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BMS3052 > Respiratory & Sleep Disorders > Flashcards

Respiratory & Sleep Disorders Flashcards

1
Q

Define

Accelerated silicosis

A

an aggressive form of pneumoconiosis. It is caused by the inhalation of large amounts of respirable crystalline silica (very fine silica dust). This scars the lungs and causes progressive respiratory impairment.

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2
Q

Define

Acute silicosis

A

silicosis that happens after weeks or months of being around high levels of silica

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3
Q

Define

Asthma

A

Chronic inflammatory lung disease that leads to reversible narrowing of the airways, associated with increased airway hyperresponsiveness (AHR). Includes recurring episodes of breathing problems including shortness of breath, wheezing, chest tightness or night-time or early morning coughing

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4
Q

Define

Bronchodilator

A

a drug that relaxes bronchial muscle resulting in expansion of the bronchial air passages

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5
Q

Define

Bronchospasm

A

constriction of the air passages of the lung (as in asthma) by spasmodic contraction of the bronchial muscles

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6
Q

Define

Broncial thermoplasty

A

a procedure that applies directed heat to the airway walls, reducing the bulk of airway smooth muscle and thereby reducing the potential for airway constriction

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7
Q

Define

Calmodulin

A

a calcium-binding protein that mediates cellular metabolic processes (such as the contraction of muscle fibers) by regulating the activity of calcium-dependent enzymes

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8
Q

Define

Chronic obstructive pulmonary disease (COPD)

A

pulmonary disease (such as emphysema or chronic bronchitis) that is characterized by chronic typically irreversible airway obstruction resulting in a slowed rate of exhalation

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9
Q

Define

Chronic silicosis

A

silicosis that results from long-term exposure (more than 20 years) to low amounts of silica dust

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10
Q

Define

Dysphonia

A

defective use of the voice

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11
Q

Define

Extrinsic (allergic) asthma

A

asthma that is triggered by an allergen (such as dust mites, pet dander, pollen, or mold)

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12
Q

Define

Fibrosis

A

a condition marked by increase of interstitial fibrous tissue

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13
Q

Define

Forced expiration volume in one second (FEV1)

A

the volume of air (in liters) exhaled in the first second during forced exhalation after maximal inspiration

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14
Q

Define

Forced vital capacity (FVC)

A

the maximum amount of air a person can expel from the lungs after a maximum inhalation. It is equal to the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume

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15
Q

Define

Iatrogenic Cushing’s syndrome

A

Cushing’s syndrome that is usually related to prolonged and/or high-dose oral or parenteral steroid use

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16
Q

Define

Inhaled corticosteroid (ICS)

A

the most effective controllers of asthma. They suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2)

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17
Q

Define

Intrinsic (non-allergic) asthma

A

asthma that has a range of non-allergenic triggers, including weather conditions, exercise, infections, and stress

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18
Q

Define

Leukotriene receptor antagonists (LTRA)

A

a class of oral medication that is non-steroidal. They may also be referred to as anti-inflammatory bronchoconstriction preventors. They work by blocking a chemical reaction that can lead to inflammation in the airways

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19
Q

Define

Long-acting β2-adrenoeptor agonist (LABA)

A

usually prescribed for moderate-to-severe persistent asthma patients or patients with chronic obstructive pulmonary disease (COPD). They are designed to reduce the need for shorter-acting β2 agonists such as salbutamol (albuterol), as they have a duration of action of approximately 12 hours

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20
Q

Define

Mepolizumab

A

a humanized monoclonal antibody used for the treatment of severe eosinophilic asthma. It recognizes and blocks interleukin-5, a signalling protein of the immune system

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21
Q

Define

Nebulisation

A

a drug delivery device used to administer medication in the form of a mist inhaled into the lungs

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22
Q

Define

Non-T2-type asthma

A

asthma that commonly has an older age of onset and is often associated with obesity and neutrophilic inflammation

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23
Q

Define

Obstructive lung disease

A

a type of lung disease that occurs due to blockages or obstructions in the airways. Blockages damage the lungs and cause their airways to narrow. This damage leads to difficulty breathing

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24
Q

Define

Omalizumab

A

an immunosuppressive drug that is a recombinant monoclonal antibody selectively binding to IgE to reduce allergic reactions and that is administered by subcutaneous injection especially in the treatment of asthma and chronic hives

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25
Q

Define

Prophylaxis

A

measures designed to preserve health (as of an individual or of society) and prevent the spread of disease

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26
Q

Define

Restrictive lung disease

A

a group of lung diseases that prevent the lungs from fully expanding with air. This restriction makes breathing difficult

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27
Q

Define

Salbutamol

A

a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist which works by causing relaxation of airway smooth muscle

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28
Q

Define

Short-acting β2-adrenoeptor agonist (SABA)

A

a bronchodilator that targets the beta receptors that has a short half-life

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29
Q

Define

Silicosis

A

pneumoconiosis characterized by massive fibrosis of the lungs resulting in shortness of breath and caused by prolonged inhalation of silica dusts

How well did you know this?
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30
Q

Define

Spirometry

A

an instrument for measuring the air entering and leaving the lungs (as in determining lung function in the diagnosis of pulmonary disease)

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31
Q

Define

Sputum

A

matter expectorated from the respiratory system and especially the lungs that is composed of mucus but may contain pus, blood, fibrin, or microorganisms (such as bacteria) in diseased states

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32
Q

Define

T2-type asthma

A

asthma that is associated with Type 2 inflammation and typically includes allergic asthma and moderate-to-severe eosinophilic asthma

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33
Q

Define

Thunderstorm asthma

A

asthma that is triggered by a combination of grass pollen in the air and certain thunderstorm conditions

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34
Q

Definition

an aggressive form of pneumoconiosis. It is caused by the inhalation of large amounts of respirable crystalline silica (very fine silica dust). This scars the lungs and causes progressive respiratory impairment.

A

Accelerated silicosis

How well did you know this?
1
Not at all
2
3
4
5
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35
Q

Definition

silicosis that happens after weeks or months of being around high levels of silica

A

Acute silicosis

How well did you know this?
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36
Q

Definition

Chronic inflammatory lung disease that leads to reversible narrowing of the airways, associated with increased airway hyperresponsiveness (AHR). Includes recurring episodes of breathing problems including shortness of breath, wheezing, chest tightness or night-time or early morning coughing

A

Asthma

How well did you know this?
1
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3
4
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37
Q

Definition

a drug that relaxes bronchial muscle resulting in expansion of the bronchial air passages

A

Bronchodilator

How well did you know this?
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38
Q

Definition

constriction of the air passages of the lung (as in asthma) by spasmodic contraction of the bronchial muscles

A

Bronchospasm

How well did you know this?
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39
Q

Definition

a procedure that applies directed heat to the airway walls, reducing the bulk of airway smooth muscle and thereby reducing the potential for airway constriction

A

Broncial thermoplasty

How well did you know this?
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Not at all
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40
Q

Definition

a calcium-binding protein that mediates cellular metabolic processes (such as the contraction of muscle fibers) by regulating the activity of calcium-dependent enzymes

A

Calmodulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Definition

pulmonary disease (such as emphysema or chronic bronchitis) that is characterized by chronic typically irreversible airway obstruction resulting in a slowed rate of exhalation

A

Chronic obstructive pulmonary disease (COPD)

How well did you know this?
1
Not at all
2
3
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5
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42
Q

Definition

silicosis that results from long-term exposure (more than 20 years) to low amounts of silica dust

A

Chronic silicosis

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43
Q

Definition

defective use of the voice

A

Dysphonia

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44
Q

Definition

asthma that is triggered by an allergen (such as dust mites, pet dander, pollen, or mold)

A

Extrinsic (allergic) asthma

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45
Q

Definition

a condition marked by increase of interstitial fibrous tissue

A

Fibrosis

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46
Q

Definition

the volume of air (in liters) exhaled in the first second during forced exhalation after maximal inspiration

A

Forced expiration volume in one second (FEV1)

How well did you know this?
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47
Q

Definition

the maximum amount of air a person can expel from the lungs after a maximum inhalation. It is equal to the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume

A

Forced vital capacity (FVC)

How well did you know this?
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48
Q

Definition

Cushing’s syndrome that is usually related to prolonged and/or high-dose oral or parenteral steroid use

A

Iatrogenic Cushing’s syndrome

How well did you know this?
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2
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49
Q

Definition

the most effective controllers of asthma. They suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2)

A

Inhaled corticosteroid (ICS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Definition

asthma that has a range of non-allergenic triggers, including weather conditions, exercise, infections, and stress

A

Intrinsic (non-allergic) asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Definition

a class of oral medication that is non-steroidal. They may also be referred to as anti-inflammatory bronchoconstriction preventors. They work by blocking a chemical reaction that can lead to inflammation in the airways

A

Leukotriene receptor antagonists (LTRA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Definition

usually prescribed for moderate-to-severe persistent asthma patients or patients with chronic obstructive pulmonary disease (COPD). They are designed to reduce the need for shorter-acting β2 agonists such as salbutamol (albuterol), as they have a duration of action of approximately 12 hours

A

Long-acting β2-adrenoeptor agonist (LABA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Definition

a humanized monoclonal antibody used for the treatment of severe eosinophilic asthma. It recognizes and blocks interleukin-5, a signalling protein of the immune system

