Obstructive Lung Disease

Question 1

Which two conditions can be complicated by allergic bronchopulmonary Aspergillosis?

Answer 1

Asthma and CF

Question 2

Allergic bronchopulmonary Aspergillosis is diagnosed by detected very high levels of what in the blood?

Answer 2

IgE

Question 3

If someone aspirates a foreign body, which bronchus is it most likely to get stuck in?

Answer 3

Right inferior lobe bronchus

Question 4

What is a clinical sign that is very specific to large airway obstruction, and should always be thoroughly investigated?

Answer 4

Stridor (inspiratory wheeze)

Question 5

What are some investigations which may be performed in someone with a suspected large airway obstruction? Which is the most sensitive test?

Answer 5

Imaging (x-ray/CT) of the chest and neck, spirometry and bronchoscopy (the most sensitive test)

Question 6

What medical therapy should be prescribed for a patient with newly diagnosed asthma (aged 17+) who has an infrequent, short-lived wheeze and normal lung function?

Answer 6

SABA only

Question 7

After starting/stopping a medication for asthma, how long should the new treatment regime be followed before considering making changes?

Answer 7

4-8 weeks

Question 8

What medical therapy should be prescribed for a patient with newly diagnosed asthma (aged 17+) who has symptoms which indicate the need for maintenance therapy at presentation?

Answer 8

SABA + low-dose ICS

Question 9

What medical therapy should be prescribed for an adult whose asthma remains uncontrolled following 4-8 weeks of treatment with a SABA alone?

Answer 9

Low-dose ICS

Question 10

If an adult’s asthma remains uncontrolled following 4-8 weeks of treatment with a low-dose ICS and SABA, what treatment regimen should be tried next?

Answer 10

SABA + low-dose ICS + LTRA

Question 11

You can consider decreasing maintenance therapy for asthma when symptoms have been controlled with current maintenance therapy for how long?

Answer 11

At least 3 months

Question 12

If an adult’s asthma remains uncontrolled following 4-8 weeks of treatment with a SABA, low-dose ICS and LTRA, what treatment regime can be tried next?

Answer 12

SABA + low-dose ICS + LABA +/- LRTA

Question 13

In COPD, what combination of drugs is superior to any drug alone at increasing FEV1?

Answer 13

LABA + LAMA

Question 14

Which vaccinations should be offered to all COPD patients?

Answer 14

Pneumococcal and influenza

Question 15

If inhaled therapies are required for COPD, which medications can be offered first line to use as required?

Answer 15

SABA or SAMA

Question 16

What medical therapy should be offered to patients with COPD who are limited by symptoms or have exacerbations despite treatment with a SABA or SAMA, and have no asthmatic features suggestive of steroid responsiveness?

Answer 16

LABA + LAMA (in addition to SABA or SAMA)

Question 17

What medical therapy should be offered to patients with COPD who are limited by symptoms or have exacerbations despite treatment with a SABA or SAMA, and have asthmatic features, or features suggesting steroid responsiveness?

Answer 17

LABA + low-dose ICS (in addition to SABA or SAMA)

Question 18

Give 5 examples of anti-inflammatory medications which can be used in the treatment of asthma and COPD?

Answer 18

Corticosteroids, cromones, LTRAs, methylxanthines, anti-IgE monoclonal antibodies

Question 19

How can steroids be given in the treatment of asthma and COPD? Give an example of each type?

Answer 19

Inhaled (beclomethasone), oral (prednisolone), IV (hydrocortisone)

Question 20

Name some side effects of inhaled corticosteroids?

Answer 20

Hoarse voice, oral candidiasis, increased risk of pneumonia (only in COPD)

Question 21

Which medications should be given via a nebuliser in acute severe asthma?

Answer 21

Salbutamol (5mg) + ipratropium bromide (500mcg)

Question 22

Which medications can be given IV in acute severe asthma?

