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Flashcards in Lung diseases Deck (42):
1

Where in the lung airways does asthma affect?

Conducting airways

2

Where in the lung airways does COPD affect?

Conducting airways and parenchyma

3

Where in the lung airways does ILD/IPF affect?

Lung parenchyma

4

Where in the lung airways does TB affect?

Anywhere in the lung

5

What %FEV1 improvement following Bronchodilator administration is indicative of asthma?

>12%

6

Why does asthma worsen in pregnancy?

- 20% increase in o2 consumption
- 15% increase in metabolic rate
- 40-50% increased respiratory minute volume (amount of gas inhaled or exhaled in 1 min)

7

Factors for a diagnosis of asthma in pregnancy?

History of cough/wheeze/tightness

Reduced FEV1

Reduced FVC:FEV1 ratio

8

In what weeks of pregnancy is asthma worst?

24-26

9

Differentials to asthma in pregnancy?

Dyspnoea of pregnancy
PE/amniotic fluid embolism
Bronchitis/pneumonia
Allergic rhinitis/sinusitis
HF
GORD
Vocal cord dysfunction

10

What drugs should be used in asthma in pregnancy?

All can be used

SABA, LABA, corticosteroid, Theophylline (methyxanthine), chromones.

Corticosteroids associated with low birth weight and pre term birth should not be withheld in severe cases.

11

Long term treatment therapies for COPD?

Antimuscarinics, LABAs, ICS and LABA,

12

R/Fs for IPF?

Genetics - MUC5B
Smoking
Environmental exposure
Microbial agents - Herpes (EBV, HHV7/8, CMV)
GORD

13

Presentation of IPF?

Exertional dyspnoea
Dry cough
Clubbing
Diffuse inspiratory crackles

14

What do you have to exclude to diagnose IPF?

Exclude: Medications, Connective Tissue diseases, environmental exposures

15

Prognosis of IPF?

Median survival is 3 years

16

investigations to diagnose IPF?

Usual interstitial pneumonia (UIP) pattern on chest HRCT/ surgical lung biopsy

17

Complications of lung biopsy and mortality rate?

Acute exacerbations of interstitial disease
Pneumo/haemothorax
Empyema
Pneumonia

18

What characterises restrictive lung disease?

Loss of lung volume

19

Treatment for IPF?

• Nintedanib/pirfenidone (antifibrotics)
• Symptom control
• O2 therapy
• Transplant
• Pulmonary rehab

20

Usual presentation of pulmonary TB?

Cough
Weight loss
Night sweats
~6months of symptoms

21

Investigation findings for TB?

Atypical shadowing on CXR
Sputum acid-fast stain positive (Zhiel-Nielson)
Bronchoscopy

22

TB treatment? Length of treatment?

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

For a minimum treatment length of 6 months

23

How many women require medical intervention for asthma in pregnancy?

45%

24

What investigations should you not perform for asthma in pregnancy?

Methacholine challenge

Skin prick testing

25

adherence rate for asthma medication in pregnancy?

50%

26

What allergic investigations would you perform in asthma in pregnancy?

IgE blood analysis

27

What are asthma exacerbations most associated with?

Low birth-weight babies

28

What gene is associated with asthma in pregnancy?

ADAM33

29

prediction of severity of COPD by FEV1?

>80%, mild airways obstruction
50%- 80%, moderate airways obstruction
30%- 49%, severe airways obstruction

30

Types of oxygen therapy in stable COPD?

Long term oxygen therapy

Ambulatory oxygen (desat on exertion)

Palliative short burst oxygen therapy

31

Best way to improve mortality in COPD patients? Why?

Smoking cessation,

Makes oxygen less risky
Inhalers work better
Less exacerbations
Improved mental health
Improved cardiovascular health

32

Inhaled drug therapies in COPD?

Bronchodilators: Long acting anti-muscarinics/Long acting B-agonists

Inhaled steroids IN COMBINATION with Long acting B agonists

33

What is pulmonary rehab?

a program of exercise, education, and support to help you learn to breathe—and function—at the highest level possible.

34

Four key interventions to improve QOL in COPD?

FOOD /Smoking cessation /Pulmonary rehabilitation /oxygen therapy

35

Spirometry results of a COPD patient?

Obstructive FEV1/FVC with no bronchodilator reversibility

36

Investigation to diagnose IPF? If the first line isn't diagnostic what would you perform?

HRCT

Surgical biopsy

37

Pattern of IPF on a HRCT?

Bilateral
Basal/peripheral
predominance
Reticular lines
Honeycombing
Traction bronchiectasis

38

What type of pulmonary disease is IPF?

Restrictive

39

Tests for TB?

Sputum acid fast bacilli will be positive (zhiel-nielsen)

Induced sputum

Bronchoscopy

40

How long would a TB culture normally take to grow? What media may speed this up?

Several weeks

A Bactec 460 Radiometric culture

41

What is a ghon focus?

The primary site of TB infection

42

What does TB do to the ECM that allows it to be successful? What is the proposed mechanism of this?

Destroys it.

Increased secretions of MMPs