A

Mepolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Definition

a drug delivery device used to administer medication in the form of a mist inhaled into the lungs

A

Nebulisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Definition

asthma that commonly has an older age of onset and is often associated with obesity and neutrophilic inflammation

A

Non-T2-type asthma

How well did you know this?
1
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2
3
4
5
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56
Q

Definition

a type of lung disease that occurs due to blockages or obstructions in the airways. Blockages damage the lungs and cause their airways to narrow. This damage leads to difficulty breathing

A

Obstructive lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Definition

an immunosuppressive drug that is a recombinant monoclonal antibody selectively binding to IgE to reduce allergic reactions and that is administered by subcutaneous injection especially in the treatment of asthma and chronic hives

A

Omalizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Definition

measures designed to preserve health (as of an individual or of society) and prevent the spread of disease

A

Prophylaxis

How well did you know this?
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59
Q

Definition

a group of lung diseases that prevent the lungs from fully expanding with air. This restriction makes breathing difficult

A

Restrictive lung disease

How well did you know this?
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60
Q

Definition

a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist which works by causing relaxation of airway smooth muscle

A

Salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Definition

a bronchodilator that targets the beta receptors that has a short half-life

A

Short-acting β2-adrenoeptor agonist (SABA)

How well did you know this?
1
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2
3
4
5
Perfectly
62
Q

Definition

pneumoconiosis characterized by massive fibrosis of the lungs resulting in shortness of breath and caused by prolonged inhalation of silica dusts

A

Silicosis

How well did you know this?
1
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2
3
4
5
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63
Q

Definition

an instrument for measuring the air entering and leaving the lungs (as in determining lung function in the diagnosis of pulmonary disease)

A

Spirometry

How well did you know this?
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2
3
4
5
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64
Q

Definition

matter expectorated from the respiratory system and especially the lungs that is composed of mucus but may contain pus, blood, fibrin, or microorganisms (such as bacteria) in diseased states

A

Sputum

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65
Q

Definition

asthma that is associated with Type 2 inflammation and typically includes allergic asthma and moderate-to-severe eosinophilic asthma

A

T2-type asthma

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66
Q

Definition

asthma that is triggered by a combination of grass pollen in the air and certain thunderstorm conditions

A

Thunderstorm asthma

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67
Q

What are the five main respiratory conditions effecting Australians?

A

COPD

Asthma

Acute lower respiratory tract infection

tuberculosis

lung cancer

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68
Q

Are respiratory conditions more common in men or women?

A

Similar

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69
Q

What are the symptoms of asthma?

A

shortness of breath, tightness of chest, cough, difficulty breathing

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70
Q

Which population of people are at risk for thunderstorm asthma even if they don’t usually have asthma?

A

Hayfever sufferers

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71
Q

What are the key findings to data from the Hazelhood Mine Fire Study?

A

Poorer perceived general health compared to no exposure group

Self-reported respiratory symptoms higher

No significant relationships between exposure to smoke and self-reported doctor-diagnosed high blood pressure, high cholesterol, any cardiovascular condition, diabetes or cancer.

Increase in medical symptoms but not an increase in diagnoses

No association between fetal growth and gestational maturity but some evidence of an increase in gestational diabetes

Increased psychological distress in both adults and children

no effect on asthma-related symptoms, lung function of airway inflammation in adults

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72
Q

Following the Hazelwood Mine Fire, why did we see an increase in medical symptoms but not an increase in diagnoses?

A

symptoms have been sub‐clinical, participants have not reported their symptoms to medical practitioners and the process from symptom onset to diagnosis may often be protracted.

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73
Q

Following the Hazelwood Mine Fire, why did we see no effect on asthma related symptoms?

A

Mowell residents seem to be on medium to high doses of preventers

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74
Q

Bushfire smoke causes increased hospital presentation of people with which conditions?

A

Asthma

COPD

Other respiratory infections

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75
Q

What did the Australian Firefighters health study find?

A
  • Overall mortality lower (strong healthy worker effect and lower rates of smoking)
  • No evidence of increase in cardiovascular or respiratory mortality
  • Statistically significant increase in prostate cancer for full time, careers fire fighters - SIR 1.23 (1.10 - 1.37)
  • Significant increase in melanoma - 1.45 (1.26 - 1.66)
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76
Q

Who is most at risk of silicosis?

A

Stonecutters

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77
Q

What are the three forms of silicosis?

A

Acute

Accelerated

Chronic

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78
Q

What exposure time period is typical for acute silicosis?

A

few weeks to years

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79
Q

What exposure time period is typical for accelerated silicosis?

A

3-10 years

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80
Q

What exposure time period is typical for chronic silicosis?

A

10+ years

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81
Q

What factors influence lung function?

A
  • inflammation – airway and tissue
  • changes to airway smooth muscle
  • epithelial damage
  • mucus plugging
  • alveolar damage
  • fibrosis – airway and tissue
  • tumour
  • obesity
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82
Q

What conditions are considered an obstructive lung condition? What would the spirometry look like for these conditions?

A

Asthma

COPD

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83
Q

What conditions are considered an restrictive lung condition? What would the spirometry look like for these conditions?

A

IPF

Silicosis

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84
Q

If FEV1/FVC is less than the predicted lower limit of normal what does that tell us?

A

Airway obstruction

Could be asthma or COPD

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85
Q

How do you determine whether an obstructive lung disease is asthma or COPD?

A

If the patient responds to a bronchodilator then it is probably asthma, otherwise it could be COPD

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86
Q

If FEV1/FVC is not less than the predicted lower limit of normal and FVC is also low what does that tell us?

A

Restrictive pattern

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87
Q

If FEV1/FVC is not less than the predicted lower limit of normal but FVC is not less than normal what does that tell us?

A

Normal spirometry

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88
Q

A peak expiratory flow rate variability of >20% is an indication of ________

A

A peak expiratory flow rate variability of >20% is an indication of asthma

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89
Q

What does delivery and absorption of drugs for lung diseases depend on?

A
  • inhaler technique
  • particle / droplet size
    • 5-10 µm deposited on upper airways
    • 0.5-5 µm deposited in small airways
    • <2 µm reach alveoli
  • lipid solubility of drug determines duration of action
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90
Q

Asthma is more common in ______ aged 0-14, but more common in _______ aged 15 and over

A

Asthma is more common in boys aged 0-14, but more common in females aged 15 and over

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91
Q

What causes thunderstorm asthma?

A
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92
Q

How does asthma effect COVID-19? What about the other way?

A

If infected with COVID-19, asthma attacks may be worse*

With more severe asthma, COVID-19 disease severity may be worse

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93
Q

What are the 2 types of asthma we previously used?

A

Extrinsic (allergic)

Intrinsic (non-allergic)

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94
Q

__________ asthma involves IgE antibodies / mast cell degranulation and is triggered by re-exposure to allergen e.g. pollen, house dust mite, pets

A

Extrinisic (allergic) asthma involves IgE antibodies / mast cell degranulation and is triggered by re-exposure to allergen e.g. pollen, house dust mite, pets

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95
Q

____________ asthma involves hyperresponsive airways, ‘non specific bronchial hyperreactivity’ and is triggered by cold, infection or exercise (but exercise can reduce frequency of attacks)

A

Intrinsic (non-allergic) asthma involves hyperresponsive airways, ‘non specific bronchial hyperreactivity’ and is triggered by cold, infection or exercise (but exercise can reduce frequency of attacks)

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96
Q

What is the current classification system for asthma?

A
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97
Q

What is the most common type of asthma?

A

Allergic

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98
Q

How is asthma diagnosed?

A
  • Compatible respiratory symptoms including response to triggers AND Evidence of reversible airway obstruction (spirometry) OR Variable airflow obstruction (peak expiratory flow monitoring)
  • If these criteria are not met, but asthma still suspected
    • Bronchoprovocation with methacholine (some contraindications for this test; methacholine induces attack)
  • Recent development - evaluation of inflammatory cells in sputum
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99
Q

Describe the pathogenesis of asthma

A

excessive mucus = obstruction & barrier to inhaler therapy

basement membrane thickening = fibrosis

more smooth muscle = increased contraction

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100
Q

What is the difference in airway resistance in response to an inhaled brochoconstrictor in a healthy person, severe-, and moderate asthma?

A
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101
Q

How does the immune system respond to aeroallergins in a healthy person?

A

CD4 cells release TH1 cytokines that recruits macrophages which engulf the allogen. No effect on airways

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102
Q

How does the immune system respond to aeroallergins in someone with asthma?

A

CD4 cells release TH2 cytokines that recruit eosinophils, mast cells and plasma cells which release a cocktail of cytokines and antibodies that causes constriction of airways

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103
Q

What are the four phases of asthma pathogenesis?

A

Induction phase (difficult to prevent)

  • poorly understood, often (not always) related to acquisition of allergy

Inflammation (targeted by preventer medication)

  • not completely understood, some mediators known
  • e.g. IgE in allergic asthma, IL-5 in eosinophilic asthma

Airway remodelling (difficult to reverse)

  • not completely understood, changes well characterised

Smooth muscle shortening (targeted by reliever / controller medication)

  • well understood, most important mediators identified
  • e.g. histamine, Cys-LTs
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104
Q

What causes the inflammation seen in allergic asthma and eosinophilic asthma?

A

Allergic: IgE

Eosinophilic: IL-5

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105
Q

What types of drugs are used to treat/control asthma?

