Respiratory diseases

Question 1

What are the types of Asthma?

Answer 1

Atopic
Non- Atopic
Occupational

Question 2

What type of reaction is Atopic Asthma?

Answer 2

Hypersensitivity reaction Type I

Question 3

What are people with Atopic Asthma likely to have a history of in their family?

Answer 3

Atopy

Question 4

What T cells are activated during an asthma attack?

Answer 4

T Helper Type II Lymphophytes

Question 5

What is the main granulocyte responsible for asthma and how is it stimulated and how does it create asthmatic symptoms?

Answer 5

Eosinophils - activated by IL-5.
these release IL - 3 & 4
this stimulates Plasma Cell production of IgE.
IgE bind with Mast Cells, making them ultrasenastitive to the original antigen

Question 6

What are the two phases of asthma?

Answer 6

Early Phase - immediate bronchoconstriction

Late Phase - arrival of further inflammatory cells which induce further inflammation

Question 7

What remodeling occurs to the bronchi?

Answer 7

Increased vascular permeability
Loss of epithelial cells 
Hypertrophy of goblet cells - increased muscous 
Hypertrophy of the smooth muscle 
Myofibroblast accumulation

Question 8

What are the main treatments for Asthma?

Answer 8

Anti-inflammatories
Bronchodilators
Anticholinergics

Question 9

Name a Beta 2 Blocker used in treatment of asthma

Answer 9

Salbutamol ; Salmetarol

Question 10

Name two inhaled steroids

Answer 10

Beclomethasone ; Fluticasone

Question 11

What receptor does Salbutamol work on?

Answer 11

Beta II

Question 12

WHat receptor does Tiotropium work on?

Answer 12

Muscarine III

Question 13

In COPD what is the term obstruction meant by?

Answer 13

There is difficulty in expiration resulting in increased residual volume and increased pressures thus affecting the inspiration.

Question 14

How might emphysema affect the oxygen diffusion?

Answer 14

Reduction in surface area - due to inflation of the acinar, caused by destruction in elastin.

remodelling increasing thickness of the membranes resulting in slower diffusion

Question 15

How would a obstruction disease such as COPD by diagnosed?

Answer 15

FEV1 <70%

Question 16

Why would patients with COPD have barrel chests, hyper percussion and Hemi - diaphragms?

Answer 16

The loss of elastin allows the chest wall to pull the lung further as compliance is increased. This creates large areas of lung which poorly ventilated by still increased in size.

Question 17

In terms of the emphysema present, what treatment can be given?

Answer 17

Supplemental oxygen

Question 18

What variables can affected your FEV1?

Answer 18

Age
Gender
Height

Potentially ethnicity
Potentially weight

Question 19

What treatments would be given to someone with COPD?

Answer 19

To stop smoking - biggest

Bronchioles:

• B2 agonists
• Muscurinic antagonists
• Inhalant corticosteriods

Acinar:
- Oxygen

Question 20

When would FVC be reduced in obstructive pulmonary disease?

If the FVC is reduced what would be increased?

Answer 20

If there is air trapping

Increased in Residual volume

Question 21

What is the more common diagnosis of reduced FVC?

Answer 21

Restrictive lung disease

Question 22

In peak expiratory flow rate measurements, if a patient has a variable forced expiration, what can this be a suggestion of? and why?

Answer 22

Asthma
- because it is reversible.

commonly see “morning dipping”

Question 23

What is Atelectasis? and causes?

Answer 23

Collapse/ loss of volume in the lung, lobe or segment.

usually due to obstruction to the conduction zone supplying that area i.e. tumour

Question 24

What is the definitions of Chronic Bronchitis?

Answer 24

Presence of cough and sputum produced most days produced for 3 months of 2 years

Question 25

What changes occur to the colmnar and cubodial epithelium in the ariways in COPD?

Answer 25

Metaplastic changes where the epithelium is changed to simple squamous

increased in goblet cells.

Question 26

Outwith pharmacological treatments for COPD, what else may be used to help?

Answer 26

Pulmonary rehabilitation

Question 27

Name a long acting anticholinergic

Answer 27

Tiotropium

Question 28

What are some of the common reasons for poor prognosis of asthma treatment?

Answer 28

• poor inhaler techniques
• poor compliance
• smoking - inhibits steroid ability

Question 29

List the stages of treatment for asthma?

Answer 29

stage 1. Low does ICS + SABA

Stage 2. Add LABA - usually a combo with ICS inhaler

Stage 3. Increased dose of ICS or add LAMA

Stage 4. [Referral to specialist care]. Increased dose of ICS

Stage 5. Add steriod tablet and up dose of ICS

Question 30

What would promote you do move up a stage of therapy for asthma?

Answer 30

SABA use > 3 doses a week

Question 31

What are common side effects of using ICS?

Answer 31

Dysphonia

oral candida infections

Question 32

What technique is used to assess pulmonary circulation. or Ventilation perfusion?

Answer 32

The ventilation pulmonary scan is a nuclear medicine scan that is to assess for any PE.

A radioactive isotope is breathed in followed by the injection of another radioactive isotope which allows the assessment of ventilation perfusion.

Question 33

What is a PET scan?

Answer 33

Position Emission tomography.

analyses the uptake of radioactive glucose which is rapidly taken up by tumour tissue. The substance can’t be broken down further and as such remain in the cell providing imaging.

Question 34

When would ultrasound be used to examine the chest?

Answer 34

For detection of plural fluid.

May also be useful for guided therapy of empyema drainage.

Question 35

Describe bronchoscopy

Answer 35

This is where a small camera is used to assess the airways - performed under local anesthesia with some mild sedation.
this can assess for obstruction and disorientation.

small samples of tissue may be taken