Describe the typical clinical features of common respiratory conditions

Question 1

What is COPD?

Answer 1

A lung disease caused by inflammation of the small airways. Includes chronic bronchitis (characterized by productive cough ≥ 3 months in 2 consecutive years) and emphysema (dilation of the air spaces distal to the terminal bronchioles). Most cases of COPD (~ 90%) are caused by smoking.

Question 2

What is the definition of emphysema?

Answer 2

Abnormal, permanent dilation of the air spaces distal to the terminal bronchioles leading to hyperinflation, hypoxia, and dyspnea. Caused by destruction of the alveolar walls and capillaries required for gas exchange. Etiological factors include smoking, air pollution, and inhalation of chemical fumes and dust. Emphysema is a key component of COPD. Emphysema commonly leads to the formation of bulla.

Question 3

What is the definition of bronchitis?

Answer 3

A lower respiratory tract infection that causes inflammation of the bronchi. Most frequently caused by a viral infection. Typically manifests with a self-limited cough.

Question 4

What is the definition of bronchiectasis?

Answer 4

An irreversible and abnormal dilation of the bronchial tree. Typically caused by chronic pulmonary infections, obstructive pulmonary diseases (e.g., COPD), or disorders of secretion clearance and mucous plugging (e.g., cystic fibrosis). Typically presents with chronic cough productive of copious, mucopurulent sputum.

Question 5

What are some of the signs of chronic bronchitis?

Answer 5

Elevated haemoglobin Polycythaemia Peripheral oedema Rhonchi and wheezing Overweight and cyanotic

Question 6

What is the first line therapy for COPD?

Answer 6

1. SABA/SAMA

Question 7

What is the second line therapy for patients with COPD who do not show asthmatic features?

Answer 7

1. Offer a LABA+LAMA (Fluticasone + Tiotropium)

Question 8

What is the third line therapy for patients with COPD who do not show asthmatic features?

Answer 8

• add an ICS

Question 9

What is the second line therapy for patients with COPD who do show asthmatic features?

Answer 9

1. LABA + ICS

Question 10

What is the third line therapy for patients with COPD who do show asthmatic features?

Answer 10

• LABA + LAMA + ICS

Question 11

What 5 therapies should be commenced in an acute exacerbation of COPD?

Answer 11

1. Antibiotics
2. Steroids
3. Nebulised salbutamol
4. Ipratropium bromide (SAMA)
5. Oxygen

Question 13

How can PFTs be used to make a diagnosis of COPD and stage it?

Answer 13

In pulmonary function testing, a post-bronchodilator FEV1/FVC ratio of <0.70 is commonly considered diagnostic for COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) system categorises airflow limitation into stages. In patients with FEV1/FVC <0.70: GOLD 1 - mild: FEV1≥ 80% predicted GOLD 2 - moderate: 50% ≤ FEV1 < 80% predicted GOLD 3 - severe: 30% ≤ FEV1 < 50% predicted GOLD 4 - very severe: FEV1 <30% predicted.

Question 14

What does LTOT stand for?

Answer 14

Long term oxygen therapy

Question 15

What are the criteria for receiving LTOT?

Answer 15

PaO2 <7.3kPa or 55mmHg (Between 55-65mmHg or 7.3-8kPa if the patient aslo has pulmonary hypertension, peripheral oedema, erythrocytosis) SaO2 <88%

Question 16

What is Cor pulmonale?

Answer 16

Altered structure (hypertrophy, dilation) or impaired functioning of the right ventricle caused by a primary disorder of the respiratory system (e.g., COPD, cystic fibrosis, interstitial lung disease, pulmonary embolism). The primary respiratory disorder causes acute/chronic pulmonary hypertension, which in turn causes acute/chronic right heart failure.

Question 17

What is the first line therapy for chronic asthma?

Answer 17

• SABA inhaler

Question 18

What is the second line therapy for chronic asthma?

Answer 18

1. SABA
2. Low dose ICS

Question 19

What is the third line therapy for chronic asthma?

Answer 19

1. SABA
2. ICS
3. LABA

Question 20

What is the FOURTH line therapy for chronic asthma?

Answer 20

1. SABA
2. ICS
3. LABA
4. LTRA

Question 21

What is a MART inhaler?

Answer 21

MART inhalers include a steroid preventer medicine and a certain type of long-acting bronchodilator medicine which can also be used as your emergency reliever.

Question 22

What is the first line medical therapy for pleural abscess?

Answer 22

Antibiotics

Question 23

What si the management of empyema?

Answer 23

Antibiotics

Question 24

What is the intervention for pneumothorax?

Answer 24

Thoracocentesis with 14 gauge needle in 2nd ICS MCL

Question 25

What are the indications for thoracocentesis in pneumothorax?

Answer 25

1. tension
2. breathlessness
3. >2cm

Question 26

Give lights criteria for diagnosing a pleural effusion as exudative or transudtaive

Answer 26

The fluid is considered an exudate if any of the following are found:

• Ratio of pleural fluid to serum protein > 0.5
• Ratio of pleural fluid to serum LDH > 0.6
• Pleural fluid LDH > two-thirds of the upper limits of normal serum value

Question 27

What is the maximum amount of fluid that should be removed from a pleural effusion?

Answer 27

1L is the maximum amount of fluid that should be removed, or re-perfusion pulmonary oedema may occur (sudden expansion of the lung stimulates stretch receptors, blood vessels then release vasoactive factors into the lung parenchyma)

Question 28

Where should a chest drain for a pleural effusion be placed?

Answer 28

• 5th ICS MAL

Question 29

What is the management of a haemodynamically unstable patient with a PE?

Answer 29

1. Start unfractionated heparin (UFH) in haemodynamically unstable patients prior to thrombolysis.
2. alteplase thrombolysis

Question 30

What is the management of a haemodynamically unstable patient with a PE with an absolute contraindication to thrombolysis or anticoagulation?

Answer 30

• vasoactive drug (dobutamine or noradrenaline)

Question 31

What is the STAR approach to quitting smoking?

Answer 31

S = Set a quit date (based on the patient’s willingness, motivation and agreement, usually within 2-4 weeks, abrupt quitting more effective than gradual)

T = Tell family and friends (encourage to create a strong support system)

A = Anticipate challenges/obstacles patient will face and how to overcome them

R = Remove all tobacco products, recommend counselling programs and pharmacological therapies as indicated

Question 32

What are the 3 pharmacological agents which can help with smoking cessation?

Answer 32

1. NRT
2. Bupropion (bupropion acts via dual inhibition of norepinephrine and dopamine reuptake)
3. Varenicline (Nicotine receptor partial agonist)