Extras

Question 1

best investigation and treatment for vocal cord dysfuntion

Answer 1

ix direct visualisation and provoke with forced exp movement

treat with speech therapy

Question 2

smoking graph- what age stop to prevent all premature mortality

Answer 2

30

Question 3

what is hypoxic pulmonary vasoconstriction

Answer 3

where there is hypoxia but not hypercapnoea, the pulmonary artery will constrict to direct blood flow to better oxygenated lung

happens in COPD, high altitude pulmonary oedema

Question 4

why does hypercapnoea happen in COPD

Answer 4

reduced ventilatory drive

Question 5

alpha trypsin def upper or lower

Answer 5

lower emphysema

compare smoking upper emphysema

Question 6

Why is COPD harder work

Answer 6

need larger volumes to optimise expiratory air flow, but harder work as stiffer chest wall and lung at larger inflation

air trapping happens because no time to expire the whole of this large volume, so builds up

Question 7

monitor disease activity in ABPA?

Answer 7

IgE total

Question 8

treat ABPA?

Answer 8

steroids and itraconazole

omalizumab may be used

Question 9

what is OMALIZUMAB?

Answer 9

monoclonal Ab against IgE- may reduce glucocorticoid requirements

Question 10

OSA does what to your health

Answer 10

indep RF for hypertension
indep all cause mortality if AHA over 30

assoc with HF, arrhythmia, DM- but shard risk factors
MVA 2-3 X 
IMPAIRED daily function
depression x 2
pulmonayr hypertension, stroke, CAD
Increase triglycerides
Increased periop complications

Question 11

How is the bernoulli effect involved in OSA

Answer 11

airflow velocity increase at site of narrowing–>pressure on lateral walls decreases–>collapse (BERNOULLI)

Question 12

why are you apnoeic in CSA?

Answer 12

hyperventilate which drives the CO2 down, expecially in NON REM SLEEP, but throughout sleep cycle (compare OSA)

always NON sustained HYPERCAPNOEIC
if high CO2, it is sleep related hypoventilation syndrome

Question 13

what do you do if CPAP causes CSA (can happen)

Answer 13

adaptive servoventilation

Question 14

NM disease what do you use for sleep?

Answer 14

Bipap not cpap

Question 15

Continuous oxygen therapy who gets it

Answer 15

PaO2 55 or under awake at rest 1 months post smoking
PaO2 59 or under if polycythemia, RHF or pulm hypertension on echo

15 hours per day for max benefit

can use intermittent for QOL if desat 88 or below on walk test

Question 16

MMRC dyspnoea scale 0-4

Answer 16

0- nil except strenuous
1- hurrying or hill
2-shorter of breath than others same age
3- after 100m or a few mins
4- cannot leave house, cannot get dressed

Question 17

COPDX severity based on FEV1

Answer 17

MILD- FEV1 60-80% PREDICTED- few sx and ADLs ok
MODERATE- FEV1 40-60%- breathless on the flat
SEVERE- FEV1 UNDER 40% PREDICTED- minimal exertions, complications of disease like pulm hypertension

Question 18

COPD diagnosis bronchodilator

Answer 18

ratio under 0.7 POST bronchodilator not fully reversible

earliest thing to go is actually lung volumes, before FEV1

Question 19

what proportion of smokers develop clinical disease CODP

Answer 19

10-20%

Question 20

systemic corticosteroids in COPD exac effect

Answer 20

improve FEV1, PaO2, reduce treatmetn failure, relapse, length stay

5 dys enough

Question 21

MOA of indacaterol

Answer 21

very long acting beta agonist

Question 22

effect of adding anticholinergic or LABA in COPD moderate

Answer 22

mortality
QOL
reduce exacerbations

Question 23

pneumovax does what

Answer 23

reduce invasive disease

Question 24

flu vax does what

Answer 24

reduce number and severity of exacerbations

Question 25

COPD mortality causes

Answer 25

probably resp over VCS and cancer

Question 26

beta blockers in COPD

Answer 26

even if severe disease or reversible component that is fine

Question 27

Survival improvement in COPD?

Answer 27

pharm therapy reduces symptoms, improves QOL, and reduces exac but NO improved survival or decline in FEV1