Clinical Med Part 1 (Miller)

Question 1

What is asthma?

Answer 1

• A heterogeneous disease characterized by chronic airway inflammation and variable remodelling

Question 2

Who does asthma affect more of?

Answer 2

• Boys more than girls in childhood

- Women more than men post puberty

Question 3

What are some prenatal risk factors or triggers for asthma?

Answer 3

• Ethnicity
• Low SES
• Stress
• C-section
• Maternal tobacco smoking
• Prematurity causes four fold increase in risk

Question 4

What are some postnatal risk factors for asthma?

Answer 4

• Levels of endotoxins and allergens within the home
• Viral and bacterial infections
• Air pollution
• Antibiotic use
• Acetaminophen exposure
• Obesity

Question 5

What causes the airway inflammation in asthma?

Answer 5

• Type 2 hypersensitivity
• Sensitized by allergens like dust mites, pet dander, pollen, fungi
• Accompanying inflammatory infiltrate (eosinophils and mast cells)
• Defective resolution of process

Question 6

What causes the airway remodeling in asthma?

Answer 6

• Increased airway smooth muscle
• Thickened subepithelial reticular lamina
• Increased mucous cells in new areas
• Increased mucous production

Question 7

What is the clinical presentation of asthma?

Answer 7

• Cough, recurrent wheezing, chest tightness and SOB

Question 8

What is asthma typically worse?

Answer 8

• At night, with exercise, viral infection, exposure to allergens, changes in weather, laughing or crying

Question 9

How is asthma diagnosed?

Answer 9

• Combination of appropriate clinical symptoms in association with documented reversible airflow limitation and/or airway hyperresponsiveness

Question 10

Does a normal spirometry exclude the diagnosis of asthma?

Answer 10

• No

Question 11

What is the main goal for treatment of asthma?

Answer 11

• Provide the best quality of life through minimizing disease symptoms and abolishing disease exacerbations

Question 12

What are some complications of asthma?

Answer 12

• Poor quality of life
• Pneumonia
• Pneumothorax
• Asthma exacerbation
• Respiratory failure
• Airway remodeling

Question 13

What can cause an asthma exacerbation?

Answer 13

• Benign viral infections or allergens

Question 14

What can be used to treat and asthma exacerbation

Answer 14

• Bronchodilators, systemic glucocorticoids, O2

Question 15

What are some prevention methods that for asthma?

Answer 15

• Breastfeeding
• Avoidance of active and passive tobacco smoke exposure
• Interventions that target obesity
• Balanced diet comprising of adequate micronutrients
• Allergen avoidance
• Vaccinations

Question 16

What is COPD?

Answer 16

• Persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and lungs

Question 17

Who has a higher mortality with COPD?

Answer 17

• Men
• Older people
• People in poverty

Question 18

What are some COPD risk factors?

Answer 18

• Smoking/exposure to tobacco smoke
• History of tuberculosis
• Outdoor air pollution??

Question 19

What are the main pathological features of COPD?

Answer 19

• Obstructive bronchitis
• Emphysema
• Mucus hypersecretion

Question 20

What are some other pathological features of COPD?

Answer 20

• Chronic inflammation
• Accelerated aging of lung parenchyma
• Oxidative stress

Question 21

What does the oxidative stress in COPD lead to?

Answer 21

• Telomere shortening
• Cellular senescence
• DNA damage
• Mitochondrial dysfunction
• Decreased autophagy
• Stem cell exhaustion
• Decreased anti ageing molecules

Question 22

What is the pathology of acute exacerbations in COPD?

Answer 22

• Episodes of symptom worsening that are usually associated with increased airway inflammation and systemic inflammatory effects

Question 23

What are the symptoms of an acute exacerbation in COPD?

Answer 23

• Increased dyspnea
• Increased sputum purulence
• Increased cough
• Increased wheezing
• Beyond normal day-to-day variation

Question 24

What does the clinical presentation look like for COPD?

Answer 24

• Decreased capacity to exercise with parallel decrease in activity
• Low muscle strength
• Low BMI
• Other comorbidities

Question 25

What are the two phenotypes of people with COPD?

Answer 25

• Pink puffers

- Blue Bloaters

Question 26

How is COPD dianosed?

Answer 26

• FEV1/FVC <0.7
• Low FEV1
• <12% reversibility

Question 27

What are the different GOLD stages for COPD?

Answer 27

• Gold 1: FEV1 >80%
• Gold 2: 50% < FEV1 <80%
• Gold 3: 30% < FEV1 < 50%
• Gold 4: FEV1 < 30%

Question 28

What are the goals for treatment and management for COPD?

Answer 28

• Reduce symptoms– improve exercise intolerance and improve health status
• Reduce risk– prevent disease progression, prevent/treat exacerbations, reduce mortality

Question 29

What are some nonpharmacologic treatment for COPD?

Answer 29

• Pulmonary rehab
• Lung volume reduction surgery and transplantation
• Smoking cessation

Question 30

What are some pharmacologic treatments for COPD?

Answer 30

• Bronchodilators (prefer long acting meds: LABA=LAMA)
• Inhaled corticosteroids (for those at high risk of exacerbation)
• Oxygen

Question 31

What do bronchodilators do for COPD?

Answer 31

• Improve lung function, reduce breathlessness, improve exercise capacity, and improve health status

Question 32

What do inhaled corticosteroid do in COPD?

Answer 32

• Improves lung function, decrease breathlessness

- Increase risk of PNA, oral thrush, hoarse voice, maybe osteoporosis

Question 33

What does oxygen do in COPD?

Answer 33

• REDUCE MORTALITY

Question 34

How can COPD acute exacerbations be treated?

Answer 34

• Early RX prevents hospitalization and shorten recovery
• Oral antibiotics
• Oral corticosteroids (MAINSTAY)
• Oxygen if needed

Question 35

How can COPD exacerbations be prevented?

Answer 35

• Flu vaccine
• Pneumococcal vaccine
• Use of long acting bronchodilators and ICS