4

• what is cyanosis

  blue or purple colouration in skin or mucous membranes
• what are crepitations ?

  crackling sounds heard with stethescope
• what is a wheeze?

  continuous, coarse, whistling sound produced when breathing
• what is haemoptysis?

  spitting or coughing up of blood or blood-streaked mucous
• what is COPD?

  chronic obstructive pulmonary disease
• what does COPD involve?

  patients with chronic bronchitis and emphysema
• what is chronic bronchitis?

  chronic cough that produces sputum for at least 3 months yearly for 2 consecutive years
• what is emphysema?

  dilation and destruction of lung tissue that is associated with loss of elastic tissue, resulting in loss of shape of air sacs
• what is ipratropium bromide ?

  anticholergenic drug used for treatment of COPD and asthma
• what is a metered dose inhaler (MDI) ?

  a device that delivers a specific amount of medication to the lungs in the form of short bursts of aerosolised medicine inhaled by the patient
• what is the normal range for the white cell count?

  4 - 11 x10^9 cells per litre
• what are some indications of infection?

  elevated WCC , yellow / green sputum
• what are commonly implicated organisms in a respiratory infection?

  streptococcus pneumoniae (gram positive bacteria), haemophilus influenzae (gram negative bacteria), parainfluenza virus
• what antibiotics are indicated in respiratory infections?

  first line - amoxicillin or some penicillin based antibiotic

  second line - tetracycline, erythromycin (macrolide based drug)
• name the 4 major groups in the penicillin structure

  beta-lactam ring, 5-membered sulphur containing ring, amide and carboxylic acid group
• explain how some bacteria have become resistant to penicillin

  they have become able to produce beta-lactamases, which are mutated transpeptidases that prevent penicillin from working
• describe structure of clavulanic acid

  beta-lactam ring, 5-membered O containing ring and carboxylic acid
• how is clavulanic acid used to overcome problems with resistance ?

  it destroys beta-lactamases by mimicking the shape of penicillin and entering the active site of beta-lactamases
• if there were problems with resistance with penicillin based antibiotics, what other antibiotic classes are a possibility?

  macrolides, or prescribe beta-lactamase inhibitor with penicillin based antibiotic
• name some examples of macrolides

  erythromycin, clarithromycin and azithromycin
• what formulation of antibiotic would be recommended for an outpatient?

  oral treatment, rather than IV
• what is the FEV1

  forced expiratory volume in one second - volume of air that can be forcibly expired in one second after full inspiration
• what is FVC?

  forced vital cappacity - the maximum amount of air that a person can expel after maximum inspiration in litres
• what is the normal FEV1/FVC ratio?

  80%
• what lifestyle changes could be recommended for a smoker with COPD?


  quit smoking, avoid passive smoking, exercise to improve quality of life
• what vaccine should a COPD patient receive annually?


  influenza every winter
• what is the mechanism of action of ipratropium bromide?

  Antagonist of the muscarinic acetylcholine receptors