Respiratory

Question 1

What are the main classes of drugs used to treat respiratory disease?

Answer 1

inhaled corticosteroids
bronchodilators

Question 2

What kind of drugs end in “…mab”?

Answer 2

monoclonal antibodies

Question 3

What kind of drugs end in “…sone”?

Answer 3

corticosteroids

Question 4

What kind of drugs end in “…lone”?

Answer 4

corticosteroids

Question 5

What kind of drugs end in “…terol”?

Answer 5

bronchodilators

Question 6

What kind of drugs end in “…nib”?

Answer 6

kinase inhibitors

Question 7

What are the advantaged for inhaled medicines?

Answer 7

lungs are robust
large surface area for absorption
rapid absorption
fewer drug metabolising enzymes
fewer systemic side effects

Question 8

What lung diseases are associated with bronchoconstriction?

Answer 8

Asthma
COPD

Question 9

How does bronchoconstriction differ between asthma and COPD?

Answer 9

it is mostly irreversible in asthma and much less reversible in COPD

Question 10

What are the categories of bronchodilator drugs?

Answer 10

adrenergic (sympathetic)
causes bronchodilation

anti-cholinergic (parasympathetic)
blocks bronchoconstriction

Question 11

What is another name for adrenergic bronchodilators?

Answer 11

beta 2 adrenergic agonists

Question 12

What diseases are associated with respiratory inflammation?

Answer 12

pneumonia
asthma
COPD
IPF (idiopathic pulmonary fibrosis)

Question 13

How do you decide what drugs to use to treat respiratory inflammation?

Answer 13

determine whether it’s chronic or acute exacerbate inflammation and treat based on that

Question 14

What class of drugs are used to treat respiratory inflammation?

Answer 14

glucocorticoids (inhaled corticosteroids: ICS)

Question 15

What is a limitation of treated respiratory inflammation with glucocorticoids?

Answer 15

only really effective for asthma, relatively ineffective in COPD, CF, IPF

people with severe asthma can become resistant

Question 16

What are the side effects of ICS?

Answer 16

loss of bone density
adrenal suppression
cataracts, glaucoma

Question 17

What is the pleura?

Answer 17

lining of the lung

Question 18

Describe the basic anatomy of the pleura.

Answer 18

2 layers:
visceral pleura- forms outer covering of lung
parietal pleura- forms inner lining of chest wall

between the 2 layers in the pleural space which contains about 5-10mls of fluid

Question 19

What is the purpose of the pleura?

Answer 19

allows optimal expansion and contraction of lungs

pleural fluid and visceral and parietal pleurae to glide over with friction during respiration

Question 20

What is a pneumothorax?

Answer 20

‘collapsed lung’

presence off air in the pleural space

Question 21

What causes a pneumothorax?

Answer 21

air enters the lungs due to:
- hole in lung/ pleura
- chest wall injury

intra pleural pressure is negative, which leads to air being sucked into cavity

Question 22

What are the classifications of pneumothorax?

Answer 22

• primary spontaneous
• secondary spontaneous
• traumatic
• iatrogenic

Question 23

What is a primary spontaneous pneumothorax?

Answer 23

collapsed lung with no underlying lung disease

rupture of apical pleural bleb

Question 24

What are the risk factors for a primary spontaneous pneumothorax?

Answer 24

male
smoker
tall
age 20-40 y/o

Question 25

What is secondary spontaneous pneumothorax?

Answer 25

collapsed lung in presence of known lung disease

Question 26

What type of lung disease causes secondary spontaneous pneumothorax?

Answer 26

60% COPD asthma/ ILD/ CF/ lung cancer cystic lung disease also... Infection: - PCP/ TB - lung abscess Genetic predisposition: - Marfan's syndrome, Birt-Hogg Dube - LAM (lymphangioleiomyomatosis) Catamenial pneumothorax

Question 27

What is a traumatic pneumothorax?

Answer 27

penetrating chest wall injury may be a puncture from a rib may also rupture bronchus/ oesophagus

Question 28

What is iatrogenic pneumothorax?

Answer 28

'doctor induced' collapsed lung risks include: - pacemakers - CT lung biopsies - central line insertion - mechanic ventilation - pleural aspiration

Question 29

How does pneumothorax present?

Answer 29

asymptomatic acute/ sudden breathlessness pleuritic chest pain cough

Question 30

What is the worst possible complication of pneumothorax?