A

Short-acting β2-adrenoeptor agonist (SABA)

Long-acting β2-adrenoeptor agonist (LABA)

Inhaled corticosteroid (ICS)

Leukotriene receptor antagonist

Monoclonal antibodies

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106
Q

Why do we use relievers in asthma?

A

Target immediate (acute) phase of asthma

Relieve airway smooth muscle spasm

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107
Q

Why do we use preventers (controllers) in asthma?

A

Target late (chronic) phase of asthma

Reduce inflammation

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108
Q

Which drugs are used to target the immediate phase of asthma?

A

SABAs

CysLT-receptor antagonists

Theophylline

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109
Q

Which drugs are used to target the late phase of asthma?

A

Glucocorticoids

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110
Q

How do relievers (glucocorticoids) target airway contraction?

A

Decreases contraction

  • targets mediators of allergy (histamine leukotrienes
  • targets parasympathetic vagal efferents (decreases)

Increases relaxation

  • increases sympathetic efferents to adrenal medulla
  • Available synthetic β2-adrenoeptor agonists (salbutamol)
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111
Q

How does histamine, cys leukotrienes and acetylcholine cause airway contraction in asthma?

A

They bind to a GCPR which causes a cascade resulting in calcium release which interacts with the myosin light chain resulting in contraction

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112
Q

Which endogenous molecules cause airway contraction?

A

Histamine

Leukotrienes

Acetylcholine

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113
Q

Which exogenous drugs can be used to induce airway relaxation?

A

β2-adrenoeptor agonists

Salbutamol

Phosphodiesterase (PDE) inhibitor

Theophylline

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114
Q

Which endogenous molecule can induce airway relaxation?

A

Adrenaline

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115
Q

What is the mechanism by which a β2-adrenoeptor agonist inhibits airway contraction in asthma?

A

The β2-adrenoeptor agonist binds to a GPCR which causes ATP to be coverted to cAMP which is converted into protein kinase A (PKA) which inhibits the release of calcium and converts myosin light chain into the inactive form

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116
Q

What is the first step in the treatment of asthma?

A

Salbutomol/albuterol (Ventolin)

administered via inhalation leads to bronchodilation

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117
Q

What are the other positive effects of SABAs?

A
  • decrease release of inflammatory mediators from mast cells
  • stimulate mucociliary clearance
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118
Q

What are the adverse effects of SABAs?

A
  • tachycardia (β1-mediated)
  • muscle tremor (β2-mediated)
  • potential for tolerance with overuse or infection (receptor downregulation / desensitization)
  • no effect on remodelling
  • reduced efficacy with smoking/ infection
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119
Q

Why have LABAs been linked to increased mortality?

A

They mask symptoms of inflammation

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120
Q

How are LABAs used?

A

used only for prophylaxis, only in conjunction with inhaled steroids (Step 3)

alternative to increased steroid dose

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121
Q

Beta-adrenoceptor ____________ are contraindicated in asthma

A

Beta-adrenoceptor antagonists are contraindicated in asthma

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122
Q

What is step 2 of treating asthma?

A

Reliever as required, add daily low dose ICS alone

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123
Q

What is step 3 of treating asthma?

A

Change to ICS/LABA combination

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124
Q

Why are controllers (ICS) not useful for acute attacks?

A

They effect the sythensis of inflammatory factors which takes time to take effect

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125
Q

What is the mechanism of action for ICS?

A

Transactivation: Increase anti-inflammatory proteins

Transrepression: Decrease pro-inflammatory proteins

  • reduced cytokine synthesis
    • decreased eosinophil activation
  • reduced activity of PLA2 (via increased annexin A1)
  • reduced COX-2 synthesis
    • decreased generation of prostaglandins / leukotrienes
  • reduced IgE synthesis by B cells
    • decreased mast cell activation, less histamine release
  • decreased symptoms of secretions; swelling; inflammation
    • BUT NO ACUTE EFFECT ON BRONCHOSPASM
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126
Q

What are the adverse effects of corticosteroids?

A

Most relate to chronic oral use

  • suppress endogenous glucocorticoid synthesis
  • iatrogenic Cushing’s syndrome
  • suppress response to infection and injury
  • behavioural disturbances
  • cataracts, glaucoma
  • metabolic effects
  • growth suppression - use cautiously in children
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127
Q

What are leukotriene receptor antagonists (LTRAs)?

A
  • i.e. Montelukast, Zafirlukast
  • orally active, prophylactic use only (preventers)
  • modest bronchodilatation (about half that of β2-agonists)
  • efficacy in chronic asthma in combined therapy with ICS / LABA
  • indicated for aspirin- and exercise-induced asthma
  • limited side effects - liver function may be impaired in some patients
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128
Q

What is step 5 for the treatment of severe, persistent allergic asthma?

A

Omalizumab

recombinant monoclonal antibody against immunoglobulin E (IgE)

inhibits IgE-induced release of mast cell mediators - histamine, cys LTs

subcutaneous administration every 2-4 weeks by health provider

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129
Q

What is step 5 for the treatment of eosinophilic asthma?

A

Mepolizumab

recombinant monoclonal antibody against IL-5

inhibits eosinopilia

subcutaneous administration every 4 weeks by health provider

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130
Q

How do you manage life-threatening acute asthma?

A
  • consider anaphylaxis and manage if suspected
  • treat with adrenaline if patient unable to inhale salbutamol
  • administer salbutamol by continuous nebulisation
  • subsequent treatment depends is there marked, some or no improvement or worsening?
  • may require
    • ventilation
    • i.v. magnesium sulfate
    • nebulised SABA/SAMA
    • i.v. salbutamol
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131
Q

Define

Alpha-1-antitrypsin

A

a protein belonging to the serpin superfamily. As a type of enzyme inhibitor, it protects tissues from enzymes of inflammatory cells, especially neutrophil elastase

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132
Q

Define

Chronic bronchitis

A

a persisting infection and inflammation of the larger airways of the lungs – the bronchi

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133
Q

Define

Elastase

A

an enzyme from the class of proteases (peptidases) that break down proteins and elastin, an elastic fibre that, together with collagen, determines the mechanical properties of connective tissue

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134
Q

Define

Emphysema

A

a type of chronic obstructive pulmonary disease. The air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing

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135
Q

Define

Idiopathic pulmonary fibrosis (IPF)

A

a type of rare lung disease that causes the tissue around the air sacs (alveoli) within the lungs to become thickened and scarred – this is called fibrosis. This scarring makes the lungs stiff which makes it increasingly difficult to breathe deeply.

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136
Q

Define

Long-acting muscarinic receptor antagonist (LAMA)

A

result in bronchodilation with a duration of action of 12 to 24 hours, depending on the agent and are mainly prescribed for people with COPD

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137
Q

Define

Nintendanib (Ofev)

A

an oral medication used for the treatment of idiopathic pulmonary fibrosis. It has been shown to slow down decrease in forced vital capacity, and it also improves people’s quality of life. It interferes with processes like fibroblast proliferation, differentiation and laying down extracellular matrix

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138
Q

Define

Pirfenidone (Esbriet)

A

a medication used for the treatment of idiopathic pulmonary fibrosis. It works by reducing lung fibrosis through downregulation of the production of growth factors and procollagens I and II.

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139
Q

Define

Short-acting muscarinic receptor antagonist (SAMA)

A

used both in the acute and chronic management of COPD. Blocks muscarinic receptors and is effective within minutes

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140
Q

Define

TGF-B

A

a multifunctional cytokine belonging to the transforming growth factor superfamily. Plays a role in immune and stem cell regulation

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141
Q

Definition

a protein belonging to the serpin superfamily. As a type of enzyme inhibitor, it protects tissues from enzymes of inflammatory cells, especially neutrophil elastase

A

Alpha-1-antitrypsin

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142
Q

Definition

a persisting infection and inflammation of the larger airways of the lungs – the bronchi

A

Chronic bronchitis

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143
Q

Definition

an enzyme from the class of proteases (peptidases) that break down proteins and elastin, an elastic fibre that, together with collagen, determines the mechanical properties of connective tissue

A

Elastase

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144
Q

Definition

a type of chronic obstructive pulmonary disease. The air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing

A

Emphysema

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145
Q

Definition

a type of rare lung disease that causes the tissue around the air sacs (alveoli) within the lungs to become thickened and scarred – this is called fibrosis. This scarring makes the lungs stiff which makes it increasingly difficult to breathe deeply.

A

Idiopathic pulmonary fibrosis (IPF)

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146
Q

Definition

result in bronchodilation with a duration of action of 12 to 24 hours, depending on the agent and are mainly prescribed for people with COPD

A

Long-acting muscarinic receptor antagonist (LAMA)

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147
Q

Definition

an oral medication used for the treatment of idiopathic pulmonary fibrosis. It has been shown to slow down decrease in forced vital capacity, and it also improves people’s quality of life. It interferes with processes like fibroblast proliferation, differentiation and laying down extracellular matrix

A

Nintendanib (Ofev)

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148
Q

Definition

a medication used for the treatment of idiopathic pulmonary fibrosis. It works by reducing lung fibrosis through downregulation of the production of growth factors and procollagens I and II.

