Respiratory

Question 1

Chronic Bronchitis

Answer 1

Hyper secretion of mucus caused by irritation from cigarette smoking and release of neutrophil elastase leading to protease activation.

Question 2

Emphysema

Answer 2

Alveolar wall destruction due to irritation from cigarette smoking and release of neutrophil elastase leading to protease activation.

Question 3

Respiratory Cardinal Symptoms

Answer 3

Chest Pain
SoB
Cyanosis
Cough
Sputum
Wheeze
Haemoptysis
Fever

Question 4

Order of treatment for acute asthma exacerbation

Answer 4

O SHIT ME
Oxygen
Salbutamol (nebuliser)
Hydrocortisone/Prednisolone
Ipratropium bromide
Theophylline
Magnesium
Escalate/intubate

Question 4

MoA and side effects of ICS

Answer 4

Switch off multiple inflammatory genes and reverse histone acetylation.
S/E = Oral thrush; hoarse voice

Question 5

MoA and side effects of SABA

Answer 5

Agonist of beta adrenergic receptors, therefore stimulating sympathetic bronchorelaxation
S/E = Tachycardia; trembling/fine tremor; palpitations; headaches

Question 6

COPD Immunology

Answer 6

1. Inflammation from cigarette smoke
2. Alveolar macrophage stimulation (release IL-8)
3. IL-8 stimulates CD8 T cells to release chemokines (TNF-a)
4. IL-8 stimulates neutrophils to release proteases which digest proteins - specifically within the parenchyma, leading to emphysema