Answer 22

Hydrocortisone (200mg) and magnesium sulphate (2g)

Question 23

COPD is characterised by largely irreversible airway obstruction. This is an umbrella term for which conditions?

Answer 23

Chronic bronchitis and emphysema

Question 24

What is the most effective way to prevent COPD?

Answer 24

Stop smoking

Question 25

Which 3 inflammatory cells are most involved in the pathophysiology of COPD?

Answer 25

CD8+ lymphocytes, neutrophils and macrophages

Question 26

What are the 3 main pathological features of COPD?

Answer 26

Hypersecretion of mucus, small airway obstruction and alveolar destruction

Question 27

When would cromones be used?

Answer 27

Prophylaxis of allergic asthma in children

Question 28

Give an example of a monoclonal IgE antibody?

Answer 28

Omalizumab

Question 29

How are monoclonal IgE antibodies given?

Answer 29

As an IV injection every 2-4 weeks

Question 30

What is the mechanism of action of methylxanthines?

Answer 30

Non-selective phosphodiesterase inhibitors

Question 31

Give two examples of methylxanthines?

Answer 31

Theophylline and aminophylline

Question 32

How can methylxanthines be given?

Answer 32

Oral or IV

Question 33

Give an example of a leukotriene receptor antagonist?

Answer 33

Montelukast

Question 34

How are leukotriene receptor antagonists given?

Answer 34

Orally

Question 35

What kind of drug is carbocysteine?

Answer 35

Mucolytic

Question 36

Symptoms of a COPD exacerbation are often preceded by what other symptoms?

Answer 36

Coryzal symptoms

Question 37

If a patient with a COPD exacerbation presents with confusion and drowsiness, what should you suspect?

Answer 37

Type II respiratory failure

Question 38

How should a COPD exacerbation be treated?

Answer 38

Prednisolone (30mg od) and amoxicillin (500mg tds) for 5 days

Question 39

Which antibiotic should be used second line for a COPD exacerbation if the patient is penicillin allergic?

Answer 39

Doxycycline

Question 40

What are the features of alpha-1-anti-trypsin deficiency?

Answer 40

Emphysema and liver cirrhosis

Question 41

What is the most prominent feature of chronic bronchitis?

Answer 41

Chronic cough with purulent sputum production

Question 42

What is the most prominent feature of emphysema?

Answer 42

Dyspnoea

Question 43

What are some clinical signs of chronic bronchitis?

Answer 43

Cyanosis (due to hypoxaemia) and peripheral oedema (due to cor pulmonale)

Question 44

What are some potential complications of chronic bronchitis?

Answer 44

Polycythaemia, pulmonary hypertension and cor pulmonale

Question 45

What diagnosis should you suspect in someone who is a smoker, presenting with features of both COPD and asthma?

Answer 45

Asthma-COPD overlap syndrome (ACOS)

Question 46

A PEFR of what would be suggestive of severe asthma?

Answer 46

30 - 50% of predicted/previous best

Question 47

A PEFR of what would be suggestive of life-threatening asthma?

Answer 47

< 30% of predicted/previous best

Question 48

Name some features of severe asthma?

Answer 48

Unable to complete sentences, tachycardia/tachypnoea

Question 49

Name some features of life-threatening asthma?

Answer 49

Central cyanosis, silent chest, acidosis, bradycardia/hypotension

Question 50

Describe the initial management of acute severe asthma before any drugs are given?

Answer 50

Sit the patient upright and administer high flow O2 through a non-rebreather mask

Question 51

Give two examples of groups of bronchodilators (i.e. relievers) used in the treatment of asthma?

Answer 51

SABAs, LABAs

Question 52

Give two examples of groups of anti-inflammatory drugs (i.e. preventers) used in the treatment of asthma?

Answer 52

Corticosteroids and monoclonal IgE antibodies

Question 53

Give two examples of groups of drugs which act as both relievers and preventers in the treatment of asthma?

