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MedED chronic SOB Flashcards

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1
Q

What are the 3 categories of lung disease anatomically?

A

Airways
Alveolar
Parenchymal

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2
Q

What are symptoms of resp conditions that you should ask about? What specifically might you ask about?

A 
Cough- wet/dry?
SOB- exertional?
Haemoptysis
Fatigue
Chest pain- pleuritic?
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3
Q

What cells mediate inflammation in asthma?

A

Mast cells
IgE
Eosinophil

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4
Q

What happens to the airway and parenchyma in asthma?

A 
Airway= obstructed (reversibly)
Parenchyma= in tact
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5
Q

What type of obstruction is present in asthma?

A

Reversible/ variable obstruction

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6
Q

How will someone with asthma classically present?

A 
SOB
Dry cough
Chest tightness
Waking up at night coughing
Triggered when cold
Wheeze
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7
Q

What triad of atopy might someone with asthma have?

A

Food allergy
Hayfever
Eczema

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8
Q

What are risk factors for asthma?

A

Family history
Allergies eg food, hayfever, pets, dust mites
GORD (it can make asthma worse)

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9
Q

What condition can make asthma worse?

A

GORD

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10
Q

What is used to assess the severity of someones asthma? How does it work

A

ACT= asthma control test

It works by:
Score over 20= controlled
Score under 19= uncontrolled

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11
Q

What does BDR stand for?

A

Bronchodilator reversible

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12
Q

What will FEV1/FVC be in obstructive disease?

A

<0.7

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13
Q

What will FEV1/FVC be in restrictive disease?

A

> 0.7

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14
Q

What is the first line investigation for asthma?

A

Spirometry

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15
Q

What happens to FEV1 in asthma?

A

Reduced

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16
Q

What happens to FVC in asthma?

A

It stays the same

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17
Q

What investigations might you do for asthma?

A

Spirometry

Fractional exhaled nitric oxide

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18
Q

What is fractional exhaled nitric oxide in asthma?

A

Over 40 ppm

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19
Q

What treatment addresses inflammation in asthma?

A

Inhaled corticosteroids

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20
Q

What dose of ICS is most effective in asthma?

A

Low dose

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21
Q

What are the asthma reliever medications? Why are they relievers?

A

They make the symptoms go away but do not address the inflammation

1) SABA- not effective in infections or exacerbations
2) LTRA
3) LABA
4) LAMA

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22
Q

What medications should you start for an adult with asthma?

A 
First= start low dose ICS (inhalers)
Second= start LTRA
Third= add LABA (if doing this stop LTRA) 
Fourth= LABA as MART

Also give SABA alongside all of this
Review every 4-8 weeks and they have to be adherent

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23
Q

What is MART?

A

Combination inhaler of ICS with a LABA (LABA has long and short acting components)

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24
Q

What is important when reviewing medications in a patient with asthma? How might you do this

A

Adherence- they have to be adherent or it wont work
Ask them:
How many times a week would you forget you medications
Can you show me how you take your inhaler
Do you know what your medications do?

