased respiratory rate (e.g >30)
Increased pulse (e.g >120)
Decreased BP

33
Q

what kind of diagnosis is it and why

A

it is a clinical diagnosis because there is no time for investigations

34
Q

what increases the risk of anaphylaxis

A

increased risk of anaphylaxis in those with a family history of atopy, bronchial asthma and those on corticosteroid/ACEi/beta blocker therapy

35
Q

what is the mechanism of anaphylaxis

A

exposure of susceptible individuals to allergen results in the production of IgE antibodies and the release of inflammatory mediators from mast cells

36
Q

what does local histamine release cause

A

bronchoconstriction, vasodilation and increased vessel permeability

37
Q

what does anaphylaxis require

A

previous exposure to the antigen

here is a sensitisation reaction that occurs on first exposure and it is only on subsequent exposure to the allergen, that anaphylaxis occurs

38
Q

what is the difference between Anaphylactoid reactions and anaphylaxis reactions

A

are clinically distinguishable from anaphylaxis, however they are not IgE mediated, and do not require prior exposure

39
Q

how do anaphylactoid reactions happen

A

occur via direct stimulation of mast cells and can be caused by agents such as NSAIDS, opioids, blood transfusion and even exercise

40
Q

what is the treatment of anaphylactoid reactions

A

initial ABC approach - secure the airway and obtain IV access.

Give 100% oxygen. Lower the head of the bed to restore blood volume

Consider intubation

Adrenaline 0.5mg IM, repeated every 5 mins as required.

Patients that do not respond to adrenaline should be quickly intubated - reduces need for cricothyroidotomy.

antihistamine e.g 10mg
chlorphenamine and corticosteroid e.g 200mg
hydrocortisone IV

Could give IV saline as appropriate for BP management

For asthmatic wheeze - typically given inhaled B2 agonists

41
Q

what are the possible conditions associated with breathlessness

A

pneumothorax
Pneumonia
Pericarditis
PE
Pulmonary oedema / heart failure
Diabetic ketoacidosis
Acute coronary syndromes
Panic attack
Asthma
COPD

42
Q

what are the possible conditions associated with chest pain

A

GORD
Acute coronary syndrome
Boney chest pain
Myocarditis
Hypertrophic cardiomyopathy
Pneumothorax
Pneumonia
Panic attack
Pericarditis
Stable angina
Musculoskeletal chest pain
Sickle cell crisis
PE

43
Q

what is circumoral cyanosis

A

is when only your mouth or lips turn blue

often occurs when blood vessels shrink

44
Q

what is peripheral cyanosis

A

when only your hands, fingers, feet and or toes turn blue

cold weather and rarely life threatening

45
Q

what is central cyanosis

A

when other parts of the body are affected in addition to your hands and feet

46
Q

what are the possible conditions associated with cyanosis

A

asthma
Respiratory tract infection
PE
COPD
Pulmonary hypertension
Pneumonia
Congestive heart failure
Cardiac arrest
Raynaud’s

47
Q

what are the possible conditions associated with pain on inspiration

A

pneumonia
Pleurisy
Costochondritis
Pneumothorax
Pericarditis
Chest injuries

48
Q

what is stridor

A

Is a variable high pitched, turbulent respiratory sound that can be assessed during breathing

49
Q

what is the most common cause of stridor

A

viral infection called croup

50
Q

what can respiratory arrest be casued by

A

airway obstruction

decreased respiratory effort

respiratory muscle weakness

51
Q

what is decreased respiratory effort

A

DRE reflects CNS impairment due to one of the following:

  • CNS disorder (stroke etc)
  • adverse medication
  • metabolic disorder
52
Q

when may hypoventilation develop

A

if the brain stem is compressed

53
Q

what are examples of drugs that decrease respiratory effort

A

opioids and sedative-hypnotics (barbiturates and alcohol)

54
Q

gabapentin and pregabalin may causes serious breathing difficulties in which patients

A

patients using opioids or other drugs that depress the CNS, older patients or patients who have underlying respiratory impairment, such as COPD

55
Q

when can respiratory muscle fatigue occur

A

If patients breathe for extended periods at a minute ventilation exceeding about 70% of their maximum voluntary ventilation

56
Q

what are neuromuscular causes of respiratory muscle weakness

A

Neuromuscular causes include spinal cord injury, neuromuscular diseases (eg, myasthenia gravis, botulism, poliomyelitis, Guillain-Barré syndrome), and neuromuscular blocking drugs (eg. succinylcholine, rocuronium, vecuronium).

57
Q

how is respiratory arrest diagnosed

A

clinical evaluation

58
Q

when does treatment for Respiratory arrest begin

A

simultaneously with diagnosis

the first consideration Is to exclude a foreign body obstructing the airway; if a foreign body is present, resistance to ventilation is marked during mouth to mask ventilation.

59
Q

what is the treatment for respiratory arrest

A

clearing the airway

mechanical ventilation

60
Q

what is respiratory failure

A

when the blood doesn’t have enough oxygen or too much C02

61
Q

what is Type 1 respiratory failure

A

occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia

62
Q

what is type 2 respiratory failure

A

occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body, leading to hypercapnia

63
Q

what are some common causes of respiratory failure

A

acute MI related

acute respiratory failure due to acute respiratory distress syndrome

acute respiratory failure related to COVID19

acute exacerbation of COPD

64
Q

what is the distinguishing characteristic of type 1 respiratory failure

A

is a partial pressure of oxygen <60mmHg with a normal or decreased partial pressure of carbon dioxide.

65
Q

what could happen to the A-a gradient (alveolar-arterial gradient)

A

may be normal or increased

66
Q

what is the formula for the A-a gradient

A

A-a gradient = PAO2 - PaO2,

where;
PAO2 = Alveolar partial pressure of oxygen
PaO2 = Arterial partial pressure of oxygen

67
Q

what is type 2 respiratory failure

A

defined as an increase in arterial carbon dioxide >45mmHg with a pH <7.35 due to respiratory pump failure and/or increased CO production

68
Q

what is the respiratory pump comprised of

A

comprised of the chest wall, the pulmonary parenchyma, the muscles of respiration, as well as the central and peripheral nervous systems

69
Q

what do patients present with

A

dyspnea, cough, hemoptysis, sputum production and wheezing

70
Q

what is the gold standard for diagnosing respiratory failure

A

an ABG

71
Q

LOOK UP MORE ON RESPIRATORY FAILURE AND ARREST XX

A
72
Q
A

Year 3 (63 decks)

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