Other respiratory conditions

Question 1

COPD

Answer 1

:D

Question 2

COPD:

• Describe C
• Describe O
• Is airway obstruction both reversible (by what?) and non-reversible (due to what?
• What are the 2 types of COPD

Answer 2

Chronic and progressive
Airway is obstructed
Reversible by bronchodilators, non reversible due to airway remodelling
Chronic bronchitis and emphysema

Question 3

Do you need to know about chronic bronchitis and emphysema?

Answer 3

Yes

Question 4

Do you need to know the risk factors for COPD

/

Answer 4

Yes

Question 5

Chronic and acute aspects of pathophysiology:

• what immune cell is predominant in each?
• Do you need to know more detail?

Answer 5

ChroNic: Neutrophils
AcutE: Eosinophils
Yes

Question 6

Diagnosis: what will happen to:
-FEV1
-FVC
%FEV1/FVC
Peak expiratory flow rate 
-Flow volume diagram
-Do you need to know symptoms and FEV1 decreases for mild/mod/severe COPD?

Answer 6

FEV1 decreases 
FVC doesn't change 
FEV1/FVC decreases 
PEF decreases 
Cove shaped 
Yes

Question 7

Asthma vs COPD: differences in terms of

• Nature of airway obstruction
• Whether airflow obstruction can be improved
• Age of onset
• Do you need to know immune cell changes?

Answer 7

More intermittent vs progressively worsening
Improvement vs less improvement
Young vs 60+
Yes

Question 8

Do you need to know COPD epidemiology

Answer 8

Yes

Question 9

What are early interventions for COPD?

Answer 9

Encourage smoking cessation
Encourage exercise
Encourage flu and pneumococcal vaccinations
Treat comorbidites

Question 10

What are the pharmacological therapies for COPD

Answer 10

Dilators
Corticosteroids
Alpha-1 antitrypsin replacement

Question 11

Do you need to know more about dilators?

Answer 11

Yes

Question 12

Corticosteroids: describe efficacy in

• Chronic vs acute COPD
• COPD vs asthma

Answer 12

Not good in chronic (mainly neutrophils and macrophages), but good for acute (work on eosinophils)
Not as good as in treating asthma

Question 13

Should corticosteroids by the oral route be used long term, why?

Answer 13

No, due to sdie effects

Question 14

What factors should be considered when prescribing steroids for COPD

Answer 14

Frequency of exacerbations

Levels of eosinophils

Question 15

Alpha 1 antitrpysin:

• Where is it usually produced?
• After it is produced, what is its mechanism?
• What happens with alpha 1 antitrypsin deficiency

Answer 15

Liver
Travels to lung and coats it; protects lung elastin from being degraded by neutrophil elastase.
Alpha-1 antitrypsin gets stuck in liver, neutrophil elastase degrades elastin

Question 16

What medication is used to treat alpha 1 antitrypsin deficiency?

Answer 16

Alpha 1 proteinase inhibitor Zemaira

Question 17

What are late stage interventions

Answer 17

Oxygen therapy

Surgery

Question 18

Surgery

• Can surgery to reduce lung volume improve breathlessness?
• Is transplantation viable?

Answer 18

Yes

Question 19

How much oxygen therapy is needed per day?

Answer 19

15 hours

Question 20

Does the evidence say that e cigarettes have helped reduce smoking rates?

Answer 20

NO

Question 21

Is vaping safe?

Can vaping make you more susceptible to COVID?

Answer 21

No

Yes

Question 22

Do you need to know about

• Acute and long term effects of vaping?
• EVALI

Answer 22

Yes

Yes

Question 23

IDIOPATHIC PULMONARY FIBROSIS

Answer 23

:D

Question 24

Do you need to know

• Epidemiology
• Risk factors
• Symptoms

Answer 24

Yes

Question 25

Idiopathic pulmonary fibrosis pathology - first step: - What is the trigger? - What factors contribute to it? - What are the cellular effects?

Answer 25

Repetitive microinjuries Aging, environmental factors and genetic susceptibility Leads to epithelial cell senescence, apoptosis, proliferation, activation (to form proinflammatory mediators), EMT

Question 26

After this, what do the epithelial cells release?

Answer 26

Growth factors and cytokines

Question 27

How do growth factors and cytokines lead to fibrosis?

Answer 27

Fibroblast migration and proliferation ECm accumulation (from above cells) Differentiation of fibroblasts to myofibroblasts)

Question 28

Is there positive feedback regarding fibrosis formation?

Answer 28

Yes

Question 29

What is the histological and functional effect of fibrosis

Answer 29

Reduced sruface for gas exchange

Question 30

What are the 2 medical treatments for IPF

Answer 30

Pirfenidone (Esbrit) | Nintedanib (Ofev)

Question 31

For Pirfenidone and Nintedanib, do they treat the progression of IPF and reverse established fibrosis? Are both taken orally?

Answer 31

Only prevent progression, cannot reverse. | Yes

Question 32

Pirfenidone: mechanism of action

Answer 32

Inhibits TGF-B

Question 33

Nintedanib: mechansim of action?

Answer 33

Reduces growth factor signalling

Question 34

D you need to know more about Pirfenidone and Nintedanib?

Answer 34

Yes

Question 35

What is the surgical option for treating IPF?

Answer 35

Lung transplantation

Question 36

SILICOSIS

Answer 36

:D

Question 37

Alternative names for silica?

Answer 37

crystalline silica, crystalline silicon dioxide, SiO2

Question 38

Do you need to know - Silica content of various stones - Daily exposure limit of silica

Answer 38

Yes

Question 39

Silicosis: - Cause - Effect on lung structure and function?

Answer 39

Inhaling silica | Pulmonary interstitial fibrosis, progressive loss of lung functino

Question 40

Is there a cure for silicosis?

Answer 40

No

Question 41

how can silicosis be prevented?

Answer 41

Wet cutting Proper ventilation Washing hands and clothes, proper PPE

Question 42

What are the 3 types of silicosis? Do you need to know about them in detail?

Answer 42

Acute silicosis Accelerated silicosis Chronic silicosis

Question 43

Do you need to know about epidemiology?

Answer 43

Yes

Question 44

What are the 3 steps of silicosis pathogenesis?

Answer 44

Silica uptake: alveolar macrophagse phagocytose silica particles Inflammation: macrophages release ROS and cytokines, leading to activation of fibroblasts Macrophages undergo apoptosis, releasing silica. Silica is taken up by macrophages again, leading to positive feedback

Question 45

Do you need to know studies about these steps?

Answer 45

Yes

Question 46

What two drugs treat silicosis?

Answer 46

Nintedanib | Relaxin

Question 47

Do you need to know about relaxin?

Answer 47

Yes

Question 48

What procedure is used to treat silicosis? How does it work?

Answer 48

Whole lung lavage - put saline in lungs, removes silica.