Lung diseases

Question 1

Where in the lung airways does asthma affect?

Answer 1

Conducting airways

Question 2

Where in the lung airways does COPD affect?

Answer 2

Conducting airways and parenchyma

Question 3

Where in the lung airways does ILD/IPF affect?

Answer 3

Lung parenchyma

Question 4

Where in the lung airways does TB affect?

Answer 4

Anywhere in the lung

Question 5

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

Answer 5

> 12%

Question 6

Why does asthma worsen in pregnancy?

Answer 6

• 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)

Question 7

Factors for a diagnosis of asthma in pregnancy?

Answer 7

History of cough/wheeze/tightness

Reduced FEV1

Reduced FVC:FEV1 ratio

Question 8

In what weeks of pregnancy is asthma worst?

Answer 8

24-26

Question 9

Differentials to asthma in pregnancy?

Answer 9

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

Question 10

What drugs should be used in asthma in pregnancy?

Answer 10

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.

Question 11

Long term treatment therapies for COPD?

Answer 11

Antimuscarinics, LABAs, ICS and LABA,

Question 12

R/Fs for IPF?

Answer 12

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

Question 13

Presentation of IPF?

Answer 13

Exertional dyspnoea
Dry cough
Clubbing
Diffuse inspiratory crackles

Question 14

What do you have to exclude to diagnose IPF?

Answer 14

Exclude: Medications, Connective Tissue diseases, environmental exposures

Question 15

Prognosis of IPF?

Answer 15

Median survival is 3 years

Question 16

investigations to diagnose IPF?

Answer 16

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

Question 17

Complications of lung biopsy and mortality rate?

Answer 17

Acute exacerbations of interstitial disease
Pneumo/haemothorax
Empyema
Pneumonia

Question 18

What characterises restrictive lung disease?

Answer 18

Loss of lung volume

Question 19

Treatment for IPF?

Answer 19

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

Question 20

Usual presentation of pulmonary TB?

Answer 20

Cough
Weight loss
Night sweats
~6months of symptoms

Question 21

Investigation findings for TB?

Answer 21

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

Question 22

TB treatment? Length of treatment?

Answer 22

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

For a minimum treatment length of 6 months

Question 23

How many women require medical intervention for asthma in pregnancy?

Answer 23

45%

Question 24

What investigations should you not perform for asthma in pregnancy?

Answer 24

Methacholine challenge

Skin prick testing

Question 25

adherence rate for asthma medication in pregnancy?

Answer 25

50%

Question 26

What allergic investigations would you perform in asthma in pregnancy?

Answer 26

IgE blood analysis

Question 27

What are asthma exacerbations most associated with?

Answer 27

Low birth-weight babies

Question 28

What gene is associated with asthma in pregnancy?

Answer 28

ADAM33

Question 29

prediction of severity of COPD by FEV1?

Answer 29

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

Question 30

Types of oxygen therapy in stable COPD?

Answer 30

Long term oxygen therapy Ambulatory oxygen (desat on exertion) Palliative short burst oxygen therapy

Question 31

Best way to improve mortality in COPD patients? Why?

Answer 31

Smoking cessation, ``` Makes oxygen less risky Inhalers work better Less exacerbations Improved mental health Improved cardiovascular health ```

Question 32

Inhaled drug therapies in COPD?

Answer 32

Bronchodilators: Long acting anti-muscarinics/Long acting B-agonists Inhaled steroids IN COMBINATION with Long acting B agonists

Question 33

What is pulmonary rehab?

Answer 33

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

Question 34

Four key interventions to improve QOL in COPD?

Answer 34

FOOD /Smoking cessation /Pulmonary rehabilitation /oxygen therapy

Question 35

Spirometry results of a COPD patient?

Answer 35

Obstructive FEV1/FVC with no bronchodilator reversibility

Question 36

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

Answer 36

HRCT Surgical biopsy

Question 37

Pattern of IPF on a HRCT?

Answer 37

``` Bilateral Basal/peripheral predominance Reticular lines Honeycombing Traction bronchiectasis ```

Question 38

What type of pulmonary disease is IPF?

Answer 38

Restrictive

Question 39

Tests for TB?

Answer 39

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

Question 40

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

Answer 40

Several weeks A Bactec 460 Radiometric culture

Question 41

What is a ghon focus?

Answer 41

The primary site of TB infection

Question 42

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

Answer 42

Destroys it. Increased secretions of MMPs