Case 3

Question 1

What is the most important risk factor to smoking

Answer 1

Smoking

Question 2

What is a risk factor for COPD

Answer 2

Antiproteniase (alpha 1 antitrypsin deficency

Airway hyper-reactivity

Question 3

What are the investigations for COPD

Answer 3

Lung function test
Blood gasses 
Sputum examination 
Blood count 
Alpha 1 - antitrypsin levels and genotype

Question 4

Why is a sputum examination used in COPD

Answer 4

Sputum colour can help identify infection

Question 5

What are the lung function tests and what are the results

Answer 5

Evidence of airflow limitation
FEV1 less than 80%
FEV1:FVC ration less than 70%
PEFR low

Question 6

What is the treatment for COPD

Answer 6

Stopping smoking 
Bronchodilators 
Corticosteroids 
Antibiotics 
Oxygen therapy

Question 7

What is the aim in bronchodilators with COPD

Answer 7

Beta Adrenergic agonist

Question 8

What colour would the sputum be if there was a bacterial infection in COPD

Answer 8

Yellow or green

Question 9

What is the aim of oxygen therapy

Answer 9

Increase the PaO2 to at least 8 kPa

Question 10

Why would you not give 100% O2 to a COPD patient

Answer 10

In a COPD patient there is less new oxygen going in and less old carbon dioxide coming out therefore there is a higher co2 conc in the alveoli and over time the patient becomes sensitised to the Hypercapnia and relies on hypoxaemia to driver the ventilation and o2 would reduce this.

Question 11

What level of O2 would be given to a COPD patient

Answer 11

24%-28%

Question 12

What percentage of oxygen would be given if the respiratory rate increases above 30

Answer 12

40% o2

Question 13

What are the clinical features of COPD

Answer 13

Emphysema

Chronic Bronchitis

Question 14

What are the three mechanisms are suggested for the limitation of airflow in small airways

Answer 14

Loss of elasticity and alveolar attachments of airways due to emphysema
Inflammation and scarring cause the small airways to narrow
Mucus secretion which blocks the airways

Question 15

Summary of Emphysema, chronic Bronchitis and asthma

Answer 15

Emphysema = alveolar wall destruction and over inflation (air gets trapped and causes them to over inflate
chronic bronchitis = production cough and airway inflammation
Asthma = reversible obstruction

Question 16

What would a reduces FEV1 but normal FCV be

Answer 16

airways obstruction

Question 17

What would a Reduced FEV1 and FVC of less be

Answer 17

airways restriction

Question 18

What bacteria causes pneumonia

Answer 18

Streptococcus pneumoniae

Question 19

What is Bronchiectasis

Answer 19

Damaged cell wall thus bigger bronchus thus dilated bronchus

Question 20

What is hemoptysis

Answer 20

coughing up blood

Question 21

What is hepatization of lungs

Answer 21

red blood cells, neutrophils, and fibrin in the pulmonary alveolus

Question 22

What is the common organism in a patient with bronchiectasis

Answer 22

Pseudomonas auerginosa

Question 23

What type of emphysema is caused by an alpha one antitrypsin deficiency

Answer 23

Pan acinar emphysema

Question 24

What does Pan and Acinar mean

Answer 24

Pan means whole and Acinar means a clump of acinus ( alveoli )

Question 25

What is the gene that codes for Alpha 1 Antitrypsin in the liver

Answer 25

Serpina 1 on chromosome 14

Question 26

What does the Pi Z mutation of Alpha 1 antitrypsin cause

Answer 26

it gets stuck in the endoplasmic reticulum in the liver hepatocytes which can damage the liver causing scaring and then billie ruben builds up and then you can have jaundice

Question 27

Would having a normal allele and a mutant allele for alpha 1 antitrypsin be symptomatic ?

Answer 27

Not normally in a non smoker

Question 28

What produces elastase

Answer 28

neutrophils

Question 29

What does elastase do normally

Answer 29

important immunological role of breaking down Shigella virulence factors

Question 30

What happens when elastase meets alpha one antitrypsin

Answer 30

it destroys elastase