Asthma and COPD

Question 1

what is asthma

Answer 1

recurrent episodes of airway obstruction due to chronic inflammatory hypersensitivity and hyperresponsiveness of airways

Question 2

symptoms of asthma and signs

Answer 2

wheeze (due to turbulent flow)
cough
SOB
atopy
family history of asthma, atopy
worse at night

Question 3

kind of inflammation in asthma (cell)

Answer 3

eosinophilic inflammation leadig to bronchospasma and mucosal inflammation

Question 4

diagnosis of asthma

Answer 4

FEV1/FVC salbutamol test

Question 5

treatment of acute asthma attack

Answer 5

oxygen, nebulised salbutamol, tiotropium

Question 6

asthma management

Answer 6

salbutamol (SABA) <3 times per week

otherwise manage with LABA, inhaled steroids/preventers (fluticasone, budesonide)

Question 7

complications of asthma

Answer 7

acute attack
collagen deposition/fibrosis
smooth muscle cell hyperplasia, goblet cell hyperplasia

Question 8

salbutamol side effects

Answer 8

tremor

Question 9

steroid complications in asthma

Answer 9

appettie/weight gain, interrption of sleep

oral thrush, dysphonia (hoarse voice)

Question 10

prednisolone side effects

Answer 10

weight gain/appetie
mood change
can raise blood sugar

Question 11

pathology of COPD

Answer 11

chronic bronchial inflammation/obstruction
loss of cilia
mucus hypersecretion
loss of A-C units, gas exchange surface area, loss of elastic support for airways

Question 12

what is tiotropium

Answer 12

a long acting anticholinergic used in COPD to reduce mucus, reduces exacerbations

Question 13

treatments available for COPD

Answer 13

anticholinergics (tiotropiums)
SABA
inhaled steroids +- LABA
oxygen if PaO2<55

Question 14

vaccinations for COPD patients

Answer 14

yearly influenza

5 yearly pneumococcal

Question 15

what is pneumonia

Answer 15

infection of alveolar units leading to VQ mismatch, diffusion impairment and increased work of breathign

Question 16

what is the rationale behind empiric antibiotics for community acquired pneumonia?

Answer 16

cover both typical and atypical organisms
outcomes are worse if we wait
usually start with penicillin and doxycyline

Question 17

antibiotics for TB

Answer 17

INAH, rifampicin, pyrazinamide, ethambutol

Question 18

findings on examination in asthma attack

Answer 18

tachypnoea
anxiety
wheeze
prolonged expiratory phase
cyanosis
use of accessory muscles

Question 19

types of inflammation in COPD

Answer 19

neutrophilic, macrophages

proteinase-antiproteinase imbalance destroying alveolar connective tissue

Question 20

changes in lung parenchyma in COPD

Answer 20

loss of alveolar-capillary membrane so loss of surface area for gas exchange
loss of elastic support
lose oxygenation capacity

Question 21

mechanism of emphseama

Answer 21

protease/antiprotease imablance digest elastin and other structureal proteins in alveolar wall
macrophages and t cell inflammation

Question 22

function of alpha1antitrypsin

Answer 22

degrade proteases in the lung and the liver

Question 23

why might you use slow vitgal capacity in assessing COPD

Answer 23

forced vital cpacity can cause airway collapse, trapping air and giving an underestimate of vital capacity

Question 24

what should the forced expiratory ratio be below to indicate obstruction

Answer 24

<0.7

Question 25

what kind of inflammation is asthma?

Answer 25

eosinophilic

Question 26

COPD goals of treatment

Answer 26

control symptoms improve lung function prevent exacerbations/deterioiration smoking cessation

Question 27

COPD treatment plan? side effeects?

Answer 27

mild: treat symptoms with short and long beta 2 agonist (salbutamol) but get tremor more: add tiotropium/anticholinergic to lower SOB, but get anti-SLUD severe: inhaled steroids (fluticasone) but get increased pneumonia risk also pulmonary rehabilitation couse (8 week exercise class) low dose theophylline may be antiinflammatory VACCINES: influenza and twice pneumoccocal 5 years apart HOME OXYGEN THERAPY

Question 28

requirements for home oxygen therapy

Answer 28

PaO2<55mmHg | smoking cessation

Question 29

what is lung volume reduction surgery

Answer 29

resection of emphysematous lung to decompress areas of functional lung

Question 30

what is a COPD exacerbation and how should it be treated

Answer 30

change in patients baseline SOB, sputum amount/colour, coough beyond normal day-day variations with acute onset. usually infectious, treat with doxycyline

Question 31

what happens to pulmonary pressures as CO increases

Answer 31

it stays the same by recruiting pulmonary vessels

Question 32

causes of pulmonary hypertension

Answer 32

increased Left atrial pressure increased pulmonary flow (fluid overload, left to right shunt) increased pulmonary vascular resistance (vasoconstriction in hypoxia etc)

Question 33

consequences of pulmonary hypertension

Answer 33

right ventricular dilation/hypertrophy can lead to systemic venous pressure elevation

Question 34

symptoms of pulmonary vascular disease

Answer 34

``` SOB syncope tiredness ankle swelling cough pleuritic pain haemoptysis ```

Question 35

signs of pulmonary vascular disease

Answer 35

right ventriucular heave loud P2 elevated JVP ascites

Question 36

what criteria dow e use to grade likeliness of PE

Answer 36

wells criteria

Question 37

PE diagnosis

Answer 37

D-dimer: negative result excludes PE CTPA VQ scan

Question 38

treatment for PE

Answer 38

supportive oxygen | anticoagulation (heparin and warfarin)

Question 39

causes of clubbing

Answer 39

NSCLC, bronchiectasis, fibrosis, SBE, biliary cirrhosis

Question 40

why do we do metabolic flap in resp exam

Answer 40

can be caused by hypercapnoea

Question 41

what lobe are we listening to on the back and why?

Answer 41

the oblique fissure goes up high posteriorly so it is the lower lobe

Question 42

what causes crackles physiologically? (2 things)

Answer 42

bubbling of air through secretions sudden opening of small airways with equalisation of pressure (at end of inspiration)

Question 43

percussion and breath soudns in pleural effusion?

Answer 43

decreased percussion and breath sounds

Question 44

percussion and breath sounds in consolidation?

Answer 44

increased breath sounds and decreased percussion