Formative questions Flashcards
Function of the lungs
(1. ) Gas exchange
(2. ) Acid-base balance
(3. ) Defence
(4. ) Hormones
(5. ) Heat exchange
Type 1 vs type 2 resp failure?
Type 1 respiratory failure is when there is low oxygen and normal or low carbon dioxide
Type 2 respiratory failure is when there is low oxygen and raised carbon dioxide.
What would you expect the FEV1/FVC ratio to be in restrictive vs obstructive lung disease. Can you give an example for each?
(1.) FEV1/FVC ratio of <0.7 in obstructive lung disease. Examples: asthma, bronchiectasis, bronchitis, COPD
(2.) FEV1/FVC ratio normal in restrictive lung disease.
Examples: interstitial lung disease, scoliosis, neuromuscular disease, marked obesity
What do you expect to happen to gas exchange in people with interstitial lung disease?
The ability for gas exchange is diminished due to the thickening of the alveolar membrane in patients with ILD.
Describe the pathophysiology of idiopathic pulmonary fibrosis.
(1. ) Fibroblasts are sent to the lungs to repair damaged tissue and become myofibroblasts - these deposit collagen into the extracellular matrix
(2. ) In IPF they are resistant to apoptosis so myofibroblasts proliferate and form fibroblastic foci.
(3. ) This process results in thickened tissue and reduced gas exchange causing symptoms of breathlessness.
(4. ) As the fibrosis worsens it causes honeycombing of the alveoli especially at the periphery and bases of the lungs.
(5. ) There are areas of the lung that remain normal with other areas with extensive disease.
(6. ) This is the most aggressively progressing fibrotic ILD.
In hypersensitivity pneumonitis, what type of hypersensitivity reaction does it rely on and therefore what is a key component to acquiring this disease? Therefore what questions would you want to include in your history if you suspect this diagnosis?
(1.) Type 3 hypersensitivity = reaction
which is a result of immune complex formation between antibody and antigen.
(2. ) Pt must have been previously exposed to the antigen in order to form the antibody and it is on repeat exposure that this occurs also referred to as “prior sensitisation”.
(3. ) Identification of the antigen is the primary goal so you would want to know if they have any pets, details of occupation, hobbies, exposure to mould, etc.
List at least three medications that can cause drug-induced ILD.
(1. ) Nitrofurantoin
(2. ) methotrexate
(3. ) amiodarone
(4. ) bleomycin
(5. ) novel checkpoint inhibitors used for cancer.
What are the three main pathophysiologic changes that occur in asthmatics?
(1. ) Inflammation of the mucous membranes
(2. ) increased secretions
(3. ) contraction of the bronchiolar musculature.
What is a typical presenting history of a patient with asthma vs COPD?
Asthma
(1. ) Episodic wheeze, cough, breathlessness, diurnal variation.
(2. ) Onset early in life.
(3. ) Provoking factors: allergens, infections, menstrual cycle, exercise, cold air, laughter/emotion.
(4. ) Fax or PMHx of atopy (hay fever, eczema, asthma), food allergies or drug allergies.
COPD
(1. ) Progressive breathlessness, may have wheeze and cough as part of symptoms.
(2. ) Less day to day and diurnal variation.
(3. ) Onset later in life.
(4. ) Smoking history.
(5. ) Provoking factors: infections, cold air.
What factors help you assess the severity of disease in asthmatics?
We need to assess their day to day control and how often they have exacerbations.
(1. ) Number of inhalers they use
(2. ) recent nocturnal waking
(3. ) usual asthma symptoms in the day
(4. ) interference with ADLs (activities of daily living)
(5. ) How often they require rescue treatments including antibiotics and steroid course
(6. ) how often they present to AE, any previous admissions to HDU or ITU and if they have ever been intubated due to their asthma
What complications can arise from frequent use of oral steroids (ex. prednisolone)?
Diabetes, cataracts, osteoporosis, hypertension, skin thinning, easy bruising, growth retardation, osteonecrosis of the femoral head, adrenal suppression.
What score do we use to risk stratify patients with pneumonia? Describe the components of the score and what the scores advise.
CURB65:
- C = Confusion (AMTS <8/10)
- U = Urea <7
- R = RR >30
- B = <90/60mmHg
- 65 = >65y
0-1: mild
- only admit if social circumstances dictate or single worrying feature
- PO amoxicillin or if penicillin allergy clarithromycin or doxycycline
2: moderate
- admit to hospital
- PO amoxicillin AND clarithromycin
3-5: severe
- admit and monitor closely
- IV co-amoxiclav and clarithromycin
4-5
- consider admission to critical care unit
- IV co-amoxiclav and clarithromycin
What red flag symptoms would you associate with lung cancer?
- Haemoptysis
- cough
- recurrent chest infections
- increasing SoB
- General “type B” symptoms of cancer: weight loss, loss of appetite, nausea, night sweats, fatigue.
Mesothelioma is associated with exposure to what and what is the prognosis?
Associated with asbestos exposure affecting the pleura.
Duration from diagnosis to death - 8-12 months.
In the UK, who is at risk of contracting tuberculosis?
Those born in high prevalence areas (mainly in London), IVDU, homeless, HIV+, alcoholics, prisioners.
