Lung diseases Flashcards
Where in the lung airways does asthma affect?
Conducting airways
Where in the lung airways does COPD affect?
Conducting airways and parenchyma
Where in the lung airways does ILD/IPF affect?
Lung parenchyma
Where in the lung airways does TB affect?
Anywhere in the lung
What %FEV1 improvement following Bronchodilator administration is indicative of asthma?
> 12%
Why does asthma worsen in pregnancy?
- 20% increase in o2 consumption
- 15% increase in metabolic rate
- 40-50% increased respiratory minute volume (amount of gas inhaled or exhaled in 1 min)
Factors for a diagnosis of asthma in pregnancy?
History of cough/wheeze/tightness
Reduced FEV1
Reduced FVC:FEV1 ratio
In what weeks of pregnancy is asthma worst?
24-26
Differentials to asthma in pregnancy?
Dyspnoea of pregnancy PE/amniotic fluid embolism Bronchitis/pneumonia Allergic rhinitis/sinusitis HF GORD Vocal cord dysfunction
What drugs should be used in asthma in pregnancy?
All can be used
SABA, LABA, corticosteroid, Theophylline (methyxanthine), chromones.
Corticosteroids associated with low birth weight and pre term birth should not be withheld in severe cases.
Long term treatment therapies for COPD?
Antimuscarinics, LABAs, ICS and LABA,
R/Fs for IPF?
Genetics - MUC5B Smoking Environmental exposure Microbial agents - Herpes (EBV, HHV7/8, CMV) GORD
Presentation of IPF?
Exertional dyspnoea
Dry cough
Clubbing
Diffuse inspiratory crackles
What do you have to exclude to diagnose IPF?
Exclude: Medications, Connective Tissue diseases, environmental exposures
Prognosis of IPF?
Median survival is 3 years
investigations to diagnose IPF?
Usual interstitial pneumonia (UIP) pattern on chest HRCT/ surgical lung biopsy
Complications of lung biopsy and mortality rate?
Acute exacerbations of interstitial disease
Pneumo/haemothorax
Empyema
Pneumonia
What characterises restrictive lung disease?
Loss of lung volume
Treatment for IPF?
- Nintedanib/pirfenidone (antifibrotics)
- Symptom control
- O2 therapy
- Transplant
- Pulmonary rehab
Usual presentation of pulmonary TB?
Cough
Weight loss
Night sweats
~6months of symptoms
Investigation findings for TB?
Atypical shadowing on CXR
Sputum acid-fast stain positive (Zhiel-Nielson)
Bronchoscopy
TB treatment? Length of treatment?
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol
For a minimum treatment length of 6 months
How many women require medical intervention for asthma in pregnancy?
45%
What investigations should you not perform for asthma in pregnancy?
Methacholine challenge
Skin prick testing
adherence rate for asthma medication in pregnancy?
50%
What allergic investigations would you perform in asthma in pregnancy?
IgE blood analysis
What are asthma exacerbations most associated with?
Low birth-weight babies
What gene is associated with asthma in pregnancy?
ADAM33
prediction of severity of COPD by FEV1?
> 80%, mild airways obstruction
50%- 80%, moderate airways obstruction
30%- 49%, severe airways obstruction
Types of oxygen therapy in stable COPD?
Long term oxygen therapy
Ambulatory oxygen (desat on exertion)
Palliative short burst oxygen therapy
Best way to improve mortality in COPD patients? Why?
Smoking cessation,
Makes oxygen less risky Inhalers work better Less exacerbations Improved mental health Improved cardiovascular health
Inhaled drug therapies in COPD?
Bronchodilators: Long acting anti-muscarinics/Long acting B-agonists
Inhaled steroids IN COMBINATION with Long acting B agonists
What is pulmonary rehab?
a program of exercise, education, and support to help you learn to breathe—and function—at the highest level possible.
Four key interventions to improve QOL in COPD?
FOOD /Smoking cessation /Pulmonary rehabilitation /oxygen therapy
Spirometry results of a COPD patient?
Obstructive FEV1/FVC with no bronchodilator reversibility
Investigation to diagnose IPF? If the first line isn’t diagnostic what would you perform?
HRCT
Surgical biopsy
Pattern of IPF on a HRCT?
Bilateral Basal/peripheral predominance Reticular lines Honeycombing Traction bronchiectasis
What type of pulmonary disease is IPF?
Restrictive
Tests for TB?
Sputum acid fast bacilli will be positive (zhiel-nielsen)
Induced sputum
Bronchoscopy
How long would a TB culture normally take to grow? What media may speed this up?
Several weeks
A Bactec 460 Radiometric culture
What is a ghon focus?
The primary site of TB infection
What does TB do to the ECM that allows it to be successful? What is the proposed mechanism of this?
Destroys it.
Increased secretions of MMPs