A

Pirfenidone (Esbriet)

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149
Q

Definition

used both in the acute and chronic management of COPD. Blocks muscarinic receptors and is effective within minutes

A

Short-acting muscarinic receptor antagonist (SAMA)

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150
Q

Definition

a multifunctional cytokine belonging to the transforming growth factor superfamily. Plays a role in immune and stem cell regulation

A

TGF-B

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151
Q

What drug types are used in both COPD and asthma but are more commonly used for COPD?

A

SAMA

LAMA

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152
Q

What drug types are used in both COPD and asthma equally?

A

SABA

LABA

ICS

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153
Q

What type of drug is salbutamol?

A

SABA

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154
Q

What are the five risk factors for COPD?

A
  1. Genetic reasons (alpha-1 antitrypsin deficiency)
  2. Occupational dust and chemicals
  3. Indoor smoke from wood, coal, cow dungs, crop residues used for cooking
  4. Frequent lung infections as a child
  5. Smoking and passive smoking
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155
Q

Which gender is COPD more common in?

A

Males

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156
Q

What are the major features of COPD?

A
  • progressive decline in lung function
  • chronic bronchitis
    • excessive phlegm/sputum, cough
  • emphysema
    • breakdown of alveolar walls, driven by elastase-induced damage
  • most patients have both
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157
Q

What is the difference between healthy and COPD lung pathology?

A
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158
Q

What cytokine do macrophages produce that stimulate neutrophils to produce elastase in COPD?

A

IL-8

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159
Q

How is COPD different to asthma?

A

COPD:

Progressively worsening airflow obstruction

Often presents in 6th decade of life or later in patients

More permanent airflow obstruction; less reversibility and less normalisation of airflow obstruction

Cellular inflammation: neutrophils, macrophages, eosinophils and mast cells may occur

Emphysema frequently found

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160
Q

What are the typical symptoms and lung function of someone with mild COPD?

A

Few symptoms

Breathless on moderate exertion

Recurrent chest infections

Little or no effect on daily activities

FEV1 = 60-80% predicted

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161
Q

What are the typical symptoms and lung function of someone with moderate COPD?

A

Breathless walking on level ground

Increasing limitation of daily activities

Cough and sputum production

Exacerbations requiring oral corticosteroids and/or antibiotics

FEV1 = 40-59% predicted

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162
Q

What are the typical symptoms and lung function of someone with severe COPD?

A

Breathless on minimal exertion

Daily activities severely curtailed

Experiencing regular sputum production

Chronic cough

Eacerbations of increasing frequency and severity

FEV1 < 40% predicted

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163
Q

What are some non-pharmacological interventions for COPD?

A

Risk reduction: smoking cessation, flu shot

Optimise function: encourage exercise, review nutrition

Consider co-morbitities: especially CVD, mental illness and lung diseases

Refer to pulmonary rehabilitation for sympomatic patients

Oxygen therapy for moderate to severe patients

164
Q

What is typical of a spirometry graph for someone with COPD?

A

Slower rate of expiration, decreased FEV1

Reduced peak expiratory flow and extreme coving

165
Q

In terms of pharmacological treatment, what drugs are introduced first to manage COPD?

A

SAMA

SABA

166
Q

In terms of pharmacological treatment, what drugs are introduced second to manage COPD?

A

Add long acting bronchodilators:

LAMA

LABA

167
Q

In terms of pharmacological treatment, what drugs are introduced third to manage COPD?

A

Consider adding anti-inflammatory agent:

ICS

168
Q

What are the main effects of the M3 antagonists (SAMA/LAMA)?

A

Both oppose tonic parasympathetic drive (ACh)

Both reduce mucous

169
Q

What are the main effects of Beta-2-adrenoceptor agonists (SABA/LABA) in COPD?

A

Oppose all constrictors

Stimulate mucosiliary clearance

Inhibit release of inflammatory mediators from mast cells

170
Q

How do M3 antagonists decrease contraction?

A

Competetively inhibits the ACh receptors preventing the calcium release that leads to contraction

171
Q

Which contraction signalling molecule is the most important in COPD?

A

ACh

172
Q

What are the adverse-effects of M3 antagonists?

A

dry throat (local anti-SLUD)

acute infection

flu-like symptoms

trouble breathing

173
Q

What are the features of corticosteroid use in COPD?

A

less effective in COPD than in asthma, but still widely prescribed

poor efficacy in reducing inflammation due to macrophages and neutrophils (compared to effective inhibition of eosinophils in allergic asthma)

do not affect symptoms

inhaled route - may reduce frequency and severity of exacerbations

oral route - used to treat exacerbations

174
Q

What are the triggers and therapies used for COPD?

A

Triggers:

  • Viruses
  • Bacteria
  • Pollutants

Therapy

  • Antibiotics
  • Steroids
  • Bronchodilators
  • Pulmonary rehab
175
Q

Which cell type do corticosteroids particularly target in COPD?

A

Eosinophils

176
Q

When should ICS be prescribed to patients with COPD?

A

When they have a high eosinophil count

177
Q

What are the two most cost effective ways to prevent/treat COPD?

A

Flu vaccines

Smoking cessation

178
Q

How does alpha1-antitrypsin deficiency lead to COPD?

A
179
Q

What possibly caused the spike in deaths from marijuana vaping?

A

Pesticide contamination

180
Q

True or False:

IPF is relatively rare

A

True

181
Q

What are the causes/implications of IPF?

A

Cause:

Unknown

Implications:

Smoking

Certain animal exposures

Certain viruses/bacteria

Acid reflux disease

Genetics

Radiation

Certain medicine/antibiotics

182
Q

Describe the pathophysiology of IPF?

A
183
Q

What are the symptoms of IPF?

A

Shortness of breath

Persistent, dry, hacking cough

Fatigue

Clubbing of fingers

184
Q

What causes the clubbing of fingers seen in IPF?

A

Increased growth factors and decreased oxygen

185
Q

Why don’t we use dilators to treat IPF?

A

Symptoms are not due to brochoconstriction

Bronchodilators have little or no benefit in relieving symptoms

186
Q

Why don’t we use anti-inflammatories to treat IPF?

A

Previously combination treatment with prednisone (a corticosteroid), azathioprine (an immunosuppressive) and N‑acetyl cysteine (NAC; a mucolytic)

NOW RECOMMENDED AGAINST DUE TO ADVERSE OUTCOMES

187
Q

How is pirfenidone administered?

A

Orally

188
Q

What is the mechanism of action for pirfenidone?

A

not completely defined

inhibits TGFβ

  • anti-inflammatory
  • anti-fibrotic
189
Q

What are the adverse effects of pirfenidone?

A
  • upper gastrointestinal symptoms (take with food)
  • anorexia
  • photosensitivity
  • skin rash
  • liver toxicity (need to monitor function)
190
Q

How is nintedanib administered?

A

Orally

191
Q

What is the mechanism of action of nintedanib?

A
  • not completely defined
  • inhibits tyrosine kinase
  • reduces signaling of multiple growth factors
    • TGFβ, PDGF, FGF, VEGF
      • anti-fibrotic
192
Q

Which signalling pathways does nintedanib interfere with?

A
193
Q

What are the adverse effects of nintedanib?

A

arterial thromboembolic events including myocardial infarction (caution with coronary artery disease, myocardial ischaemia)

liver toxicity (need to monitor function)

194
Q

What are the final options for IPF?

A

Lung transplantation

Pallative care

195
Q

What causes silicosis?

A

Inhaled respirable crystalline silicon dioxide dust particles

196
Q

What occupations have seen silicosis cases?

A

Mining

Denim sandblasting

Stone cutting

197
Q

What happens when a macorphage injects a silica molecule?

A

Since it’s inert it results in apoptosis of the macrophage causing the silica to be released

198
Q

What cytokines do macrophages release in response to silica ingestion?

A

TNF-a

IL-1B

TGF-B

199
Q

How does TGF-B cause increased collagen and elastin production in silicosis?

A

Stimulates fibroblast cells to produce ECM

Causes epithelial cells to become fibroblast-like and produce ECM

200
Q

How is whole lung lavage used to treat silicosis?

A
  • May be used in early stages after high exposure to reduce silica load in the lung
  • Up to 10 litres of saline is added to and removed from the lung • Requires anaesthesia, ICU monitoring
  • Allows the level of exposure to be measured – grams of silica collected
    • not all silica removed (repeat procedure?)
  • Being trialled in Queensland (<10 cases to date)
201
Q

How is relaxin used to treat silicosis?

A

Relaxin is a RXFP1 agonist which inactivates the TGF-B receptor preventing the production of ECM

It also acts as a vaso- and bronchodilator

202
Q

Define

Actigraphy

A

a non-invasive method of monitoring human rest/activity cycles

203
Q

Define

Acute respiratory distress syndrome (ARDS)

A

a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. For those who survive, a decreased quality of life is common

204
Q

Define

Airborne

A

disease transmission through small particulates that can be transmitted through the air over time and distance

205
Q

Define

Alpha waves

A

neural oscillations in the frequency range of 8–12 Hz arising from the synchronous and coherent electrical activity of thalamic pacemaker cells in humans. Typical of sleepy wakefulness

206
Q

Define

Basic reproduction number (R0)

A

the reproduction number (R) when the entire population is susceptible.

