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Case 2 Flashcards

Hello Orla (78 cards)

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1
Q

What are the 4 Categorisations of asthma

A

Atopic
Non-atopic
Drug induced
Occupational

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2
Q

Atopic vs

Non-atopic

A

Atopic also known as extrinsic is a type 1 IgE mediated hypersensitivity reaction , DEFINITE EXTERNAL CAUSE
Non-atopic (intrinsic) - no causative agent can be identified

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3
Q

What is occupational asthma

A

 This form of asthma is stimulated by fumes, organic and chemical dusts, gases, and other chemicals.
 Minute quantities of chemicals are required to induce the attack, which usually occurs after repeated exposure.
 The underlying mechanisms vary according to stimulus and include type I hypersensitivity reactions, direct release of bronchoconstrictor substances, and hypersensitivity responses of unknown origin.

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4
Q

What is Drug-induced Asthma

A

 Several pharmacologic agents provoke asthma

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5
Q

What are two common Drug-induced Asthma

A

Aspirin (pain)

Propranolol (hypertension)

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6
Q

What does atopy mean

A

a group of disorders that appear to run in families

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7
Q

What are the 3 types off phases of atopic asthma

A

Immediate
Duel and late
Isolated

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8
Q

What is the Early Phase Reaction

A
  • In the airways, the scene for the reaction is set by initial sensitisation to inhaled allergens, which stimulate induction of Th2 cells.
  • Th2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce IgE and other antibodies.
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9
Q

What percentage of UK adults smoke

A

16%

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10
Q

COM-B framework

A

Capability
Motivation
Opportunity
Behaviour

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11
Q

What is tidal volume

A

Volume of air displaced between normal inspiration and expiration

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12
Q

Inspiratory reserve volume

A

is the extra volume of air that can be inspired over and above the normal tidal volume when the person inspires with full force (≈3000ml).

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13
Q

Expiratory reserve volume

A

maximum extra volume of air that can be expired by forceful expiration after the end of a normal tidal expiration (≈1100ml)

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14
Q

Residual volume

A

volume of air remaining in the lungs after the most forceful expiration

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15
Q

What gives us maximum volume

A

Tidal
Inspiratory reserve
Expiratory reserve
Residual

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16
Q

Functional residual capacity

A

= expiratory reserve volume + residual volume

This is the amount of air that remains in the lungs at the end of normal expiration.

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17
Q

Vital capacity

A

= inspiratory reserve volume + tidal volume + expiratory reserve volume
This is the maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent.

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18
Q

What are the Methods of Studying Respiratory Abnormalities

4

A

Arterial Blood Gases
Peak Expiratory Flow Rate (PEFR)
Spirometry
Pulse Oximetry

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19
Q

Arterial Blood Gases

A

a blood test that measures
 The arterial oxygen tension
 The arterial carbon dioxide tension
 The acidity of the arterial blood

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20
Q

Pulse Oximetry

A

• They measure the difference in absorbance of light by oxygenated and deoxygenated blood to calculate its oxygen saturation (SaO2).

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21
Q

Peak Expiratory Flow Rate (PEFR)

A
  • This is the maximum rate at which a person can forcibly expel air form their lungs at any time
  • Normal values are dependent on height
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22
Q

Spirometry

A
  • Procedure: person inspires maximally to the total lung capacity and then exhales into the spirometer with the maximum expiratory effect as rapidly and as completely as possible.
  • FEV1 is expressed as a percentage of the FVC, i.e. how much of the FVC is exhaled by the end of the first second.
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23
Q

Types of Respiratory Failure

A
  • Type I: hypoxia WITHOUT hypercapnia.

* Type II: hypoxia WITH hypercapnia.

