Session 7

Question 1

Define COPD.

Answer 1

Disease characterised by airflow obstruction which is usually progressive, not fully reversible and does not change markedly over several months. it encompasses emphysema and/or chronic bronchitis.

Question 2

What is the most common cause of COPD?

Answer 2

Smoking.

Question 3

What is emphysema?

Answer 3

pathological process where there is destruction of the terminal bronchioles and distal airspaces causing loss of alveolar surface area and impairment of gas exchange.

Question 4

Why do the lungs hyperinflate in emphysema?

Answer 4

The loss of elastic tissue means that the lungs cant resist the natural tendency of the rib cage to expand outwards so hyperinflation occurs.

Question 5

What is chronic bronchitis?

Answer 5

Chronic inflammation with excess mucus secretion in the large airways of the lungs.

Question 6

What can cause COPD?

Answer 6

Smoking, alpha-1 antitrypsin deficiency, occupational exposure, pollution.

Question 7

How does COPD usually present?

Answer 7

Cough and sputum production are usually the first signs, most patients wont present until they become breathless.

Question 8

What is exacerbation of COPD?

Answer 8

Increased breathlessness, increased cough and increased sputum production compared to the baseline.

Question 9

What is the MRC dyspnoea score?

Answer 9

A way of quantifying the level of breathlessness in a patient typically used in COPD.

Question 10

What are typical signs on examination of COPD?

Answer 10

Pursed lip breathing, tachypnoea, using accessory muscles to breathe, barrel chest, wheeze, quiet breath sounds, cyanosis, oedema.

Question 11

How is airflow obstruction measured in COPD?

Answer 11

Using spirometry.

Question 12

What does spirometry show in COPD sufferers?

Answer 12

Reduced total expiratory volume as obstructive condition, FEV1.0 us usually low, FEV1.0/FVC is usually low.

Question 13

How is COPD diagnosed?

Answer 13

Using a combination of the suggestive symptoms and presence of airflow obstruction on spirometry. CXR used to exclude other diagnoses

Question 14

How is COPD managed?

Answer 14

Stop smoking, bronchodilators, antimuscarinics, steroids, mucolytics, diet supplements, may need oxygen therapy and lung volume reduction.

Question 15

How do beta-2 agonists work?

Answer 15

Binds to beta-2 receptor activating adenyl cyclase; [cAMP] increases and PKA activated; MLCK is phosphorylated and activated; smooth muscle relaxes and causes bronchodilation in the lungs.

Question 16

What are the adverse effects of beta-2 agonists used in COPD therapy?

Answer 16

Tachycardia and tremor due to activation of other beta-2 receptors; anxiety; palpatations; hypokalaemia due to increased skeletal muscle potassium uptake.

Question 17

How do methylxanthines work?

Answer 17

Inhibit phosphodiesterases so less cAMP is broken down, causing bronchodilation.

Question 18

What are the potential side effects of long term steroid use?

Answer 18

Think skin, bruising, cataracts, adrenal insufficiency, osteoporosis, DM, fluid retention, mental disturbance, GI symptoms, proximal myopathy.

Question 19

Why is pulmonary rehabilitation performed in COPD?

Answer 19

To prevent deconditioning from social anxiety and inactivity.

Question 20

When is long-term oxygen therapy offered to COPD patients?

Answer 20

If pO2 is consistently below 7.3kPa (8kPa with cor pulmonale) if patients are non-smokers and don’t retain high CO2 levels.

Question 21

What is the aim of COPD treatment?

Answer 21

To improve sufferers’ quality of life as the condition can’t be reversed or cured.

Question 22

How are acute exacerbations of COPD treated?

Answer 22

Controlled oxygen therapy, nebs, steroids, antibiotics if infective, repeat ABG, consider IV bronchodilators.

Question 23

What are the contraindications to non-invasive ventilation?

Answer 23

Untreated pneumothorax, impaired consciousness, increased upper airway secretions, facial injury, vomiting, agitation, life threatening hypoxia.

Question 24

Briefly describe the epidemiology of lung cancer.

Answer 24

Most common cancerous cause of death in UK, very low 5 year survival rate, lowest one year survival rate, more common in less affluent socio-economic groups, large link to smoking, link to occupational carcinogens.

Question 25

What are the advantages of lung cancer screening?

Answer 25

Detects disease before critical point, causes little morbidity, affordable, available, allows earlier treatment so better prognosis.

Question 26

What are the disadvantages of lung cancer screening?

Answer 26

Detects some pseudo-disease so can lead to overdiagnosis.

Question 27

How is lung cancer staged?

Answer 27

Using TNM staging based on primary tumour, lymph nodes and metastases.

Question 28

Which stages of lung cancer are operable?

Answer 28

IA-IIB.

Question 29

Which stages of lung cancer are non-operable?

Answer 29

IIIA.

Question 30

Which stages of lung cancer are palliative?

Answer 30

IIIB and IV.

Question 31

Where does lung cancer typically spread to?

Answer 31

Brain, draining lymph nodes, pericardium, lungs, pleura, liver, adrenal glands, bone.

Question 32

How is lung cancer staged?

Answer 32

Using imaging (usually CXR) and tissue sampling.

Question 33

What are the typical presenting symptoms of lung cancer?

Answer 33

Cough, dyspnoea, wheezing, haemoptysis, lung infection, chest/shoulder pain, weight loss, lethargy/malaise, metastatic symptoms (bone pain, bloated face, hoarseness, etc.), metabolic symotoms (hypercalcaemia, hyponatraemia).

Question 34

What is paraneoplastic syndrome?

Answer 34

Consequence of cancer in the body where the syndrome isn’t due to the presence of local cancer cells.

Question 35

What paraneoplastic symotoms can occur in lung cancer?

Answer 35

Hypercalaemia, Cushing’s syndrome, SIADH, anaemia, thrombocytosis, peripheral neuropathy, dermatomyositis, finger clubbing.

Question 36

Describe the pathology of lung cancer.

Answer 36

Carcinoma (invasive malignant epithelial tumour). Usually non-small cell lung cancer but may also be small-cell or other rare tumours. Molecular markers are EGFR, ALK, KRAS and PD1 mutations.

Question 37

How is lung cancer treated?

Answer 37

Surgery if operable; radical/palliative radiotherapy; combination chemotherapy if appropriate; combination chemo-radiotherapy; biological therapies; palliative care.