session 6

Question 1

patients at risk of exacerbation

Answer 1

previous exacerbation, disease severity, GORD, pulmonary hypertension, resp failure

Question 2

causes of exacerbations

Answer 2

bacteria (haemophilus influenzae), virus (rhinovirus), pollution, eosinopihils

Question 3

what COPD therapies improve symptoms

Answer 3

pulmonary rehab, bronchodilators, mucolytics, refractory dysponea management

Question 4

what COPD therapies improve risk

Answer 4

smoking cessation, oxygen therapy, anti inflammatories. non invasive ventillation

Question 5

example of proximal bronchodilators

Answer 5

act at muscarinic receptors M3

Question 6

example of distal bronchodilators

Answer 6

B2 agonists. increase in cAMP, and therefore broncodilation

Question 7

definition of bronchiectasis

Answer 7

long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

Question 8

symptoms bronchiectasis

Answer 8

cough with sputum, breathlessness, recurrent infections, haemoptysis, weight loss

Question 9

how is bronchiectasis diagnosed

Answer 9

crackles on auscultation, CXR, CT scan shows signet ring sign

Question 10

2 red flags for possible mis diagnosed bronchiecstasis

Answer 10

• asthma without reversible airway obstruction on spirometry/inspiratory squeaks and crackles
• COPD but diminished breath sounds, and hearing squeaks and crackles
• recurrent chest/sinus infections
• IBS/RA

Question 11

differences in location chronic bronchitis, bronchiectasis, asthma and emphysema

Answer 11

chronic bronchitis- broncus
bronchiectasis- bronchus
asthma- bronchus
emphysema- alveoli

Question 12

differences in pathology chronic bronchitis, bronchiectasis, asthma and emphysema

Answer 12

chronic bronchitis- mucous gland hyperplasia, hypersecretion
bronchiectasis- airway dilation, scarring
asthma- smooth muscle hyperplasia, excess mucus, inflammation
emphysema- airspace enlargment, wall destruction

Question 13

differences in etiology chronic bronchitis, bronchiectasis, asthma and emphysema

Answer 13

chronic bronchitis- tobacco, pollution
bronchiectasis- severe and persistant infections
asthma- immunological
emphysema- tobacco smoke

Question 14

main symptoms chronic bronchitis, bronchiectasis, asthma and emphysema

Answer 14

chronic bronchitis- cough, white sputum
bronchiectasis- cough, yellow smelly sputum, fever
asthma- episodic wheezing, cough, dyspnea
emphysema- dysnpnea

Question 15

most common gene mutation CFTR

Answer 15

Phe50del- defective intracellular production and traffiking, decreased stability

Question 16

what can a CFTR mutation affect

Answer 16

manufacture protein, transport protein, processsing function, membrane stability

Question 17

x ray sign CF

Answer 17

tram track sign shows thick walled dilateed bronchi

Question 18

x ray sign bronchiecstasis

Answer 18

signet ring sign shows dilated bronchus accompyaning pulmonary artery

Question 19

signs for late diagnosis of CF

Answer 19

recurrent idiopathic pancreatitis, sinusitis and lung infections, infertility

Question 20

complications CF

Answer 20

bronchiecstasis, pneumothorax, ABPA, haemoptysis, resp failre. chronic sinusitis, nasal polyposis

Question 21

signs bronchiecstasis

Answer 21

hypoxaemia, fever, haemoptysis, fine crackles, inspiratpry squeaks, clubbing

Question 22

signs acute severe asthma

Answer 22

cannot complete full sentences, wheeze when ausciltated, peak expiratory flow rate 33-50%,
O2 >92%,
RR > 25,
pulse >110

Question 23

signs life threatening asthma

Answer 23

acute severe features plus silent chest/starting to tire causing altered consciousness/cyanotic
PEFR < 33%
O2 < 92
RR dropping

Question 24

management acute severe asthma

Answer 24

oxygen, nebulised salbutamol, steroids, senior