Lung Flashcards Preview

SBOMs > Lung > Flashcards

Flashcards in Lung Deck (40)
Loading flashcards...
1

What proportion of pregnant women have asthma?

8%

2

Most severe asthma in which weeks of pregnancy?

24, 25 and 26

3

What is poorly controlled asthma in pregnancy linked with?

Pre-eclampsia
Pre-term birth
IUGR
Perinatal death
Congenital malformations

4

How many women experience dyspnoea in pregnancy?

60%

5

What can you use to monitor asthma in asthmatic pregnant women?

FEV1 (doesn't change in pregnancy even though resp minute volume increases)

6

How many women experience improvement/no change/worsening of their asthma in pregnancy?

Improvement: 34%
Unchanged: 26%
Worsen: 36%

7

What improvement in FEV1 is expected after salbutamol therapy?

12% improvement or more

8

What are the differential diagnoses for breathlessness in pregnancy?

Dyspnoea of pregnancy
PE
Amniotic fluid embolism
Bronchitis/pneumonia
Post nasal drip (rhinitis)
Congestive heart failure/cardiomyopathy
GORD
Vocal cord dysfunction
Dysfunctional breathing

9

Management of asthma in pregnancy

Smoking cessation
Vaccination
Body weight
Folate
Routine monitoring
Eduction about SE and adherence
Control of environmental triggers
Inhaler techniques
Management of existing conditions

10

What asthma treatments cannot/should not be used in pregnancy?

Leukotriene receptor antagonists
Anticholinergics
Immunotherapy

11

What is the advice for oral corticosteroids?

Not teratogenic
Small risk of cleft lip
Associated with low birth weight and pre-eclmapsia but possible confounding variable is severity of asthma
Benefits outweigh risks of uncontrolled asthma!

12

Is there any genetic link to maternal asthma?

ADAM33 gene is induced in allergic maternal asthma

13

Advice of how to avoid allergens?

Remove pets from home
Encase pillow and mattress with impermeable covers
Wash sheet and blankets weekly in hot water

14

Any advice for labour with maternal asthma?

Avoid carboprost, ergonovine and indomethacin
Instead use prostaglandin, MgSO4 or terbutaline

15

What other diseases are included in the COPD diagnosis?

Chronic bronchitis, emphysema and asthma

16

Spirometry diagnosis of COPD?

FEV1/FVC ratio less than 0.7
No reversibility with B2 agonists

17

What is LTOT?

Long term oxygen therapy
Increases survival for those with chronic respiratory failure
Lowers cardiac risk and improves cognition (not as hypocapnic)

18

What are the arguments for smoking cessation in COPD?

Improves mortality and health quality
Makes oxygen less risky
Inhalers work better
Less exacerbations
Improves mental and cardiovascular health

19

Treatment of COPD?

Inhaled antimuscarinics + LABAs + steroids
Stand by oral steroids and antibiotics
Mucolytics

20

What can be offered for repeated infective exacerbations of COPD?

Long term macrolide antibiotics
(eg clarithromycin)

21

What is interstitial lung disease?

Any disease that affects the space between alveolar epithelium and capillary endothelium
Inflammation, fibrosis and remodelling

22

Name 3 exposure related ILD causes

Occupational (asbestosis)
Environmental (dust mite hypersensitivity)
Medication (bleomycin)
CT disease

23

Name the major idiopathic pulmonary fibroses

Idiopathic pulmonary fibrosis
Idiopathic non specific interstitial pneumonia
Respiratory bronchiolitis interstitial lung disease

24

What is the most frequent ILD?

Idiopathic pulmonary fibrosis
Incidence is increasing
Median survival 3 yrs

25

Risk factors for idiopathic pulmonary fibrosis

Genetics (MUC58, TOLLIP, Telomerase)
Cigarette smoking > 20 pack years
Metal and woods dusts, farming, raising birds, stone cutting
Herpes viruses, EBV, CMV, Hep C
GORD

26

Presentation of idiopathic pulmonary fibrosis

Increases with age, males more than females
Exertional dyspnoea
Dry cough
Digital clubbing
Diffuse inspiratory crackles

27

Diagnosis of idiopathic pulmonary fibrosis relies on:

Exclusion of other ILDs (CT diseases, environmental exposures, medications)
Presence of 'Usual Interstitial Pneumonia' (UIP) pattern on chest High Res Chest CT/surgical lung biopsy

28

What does the 'usual interstitial pneumonia' pattern if disease involve?

Bilateral patchy fibrosis
Basal/peripheral predominance
Reticular line and fibroblast foci
Honeycombing
Traction bronchiectasis
Architectural distortion

29

When is a lung biopsy taken?

In ILD if HR CT is nor diagnostic
Mortality is 1-3%
Can have serious complications (pneumothorax, pneumonia, empyema, haemothorax)

30

What factors are involved in the pathogenesis of ILD?

Myofibroblast accumulation and angiogeneis
TGFBeta, CTGF, ET-1, PDGF, VEGF
Excessive ECM and collagen