Obstructive lung diseases NN

Question 1

3 types of Obstructive lung disease

Answer 1

COPD
ASTHMA
BRONCHIECTASIS (CYSTIC FIRBOSIS RELATED)

Question 2

Chronic bronchitis definition

Answer 2

COPD with productive cough for >3 months for 2+ years

Question 3

Definition of emphysema

Answer 3

COPD with increase neutrophil and nuclease/elastase release. This destroys elasticity of alveoli - bronchioles collapse and alveoli have decreased surface are

Question 4

Cause of COPD

Answer 4

smoking
pollutants
alpha 1 anti trypsin deficiency (only emphysema )

Question 5

Alveolar macrophages phagocytose smoke particles and release which cytokines

Answer 5

IL8, which call immune cells (neutrophils) into the lungs which release ROS, free radicals, proteases.
This destroys bronchial wall, trigger smooth muscle to contract (bronchospasm)

Question 6

What happens in bronchioles when a person smokes repeatedly and activates the immune response at the bronchial level?

Answer 6

The bronchial cells pre-emptively release TGF-beta which activates fibroblasts. Consequence increase in fibrosis.

Question 7

If centrilobular emphysema, the cause is probably

Answer 7

smoking

Question 8

If large acini in the lower lobes of the lungs (panacinar emphysema), the cause is probably

Answer 8

alpha 1 anti-trypsin deficiency

Question 9

What is the job of alpha 1 antitrypsin?

Answer 9

Inhibit the elastases released by neutrophils in the lungs to avoid destruction of the alveolar walls

Question 10

Alpha 1 anti trypsin deficiency leads to panacinar emphysema and what?

Answer 10

Liver damage

Question 11

Atopic triad includes?

Answer 11

Atopic dermatitia, allergic rhinitis, allergic asthma

Question 12

Can viral URTI cause asthma exacerbation

Answer 12

yes

Question 13

Can BB exacerbate asthma?

Answer 13

Yes. Bronchioles have B2 adrenergic receptors which have to bronchodilate.
So BB will block the ability of bronchodilation

Question 14

What is Samters triad?

Answer 14

Patients with nasal polyps, asthma, ASA usage - can develop a massive asthma exacerbation

Question 15

What happens during an asthma attack?

Answer 15

Bronchospasm
bronchial edema
bronchial hyper response spasm
increase mucus and increase bronchial edema

Question 16

Regarding asthma, a dendritic cell picks up the irritant, shows it to a helpter T cell which releases IL4/5, which activates plasma cells to?

Answer 16

Release antibodies IgE, which activate Mast cells to release Leukotriens, PGI, histamines

Question 17

IL 5 can trigger bone marrow to increase production of?

Answer 17

eosinophils. They release major basic protein and cationic peptides.

Question 18

An 86-year-old female presents with intermittent claudication.

Which investigation will be most helpful in determining whether she is a suitable candidate for bypass surgery?

Answer 18

Digital subtraction arteriography.
a form of angiography that compares images before and after intravenous injection of an iodine-based dye.

Question 19

Which vessel lies closest to the posterior aspect of the manubrium of the sternum at the midline and so is vulnerable when this bone is divided?

Answer 19

Left brachiocephalic trunk

Question 20

The uterus reaches the umbilicus at week 20. The symphysial-fundal height (SFH) is usually equal (± 2 cm) to the number of weeks of gestation. This is measured by first palpating the fundus of the uterus. The tape measure is placed at this point and then rolled over the longitudinal axis of the uterus until it reaches the pubic symphysis. The length in centimetres is then recorded.

Answer 20

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Question 21

batwing pattern of diffuse infiltrates on CXR

Answer 21

pneumocystitis jirovecii
Pneumocystis is an opportunistic fungus that predominantly affects the lung. In the lung, it typically resides in the alveoli, tightly adhering to type I cells. The immune reaction against the organism by the alveolar macrophages results in extensive exudation and the formation of a hyaline membrane. Lung biopsy shows foamy vacuolated exudates. Extra-pulmonary sites include the thyroid, lymph nodes, liver and bone marrow.

Question 22

Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of SLE. It presents with sudden dyspnea, decreased hematocrit, and possibly hemoptysis. BAL fluid shows haemorrhage and chest X-ray reveals diffuse infiltrates. Infections must be ruled out before treatment. Normal CRP levels suggest no severe infection, while low complement indicates an SLE flare. Urine testing for renal involvement is important. Prompt and aggressive treatment, including plasmapheresis, improves prognosis. DLCO may be high due to alveolar blood’s ability to absorb carbon monoxide. Clinical diagnosis, imaging, and bronchoscopy guide therapy initiation as a medical emergency. Lung biopsy shows pulmonary capillaritis with neutrophilic infiltration resembling ARDS-like damage in SLE-associated DAH.

Answer 22

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Question 23

Bronchoalveolar lavage (BAL) positive for CD4 cells

Answer 23

SARCOIDOSIS

Question 24

aspirin overdose symptoms

Answer 24

Mild aspirin (salicylate) overdose presents as tinnitus (salicylates are ototoxic), nausea and vomiting, while more severe overdoses can present with confusion, hallucinations, seizures and pulmonary oedema. Salicylates stimulate the respiratory centre, leading to an initial respiratory alkalosis, as shown in this case. Metabolic acidosis can follow.

Question 25

Monitoring of aneurysms can be done using ultrasound or CT scanning. For aneurysms measuring 3-4.4 cm, annual scans are recommended. Aneurysms measuring 4.5-5.4 cm require scans every three months. Once an aneurysm reaches 5.5 cm, referral to a vascular surgeon is necessary. Abdominal ultrasound scans are used for the initial screening of AAAs, typically performed on men during their 65th birthday year. Routine screening for females is not recommended, as AAAs are predominantly found in males.

Answer 25

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Question 26

Hydatidiform mole is part of gestational trophoblastic disease, resulting from abnormal fertilisation of an ovum, leading to complete or partial mole (46 XX, XY or 69 XXX, XXY). Both subtypes result in non-viable pregnancies, with complete mole being more common. These moles typically present at the extremes of reproductive age. This woman’s symptoms of vaginal bleeding, excessive vomiting, large-for-dates uterus, and high hCG level align with hydatidiform mole. Pelvic ultrasound may reveal a ‘snowstorm’ appearance. Treatment options depend on fertility desires, with dilation and evacuation for fertility preservation and hysterectomy for those not wanting to conceive. Antiemetics are prescribed for nausea and vomiting.

Answer 26

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