207
Q

Define

Beta waves

A

periodic and repeating fluctuations heard in the intensity of a sound when two sound waves of very similar frequencies interfere with one another. Typical of wakefulness

208
Q

Define

Cluster

A

an aggregation of cases grouped in place and time that are suspected to be greater than the number expected

209
Q

Define

Convalescent plasma

A

the liquid part of blood that contains antibodies

210
Q

Define

COVID-19

A

an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic

211
Q

Define

Delta waves

A

a high amplitude brain wave with a frequency of oscillation between 0.5 and 4 hertz. Typical of slow wave sleep

212
Q

Define

Dexamethasone

A

a type of corticosteroid medication. It is used in the treatment of many conditions, including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, and along with antibiotics in tuberculosis. Being explored as an option for COVID-19

213
Q

Define

Direct transmission

A

when there is physical contact between an infected person and a susceptible person.

214
Q

Define

Endemic

A

the constant presence of a disease or infectious agent in a population within a geographic area

215
Q

Define

Epidemic

A

an increase, often sudden, in the number of cases above what is normally expected in that population in that area

216
Q

Define

Fomites

A

objects or materials which are likely to carry infection, such as clothes, utensils, and furniture

217
Q

Define

Incubation stage

A

the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent

218
Q

Define

Indirect transmission

A

refers to the transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).

219
Q

Define

Infectious disease

A

diseases caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another

220
Q

Define

K complex

A

a waveform that may be seen on an electroencephalogram (EEG). It occurs during stage 2 of NREM sleep. It is the “largest event in healthy human EEG”

221
Q

Define

Latent period

A

the period between infection with a virus or other microorganism and the onset of symptoms, or between exposure to radiation and the appearance of a cancer.

222
Q

Define

Myocarditis

A

an inflammation of the heart muscle. Itcan affect your heart muscle and your heart’s electrical system, reducing your heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias)

223
Q

Define

NREM sleep

A

dreamless sleep. During this phase, the brain waves on the electroencephalographic (EEG) recording are typically slow and of high voltage, the breathing and heart rate are slow and regular, the blood pressure is low, and the sleeper is relatively still

224
Q

Define

Outbreak

A

a noticeable, often small but sudden, increase over the expected number of epidemiologically linked cases

225
Q

Define

Pandemic

A

an epidemic with a P ( p for passport) ‐ A new pathogen that spreads from person to person across the globe”.

226
Q

Define

Phasic REM

A

REM that is characterized by PGO waves and actual “rapid” eye movements

227
Q

Define

Polysomnography

A

a test used to diagnose sleep disorders. It records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study

228
Q

Define

REM sleep

A

a unique phase of sleep in mammals and birds, characterized by random rapid movement of the eyes, accompanied by low muscle tone throughout the body, and the propensity of the sleeper to dream vividly

229
Q

Define

Remdesivir

A

a broad-spectrum antiviral medication developed by the biopharmaceutical company Gilead Sciences. It is administered via injection into a vein

230
Q

Define

Reproduction number (R)

A

the average number of new infections caused by 1 infected individual

231
Q

Define

SARS-COV2

A

the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), a respiratory illness. It is a positive-sense single-stranded RNA virus.

232
Q

Define

Sawtooth waves

A

a kind of non-sinusoidal waveform. It is so named based on its resemblance to the teeth of a plain-toothed saw with a zero rake angle

233
Q

Define

Sleep spindles

A

bursts of neural oscillatory activity that are generated by interplay of the thalamic reticular nucleus (TRN) and other thalamic nuclei during stage 2 NREM sleep in a frequency range of ~11 to 16 Hz (usually 12–14 Hz) with a duration of 0.5 seconds or greater (usually 0.5–1.5 seconds)

234
Q

Define

Sporadic

A

a disease that occurs infrequently and irregularly

235
Q

Define

Theta waves

A

a neural oscillatory pattern that can be seen on an electroencephalogram, recorded either from inside the brain or from electrodes attached to the scalp. Typical of sleep onset or light sleep

236
Q

Define

Tonic REM

A

REM that is characterized by theta rhythms in the brain

237
Q

Define

Two Process Model of Sleep-Wake Regulation

A

posits that the interaction of its two constituent processes, a sleep/wake dependent homeostatic Process S and a circadian Process C, generates the timing of sleep and waking

238
Q

Define

Vector-borne

A

illnesses that are transmitted by vectors, which include mosquitoes, ticks, and fleas

239
Q

Define

Vehicle-borne

A

an indirect transmission process during which the pathogen is indirectly transferred from a reservoir, source or host to another host by inanimate intermediary vehicle objects

240
Q

Define

Virus shedding

A

occurs when a virus replicates inside your body and is released into the environment. at that point, it may be contagious

241
Q

Definition

a non-invasive method of monitoring human rest/activity cycles

A

Actigraphy

242
Q

Definition

a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. For those who survive, a decreased quality of life is common

A

Acute respiratory distress syndrome (ARDS)

243
Q

Definition

disease transmission through small particulates that can be transmitted through the air over time and distance

A

Airborne

244
Q

Definition

neural oscillations in the frequency range of 8–12 Hz arising from the synchronous and coherent electrical activity of thalamic pacemaker cells in humans. Typical of sleepy wakefulness

A

Alpha waves

245
Q

Definition

the reproduction number (R) when the entire population is susceptible.

A

Basic reproduction number (R0)

246
Q

Definition

periodic and repeating fluctuations heard in the intensity of a sound when two sound waves of very similar frequencies interfere with one another. Typical of wakefulness

A

Beta waves

247
Q

Definition

an aggregation of cases grouped in place and time that are suspected to be greater than the number expected

A

Cluster

248
Q

Definition

the liquid part of blood that contains antibodies

A

Convalescent plasma

249
Q

Definition

an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic

A

COVID-19

250
Q

Definition

a high amplitude brain wave with a frequency of oscillation between 0.5 and 4 hertz. Typical of slow wave sleep

A

Delta waves

251
Q

Definition

a type of corticosteroid medication. It is used in the treatment of many conditions, including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, and along with antibiotics in tuberculosis. Being explored as an option for COVID-19

A

Dexamethasone

252
Q

Definition

when there is physical contact between an infected person and a susceptible person.

A

Direct transmission

253
Q

Definition

the constant presence of a disease or infectious agent in a population within a geographic area

A

Endemic

254
Q

Definition

an increase, often sudden, in the number of cases above what is normally expected in that population in that area

A

Epidemic

255
Q

Definition

objects or materials which are likely to carry infection, such as clothes, utensils, and furniture

A

Fomites

256
Q

Definition

the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent

A

Incubation stage

257
Q

Definition

refers to the transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).

A

Indirect transmission

258
Q

Definition

diseases caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another

A

Infectious disease

259
Q

Definition

a waveform that may be seen on an electroencephalogram (EEG). It occurs during stage 2 of NREM sleep. It is the “largest event in healthy human EEG”

A

K complex

260
Q

Definition

the period between infection with a virus or other microorganism and the onset of symptoms, or between exposure to radiation and the appearance of a cancer.

A

Latent period

261
Q

Definition

an inflammation of the heart muscle. Itcan affect your heart muscle and your heart’s electrical system, reducing your heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias)

A

Myocarditis

262
Q

Definition

dreamless sleep. During this phase, the brain waves on the electroencephalographic (EEG) recording are typically slow and of high voltage, the breathing and heart rate are slow and regular, the blood pressure is low, and the sleeper is relatively still

A

NREM sleep

263
Q

Definition

a noticeable, often small but sudden, increase over the expected number of epidemiologically linked cases

A

Outbreak

264
Q

Definition

an epidemic with a P ( p for passport) ‐ A new pathogen that spreads from person to person across the globe”.

A

Pandemic

265
Q

Definition

REM that is characterized by PGO waves and actual “rapid” eye movements

A

Phasic REM

266
Q

Definition

a test used to diagnose sleep disorders. It records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study

A

Polysomnography

267
Q

Definition

a unique phase of sleep in mammals and birds, characterized by random rapid movement of the eyes, accompanied by low muscle tone throughout the body, and the propensity of the sleeper to dream vividly

A

REM sleep

268
Q

Definition

a broad-spectrum antiviral medication developed by the biopharmaceutical company Gilead Sciences. It is administered via injection into a vein

A

Remdesivir

269
Q

Definition

the average number of new infections caused by 1 infected individual

A

Reproduction number (R)

270
Q

Definition

the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), a respiratory illness. It is a positive-sense single-stranded RNA virus.

A

SARS-COV2

271
Q

Definition

a kind of non-sinusoidal waveform. It is so named based on its resemblance to the teeth of a plain-toothed saw with a zero rake angle

A

Sawtooth waves

272
Q

Definition

bursts of neural oscillatory activity that are generated by interplay of the thalamic reticular nucleus (TRN) and other thalamic nuclei during stage 2 NREM sleep in a frequency range of ~11 to 16 Hz (usually 12–14 Hz) with a duration of 0.5 seconds or greater (usually 0.5–1.5 seconds)

A

Sleep spindles

273
Q

Definition

a disease that occurs infrequently and irregularly

A

Sporadic

274
Q

Definition

a neural oscillatory pattern that can be seen on an electroencephalogram, recorded either from inside the brain or from electrodes attached to the scalp. Typical of sleep onset or light sleep

A

Theta waves

275
Q

Definition

REM that is characterized by theta rhythms in the brain

A

Tonic REM

276
Q

Definition

posits that the interaction of its two constituent processes, a sleep/wake dependent homeostatic Process S and a circadian Process C, generates the timing of sleep and waking

A

Two Process Model of Sleep-Wake Regulation

277
Q

Definition

illnesses that are transmitted by vectors, which include mosquitoes, ticks, and fleas

A

Vector-borne

278
Q

Definition

an indirect transmission process during which the pathogen is indirectly transferred from a reservoir, source or host to another host by inanimate intermediary vehicle objects

A

Vehicle-borne

279
Q

Definition

occurs when a virus replicates inside your body and is released into the environment. at that point, it may be contagious

A

Virus shedding

280
Q

What are the unique features of infectious diseases?