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24
Q

What is hypercapnia

A

too much co2

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25
What is the rate of diffusion directly proportional to
partial pressure of that gas
26
What is Henry’s Law
Partial Pressure= (Concentration of Dissolved Gas)/(Solubility Coefficient)
27
What is the difference in hypoxia and hypoxaemia
Hypoxia is failure of oxygenation at the tissue level Hypoxaemia is when PaO2 is below the normal range
28
How does pulse Oximetry work
Measures the difference in absorbable of light by oxygenated and deoxygenated blood to calculate the oxygen saturation (SaO2)
29
What is Spirometry
FEV1 expressed as a percentage of the FVC
30
What is the difference in Type 1 and 2 respiratory failure
Type I - hypoxia WITHOUT Hypercapnia Type II - hypoxia WITH Hypercapnia
31
What are the respective pressures of Co2 and O2 in alveolar air
Alveolar Air has more Co2 and less O2
32
Why is a slow replacement of alveolar air important
It is important in preventing sudden changes in gas concentrations in the blood
33
How many alveoli are there in the lungs
300 million
34
What are the layers of the respiratory membranes
``` Layer of fluid lining the alveolus Alveolar epithelium Epithelial basement membrane Thin interstitial space Capillary basement membrane Capillary endothelial membrane ```
35
What is perfusion
The amount of blood that reaches the alveoli via the pulmonary capillaries
36
What is ventilation
Aeration of the lungs
37
If the blood flow is good what could be another factor to do with blood that makes it difficult to absorb air bitch
Blood flow going to different parts of the lungs
38
In quantitative terms what is Va/Q
Ventilation perfusion ratio
39
What does Va and Q stand for
Va is alveolar ventilation and Q is perfusion (blood flow to the lungs)
40
In terms of perfusion and ventilation explain the apex and the lower lobes of the lungs
Top the perfusion is decreased so Va/Q is too high so there is a moderate degree of dead space in the lung At the lower lung there is slightly too little ventilation in relation to blood flow this Va/Q is reduced
41
What happens during exercise in terms of surface area and physiological shunts
Increased surface area of ventilation/ perfusion ratio in the upper lung
42
What nervous system at the start of exercise causes vasoconstriction
Sympathetic
43
What is the shunt flow
This blood is shunted past the gas exchange areas and isn’t exposed to air
44
What is venous admixture
Oxygenated blood from pulmonary veins to mix with shunt flow
45
What is the maximum the PO2 can rise in mmHG in blood
95mm Hg due to the O2 pressure in the arterial blood
46
What diffuses more rapidly Co2 and O2 and what does this entail when relating to pressure difference
Co2 defuses 20 times more rapidly thus a lesser conc gradient is needed
47
What percentage of O2 is carried in the blood / dissolved in the blood
97% is in combination with Hb and 3% is dissolved in water of the plasma and blood
48
What does Venus blood have
Large oxygen reserve which can be mobilised if tissue oxygen demands increase
49
How does oxygen diffuse from the alveoli into the pulmonary blood as a result of
Partial pressure difference
50
What nervous system causes vasoconstriction at the start of exercise
Sympathetic nervous system
51
How do you make carbonic acid
H2O and Co2
52
What does Haemoglobin act as
Acid-base buffer
53
What maintains the pH of red blood cells
Chloride shift
54
What is the Haldane effect
Binding of oxygen with Hb tends to displace carbon dioxide from the blood
55
What is the Bohr effect
Increase in carbon dioxide in the blood causes oxygen to be displaced from the haemoglobin
56
Combination of O2 with Hb causes a (stronger acid or base)
Stronger acid
57
What is Hypercapnia
Excess carbon dioxide in the body fluids
58
What is the transport capacity for blood of Co2 vs O2
Blood has 3 times more capacity for Co2 than O2
59
What is asthma
Inflammation of the air passages in the lungs and effects the sensitivity of the nerve endings in the airways so they become easily irritated.
60
What are the different types of asthma
Atopic Non-atopic Drug induced Occupational asthma
61
What is the difference in atopic and non atopic asthma
Atopic is a definite external cause and is Type 1 mediated hypersensitivity reaction Non-atopic is when no causative agent can be identified eg 007 or Jonny English
62
What is less humid cold or warm air
Cold bitch
63
What IL stimulates the production of IgE by B cells
Inter Luken 4
64
What happens in airway remodelling in asthma
Hypertrophy and hyperplasia of bronchial smooth muscle - thus contracts too much and too easily Epithelial destruction and metaplasia of goblet cells thus more mucus Increased airway vascularity
65
How can a mast cell be stimulated
Venoms eg bee sting Cross linking of loaded IgE antibodies Coding and morphine
66
What is a curschmann spiral
Remember the mucus plug image that Jodie showed you
67
What are the two classes of anti asthma drugs
Bronchodilators - revers the bronchospasm of the immediate phase Anti-inflammatory agents - inhibit or prevent the inflammatory components of both phases
68
What are bronchodilators and name some and the methods of action
Beta 2 adrenergic receptor agonists and they dilate the bronchi by direct action on the B2 adrenergic receptors of smooth muscle. They also inhibit the mediator release from mast cells and Tumour necrosis factor alpha release from monocytes . They also increase mucus clearance by action on cilia. Drugs are - salbutamol/Salmetrol
69
What is the difference in salbutamol and salmetrol
Salbutamol is short acting and used for a as needed basis to control symptoms Salmetrol is longer acting and given regularly twice daily and given to those who’s asthma is inadequately controlled by glucocorticoids
70
Name an Xanthine drug
Theophylline
71
What is the action of Xanthine drugs
Inhibitor of phosphodiesterase which results in an increase in cAMP causing muscle relaxation
72
Mechanism of action of Xanthine drugs
Xanthine drugs are phosphodiesterase inhibitors. Phosphodiesterase breaks down cAMP. cAMP inhibits myosin kinase which phosphorylates myosin and causes muscles to contract. Therefore inhibiting phosphodiesterase increases the amount of cAMP and decreases the amount of myosin kinase causing muscle relaxation. This results in bronchodilation and is used to treat asthma
73
What does a muscarinic receptor antagonists do
Blocks actions of Ach at receptors in parasympathetic nervous system
74
What are glucocorticoids used for in asthma
Prevent progression of chronic asthma | Used as a prophylactic treatment for asthma
75
What does glucocorticoids do bitch
Reduce production of cytokines and spas opens thus reducing bronchospasm
76
What is the mechanism of glucocorticoid action
Enters cells Binds to intracellular receptors in cytoplasms Receptor complex moves to nucleus and binds to DNA in nucleus Alters gene transcription Reduced synthesis of IL-3
77
What does IL-3 do mr poo hey Jordan x
Cytokine that regulates mast cell production
78
What is the systemic biases in Risk perception
* Compression: overestimate low risks, underestimate high ones. * Miscalibration: overestimate accuracy of own knowledge. * Availability: overestimate notorious risks. * Optimism: underestimate personal susceptibility.
Sem 2 Case 2
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