Week 7: Obstructive and Restrictive Lung diseases

Question 1

Occupation asthma often occurs at what period

Answer 1

Within 1 year of starting new work

Question 2

Pattern of symptoms in occupational asthma

Answer 2

• Worsening during the week

* Improvements at weekends

Question 3

Risk factors for occupational asthma

Answer 3

1. inherent atopy
2. smoking
3. rhinitis and conjunctivitis (precede development of OA)

Question 4

Main types of asthma

Answer 4

1. Allergic asthma (associated with atopy)
2. Occupational asthma (non-allergic)
3. Other non-allergic asthma: viral, cold, stress

Question 5

Difference between sensitiser induced and irritant induced occupational asthma.

Which is more common

Answer 5

More common: sensitiser induced

SENSITISER
Latency period between exposure and symptoms

IRRITANT
Symptoms occur a few hours after high concentration exposure to irritant

Question 6

Who is responsible for reporting injuries, diseases and dangerous occurences during work

Answer 6

The employer

Question 7

What does PD20 mean

Answer 7

Provocative dose causing 20% drop in FEV1

Question 8

significance of FeNO

Answer 8

Measures bronchial activity (but non-specific)

Question 9

significance of sputum eosinophils

Answer 9

Correlates with challenge test

but levels will be lower if smoking

Question 10

What class of drug would improve symptoms and prognosis in COPD patients

Answer 10

LAMA

Question 11

What PaO2 levels signify that a COPD patient needs long term oxygen therapy

Answer 11

PaO2<7.3

OR

PaO2<8 +

• polycythaemia
• pulmonary hypertension
• peripheral oedema
• noctural hypoxaemia

Question 12

What type of air content should be given in a nebuliser for a COPD pt

Answer 12

• low oxygen

- high CO2

Question 13

5 drugs for symptomatic treatment of pulmonary hypertension

Answer 13

1. Warfarin
2. Oxygen
3. Diuretics
4. Digoxin
5. CCB

Question 14

4 drugs for pulmonary hypertension to improve prognosis

Answer 14

1. Endothelin receptor antagonists (eg bosentan)
2. Phosphodiesterase 5 inhibitors (eg tadalafil)
3. Prostaglandins (eg epoprostenol)
4. Soluble guanylate cyclase stimulators (eg riociguat)

Question 15

5 Lung diseases that exposure to silica can cause

Answer 15

1. Silicosis (lung fibrosis)
2. Acute silicosis
3. COPD
4. TB
5. Lung cancer

Question 16

How would sarcoidosis present on a CXR

Answer 16

Bilateral hilar lymphadenopathy

+/- pulmonary infiltrates

Question 17

How would sarcoidosis present on a lung biopsy

Answer 17

Dense fibrosis with birefringent particles

Question 18

How would coal workers pneumoconiosis present on a lung biopsy

Answer 18

Dust accumulation around terminal bronchioles + fibrosis

Question 19

What respiratory condition might experiencing cold-like symptoms after work suggest

Answer 19

Hypersensitivity pneumonitis/ Alveolitis

Question 20

How would IPF appear on cxr

Answer 20

1. fibrotic white patches at base of lung
2. big bronchi (pulled apart by scarring)
3. Honeycomb (subpleural fibrosis)

Question 21

IPF/ bronchiectasis gives fine/ coarse inspiratory crackles

Answer 21

IPF = fine inspiratory crackles (like velcro)

Bronchiectasis (obstructive) = coarse crackles

Question 22

How would sarcoidosis appear on histology

Answer 22

Non-caseating granulomas

Question 23

Squeaks on auscultation indicate

Answer 23

Hypersensitivity pneumonitis