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25
What is occupational asthma and what do you need to know about it?
Asthma due to inhaled particles at work Symptoms resolve during the holidays/ time away from work and get worse when at work To manage they should try to avoid their triggers eg use PPE, then also manage like normal asthma
26
What type of obstruction do you get in COPD?
Irreversible airway obstruction
27
What are the features of COPD?
Small airway obstruction Emphysema Excess mucus production
28
What is the main anti inflammatory molecule in the lung?
Alpha 1 antitrypsin
29
Deficiency of what causes inflammation of the lungs?
Alpha 1 antitrypsin
30
What are the biggest risk factors for COPD?
Increasing age | Smoking
31
How will someone with COPD classically present?
Dyspnoea- exertional, persistent Cough- this may be productive (30% of patients have a cough) Wheeze
32
What will you ask in a COPD hx?
Smoking? Family hx of COPD/ alpha 1 antitrypsin Have you had any exacerbations Ask all malignancy symptoms- increased risk of cancer RHF- ankle swelling Associated symptoms- pink frothy sputum/heamoptysis/ hoarse voice etc
33
What heart problem is associated with COPD and why?
RHF- the heart is pumping through an obstructed lung system
34
What are some signs of COPD?
``` Barrel chest/ hyperexpansion Wheeze Cyanosis CO2 flap Tachypnoea Cor pulmonale= ankle swelling, raised JVP, RV heave Tar staining Flared nostrils Use of accessory muscles to breathe Look for clubbing because of increased risk of malignancy ```
35
How do you identify hyperexpansion?
Reduced cricosternal distance
36
What is the first line investigation for COPD?
Spirometry
37
What will you see on spirometry in COPD?
Obstruction with no bronchodilator reversibility | FEV1/FVC <0.7
38
What should you use to assess severity of COPD? What does it measure
MRC- it measures dyspnoea
39
What is the first line pharmacological treatment for COPD?
SABA or SAMA If this doesnt help and there are asthma features (eosinophils, FEV1 variability, peak flow variability)= ICS and LABA, then ICS and LABA and LAMA If no asthma features= LABA and LAMA, them LABA and LAMA and ICS
40
Why is ICS not given to COPD patients unless they have asthma features?
It reduces immunity and increases risks of flares which they are more likely to die of
41
How will someone with idiopathic pulmonary fibrosis present?
``` Chronic SOB Progressive exertional dyspnoea Dry cough Clubbing Bibasal inspiratory creps Weight loss, fatigue, malaise ```
42
What crackles do you get with fibrosis?
Bi basal fine end inspiratory crackles
43
What are risk factors for pulmonary fibrosis?
Increasing age | Smoking
44
What is the gold standard investigation for IPF? What will the results be?
Spirometry and gas transfer- Spirometry= FEV1/FVC >0.7, reduced gas transfer
45
What is DLCO and what does it tell you?
Diffusing capacity for carbon monoxide- it tells you how quick carbon monoxide is moving across the alveoli and will therefore tell you if there is an alveolar pathology
46
What are causes of pulmonary fibrosis?
Exposure to toxins | Rheumatoid arthritis- check rheumatoid factor, anti ccp, ana panel etc
47
How is IPF managed?
Specialist care: Pulmonary rehab Ambulatory or long term o2 Antifibrotics (pirfenidone or nintedanib if FVC is between 50-80% predicted)
48
What is the prognosis of IPF?
2/3 years It will stay until you die Decline might be slow or extremely fast
49
What are extrapulmonary symptoms of sarcoidosis?
Joint pain Lupus pernio or erythema nodosum Eye problems- photophobia, red painful eye, blurry vision
50
What is sarcoidosis?
Non caseating granulomas deposited around the body causing disease Can affect all organs but most commonly lungs
51
What are risk factors for sarcoidosis?
Infection with TB Women aged 20-40 Family hx Afro caribbean
52
How will someone with sarcoidosis classically present?
Chronic dry cough Fatigue Progressive SOB (exertional) Skin lesions- erythema nodosum or lupus pernio Eye problems - photophobia, painful red eye, blurry vision due to posterior and anterior uveitis Facial nerve palsy Cardiomyopathy
53
What is a non caseating granuloma?
A collection of macrophages around a core
54
Is there necrosis in sarcoidosis?
No
55
What are some signs of sarcoidosis when you examine someone?
Wheeze Ronchi Erythema nodosum
56
What are pulmonary manifestations of sarcoidosis?
Bilateral hilar lymphadenopathy
57
What electrolyte is high in sarcoidosis?
Calcium
58
What is there a lack of in stage 4 sarcoidosis?
Hilar lymphadenopathy
59
What investigations are done for sarcoidosis?
``` Investigate all organs Lungs: CXR High resolution CT ECG UEs LFTs ```
60
What is high in sarcoidosis?
Calcium | Serum ACE
61
How is sarcoidosis managed?
Mainly corticosteroids | Immunosupressants if this doesnt work eg azothioprine, methotrexate
62
What is OSA?
Complete or partial collapse of the upper airway causing obstructive apnoea or hypopnoea
63
What are risk factors for OSA?
Obesity Cushings Acromegaly Menopause
64
How will OSA present?
Loud snoring, then silence then snoring again Daytime sleepiness Restless sleep
65
What will someone with sleep apnoea tell you when they present?
They will tell you they are tired and have bad sleep | They may not be aware they are waking at night because they can wake up hundreds of times without knowing it
66
What scoring system is used for OSA? What does it stand for? What score is needed
STOP BANG: snoring, tired, observed apnoea, pressure (BP), BMI over 35, age over 35, neck cirum over 40 and male gender Score over 3= refer to polysomnography
67
What is the gold standard investigation for OSA? What does it calculate
Night time in lab polysomnography | It calculates apnoea hypopnoea index which is average no of obstrucitve events per hour
68
What is treatment for OSA when someone is asymptomatic vs symptomatic
``` Everyone= weight loss, smoking and alcohol stop, sleep on side if poss Asymp= intra oral mandibular advancement device Symp= CPAP ```
69
What occupational lung disease is caused by coal?
Simple pnuemocosis | Progressive massive fibrosis
70
What is simple pneumoconosis?
Coal in the lungs
71
What are symptoms of simple pneunomocosis?
None, usually asymptomatic
72
How will someone with progressive massive fibrosis present?
History of working in a coal mine Exertional dyspnoea Cough with or without black sputum Fibrotic masses on CXR
73
What is important to remember in occupational lung disease?
The patients may be entitled to compensation if they apply within 3 years of being diagnosed
74
What professions increase risk of silicosis?
Arty stuff like stonemasonry, pottery, ceramics
75
How will someone with silicosis present?
Cough and SOB | Upper lobe fibrotic masses
76
What 3 main particles cause interstitial lung disease?
Coal Asbestos Silica
77
What professions increase risk of asbestosis?
Working with asbestos: shipyard workers, mining, aerospace Working near asbestos: electricians, painters and masons Background workers
78
How will someone with asbestosis present?
Chronic progressive exertional dyspnoea Dry cough May have malignancy symptoms- FLAWS and haemoptysis
79
What are signs of asbestosis?
``` Clubbing Reduced expansion Asbestos warts Bibasal crackles RHF ```
80
What type of CT is done for ILD?
High resolution

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