Y2 revision

Question 2

What is bronchiectasis?

Answer 2

Airways become widened and full of secretions, mostly due to an infection such as pneumonia

• Like COPD but infection rather than smoking
• Can often clinically resemble COPD and asthma

Question 3

What is wheezing?

Answer 3

• Heard on EXPIRATION
• Musical noise produced by air moving through narrowed airways
• Think asthma and COPD

Question 4

What is stridor?

Answer 4

• Heard on INSPIRATION
• Think whooping cough, epiglottitis, foreign body, tumour, oedema

Question 5

Discuss asthma

Answer 5

REVERSIBLE AIRFLOW OBSTRUCTION

• Eosinophil infiltration (IL-5)
• Excessive Th2 response – cytokines and inflammation
• Smooth muscle hypertrophy
• Increased mucus production
• Polyphonic

Question 6

What is Cheyne Stokes respiration?

Answer 6

• Abnormal breathing pattern
• Progressively deeper and faster breathing
• resulting in apnea (temporary cessation of breathing)

Question 7

Define apnea

Answer 7

Temporary cessation of breathing

Question 8

Outline some respiratory symptoms

Answer 8

• Clubbing (>180)
• Astrexis (flapping tremor)
• Use of accessory muscles
• Intercostal drawing
• Pursed lip breathing

Question 9

What are rhonchi?

Answer 9

Low pitched wheezes

Question 10

What is the leading cause of death amongst all infectious diseases?

Answer 10

Lower respiratory tract infections

Question 11

Discuss acute bronchitis

Answer 11

• Inflammation of bronchial tree
• Peak incidence in winter
• S.O.B, wheezing, chest pain
• No consolidation
• Usually viral

Question 12

Discuss legionella pneumophilia

Answer 12

* penecillins don’t work: quinolones or macrolides*

• Gram negative bacteria, aerobic, non spore forming
• Resides in water >50 degrees – killed
• Causes Legionnaire’s - a type of atypical pneumonia
• Can be caught from air conditioning systems and spas
• Replicates inside macrophages

Question 13

What is mycoplasma pneumoniae?

Answer 13

• Atypical bacteria that commonly causes mild infections of the URT
• Pneumonia caused by M.pneumoniae is referred to as walking pneumonia because symptoms are a lot milder that other types
• Treated with macrolides or tetracycline

Question 14

What is haemophilus influenzae?

Answer 14

• Gram negative, coccobacillary, anaerobic
• Grows well on chocolate agar at 37 degrees with a CO2 rich environment

type B: most common, meningitis, septicaemia, pneumonia

Question 15

Types of asbestos

Answer 15

1. Serpentine – 99%, white (least potent), curly and flexible fibres
2. Amphiboles – 1%, blue or brown (most potent), straight and rigid fibres

Question 16

Discuss TB

Answer 16

• Caused by m.tuberculosis and m.bovis (mainly the former)
• Bacterial infection spread via aerosols
• Strict aerobes, acid fast (bright red when ziehl-neelsen stained)
• Rod shaped, non classified as either gram +/-
• Grows inside macrophages (obligate intracellular pathogen
• 2 million people infected worldwide, 90% asymptomatic

Question 17

What are the mechanisms of airflow obstruction?

Answer 17

• Excessive secretions
• Contraction of bronchial smooth muscle
• Loss of outward traction due to lack of alveoli tethering walls

Question 18

Outline the airway changes seen in asthma

Answer 18

Acute:

• smooth muscle contraction
• Mucus hypersecretion
• Plasma leakage
• Oedema
• Sensory nerve activation

Chronic:
- Smooth muscle hypertrophy

Question 19

Diagnosis of asthma

Answer 19

• presence of reversible airflow obstruction
• Increase of FEV1 of 15% when bronchodilator given

Question 20

Discuss COPD

Answer 20

• Encompasses emphysema, chronic bronchitis and chronic asthma
• NEUTROPHILS
• Chronic, slowly progressing
• Airflow obstruction that doesn’t change for months
• chronic productive cough
• FEV1 does not improve after bronchodilator given
• mucus gland hypertrophy, smooth muscle hypertrophy, inflammatory cell infiltrate

Question 21

Discuss emphysema

Answer 21

• Pink puffers
• Abnormal enlargement of airspace due to wall destruction
• alveoli become damaged and elasticity is lost – decreased surface area and alveoli can collapse
• Air trapping occurs because recoil mechanism is lost

Question 22

Discuss chronic bronchitis

Answer 22

• Blue bloaters
• Smooth muscle hypertrophy and mucus hypersecretion

Question 24

What are the stages of COPD?

Answer 24

FEV1 % of predicted:

80% = stage 1

50-79% = stage 2

30-49% = stage 3

<30% = stage 4

Question 25

How is chronic pulmonary hypertension treated?

Answer 25

• Long term oxygen therapy
• Anticoagulants to reduce clot risk
• Diuretics to address oedema

Question 26

Discuss respiratory failure

Answer 26

Type 1: hypoxic, normocapnic e.g. acute asthma

Type 2: hypoxic and hypercapnic

Question 27

Compare and contrast obstructive and restrictive lung diseases

Answer 27

Obstructive:
- COPD
- Asthma
- Bronchiectasis
FEV1: FVC = <70%

Restrictive:
- Fibrosis
- OBCT
- Neuromuscular
FEV1: FVC = >70%

Question 28

Discuss idiopathic pulmonary fibrosis

Answer 28

Fibrosis that occurs as a result of an unknown reason

• M:F 2:1
• Average age 71 years
• Median survival: 3.9 years

Question 29

How is idiopathic pulmonary fibrosis managed?

Answer 29

• pirfenidone: inhibits collagen synthesis and decreases pro-fibrotic cytokines

Question 30

What is monkeleukast?

Answer 30

Leukotriene receptor antagonist – blocks the contraction of smooth muscle

Question 31

Discuss treatment of COPD

Answer 31

• SMOKING CESSATION!
• salbutamol to promote dilation
• anticholinergics (IPATROPIUM) to prevent smooth muscle contracting and clear mucus

*O2 – decreases resp. drive so do not give

Question 32

What is ipratropium?

Answer 32

Muscarinic antagonist, anticholinergic – blocks bronchial secretion and constriction by the parasympathetic nervous system, for treatment of COPD