A

Case is a source of infection for others

  • Failure to detect early and treat is detrimental

Urgency in response

  • Prompt response is important. Surveillance and preparedness is key

Multiple prevention measures is critical

  • Prevent exposure and transmission
  • Treatment is a key prevention
  • Increase resilience of population

Immunity

  • Prior exposure may confer immunity.
  • Vaccination is important measure
  • Heard immunity
281
Q

How are infectious diseases transmitted?

A

Direct transmission

  • Direct physical contact

Indirect transmission

  • Vehicle‐borne
    • Contaminated inanimate materials or objects (fomites).
  • Vector‐borne
    • Mechanical: No multiplication of agent (i.e. fly) in vector
    • Biological: Multiplication of agent (i.e. Mosquitoes) in vector

Airborne

  • Droplet
    • Microbial aerosols usually the respiratory tract.
  • Dust
    • The small particles from soil clothes, bedding or contaminated floors by wind or mechanical agitation.
282
Q

Rank these terms in increasing magnitude of impact:

Cluster, epidemic, outbreak and pandemic

A

Cluster < outbreak < epidemic < pandemic

283
Q

What happens when the reproduction number of an illness is greater than and less than 1?

A

R >1: epidemic progresses

R <1: epidemic wanes

284
Q

SARS-CoV-2 is the third known zoonotic coronavirus disease. What are the other two?

A

SARS-CoV

MERS-CoV

285
Q

Whole‐genome comparison shows Covid‐19 shares 96% of genetic material with ____________coronavirus

A

Whole‐genome comparison shows Covid‐19 shares 96% of genetic material with bat coronavirus

286
Q

Which coronavirus cluster does SARS-CoV-2 belong to?

A

Beta

287
Q

What is the natural and intermediate host of SARS-CoV?

A

Natural: Bats

Intermediate: Civet cats

288
Q

What is the natural and intermediate host of MERS-CoV?

A

Natural: Bats

Intermediate: Camels

289
Q

What is the natural and intermediate host of SARS-CoV-2?

A

Natural: Bats

Intermediate: Unknown

290
Q

What is the incubation period of COVID 19?

A

1-14 days

291
Q

How can SARS-CoV-2 be transmitted?

A
  • Direct or indirect contact
  • Fomites - remains on surfaces
  • Aerosol - respiratory droplets
  • Fecal-oral route - virus shedding in 41%
  • Body fluid and sexual activity - not fully understood
292
Q

What do we know about the pathophysiology of COVID-19?

A
  • Virus binds to the angiotensin‐converting enzyme‐2 (ACE2) receptor in humans [24]
    • Downregulate ACE2, leading to a toxic over accumulation of plasma angiotensin‐II, which may induce acute respiratory Distress syndrome (ARDS) and myocarditis [25,26].
  • ACE 2 is present in respiratory tract, endothelium of vessels and in several organs
    • Explains extra pulmonary manifestations associated with infection ( e.g. heart, oesophagus, kidneys, bladder, and ileum) [27].
  • COVID‐19 is hypothesised to be a disease of the endothelium.
    • In autopsy pulmonary artery obstruction by thrombotic material at both the macroscopic and microscopic levels has been identified.
    • Histopathologic of brain showed hypoxic changes but no encephalitis due to virus.
    • Endotheliopathy and platelet activation are likely to be associated with coagulopathy, critical illness and death
293
Q

Which receptor does SARS-CoV-2 target?

A

ACE2

294
Q

Why is SARS-CoV-2 less common in children?

A

Low ACE2 in the nasal epithelium of children ages <10 years compared with adults

Explains why COVID‐19 is less prevalent in children [28].

295
Q

What are the risk factors for COVID-19?

A

Age

Sex

Obesity

Co-morbidities

Ethnicity?

Genetics

Viral factors

Immune factors

296
Q

Which cytokine is particularly upregulated in moderate and severe COVID-19?

A

IL6

297
Q

What is the clinical diagnositic criteria for mild COVID-19?

A
  • Symptomatic patients meeting the case definition for COVID‐19 without evidence of hypoxia or pneumonia
  • Common symptoms include fever, cough, fatigue, anorexia, dyspnoea, and myalgia.
  • Nonspecific Symptoms include sore throat, nasal congestion, headache, diarrhoea, nausea/vomiting, and loss of smell/taste.
298
Q

What is the clinical diagnositic criteria for moderate COVID-19?

A

Clinical signs of pneumonia but no Signs of severe pneumonia including blood oxygen saturation levels (SpO₂) ≥90% on room air.

299
Q

What is the clinical diagnositic criteria for severe COVID-19?

A

Clinical signs of severe pneumonia and severe respiratory distress and blood oxygen saturation levels (SpO₂) <90% on room air.

300
Q

What is the clinical diagnositic criteria for critical COVID-19?

A

Presence of acute respiratory distress syndrome (ARDS), sepsis, or septic shock. May have acute pulmonary embolism, acute coronary syndrome, acute stroke, and delirium.

301
Q

What tests are used to detect COVID-19?

A

Virus detection

  • Nasopharyngeal specimens or lower respiratory samples ‐ RT‐PCR

Antibody detection

  • Tells about a past infection.
  • SARS‐CoV‐2 immunoglobulin G (IgG)/IgM antibodies in serum, plasma, or whole blood

Laboratory tests

Imaging

302
Q

Where are COVID-19 sufferers cared for?

A
  • Asymptomatic or mild disease can be managed at home
  • Patients with moderate or severe disease in hospital
  • Patients with critical disease require intensive care.
303
Q

What is the current treatment approach for COVID-19?

A
  • Supportive care according to the clinical presentation.
  • Oxygen therapy, high‐flow nasal oxygen, non‐invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation.
  • Intravenous fluids, venous thromboembolism prophylaxis
  • Antibiotics if there is clinical suspicion of bacterial infection.
  • Low‐dose dexamethasone (steroid)
304
Q

What are the current experimental therapies for COVID-19?

A
  • remdesivir, Lopinavir / ritonavir
  • Convalescent plasma
305
Q

What is the difference between quarantine and isolation?

A

Isolation separates people with coronavirus (COVID‐19) from people who do not have the virus.

Quarantine separates and restricts the movement of people who have been or may have been exposed to coronavirus (COVID‐19)

306
Q

What are the four main functions of sleep?

A

Conserve energy

Enhance survival / adaptation

Restorative / repair of injury (NREM)

Aid learning / memory consolidation (REM)

307
Q

What are the current findings on how much sleep we need?

A
  • Adults should sleep 7 or more hours per night on a regular basis to promote optimal health.
  • Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents.
  • Sleeping more than 9 hours per night on a regular basis may be appropriate for young adults, individuals recovering from sleep debt, and individuals with illnesses. For others, it is uncertain whether sleeping more than 9 hours per night is associated with health risk.
308
Q

How does loss of sleep effect performance and alertness?

A

The more sleep we lose, the worse both out performance and alertness are. However, performance suffers more than our perception of how alert we are which can be dangerous

309
Q

What are the objective and subjective ways of measuring sleep?

A

Objective

  • Polysomnography
  • Actigraphy

Subjective

  • Sleep diary
  • Self-report questionnaires
310
Q

What are the two distinct stages of sleep?

A

REM

NREM

311
Q

How many stages of NREM sleep are there?

A

3

312
Q

What is the best way to measure sleep?

A

Polysomnography

313
Q

What are the main recording parameters of polysomnography?

A

Brain waves - Electroencephalogram (EEG)

Eye movement – Electrooculogram (EOG)

Muscle activity – Electromyogram (EMG)

Breathing or airflow

Heart rate and rhythm – Electrocardiogram (ECG)

Oxygen saturation – pulse oximetry (SpO2)

314
Q

What does an EEG measure?

A

Difference in electrical potential between pairs of electrodes placed on the scalp.

315
Q

List the common brainwaves in order of decreasing frequency

A

(Gamma)

Beta

Alpha

Theta

Delta

316
Q

________waves: 4 – 7 Hz/cps - Sleep onset, light sleep

___________waves: 0.5 – 3 Hz/cps - Deep sleep

________waves: 14-26 Hz/cps - Alert waking activity, arousal from sleep

_________-waves: 8 – 13 Hz/cps - Relaxed waking, eyes closed, arousal from sleep

A

Theta waves: 4 – 7 Hz/cps - Sleep onset, light sleep

Delta waves: 0.5 – 3 Hz/cps - Deep sleep

Beta waves: 14-26 Hz/cps - Alert waking activity, arousal from sleep

Alpha waves: 8 – 13 Hz/cps - Relaxed waking, eyes closed, arousal from sleep

317
Q

Score sleep in 30 sec sequential ________commencing at the start of the study

A

Score sleep in 30 sec sequential epochs commencing at the start of the study

318
Q

If 2 or more stages coexist in an epoch, what do we assign it as?

