Respiratory (Week 8)

Question 1

Define ‘residual volume’ in terms of spirometry testing

Answer 1

Air in the lung which cannot be blown out

Question 2

In relation to lung function, what term defines the measurement from being fully inspired to full expiration?

Answer 2

Vital capacity

Question 3

What 2 results in reversibility testing spirometry suggest a diagnosis of asthma?

Answer 3

15% and 400ml reversibility in FEV1

Question 4

What does an FEV1/FVC ration <70% indicate?

Answer 4

Obstructive disease

Question 5

What FEV1/FVC ratio shows restrictive lung disease?

Answer 5

> 70%

Question 6

Name three causes of hypoxaemia

Answer 6

Hypoventilation
Ventilation/perfusion mismatch
Shunting (e.g. congenital heart disease)

Question 7

What PCO2 measurement would indicate type II respiratory failure?

Answer 7

PCO2>6

Question 8

A PCO2 of <6 would indicate what?

Answer 8

Type I respiratory failure

Question 9

Name 3 cell types associated with COPD?

Answer 9

CD8+ cells, macrophages and neutrophils

Question 10

Which deficiency present in some COPD patients means they are unable to balance destructive enzymes in lungs?

Answer 10

Alpha 1 anti-trypsin deficiency

Question 11

Define chronic bronchitis

Answer 11

Productive sputum most days for at least 3 months in at least 2 years

Question 12

In chronic bronchitis, what causes loss of interstitial support in airways leading to inflammation?

Answer 12

Free radicals from neutrophils

Question 13

Define emphysema

Answer 13

Permanent enlargement of airspaces distal to terminal bronchioles

Question 14

Name 3 features of COPD on CXR

Answer 14

Hyperinflated lungs
Thin heart
Flattened hemi-diaphragm
Dark lungs

Question 15

In COPD, what does <30% predicated FEV1 indicate?

Answer 15

Stage 4 (very severe) disease

Question 16

Define pneumothorax

Answer 16

Air within pleural cavity causing collapse of elastic lung

Question 17

Name three classifications of pneumothorax determined by cause

Answer 17

Traumatic
Iatrogenic
Spontaneous (primary/secondary)

Question 18

If tension pneumothorax goes untreated, how does arrest occur?

Answer 18

Increased intra-pleural pressure leading to impaired venous return and BP fall

Question 19

What measurement defines a ‘small’ pneumothorax

Answer 19

<2cm

Question 20

Define talc pleurodesis in terms of pneumothorax management

Answer 20

Medicated talc applied to visceral pleura causes inflammatory response of adhesion of pleura to chest wall

Question 21

Define the term allergy

Answer 21

Immune mediated intolerance of an external factor

Question 22

Define the term intolerance

Answer 22

Inability to cope with normally acceptable conditions

Question 23

What pathological mechanism causes a wheeze?

Answer 23

Turbulent airflow, a consequence of allergy

Question 24

What two injectable agents can be effective in asthma management?

Answer 24

Anti-IL5 and anti-IL13

Question 25

What disease is a result of allergy of the lung parenchyma caused by a trigger?

Answer 25

Extrinsic allergic alveolitis (EAA)

Question 26

In EAA, chronic exposure to triggers can lead to which 2 lung complications?

Answer 26

Fibrosis (interstitial scarring) and emphysema

Question 27

What fungus colonises keratinised areas?

Answer 27

Dermatophytes (ringworm)

Question 28

Fungal meningitis is caused by which fungus?

Answer 28

Cryptococcus neoformans

Question 29

Which fungal infection only occurs in immunocompromised patients?

Answer 29

Pneumocystis jiroveci

Question 30

What is the mechanism of action of the anti-fungal Amphotericin B

Answer 30

Exploits ergosterol by forming pore in fungal membrane = cell death

Question 31

What is the function of ergosterol?

Answer 31

An essential part of fungus plasma membranes

Question 32

Why would IV magnesium be given in life threatening asthma exacerbations?

Answer 32

To relax smooth muscle and block histamine release from mast cells

Question 33

What is the general MOA of corticosteroids?

Answer 33

Bind to glucocorticoid receptors to dampen pro-inflammatory genes by reversing histone acetylation

Question 34

How do anti-muscarinic drugs work?

Answer 34

Antagonist of M1 and M3 cholinergic receptors in lungs to counteract direct bronchoconstriction

Question 35

Give an example of a) Short acting anti-muscarinic b) Long-acting anti-muscarinic

Answer 35

a) Ipratropium bromide | b) Tiotropium

Question 36

Briefly define the MOA of methylxanthines

Answer 36

Non-selective phosphodiesterase inhibitor which increases cAMP to cause bronchial SM relaxation

Question 37

What is the function of the drug Carbocisteine in COPD?

Answer 37

Mucolytic to reduce sputum viscosity

Question 38

What is the function of the drug Roflumilast in COPD?

Answer 38

Phosphodiesterase-4 selective inhibitor to reduce pro-inflammatory cytokines

Question 39

Define pleural effusion

Answer 39

>15ml fluid in pleural space

Question 40

What usually causes transudate pleural effusions?

Answer 40

Excess fluid being pushed into pleura bilaterally with no extra cause e.g. due to heart failure

Question 41

What usually causes exudate pleural effusions?

Answer 41

An additional causative pathology e.g. malignancy or empyema

Question 42

In pleural effusion, what does grey fluid on ultrasound usually indicate?

Answer 42

Exudate pleural effusion due to excess protein in fluid appearing grey

Question 43

In what circumstance should a pleural effusion NEVER be drained?

Answer 43

If the cause of the effusion is undiagnosed

Question 44

What would you expect the pH and glucose levels to be in a para-pneumonic pleural effusion? (arises as a result of pneumonia)

Answer 44

pH <7.2 Glucose <2.2

Question 45

What three symptoms occur in obstructive sleep apnoea?

Answer 45

1. Upper airway obstruction during sleep 2. Intermittent hypoxia 3. Sleep fragmentation

Question 46

Name three treatments of sleep apnoea

Answer 46

1. Continuous positive airways pressure (CPAP) 2. Mandibular advancement device 3. Sleep position trainers

Question 47

Name three non-metastatic effects of lung cancer

Answer 47

1. Cushing's (ACTH secreting tumour) 2. SIADH (ADH secretion leading to water retention) 3. Hypercalcaemia (parathyroid hormone related peptide secrtetion causing osteoclast activity)

Question 48

Which type of lung cancer occurs in the periphery of the lungs and more commonly in women?

Answer 48

Adenocarcinoma

Question 49

Which lung cancer type is the most aggressive and metastasises early in the disease process?

Answer 49

Small cell carcinoma

Question 50

Define mesothelioma

Answer 50

Pleural tumour almost always caused by asbestos exposure

Question 51

Define sarcoidosis

Answer 51

Multisystem inflammation of unknown cause, commonly affecting lungs and intrathoracic lymph nodes

Question 52

Name 2 signs of Idiopathic pulmonary fibrosis

Answer 52

Bibasilar crackles | Subpleural honeycombing

Question 53

Define pulmonary fibrosis

Answer 53

Scarring of the lungs with a specific cause such as smoking

Question 54

Give an example of an occupational cause of pulmonary fibrosis

Answer 54

Asbestos exposure

Question 55

Give two examples of a drug which can cause pulmonary fibrosis

Answer 55

Amiodarone | Methotrexate

Question 56

Give two examples of diseases which can cause pulmonary fibrosis

Answer 56

Lupus | Rheumatoid arthritis

Question 57

What imaging method is used to diagnose pulmonary fibrosis?

Answer 57

High resolution CT scan (HRCT)