Answer 30

life threatening respiratory failure/ cardiac arrest

Question 31

What are the symptoms of lung cancer?

Answer 31

LOCAL: - increasing shortness of breath - continuous cough for more than 3 weeks - haemoptysis - recurrent chest infections GENERALISED/ SYSTEMIC: - general malaise - weight loss - paraneoplastic syndrome

Question 32

What type of cancer are most lung tumours?

Answer 32

90% are carcinomas others include: - benign tumours - salivary gland tumours - soft tissue tumours (sarcomas) - lymphoma

Question 33

What is the classification of lung carcinomas?

Answer 33

non-small cell lung carcinoma (NSCLC) small cell lung carcinoma (SCLC)

Question 34

How is non-small cell lung cancer treated?

Answer 34

resection +/- chemotherapy

Question 35

What % of lung carcinomas are non-small cell?

Answer 35

85%

Question 36

What are the 3 main types of non-small cell lung carcinoma?

Answer 36

adenocarcinoma squamous cell carcinoma large cell carcinoma

Question 37

How do you differentiate between types of non-small cell carcinomas?

Answer 37

can only really differentiate from the histology

Question 38

What risk factor is most associated with small cell carcinoma?

Answer 38

cigarette smoking

Question 39

What is ILD?

Answer 39

interstitial lung disease

Question 40

What is an example of restrictive lung disease?

Answer 40

emphysema interstitial lung disease

Question 41

How can interstitial lung diseases be physiologically measured?

Answer 41

- restriction of lung volumes (measured by FVC) - reduction in lung gas transfer efficiency (DLCO/ TLCO) - hypoxia, particularly on exertion - reduction in exercise capacity

Question 42

Why is not possible to lump all ILDs together?

Answer 42

because treatment varies massively depending on the type of ILD

Question 43

Describe the pathophysiology of idiopathic pulmonary fibrosis.

Answer 43

- fibroblasts repair damaged tissue - fibroblasts migrate to the lungs and become myofibroblasts - myofibroblasts deposit collagen in the extracellular matrix - In IPF, these fibroblasts are resistant to apoptosis (cell death) - my-fibroblasts proliferate and form fibroblastic foci - the thickened tissue leads to lower gas exchange efficiency in the lungs

Question 44

What are the key features of idiopathic pulmonary fibrosis?

Answer 44

- collections of fibroblasts - thickening of alveolar interstitium - destruction (honeycombing) of alveoli - affects periphery and base of lungs - spatial heterogeneity (normal lung tissue next to abnormal tissue)

Question 45

How is IPF treated?

Answer 45

pirfenidone and nintedanib

Question 46

What are the main side effects of pirfenidone?

Answer 46

photosensitivity (skin rash) gastrointestinal upset

Question 47

How does pirfenidone affect the progression of IPF?

Answer 47

does not improve the condition, patients will still worsen but the decline won't be as steep

Question 48

What is the main side effect of nintedanib?

Answer 48

diarrhoea

Question 49

What is the mechanism of action of nintedanib?

Answer 49

inhibitor or multiple tyrosine kinase receptors interferes with processes such as fibroblast proliferation, migration and differentiation and secretion of extracellular matrix (collagen)

Question 50

Can nintedanib improve IPF?

Answer 50

no- same as pirfenidone in that sense, won't reverse any damage but will slow down deterioration

Question 51

What is hypersensitivity pneumonitis?

Answer 51

also called extrinsic allergic alveolitis inflammation of the lungs as part of an allergic reaction

Question 52

What type of reaction is hypersensitivity pneumonitis?

Answer 52

type III hypersensitivity reaction

Question 53

What is the typical presentation of TB?

Answer 53

lung infection, productive cough, blood in the sputum

Question 54

What vaccine protects against TB?

Answer 54

BCG vaccine

Question 55

What is the leading killer of people with HIV?

Answer 55

TB

Question 56

What does "smear positive" mean in TB?

Answer 56

if there is enough bacteria in the sputum to see the bacterium under the microscope

Question 57

How do acquire TB if not from other people?

Answer 57

drinking unpasteurised cows milk- cows can be infected with m.bovis which can give humans TB of the gut

Question 58

What is the historical name for TB?

Answer 58

consumption

Question 59

What is the classic x-ray sign of TB?

Answer 59

cavity in apex of lung (white ring at top of lung)