A

Assign the stage comprising the greatest portion of the epoch

319
Q

What is the typical brain activity of someone who is vigilantly wakeful?

A

Beta activity

Desynchronized

High frequency (15-20 Hz)

Low amplitude

320
Q

What is the typical EEG, EOG and EMG activity of someone who is relaxed wakeful?

A

EEG: low voltage, mixed frequency; rhythmic alpha activity (8-13 Hz)

EOG: REMs or none, SEMs when drowsy

EMG: relatively high level of tonic activity, affected by voluntary movements

321
Q

What is the typical EEG, EOG and EMG activity of someone who is in stage N1 sleep?

A

EEG: low amplitude, mixed frequency; mainly theta activity (4-7 Hz), vertex sharp waves

EOG: SEMs are often seen

EMG: tonic activity, may be slight decrease from waking

322
Q

What is the typical EEG, EOG and EMG activity of someone who is in stage N2 sleep?

A

EEG: Low amplitude, mixed frequency (8-15 Hz) Sleep spindles (11-16 Hz, ≥ 0.5 sec): waxing and waning spindle shape K complex: negative sharp wave followed immediately by slower positive component (≥ 0.5 sec)

EOG: occasionally SEMs

EMG: tonic activity, low level, usually less than N1

323
Q

What is this brainwave called? When is it seen?

A

K complex

Stage N2 sleep

324
Q

What is this brainwave called? When is it seen?

A

Sleep spindle

Stage N2 Sleep

325
Q

What is the typical EEG, EOG and EMG activity of someone who is in stage N3 sleep?

A

EEG: ≥ 20% of epoch, high amplitude (>75µv), slow wave activity (delta) (≤ 2 Hz)

EOG: none

EMG: tonic activity, low leve

326
Q

What type of waves are these? What stage of sleep is this?

A

Delta waves

Stage N3 sleep

327
Q

What is the typical EEG, EOG and EMG activity of someone who is in REM sleep?

A

EEG: low amplitude, mixed frequency (similar to N1). Sawtooth waves may occur

EOG: Bursts of EOG activity – rapid eye movements = phasic REM Epochs of no EOG activity = tonic REM

EMG: Chin EMG drops to its lowest level • Reflective of the inhibition of motor activity and loss of muscle tone which occurs in REM

328
Q

Bursts of EOG activity – rapid eye movements = _______REM

Epochs of no EOG activity = ______REM

A

Bursts of EOG activity – rapid eye movements = phasic REM

Epochs of no EOG activity = tonic REM

329
Q

What stage of sleep is this?

A

REM sleep

330
Q

What is the order of sleep stages in a typical sleep cycle?

A

Awake

Stage N1

Stage N2

Stage N3

REM

331
Q

Which stage of sleep is also called slow wave sleep?

A

Stage N3

332
Q

What part of the night is stage N3 sleep more prominent? What about REM?

A

Stage 3/4 (N3) more prominent in first third

REM more prominent in second half

333
Q

How long is a typical sleep cycle?

A

90 minutes

334
Q

Which stages of sleep change the most as we age?

A

Increased wake after sleep onset (WASO)

Decreased slow wave sleep (N3)

335
Q

Peak in circadian drive for wakefulness in the __________.

Peak in circadian drive for sleep in the ___________.

A

Peak in circadian drive for wakefulness in the evening.

Peak in circadian drive for sleep in the early morning.

336
Q

_________drive for wakefulness opposes __________drive for sleep in the evening (just prior to normal bedtime) – helps maintain wakefulness.

A

Circadian drive for wakefulness opposes homeostatic drive for sleep in the evening (just prior to normal bedtime) – helps maintain wakefulness.

337
Q

Define

Apnea

A

the cessation of breathing

338
Q

Define

Apnea-hypopnea index (AHI)

A

the number of apneas or hypopneas recorded during the study per hour of sleep

339
Q

Define

Continuous positive airway pressure (CPAP)

A

a type of positive airway pressure, where the air flow is introduced into the airways to maintain a continuous pressure to constantly stent the airways open, in people who are breathing spontaneously

340
Q

Define

Endotype

A

A subtype of a condition that has a distinct functional or pathobiological mechanism

341
Q

Define

Hypoglossal nerve stimulator

A

an implanted medical device that reduces the occurrence of OSA by electrically stimulating the hypoglossal nerve, which causes tongue movement

342
Q

Define

Hypopnea

A

abnormally slow or shallow breathing

343
Q

Define

Loop gain

A

a function of how much output is fed back to the input. Considered as a ratio of the controller gain (i.e., ventilatory response to CO2), the plant gain (i.e., blood gas response to a change in ventilation), and feedback gain (i.e., the speed [cardiac output] of feedback signal [CO2] back to the controller). Under normal non-REM sleep conditions, small (<2 mm Hg) changes in Pco2 are promptly recognized by the chemoreceptors, maintaining stable ventilation. This tightly controlled, and rapidly responsive, negative feedback system between the brain and the lungs allows for stable ventilation with miniscule changes in CO2 levels.

344
Q

Define

Mandibular advancement devices

A

Devices that prevent upper airway collapse by protruding the mandible forward, thus altering the jaw and tongue position

345
Q

Define

Maxillo-mandibular advancement

A

surgery that moves the upper (maxilla) and lower (mandible) jaws forward, and it effectively enlarges the airway in both the palate and tongue regions

346
Q

Define

Obstructive sleep apnea (OSA)

A

occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off

347
Q

Define

Oral pressure therapy

A

a treatment for obstructive sleep apnea (OSA) that uses negative pressure in the mouth to shift the soft palate and tongue forward

348
Q

Define

Waking hypersomnolence

A

a condition where a person experiences significant episodes of sleepiness, even after having 7 hours or more of quality sleep

349
Q

Definition

the cessation of breathing

A

Apnea

350
Q

Definition

the number of apneas or hypopneas recorded during the study per hour of sleep

A

Apnea-hypopnea index (AHI)

351
Q

Definition

a type of positive airway pressure, where the air flow is introduced into the airways to maintain a continuous pressure to constantly stent the airways open, in people who are breathing spontaneously

A

Continuous positive airway pressure (CPAP)

352
Q

Definition

A subtype of a condition that has a distinct functional or pathobiological mechanism

A

Endotype

353
Q

Definition

an implanted medical device that reduces the occurrence of OSA by electrically stimulating the hypoglossal nerve, which causes tongue movement

A

Hypoglossal nerve stimulator

354
Q

Definition

abnormally slow or shallow breathing

A

Hypopnea

355
Q

Definition

a function of how much output is fed back to the input. Considered as a ratio of the controller gain (i.e., ventilatory response to CO2), the plant gain (i.e., blood gas response to a change in ventilation), and feedback gain (i.e., the speed [cardiac output] of feedback signal [CO2] back to the controller). Under normal non-REM sleep conditions, small (<2 mm Hg) changes in Pco2 are promptly recognized by the chemoreceptors, maintaining stable ventilation. This tightly controlled, and rapidly responsive, negative feedback system between the brain and the lungs allows for stable ventilation with miniscule changes in CO2 levels.

A

Loop gain

356
Q

Definition

Devices that prevent upper airway collapse by protruding the mandible forward, thus altering the jaw and tongue position

A

Mandibular advancement devices

357
Q

Definition

surgery that moves the upper (maxilla) and lower (mandible) jaws forward, and it effectively enlarges the airway in both the palate and tongue regions

A

Maxillo-mandibular advancement

358
Q

Definition

occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off

A

Obstructive sleep apnea (OSA)

359
Q

Definition

a treatment for obstructive sleep apnea (OSA) that uses negative pressure in the mouth to shift the soft palate and tongue forward

A

Oral pressure therapy

360
Q

Definition

a condition where a person experiences significant episodes of sleepiness, even after having 7 hours or more of quality sleep

A

Waking hypersomnolence

361
Q

What is considered mild, moderate and severe sleep apnea?

A

Mild: 5-15 events/hour

Moderate: 15-30 events/hour

Severe: >30 events/hour

362
Q

What are the risk factors for obstructive sleep apnea?

A

Obesity

Increasing age

Male gender

Anatomic abnormalities of upper airway

Family history

Alcohol/sedative use

363
Q

What is the pathogenesis of obstructive sleep apnea?

A
364
Q

What are the neurocogitive clinical consequences of OSA?

A
  • Waking Hypersomnolence
  • Decreased quality of life
  • Increased automobile crashes
  • Increased risk of mental illness
365
Q

What are the cardiovascular clinical consequences of OSA?

A
  • Systemic hypertension
  • Arrthymias
  • Increased incidence of congestive heart failure, stroke, and myocardial infarction
366
Q

What is the first line treatement for OSA?

A

CPAP

367
Q

What percentage of patients continue to use CPAP beyond 3 months?

A

50%

368
Q

What are the current OSA therapies for individuals intolerant to CPAP?

A

Behavioral (i.e. weight loss, positional therapy)

Medical (i.e. oral appliance, expiratory resistance valves, suction devices)

Surgical (i.e. UPPP, hypoglossal nerve stimulation)

369
Q

What are some examples of OSA behavioural interventions?

A

Weight Loss

Avoid Supine sleep

Avoid alcohol and sedatives before bed

370
Q

What has a greatest effect on OSA: Diet, exercise or both?

