Respiratory anatomy and disease

Question 1

Parasympathetic nerves cause bronchoconstriction and mucus secretion via the release of ACh which acts on which receptors?

Answer 1

M3 receptors

Question 2

What is the effect of blocking M2 receptors that are present on nerve terminals?

Answer 2

M2 receptors reduce the release of ACh by a feedback mechanism - so blocking them would lead to an increase in ACh

Question 3

There is no sympathetic innervation of human airway smooth muscle. True or false?

Answer 3

True

Question 4

How does ACh acting via M3 receptors cause muscle contraction?

Answer 4

Releases from vagus nerve
stimulates Gaq which stimulates IP3 and leads to increase in intracellular calcium
Ca2+ interacts with calmodulin to form a complex which can activate MLCK. The kinase phosphorylates myosin -> contraction

Question 5

How does activation of B-receptors via adrenaline and noradrenaline cause muscle relaxation?

Answer 5

Binding activates Gas which stimulates adenylyl cyclase leading to increased production of cAMP
cAMP activates PKA which phosphorylates several proteins - all act to reduce intracellular calcium
Less calcium so less MLCK activity so less myosin phosphorylation -> relaxation

Question 6

Which inflammatory cell is involved in asthma?

Answer 6

eosinophils

Question 7

which inflammatory cell is involved in COPD?

Answer 7

neutrophils

Question 8

What causes the immediate phase in allergic asthma?

Answer 8

the spasm of bronchial smooth muscle

Question 9

What are some of the disadvantages of B-agonists?

Answer 9

Receptor desensitisation
Receptor down-regulation
Refractory bronchoconstriction

Question 10

What are the advantages of xanthines in the treatment of asthma?

Answer 10

increase endogenous cAMP
enhance B2 agonist effects
antagonists at adenosine receptors

Question 11

Where are PDE4 found?

Answer 11

Airway smooth muscle

Question 12

What are the disadvantages of xanthines?

Answer 12

less effective than B-agonists
stimulate the heart
stimulatory effect on CNS - increased alertness, tremor
small therapeutic window

Question 13

What phosphorylates MLC?

Answer 13

MLCK

Question 14

What dephosphorylates MLCK?

Answer 14

MLC phosphatase

Question 15

The amount of muscle contraction is dependent on what?

Answer 15

The degree to which myosin is phosphorylated

Question 16

Which 2 G proteins can M3 receptors couple to?

Answer 16

Gaq

G12

Question 17

Is ipratropium bromide short acting or long acting?

Answer 17

short-acting muscarinic antagonist

Question 18

What are the advantages of antimuscarinic bronchodilators?

Answer 18

reduce mucus secretion

useful as add-on therapy in life-threatening asthma

Question 19

What are analeptics and name one.

Answer 19

Doxapram - they are respiratory stimulants for use in ventilatory failure

Question 20

What causes pneumothorax?

Answer 20

Injury to the chest and air enters as a result

Question 21

What disease may cause spontaneous pneumothorax?

Answer 21

emphysema

pneumonia

Question 22

How can pneumothorax be treated?

Answer 22

if minor - monitor by xray, absorption of air

if large - surgery to repair puncture

Question 23

What is tidal volume defined as?

Answer 23

The volume of air breathed in and out - in a healthy adults 500ml

Question 24

What is meant by vital capacity?

Answer 24

the greatest volume of air that can be expelled from the lungs after a deep breath in

Question 25

What is residual volume?

Answer 25

The air left in the lungs after forcing it out

Question 26

What is minute ventilation and what is the equation?

Answer 26

The amount of air inhaled/exhaled in a minute | tidal volume x respiratory rate

Question 27

What is alveolar ventilation and what is the equation for it?

Answer 27

The amount of gas that reaches the alveoli per breath | (tidal volume - dead space) respiratory rate

Question 28

Gaseous exchange takes place in the dead space. True or false?

Answer 28

False

Question 29

What is meant by FVC?

Answer 29

Forced vital capacity - maximum volume exhaled

Question 30

What is meant by FEV1?

Answer 30

Forced expiratory volume in 1 second

Question 31

What effect does obstructive lung disease have on FEV?

Answer 31

FEV is reduced

Question 32

What effect does obstructive lung disease have on FEV/FVC?

Answer 32

< 80%

Question 33

What effect does obstructive lung disease have on FVC?

Answer 33

Normal

Question 34

What effect does restrictive lung disease have on FEV?

Answer 34

reduced

Question 35

What effect does restrictive lung disease have on FEV/FVC?

Answer 35

> 80%

Question 36

What effect does restrictive disease have on FVC?

Answer 36

reduced

Question 37

What is meant by lung compliance?

Answer 37

The ease of expansion of the lungs and thorax

Question 38

In healthy individuals, what happens to lung volume when there is an increase in transpulmonary pressure?

Answer 38

When there is an increase in pressure, there is an increase in lung volume

Question 39

In patients with emphysema, what happens to lung volume when there is an increase in pressure?

Answer 39

A small increase in pressure will lead to a large increase in lung volume - because there is a lot of stretch but no recoil

Question 40

In patients with oedema or fibrosis, what effect will an increase in pressure have on lung volume?

Answer 40

there is low compliance - when pressure is applied, there is only a very small increase in lung volume

Question 41

Where are central chemoreceptors located?

Answer 41

brain stem medulla

Question 42

Where are peripheral chemoreceptors located?

Answer 42

aortic bodies | carotid bodies

Question 43

What are the aims of treatment for chronic asthma?

