Airways Disease Flashcards
What are the indications for Tezepelumab?
When treatment with high-dose inhaled corticosteroids plus another maintenance treatment has not worked well enough. It is recommended only if people:
- have had 3 or more exacerbations in the previous year, or
- are having maintenance oral corticosteroids.
You suspect a patient has a fixed Upper airway obstruction. You want to calculate the Empey index.
What is the correct calculation?
A) FEV1 (ml) / PEF (l/min)
B) FEV1 (ml) / PEF (l/sec)
C) FEV1 (L) / PEF (l/min)
D) FEV1 (L) / PEF (l/sec)
E) FEV1 (L) / PEF (mls/min)
A) The Empey index, which assists in identifying upper/large airway obstruction, is >10 and adds
diagnostic weight to the possible presence of UAO.
N.B. Empey index =FEV1 (ml) / PEF (l/min)
As per NICE 2024 Asthma guideline, What is a positive FeNO test indicative of asthma (with asthma symptoms)?
A) 25ppb
B) 40ppb
C) 50ppb
D) 60ppb
E) 70ppb
C) 50ppb
Measure the blood eosinophil count or fractional exhaled nitric oxide (FeNO) level in adults with a history suggestive of asthma. Diagnose asthma if the eosinophil count is above the laboratory reference range or the FeNO level is 50 ppb or more. [BTS/NICE/SIGN 2024]
As per NICE 2024 Asthma guideline, What is a positive bronchodilator reversitibility with spirometry indicative of asthma (with asthma symptoms)?
A) FEV1 increase is 12% or more OR 200 ml
B) FEV1 increase is 12% or more and 200 ml
C) FEV1 increase is 10% or more OR 200 ml
D) FEV1 increase is 10% or more and 200 ml
E) FEV1 increase is 12% or more and 400 ml
B) FEV1 increase is 12% or more and 200 ml
If asthma is not confirmed by eosinophil count or FeNO level, measure bronchodilator reversibility (BDR) with spirometry. Diagnose asthma if the FEV1 increase is 12% or more and 200 ml or more from the pre-bronchodilator measurement (or if the FEV1 increase is 10% or more of the predicted normal FEV1). [BTS/NICE/SIGN 2024]
You see a 17 year old patient with cough and wheeze. He has had FeNO of 20ppb and eosinophills of 0.2. Unfortunately the wait for Spirometry with BDR is 2 months.
What is the next appropriate management plan
A) No further tests needed. Diagnose as Asthma
B) Perform peak expiratory flow BD for 2 weeks
C) Refer for consideration of a bronchial challenge test.
D) Start ICS/LABA AIR therapy
E) Wait for Spirometry with BDR
B) Perform peak expiratory flow BD for 2 weeks
If spirometry is not available or it is delayed, measure peak expiratory flow (PEF) twice daily for 2 weeks. Diagnose asthma if PEF variability (expressed as amplitude percentage mean) is 20% or more. [BTS/NICE/SIGN 2024]
You are in asthma clinic and given a direct bronchial challenge test to interpret (methacholine).
What is deemed a negative test for bronchial hyperresponsiveness?
A) PC20 of >16mg/ml
B) PC20 of <16mg/ml
C) PC20 of > 8mg/ml
D) PC20 of >4mg/ml
E) PC20 of <2mg/ml
A) PC20 of >16
In a clinical population the test is highly sensitive, such that a normal (negative) methacholine challenge (PC20 >16 mg·mL−1, PD20 >400 μg or 2 μmol) effectively excludes current asthma if symptoms were present within the previous few days
AHR - airway hyperresponsiveness
Normal - >16mg/ml
Borderline - 4 - 16mg/ml
Mild - 1 - 4mg/ml
Moderate - 0.25 - 1mg/ml
Marked - <0.25mg/ml
What are radiological features of ABPA both in CT and CXR as per ISHAM criteria?
CT: bronchiectasis, mucus plugging and high-attenuation mucus
CXR: fleeting opacities, finger-in-glove and lung collapse.
What are cut offs of total IgE, specific IgE and serum eosinophils features of ABPA as per ISHAM criteria?
Essential components:
- A. fumigatus-specific IgE ≥0.35 kUA/L−1
- Serum total IgE ≥500 IU/mL−1
Other components (any two)
- Positive IgG against A. fumigatus
- Blood eosinophil count ≥500 cells·µL−1 (could be historical)
- Thin-section chest CT consistent with ABPA (bronchiectasis, mucus plugging and high-attenuation mucus) or fleeting opacities on chest radiograph consistent with ABPA
How is an acute exacerbation of ABPA diagnosed?
Exacerbation: In a patient with diagnosed ABPA:
* Sustained (>14 days) clinical worsening; or
* Radiological worsening; and
* Increase in serum total IgE by ≥50% from the last recorded IgE value during clinical stability, along with
* Exclusion of other causes of worsening.