A

Combined reduces both BMI and AHI

Diet lead to no change in either

Exercise decreased AHI

371
Q

What is the major challenge and benefit of recommending weight loss for OSA?

A

Challenge: The improvement in OSA with weight loss is unpredictable and non-linear – true for weight-loss via diet or surgery

Benefit: There is no downside to weight loss – it bestows significant cardiovascular risk reduction benefits (even if no improvement in OSA)

372
Q

What are some examples of OSA medical interventions?

A

Oral appliances (or Mandibular advancement devices)

Expiratory resistance valves

Suction devices

373
Q

How do expiratory resistance valves work?

A

The positive pressure they create causes the airway and lungs to expand

374
Q

What are the limitations of expiratory resistance valves?

A

Don’t work if you mouth breathe

Tolerance in real world appears poor

Cost is high in long term (have to keep purchasing them)

375
Q

What are some examples of OSA surgical interventions?

A

Maxillo-mandibular advancement

Soft tissue surgery

Stimulate the upper airway muscles:

376
Q

What are the limitations of the main CPAP alternative treatments?

A

Large variability in efficacy – Work for some, but not for others

Expensive (and invasive) to ‘test-drive’

Need robust ways to predict who will respond to therapy – How do we define a ‘responder’?

377
Q

Stable upper airways lead to no OSA but highly collapsible upper airways lead to OSA. What about vulnerable upper airways?

A

Depends on the non-anatomical traits (e.g. Loop gain, muscle responsiveness and arousal threshold)

378
Q

What are the non-anatomical traits that contribute to OSA?

A

Loop gain

Muscle responsiveness

Arousal threshold

379
Q

How do we measure the OSA endotypes?

A

‘Gold-standard’ technique involves manipulating CPAP and measuring ventilation

380
Q

What non-CPAP interventions are recommended for individuals with a small, collapsible upper airway?

A

Weight loss

Positional therapy

Oral appliances

Surgery

381
Q

What interventions are recommended for individuals with oversensitive ventilatory control systems?

A

Supplemental O2/CO2

Acetazolamide

382
Q

What interventions are recommended for individuals with poor pharygeal muscle responses?

A

Hypoglossal nerve stimulation

Noradrenergic/anti-muscarinic drugs

Training?

383
Q

What interventions are recommended for individuals with low arousal threshold?

A

Sedative/hypnotics

384
Q

Do oral appliances alter the non-anatomical traits?

A

No, only alter the passive collapsibility

385
Q

Which two factors are major predictors of response to OSA oral appliance therapy?

A

Low collapsibility

Low loop gain

386
Q

__________ predicts response to supplemental CO2 and O2

A

Loop gain predicts response to supplemental CO2 and O2

387
Q

How do we predict successful sedative treatment?

A
388
Q

What factors would make OSA endotyping clinicallly useful?

A
  • Non-invasively determined
  • Determined using currently collected clinical data
    • In-laboratory diagnostic PSG/CPAP titrations
  • Amenable to automation
389
Q

What clincal variables are used to assess the anatomy/collapsibility endotype

A

CPAP level

Negative expiratory pressure

Negative pressure pulses

390
Q

What clincal variables are used to assess the arousal threshold endotype

A

3 PSG characteristics [AHI82.5%. and %hypopneas >58.3%]

391
Q

What clincal variables are used to assess the loop gain endotype?

A

Breath-hold duration

Chemoreflex test

392
Q

__________ predicts response to combination therapy (O2+sedative)

A

CPAP level predicts response to combination therapy (O2+sedative)

393
Q

___________ also predicts response to Hypoglossal Nerve Stimulation (HGNS)

A

CPAP level also predicts response to Hypoglossal Nerve Stimulation (HGNS)

394
Q

True or False:

Collapsibility alone isnot a predictor of response to surgery

A

True

Even though surgery improves collapsibilty, loop gain is a better predictor

395
Q

__________ predicts response to surgery

A

Loop gain predicts response to surgery

396
Q

What combination of endotypes predicted a positive response to supplemental oxygen?

A

Mild collapsibility

High loop gain

Good muscle compensation

397
Q

What combination of endotypes predicted a positive response to oral appliances?

A

Mild/moderate collapsibility

Low loop gain and high arousal threshold

Weaker muscle compensation

398
Q

Which of the following three features are seen in allergic asthma?

a) High IgE, high eosinophils, high Th2 cytokines
b) High IgE, low eosinophils, high Th2 cytokines
c) Low IgE, high eosinophils, low Th2 cytokines
d) Low IgE, low eosinophils, low Th2 cytokines

A

Which of the following three features are seen in allergic asthma?

a) High IgE, high eosinophils, high Th2 cytokines

b) High IgE, low eosinophils, high Th2 cytokines
c) Low IgE, high eosinophils, low Th2 cytokines
d) Low IgE, low eosinophils, low Th2 cytokines

399
Q

Salbutamol, a short-acting β2 adrenoceptor agonist (SABA) causes airway relaxation by:

a) blocking calcium channels
b) antagonising muscarinic receptors
c) increasing synthesis of cAMP
d) inhibiting phosphodiesterase

A

Salbutamol, a short-acting β2 adrenoceptor agonist (SABA) causes airway relaxation by:

a) blocking calcium channels
b) antagonising muscarinic receptors

c) increasing synthesis of cAMP

d) inhibiting phosphodiesterase

400
Q

Mepolizumab:

a) should be used in asthmatics with high levels of neutrophils
b) is administered via the inhaled route
c) is the first choice if SABA are being used more than twice a week
d) is a recombinant monoclonal antibody against IL-5

A

Mepolizumab:

a) should be used in asthmatics with high levels of neutrophils
b) is administered via the inhaled route
c) is the first choice if SABA are being used more than twice a week

d) is a recombinant monoclonal antibody against IL-5

401
Q

Which of the following pathological features is seen in COPD but not asthma?

a) increased mucous
b) airway fibrosis
c) airway inflammation
d) emphysema

A

Which of the following pathological features is seen in COPD but not asthma?

a) increased mucous
b) airway fibrosis
c) airway inflammation

d) emphysema

402
Q

Inhaled glucocorticoids (ICS) are less effective antiinflammatories in COPD than asthma because:

a) higher levels of airway mucous in COPD reduces ICS bioavailability
b) people with asthma are more compliant and better at using inhalers than those with COPD
c) increased eosinophils in asthma but not increased neutrophils in COPD are targeted by ICS
d) smoking increases metabolism of ICS

A

Inhaled glucocorticoids (ICS) are less effective antiinflammatories in COPD than asthma because:

a) higher levels of airway mucous in COPD reduces ICS bioavailability
b) people with asthma are more compliant and better at using inhalers than those with COPD

c) increased eosinophils in asthma but not increased neutrophils in COPD are targeted by ICS

d) smoking increases metabolism of ICS

403
Q

In the treatment of idiopathic pulmonary fibrosis, pirfenidone :

a) Should only be used in combination with inhaled glucocorticoids
b) Reverses established fibrosis
c) Inhibits both fibrosis and inflammation
d) Inhibits tyrosine kinase to exert its anti-fibrotic actions

A

In the treatment of idiopathic pulmonary fibrosis, pirfenidone :

a) Should only be used in combination with inhaled glucocorticoids
b) Reverses established fibrosis

c) Inhibits both fibrosis and inflammation

d) Inhibits tyrosine kinase to exert its anti-fibrotic actions

404
Q

As we fall asleep, typically the start of the Non REM stage 1 state is characterized by the disappearance of:

a) Theta waves
b) Alpha waves
c) Delta waves
d) Beta waves

A

As we fall asleep, typically the start of the Non REM stage 1 state is characterized by the disappearance of:

a) Theta waves

b) Alpha waves

c) Delta waves
d) Beta waves

405
Q

Brad has been up late preparing the BMS3052 theme test on respiratory and sleep disorders. Due to being tired he does not set his alarm which enables him to get a full 8 hours sleep. Whilst Brad was asleep, which sleep stage would he LIKELY spend the MOST % asleep in?

a) N1
b) N2
c) N3
d) REM

A

Brad has been up late preparing the BMS3052 theme test on respiratory and sleep disorders. Due to being tired he does not set his alarm which enables him to get a full 8 hours sleep. Whilst Brad was asleep, which sleep stage would he LIKELY spend the MOST % asleep in?

a) N1

b) N2

c) N3
d) REM

406
Q

George Konstanza has recently been diagnosed with sleep apnoea. According to the latest evidence, which treatment option would be the least effective to reduce the apnoea-hypopnea index (AHI)?

a) CPAP
b) Exercise
c) Oral device
d) Weight loss

A

George Konstanza has recently been diagnosed with sleep apnoea. According to the latest evidence, which treatment option would be the least effective to reduce the apnoea-hypopnea index (AHI)?

a) CPAP
b) Exercise
c) Oral device

d) Weight loss

407
Q

Which of the following forms of obstructive sleep apnoea (OSA) does not have variable rates of success for responders to oral appliances?

a) All OSA
b) Mild OSA
c) Moderate OSA
d) Severe OSA

A

Which of the following forms of obstructive sleep apnoea (OSA) does not have variable rates of success for responders to oral appliances?

a) All OSA

b) Mild OSA

c) Moderate OSA
d) Severe OSA

BMS3052 (26 decks)

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