Airways Diseases

Question 1

Chronic Bronchitis definition

Answer 1

Clinically defined: cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years

Question 2

What defines complicated chronic bronchitis?

Answer 2

When sputum turns mucopurulent (yellow/green) or when FEV1 falls

Question 3

Large airways morphological changes of chronic bronchitis

Answer 3

Mucous gland hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis

Question 4

Small airways morphological changes of chronic bronchitis

Answer 4

Goblet cells appear

Inflammation and fibrosis in long standing disease

Question 5

Definition of emphysema

Answer 5

Pathologically defined: airspaces damaged creating too large airspaces

Question 6

3 forms of emphysema and description of each

Answer 6

Centriacinar- primarily affects upper lobes
Panacinar- primarily affects lower lobes
Periacinar- close to edge of acinar unit

Question 7

2 main causes of emphysema and how they work

Answer 7

Smoking- induces protease-antiprotease imbalance, increase in elastase (type of protease) leading to tissue destruction

Alpha-1-antitrypsin defficiency- is an antiprotease, therefore too many proteases so tissue destruction

Question 8

Cor pulmonale definition

Answer 8

Right ventricle heart failure following RV hypertrophy

Question 9

Clinical symptoms/features of asthma in children

Answer 9

Panting, wheezing, cough, SoB, variable/reversible, responds to asthma treatment

Question 10

Goals of treatment of asthma

Answer 10

Patient centred- minimal symptoms, minimal need for medication, no attacks, improved quality of life

Question 11

Acronym for measuring control of asthma

Answer 11

SANE
Short acting beta agonist (blue inhaler) uses per week
Absences from school/nursery
Nocturnal symptoms times per week
Exertional symptoms times per week

Question 12

Inhaled corticosteroids side effects

Answer 12

Slight height suppression (0.5-1cm)
Oral candidiasis (thrush)- usually only when patient also has poor oral hygiene

Question 13

Lung deposition of drug with just inhaler vs also using spacer

Answer 13

<5% without spacer

<20% with spacer

Question 14

Signs of moderate acute asthma

Answer 14

Able to speak in complete sentences
HR<110BPM
RR<25
PEF 50-75%
SaO2>92%
PaO2>8kPa

Question 15

Signs of severe acute asthma

Answer 15

Any 1 of:
inability to complete sentences in 1 breath
HR>110BPM
RR>25
PEF 35-50%
SaO2>92%
PaO2>8kPa

Question 16

Signs of life threatening acute asthma

Answer 16

Any 1 of:
grunting
cyanosis
silent chest
impaired consciousness/exhaustion
PEF<33%
SaO2<92%
PaO2<8kPa
PaCO2 normal

Question 17

Signs of near fatal acute asthma

Answer 17

Raised PaCO2

Need for mechanical ventilation

Question 18

2 types of short acting beta agonists (relievers)

Answer 18

salbutamol

terbutaline

Question 19

Symptoms of COPD

Answer 19

Cough, SoB, sputum, frequent chest infections, wheezing, weight loss, fatigue, swollen ankles

Question 20

Examination signs of COPD

Answer 20

Cyanosis, raised JVP, cachexia, wheeze, hyperinflated chest, peripheral oedema

Question 21

Stages of COPD

Answer 21

Stage 1- FEV1>80%
Stage 2- FEV1 50-79%
Stage 3- FEV1 30-49%
Stage 4- FEV1<30%

Question 22

Pharmalogical management types for COPD

Answer 22

Inhaled therapy

• short acting bronchodilators
• long acting bronchodilators
• high dose ICS (with LABA)

Long term oxygen therapy

Question 23

2 types of short acting bronchodilators

Answer 23

SABA (eg salbutamol)

SAMA (eg ipratropium)

Question 24

Types of long acting bronchodilators

Answer 24

LAMA (eg umeclidium)

LABA (eg salmeterol)

Question 25

When to use long term oxygen therapy

Answer 25

PaO2<7.3kPa
or
PaO2 7.3-8kPa if:
-polycythaemia
-nocturnal hypoxia 
-peripheral oedema 
-pulmonary hypertension

Question 26

Percentage of smokers that develop COPD

Answer 26

around 15-20%

Question 27

Is inhalation or exhalation more difficult with obstructive lung disease?

Answer 27

Expiration