Answer 43

Control symptoms prevent exacerbations no need for rescue meds achieve best possible lung function tests

Question 44

Name a SABA

Answer 44

Salbutamol

Question 45

Name a LABA

Answer 45

Salmeterol

Question 46

What type of inhaler is salmeterol?

Answer 46

Controller

Question 47

What type of inhaler is salbutamol?

Answer 47

Reliever

Question 48

Name an inhaler that is a preventer

Answer 48

Beclamethasone

Question 49

How does a nebuliser work?

Answer 49

Aqueous solution of drug is converted into a mist for inhalation through a mask or mouthpiece

Question 50

Is coordination needed when using a nebuliser?

Answer 50

no

Question 51

What are some of ADRs of B-agonists?

Answer 51

Fine tremor Tachycardia Hypokalaemia

Question 52

How is prednisolone administered?

Answer 52

Orally

Question 53

What is hydrocortisone and how is it administered?

Answer 53

Corticosteroid and is administered IV

Question 54

What are the four indications that show ICS should be used?

Answer 54

Had exacerbations of asthma in the past two years Using an inhaled B-agonist more than 3 times/week Symptomatic > 3 times a week Waking 1 night per week

Question 55

Name two leukotriene antagonists that can be used in asthma treatment

Answer 55

Montelukast | Zafirlukast

Question 56

What is theophylline and how is it administered?

Answer 56

Methylxanthine administered orally

Question 57

Theophylline is a salt of aminophylline. True or false?

Answer 57

False - aminophylline is a salt of theophylline and can be administered orally/IV

Question 58

How does smoking have an effect on use of methlyxanthines?

Answer 58

Smoking increases clearance (and so reduces plasma levels) of methylxanthines - so a patient who smokes may need to have a higher dose for therapeutic effect

Question 59

Does obesity increase or decrease clearance of methylxanthines?

Answer 59

reduces clearance

Question 60

Name a cromone that can be used in asthma therapy.

Answer 60

Nedocromil

Question 61

What factors affect PEF?

Answer 61

Age Sex Height

Question 62

What does a PEF of <50% predicted indicate?

Answer 62

Acute severe asthma

Question 63

What is acute severe asthma determined by?

Answer 63

PEF < 50% predicted Ability to talk RR > 25 HR > 110

Question 64

What is the immediate treatment that is required for acute severe asthma?

Answer 64

oxygen at the highest possible conc: 40-60% B-agonist nebuliser or multiple doses via spacer Corticosteroid: 40mg prednisolone or 100mg hydrocortisone IV

Question 65

What does step 1 BTS/SIGN guidelines for adults asthma state?

Answer 65

low dose ICS

Question 66

What does step 2 BTS/SIGN guidelines for adults asthma state?

Answer 66

Add LABA to low dose ICS (usually a combination inhaler)

Question 67

What does step 3 BTS/SIGN guidelines for adults asthma state?

Answer 67

Increase ICS to medium dose, continue LABA | consider trialling LTRA SR theophylline, LAMA

Question 68

What does step 4 BTS/SIGN guidelines for adults asthma state?

Answer 68

Increase ICS to hgih dose and add a fourth drug: | LTRA, SR theophylline, B agonist tablet, LAMA

Question 69

What does step 5 BTS/SIGN guidelines for adults asthma state?

Answer 69

Continuous or frequent use of oral steroid | Consider other treatment to minimise use of steroid tablet

Question 70

COPD is curable. True or false?

Answer 70

False - treatable but not curable

Question 71

Sputum production is associated with asthma, not COPD. True or false?

Answer 71

False - COPD

Question 72

In diagnosis of COPD, what is airflow obstruction defined as?

Answer 72

FEV less than 80% predicted and post bronchodilatory FEV/FVC less than 70% predicted

Question 73

Male gender is a risk factor for COPD. True or false?

Answer 73

True

Question 74

Name 4 side effects of antimuscarinic drugs

Answer 74

Blurred vision Urinary retention Dry mouth Constipation

Question 75

In treating COPD, what is the percentage of oxygen delivered?

Answer 75

24-28%

Question 76

What is the criteria for use of long-term oxygen therapy?

Answer 76

FEV < 35%

Question 77

Which vaccines are offered for COPD patients?

Answer 77

Annual influenza vaccine | Pneumococcal vaccine

Question 78

What are antibiotics given for in COPD?

Answer 78

Infective exacerbations

Question 79

Name a mucolytic that is used in COPD treatment

Answer 79

Carbocisteine

Question 80

What is hypercapnia?

Answer 80

CO2 retention

Question 81

What is cor pulmonale?

Answer 81

Right heart failure - usually due to COPD

Question 82

What is step 1 in BTS/SIGN child asthma?

Answer 82

Very low dose ICS or if child is under 5 LTRA

Question 83

What does step 2 in BTS/SIGN child asthma state?

Answer 83

Very low dose ICS and if child is under 5 add: LTRA | Very low dose ICS and if child is over 5 add LABA

Question 84

What does step 3 in BTS/SIGN child asthma state?

Answer 84

No response to LABA - stop and increase ICS to low dose Response to LABA, but inadequate - Cont LABA, increase ICS to low dose Response to LABA, but inadequate, cont LABA and ICS, and consider LTRA

Question 85

What does step 4 BTS/SIGN child asthma state?

Answer 85

Increase ICS to med dose and consider addition of fourth drug SR theophylline

Question 86

What does step 5 BTS/SIGN child asthma state?

Answer 86

Daily use of steroid tab Maintain med dose ICS Consider other treatment to reduce