3. BAMS Respirology

Question 1

What 2 things do drugs used for ventilation do

What do respiratory stimulants do and give an example

Answer 1

Improve airway patency and prevent mast cell degranulation

Improve gas exchange - Theophylline

Question 2

What are beta-agonists and what 2 types are there

What are anticholinergics and what do they do

What do corticosteroids do

What does Theophylline do

Answer 2

Bronchodilators - short-acting and long-acting

Bronchodilators - reduce mucus secretions

Reduce bronchial wall inflammation

Relaxes bronchial smooth muscle (bronchodilator), increase heart muscle contractility and efficiency (increase heart rate), increase blood pressure and renal blood flow and has anti-inflammatory effects

Question 3

Asthma

What is asthma

Asthma mechanism is a triad of what

List 4 symptoms of asthma

List 4 triggers of asthma

Describe the 5 stages in asthma treatment

Answer 3

Reversible airflow obstruction

Airway smooth muscle constriction, inflammation of mucosa, increased mucus production

SoB, wheeze, chest tightness, cough

Exercise, cold air, environmental (dust), infection

1. Occasional short-acting beta-agonist
2. Low dose inhaled steroid
3. High dose inhaled steroid
4. Long-acting beta-agonist, antimuscarinic drugs, theophylline
5. Oral steroid

Question 4

COPD (Chronic Obstructive Pulmonary Disease)

What are the two components of COPD

List 2 causes of COPD

List 5 components involved in COPD management

Describe 2 ways that COPD can lead to respiratory failure

How can occupational lung disease progress to respiratory failure

Answer 4

Mixed airway reversible obstruction (asthma) and destructive lung disease (emphysema)

Smoking, environment lung damage

Stop smoking, oxygen support, long-acting bronchodilator, inhaled steroids (if FEV1 < 50%), systemic steroids

Alveoli destruction causes reduced surface area for gas exchange. Also by thickening of the alveolar mucosal barrier

Due to fibrosis or tumours

Question 5

Respiratory Failure

What is Type 1 respiratory failure

List 5 causes of Type 1 respiratory failure

What is Type 2 respiratory failure

List 4 causes of Type 2 respiratory failure

Answer 5

Hypoxaemia (PaO2 <60mmHg/8kPa). Oxygen SATS < 90%, CO2 respiratory drive

High altitude, VQ mismatch, diffusion abnormality, pneumonia, pulmonary embolism

Hypoxaemia with hypercapnia (PaCO2 >50mmHg/6.7kPa)

Increased airway resistance (COPD), airway blockage/narrowing (asthma), ventilation problems in muscles, neuromuscular dysfunction

Question 6

Cystic Fibrosis

Genetic cause of cystic fibrosis

What does this genetic defect causes

List 3 symptoms of cystic fibrosis

Describe 2 investigations undertaken for diagnosis of cystic fibrosis

List the 4 components of cystic fibrosis treatment

List 3 types of medications that can be used to treat cystic fibrosis

Answer 6

Inherited (recessive) genetic condition (both parents must have the gene) - caused by CFTR gene on chromosome 7

A defect in cell chloride channels, which causes excess sticky, solid mucus to be produced and consolidation of the lungs and pancreas

Troublesome cough, repeated chest infections, poor weight gain (in maintained appetite)

Perinatal test, sweat test (salt content in sweat is greater in individuals with cystic fibrosis)

Physiotherapy, exercise, medication, transplantation

Bronchodilators, steroids, antibiotics, DNAse (breaks down mucus), pancreatic enzyme replacement, nutritional supplements

Question 7

Sleep Apnoea

What is sleep apnoea caused by

What are the different types of sleep apnoea

Describe an investigation used to diagnose sleep apnoea

List 2 types of treatment used to treat sleep apnoea

Answer 7

Airway obstruction in sleep (>10s) due to drop in airway muscle tone

Central (brain) or obstructive (OSA)

AHI (apnoea hypopnea index) - a score of less that 10 indicates few problems

CPAP (continuous positive airway pressure), mandibular advancement devices (if tongue falls back)

Question 8

URTIs (Upper Respiratory Tract Infections)

Main pathogen associated with URTIs

What common infection can this cause

List 3 virulence factors associated with this pathogen

List 2 complications associated if not treated

Describe the two types of bronchitis

List 3 types of drugs associated with bronchitis treatment

List 3 symptoms of TB

List 2 types of TB investigations

List the 2 types of TB treatment

Answer 8

S. pyogenes

Strep throat (Group A S. pyogenes)

Pyrogenic exotoxins, streptolysins, hyaluronidase, M protein

Abscess, scarlet fever, otitis media

Acute (viral, during winter) and chronic (productive cough due to smoking, infection)

Decongestants, NSAIDs, antibiotics if appropriate

Malaise, fever, weight loss

CXR, skin test

Triple therapy, long-term DOTS course

Question 9

Pneumonia and Pneumolysin

What is pneumonia

List 5 symptoms associated with pneumonia

How is pneumonia treated

Describe the main investigation and findings for a pneumonia diagnosis

What does pneumolysin inhibit

What 4 things does this inhibition cause

Answer 9

Inflammation of the lung

Shortness of breath, fever, malaise, cyanosis, cough producing purulent sputum

CXR/clinical exam (lung consolidation)

Hospitalisation and IV antibiotics

Ciliated cell cavity

Activates complement, causes lung inflammation, decreases effectiveness of PMNs, stimulates monocytes to produce cytokines

Question 10

List 4 oral implications of smoking

Answer 10

Oral cancer, periodontal disease, stained teeth, keratosis (mucosal changes)