How long should Acute ABPA be treated for with Prednisolone or Itraconazole?
A) 1 Month
B) 2 months
C) 3 months
D) 4 months
E) 5 Months
D) 4 months
We recommend a low-to-moderate dose (0.5 mg·kg−1·day−1 for 2–4 weeks, tapered and completed over 4 months) of oral prednisolone (LoC: 78.1%) or oral itraconazole (LoC: 73.5%) for 4 months as the initial therapy for treating acute ABPA.
- ISAHAM -ABPA guidelines (ERS 2024)
What are the criteria for COPD GOLD Severity A?
mMRC 0-1/CAT <10
0-1 moderate exacerbation
No Hospital admission for exacerbation
What are the criteria for COPD GOLD Severity B?
mMRC ≥2/CAT ≥10
0-1 moderate exacerbation
No Hospital admission for exacerbation
What are the criteria for COPD GOLD Severity E?
Any mMRC or CAT
≥2 moderate exacerbations
or
≥1 exacerbation leading to hospital
Name all criterias for the UK MRC dyspnoea score from 1-5
1 - Not troubled by breathlessness except on strenuous exercise
2 - Short of breath when hurrying or walking up a slight hill
3 - Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
4 - Stops for breath after walking about 100 metres or after a few minutes on level ground
5 - Too breathless to leave the house, or breathless when dressing or undressing
A patient with COPD has a FEV1 of 35%. What is his severity?
Stage 3 – Severe
Stage 1 - Mild - FEV1 ≥ 80%
Stage 2 - Moderate - FEV1 ≥ 50 - 79%
Stage 3 - Severe - FEV1 30 - 49%
Stage 4 - Very severe - FEV1 <30%
What additional feature of COPD in NICE guideline puts you into a very severe category?
A) Pulmonary HTN on ECHO
B) Severe emphysema on CT
C) RV >155%
D) DLCO <40%
E) FEV1 <50% with respiratory failure
E) FEV1 <50% with respiratory failure
Stage 4 – Very severe (or FEV1 below 50% with respiratory failure)
What are the indications for Roflumilast?
FEV1 <50%
&
2 or more exacerbations in the last year
despite being on LAMA/LABA/ICS
Use of Oral corticosteroids for asthma in the first trimester increases which risk?
A) Worsening asthma symptoms
B) Cleft Lip/palate
C) High Birth weight
D) Infant Diabetes
E) No increased risk
B) Cleft Lip/palate
What is the inheritance pattern of alpha-1-antitrypsin?
A) Autosomal co-dominant
B) Autosomal dominant
C) Autosomal recessive
D) X-linked dominant
E) X-linked recessive
A) Autosomal co-dominant
Alpha-1 antitrypsin deficiency (AATD) is inherited in families in an autosomal codominant pattern. Codominant inheritance means that two different variants of the gene (alleles) may be expressed, and both versions contribute to the genetic trait.
You are asked to report a spirometry for a patient. He is a 45 male and ex smoker. He 150cm with weight of 90kg.
His FEV1 is 1.7 litres (69% predicted)
FVC 1.7 litres (61% predicted)
Ratio 100% predicted
What is the most likely cause?
A) Asthma
B) COPD
C) Severe IPF
D) Obesity
E) Poor effort
D) Obesity
Raised BMI
Moderate Restrictive pattern
You review a flow volume loop with a expiratory loop that is truncated but normal inspiratory loop.
What is the most likely cause from the below?
A) Laryngeal tumour
B) Thyroid goitre
C) Tracheal stenosis secondary to EGPA
D) Tumour causing tracheal compression
E) Vocal cord paralysis
D) Tumour causing tracheal compression
On expiration, tumour pushes the trachea IN so causes truncation. In Inspiration the tumour is pushed out so causes no issues.
You review a flow volume loop with a inspiratory loop that is truncated but normal expiratory loop.
What is the most likely cause from the below?
A) Laryngeal tumour
B) Thyroid goitre
C) Tracheal stenosis secondary to EGPA
D) Tumour causing tracheal compression
E) Vocal cord paralysis
A) Laryngeal tumour
&
E) Vocal cord paralysis
ON breathing in the laryngeal tumours are sucked in causing inspiratory truncation while on expiration they are pushed into the wall causing little truncation
You review a flow volume loop with both inspiratory and expiratoy loop truncation
What is the most likely cause from the below?
A) Laryngeal tumour
B) Thyroid goitre
C) Tracheal stenosis secondary to EGPA
D) Tumour causing tracheal compression
E) Vocal cord paralysis
C) Tracheal stenosis secondary to EGPA
tracheal stenosis is fixed and air flow is both reduced in inspiration and expiration
In pregnancy what happens to respiratory physiology?
Expiratory Reserve volume (ERV) - Reduced
Functional Residual Capacity (FRC) - decreased
Minute ventilation - Increases
Total Lung Capacity - No change
Arterial pCO2 - Decreases
