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SBOMs > Lung > Flashcards

Lung Flashcards

1
Q

What proportion of pregnant women have asthma?

A

8%

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2
Q

Most severe asthma in which weeks of pregnancy?

A

24, 25 and 26

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3
Q

What is poorly controlled asthma in pregnancy linked with?

A 
Pre-eclampsia
Pre-term birth
IUGR
Perinatal death
Congenital malformations
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4
Q

How many women experience dyspnoea in pregnancy?

A

60%

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5
Q

What can you use to monitor asthma in asthmatic pregnant women?

A

FEV1 (doesn’t change in pregnancy even though resp minute volume increases)

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6
Q

How many women experience improvement/no change/worsening of their asthma in pregnancy?

A

Improvement: 34%
Unchanged: 26%
Worsen: 36%

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7
Q

What improvement in FEV1 is expected after salbutamol therapy?

A

12% improvement or more

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8
Q

What are the differential diagnoses for breathlessness in pregnancy?

A 
Dyspnoea of pregnancy
PE
Amniotic fluid embolism
Bronchitis/pneumonia
Post nasal drip (rhinitis)
Congestive heart failure/cardiomyopathy
GORD
Vocal cord dysfunction
Dysfunctional breathing
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9
Q

Management of asthma in pregnancy

A 
Smoking cessation
Vaccination
Body weight
Folate
Routine monitoring
Eduction about SE and adherence
Control of environmental triggers
Inhaler techniques
Management of existing conditions
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10
Q

What asthma treatments cannot/should not be used in pregnancy?

A

Leukotriene receptor antagonists
Anticholinergics
Immunotherapy

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11
Q

What is the advice for oral corticosteroids?

A

Not teratogenic
Small risk of cleft lip
Associated with low birth weight and pre-eclmapsia but possible confounding variable is severity of asthma
Benefits outweigh risks of uncontrolled asthma!

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12
Q

Is there any genetic link to maternal asthma?

A

ADAM33 gene is induced in allergic maternal asthma

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13
Q

Advice of how to avoid allergens?

A

Remove pets from home
Encase pillow and mattress with impermeable covers
Wash sheet and blankets weekly in hot water

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14
Q

Any advice for labour with maternal asthma?

A

Avoid carboprost, ergonovine and indomethacin

Instead use prostaglandin, MgSO4 or terbutaline

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15
Q

What other diseases are included in the COPD diagnosis?

A

Chronic bronchitis, emphysema and asthma

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16
Q

Spirometry diagnosis of COPD?

A

FEV1/FVC ratio less than 0.7

No reversibility with B2 agonists

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17
Q

What is LTOT?

A

Long term oxygen therapy
Increases survival for those with chronic respiratory failure
Lowers cardiac risk and improves cognition (not as hypocapnic)

18
Q

What are the arguments for smoking cessation in COPD?

A 
Improves mortality and health quality
Makes oxygen less risky
Inhalers work better
Less exacerbations
Improves mental and cardiovascular health
19
Q

Treatment of COPD?

A

Inhaled antimuscarinics + LABAs + steroids
Stand by oral steroids and antibiotics
Mucolytics

20
Q

What can be offered for repeated infective exacerbations of COPD?

A

Long term macrolide antibiotics

eg clarithromycin

21
Q

What is interstitial lung disease?

A

Any disease that affects the space between alveolar epithelium and capillary endothelium
Inflammation, fibrosis and remodelling

22
Q

Name 3 exposure related ILD causes

A

Occupational (asbestosis)
Environmental (dust mite hypersensitivity)
Medication (bleomycin)
CT disease

23
Q

Name the major idiopathic pulmonary fibroses

A

Idiopathic pulmonary fibrosis
Idiopathic non specific interstitial pneumonia
Respiratory bronchiolitis interstitial lung disease

24
Q

What is the most frequent ILD?

A

Idiopathic pulmonary fibrosis
Incidence is increasing
Median survival 3 yrs

25
Q

Risk factors for idiopathic pulmonary fibrosis

A 
Genetics (MUC58, TOLLIP, Telomerase)
Cigarette smoking > 20 pack years
Metal and woods dusts, farming, raising birds, stone cutting
Herpes viruses, EBV, CMV, Hep C
GORD
26
Q

Presentation of idiopathic pulmonary fibrosis

A 
Increases with age, males more than females
Exertional dyspnoea
Dry cough
Digital clubbing
Diffuse inspiratory crackles
27
Q

Diagnosis of idiopathic pulmonary fibrosis relies on:

A

Exclusion of other ILDs (CT diseases, environmental exposures, medications)
Presence of ‘Usual Interstitial Pneumonia’ (UIP) pattern on chest High Res Chest CT/surgical lung biopsy

28
Q

What does the ‘usual interstitial pneumonia’ pattern if disease involve?

A 
Bilateral patchy fibrosis
Basal/peripheral predominance
Reticular line and fibroblast foci
Honeycombing
Traction bronchiectasis
Architectural distortion
29
Q

When is a lung biopsy taken?

A

In ILD if HR CT is nor diagnostic
Mortality is 1-3%
Can have serious complications (pneumothorax, pneumonia, empyema, haemothorax)

30
Q

What factors are involved in the pathogenesis of ILD?

A

Myofibroblast accumulation and angiogeneis
TGFBeta, CTGF, ET-1, PDGF, VEGF
Excessive ECM and collagen

31
Q

Treatment of ILD?

A 
Pulmonary rehab
O2 therapy
Symptom control
Lung transplantation
Pirfenidone (anti TGF beta)
Nintedanib (anti PDGF, VEGF, FGF)
32
Q

What pattern of disease is seen in TB?

A

Apical lung cavitation

Casseous necrosis

33
Q

Presentation of TB

A

Night sweats
Cough
Weight loss
(for 6 months?)

34
Q

How is the diagnosis of TB made?

A

Sputum Ziehl-Nielsen stain
Induced sputum (culture takes weeks)
Bronchoscopy

35
Q

Describe how a TB culture is done?

A

Induced sputum culture
Decontamination of specimens to avoid bacterial overgrowth
Solid media
Bactec 460 radiometric culture detects CO2 production so only takes 1-3 weeks

36
Q

Treatment of TB

A 
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol 
(for 6 months minimum)
Nutritional support
Steroids?
37
Q

Why is drug resistance a threat?

A

Can take 18months of treatment if multiple drug resistant

Totally drug resistant strain found in India in 2012

38
Q

Why are cavities and extracellular matrix destruction key to the success of TB?

A

Spread of organism
Cavities permit immune evasion
Other mycobacteria and fungi can colonise cavities
Aerosol super-spreaders

39
Q

What are MMAs?

A

Matrix metalloproteinases
Can degrade fibrillar collagens at neutral pH
Are needed for cavity formation and transmission
Doxycycline suppresses MMP secretion and TB growth

40
Q

What is the role of MMAs in treatment?

A

Doxycycline suppresses MMP secretion and TB growth

Decreases cavitation and spread

SBOMs (18 decks)

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