2. Obstructive Airway Disease

Question 1

General respiratory disease symptoms (5)

Answer 1

Cough
Wheeze (expiration)
Stridor (inspiration)
SoB (distress on effort)
Pain (general/inspiration)

Question 2

General respiratory disease signs (5)

Answer 2

Chest movement with respiration
Rate of respiration
Air entry (symmetrical, reduced)
Vocal resonance
Percussion notes (resonant, dull)

Question 3

Normal rate of respiration

Answer 3

12-15 breaths/min

Question 4

General respiratory disease investigations (5)

Answer 4

Sputum exam
CXR
Pulmonary function
Bronchoscopy
VQ scan

Question 5

Pulmonary function tests (3)

Answer 5

PEFR - max. flow rate
FEV1 - forced expiratory volume/one second
FEV1/VC - measurement of respiratory function

Question 6

Types of respiratory diseases (4)

Answer 6

Infections
Airflow obstructions
Gas exchange failure
Tumours

Question 7

Types of respiratory infections

Answer 7

Pneumonia

Question 8

Types of respiratory airflow obstructions (3)

Answer 8

Asthma
COPD
Restrictive pulmonary change

Question 9

Types of respiratory gas exchange failure (3)

Answer 9

Reduced surface area
Fibrosis
Fluid

Question 10

Chronic airflow obstruction definition and examples (2)

Answer 10

Reversible airway obstructions
Asthma
COPD

Question 11

Chronic airflow obstruction exacerbations (3)

Answer 11

Infections
Exercise
Cold air

Question 12

Asthma mechanism (3)

Answer 12

Airway smooth muscle constriction
Inflammation of mucosa
Increased mucus secretion

Question 13

Asthma symptoms (3)

Answer 13

Cough
Wheeze
SoB

Question 14

Asthma triggers (5)

Answer 14

Infections
Environmental stimuli (dust, smoke, chemicals, asbestos)
Cold air
Exercise
Atopy

Question 15

First stage of asthma treatment

Answer 15

Occasional B-agonist only

Question 16

Second stage of asthma treatment

Answer 16

Low-dose inhaled steroid (or Na chromoglycate)

Question 17

Third stage of asthma treatment

Answer 17

High-dose inhaled steroid

Question 18

Fourth stage of asthma treatment (3)

Answer 18

Long-acting B-agonist, theophylline, anti-muscarinic drugs

Question 19

Fifth stage of asthma treatment

Answer 19

Oral steroid

Question 20

Types of respiratory drugs (6)

Answer 20

B-adrenergic agonists
Anticholinergic drugs
Corticosteriods
Leukotrine inhibitors
Chromones
Theophylline

Question 21

Action of B-agonists

Answer 21

Relax smooth muscle by reducing bronchoconstriction and reducing resting bronchial tone

Question 22

Action of anticholinergic drugs

Answer 22

Reduce basal tone

Question 23

Action of theophylline (3)

Answer 23

Cause adenosine inhibition

May cause CNS stimulation, diuretics and arrhythmias

Question 24

When are corticosteroids used

Answer 24

If B2-agonists are used >3 times each week

Question 25

Corticosteroid side effects (2)

Answer 25

Adrenal suppression | Osteoporosis (potentially)

Question 26

COPD is a combination of (3)

Answer 26

Chronic obstructive airway disease (asthma and emphysema) Chronic bronchitis Emphysema

Question 27

What is COPD (2)

Answer 27

Mixed airway reversible obstruction | Destructive lung disease

Question 28

Definition and outcome of emphysema (2)

Answer 28

Destruction of alveoli | Causes dilatation of others to fill the space

Question 29

How can COPD progress to respiratory failure (2)

Answer 29

Reduced surface area for gas exchange | Thickening of alveolar mucosal barrier

Question 30

COPD results in poor ventilation due to (2)

Answer 30

``` Airway narrowing (potentially reversible) Restrictive lung disease ```

Question 31

Causes of COPD (3)

Answer 31

Smoking Environmental lung damage Hereditary (emphysema)

Question 32

Occupational lung disease can lead to respiratory failure from (2)

Answer 32

Fibrosis (dust related) - coal, silicon, beryllium, asbestos, silica Tumours - asbestos (mesothelioma)

Question 33

COPD management (6)

Answer 33

``` Smoking cessation Long-acting bronchodilator Inhaled steroids (if FEV < 50%) Systemic steroids Oxygen support Pulmonary rehabilitation therapy ```

Question 34

Types of respiratory failure (2)

Answer 34

Type 1 | Type 2

Question 35

What is type 1 respiratory failure

Answer 35

Hypoxaemia (low oxygen)

Question 36

What is type 2 respiratory failure

Answer 36

Hypercapnia (ventilation failure)

Question 37

Why does type 2 respiratory failure occur

Answer 37

Due to airway blockage or narrowing

Question 38

What is respiratory failure due to (2)

Answer 38

Failure of oxygenation | Failure of ventilation

Question 39

When does failure of oxygenation occur (2)

Answer 39

When PaO2 < 8kPa or | When SaO2 < 90%

Question 40

What does failure of oxygenation result in (3)

Answer 40

Poor alveolar ventilation Diffusion abnormality VQ (ventilation perfusion) mismatch

Question 41

When does failure of ventilation occur (2)

Answer 41

When PaCO2 > 6.7kPa Only in acute respiratory failure (20% reduction in ventilation required)

Question 42

What does chronic ventilation failure result in

Answer 42

Renal compensation from acidosis

Question 43

Chronic ventilation failure involves contributions from (3)

Answer 43

Reduced compliance Airway obstruction Muscle dysfunction

Question 44

Normal breathing control (2)

Answer 44

CO2 drive controls ventilation | SaO2 usually fine

Question 45

COPD breathing control (2)

Answer 45

Hypoxia drives ventilation | CO2 tolerance