Answer 53

LTRAs and methylxanthines

Question 54

Asking what question can give an idea of how good an individual's asthma control is? What answer would indicate poor control?

Answer 54

How often do you use your salbutamol inhaler? Using it several times a day would indicate poor control

Question 55

The mainstay of treatment of asthma is with what?

Answer 55

Regular inhaled corticosteroids

Question 56

Asthma exacerbations requiring hospitalisation are usually preceded by what?

Answer 56

A period of poor control (increased use of bronchodilator and worsening of symptoms)

Question 57

Describe the airway obstruction which occurs in asthma?

Answer 57

Variable airway obstruction (which is fully reversible in the early stages)

Question 58

Which two types of inflammatory cell are most involved in the pathogenesis of asthma?

Answer 58

Eosinophils and CD4+ lymphocytes

Question 59

What are the three ways in which inflammation narrows the small airways in asthma?

Answer 59

Smooth muscle constriction, increased mucus secretion, oedema

Question 60

The airway narrowing seen in asthma leads to a reduction in which lung volumes?

Answer 60

FEV1 and PEFR

Question 61

What are some non-pharmacological ways of preventing asthma?

Answer 61

Stop smoking, lose weight, avoid allergens

Question 62

What are the three most common symptoms of asthma?

Answer 62

Wheeze, dry cough, dyspnoea

Question 63

What treatment should be offered to someone with COPD who remains uncontrolled on either a LABA + LAMA or LABA + low-dose ICS combination?

Answer 63

LABA + LAMA + low-dose ICS

Question 64

Which medication should never be used as monotherapy in the treatment of COPD?

Answer 64

Corticosteroids

Question 65

What is the mechanism of action of bronchodilators?

Answer 65

Airway smooth muscle relaxation

Question 66

Name 5 types of bronchodilator which can be used in the management of asthma and COPD?

Answer 66

Beta 2 agonists, muscarinic antagonists, LRTAs, methylxanthines, magnesium

Question 67

In what forms can beta agonists medications be given?

Answer 67

Inhaled, oral or IV

Question 68

On which receptors do beta agonists exert their effect?

Answer 68

Beta 2 receptors

Question 69

Name some potential side effects of beta 2 agonists?

Answer 69

Tachycardia, fine tremor and hypokalaemia

Question 70

Name two examples of SABAs?

Answer 70

Salbutamol and terbutaline

Question 71

Name two examples of LABAs?

Answer 71

Salmeterol and formoterol

Question 72

How long do the effects of SABAs and LABAs last for?

Answer 72

SABAs last 3-5 hours, LABAs last 8 hours

Question 73

Which receptors do anti-cholinergic drugs used in the treatment of COPD and asthma act on?

Answer 73

M3 muscarinic receptors

Question 74

Which neurotransmitter acts on the M3 muscarinic receptors to cause bronchoconstriction?

Answer 74

Acetylcholine

Question 75

Give an example of a SAMA?

Answer 75

Ipratropium

Question 76

Give an example of a LAMA?

Answer 76

Tiotropium

Question 77

What is the most common side effect of inhaled anti-cholinergic medications?

Answer 77

An unpleasant taste

Question 78

What will PFTs of a large airway obstruction show?

Answer 78

Spirometry will show an obstructive pattern, PEFR will be reduced

Question 79

Why may biopsies be dangerous in those with severe airway obstruction?

Answer 79

Risk of bleeding/oedema which will worsen the obstruction

Question 80

Describe the management of an acute large airway obstruction?

Answer 80

High flow oxygen, high dose corticosteroids, nebulised bronchodilators and adrenaline, inubation/surgery

Question 81

What are some risk factors for the development of asthma?

Answer 81

Personal/family history of atopy, bronchiolitis in childhood, premature/low birth weight, childhood exposure to tobacco smoke

Question 82

What are some examples of drugs which are known to be triggers for asthma?

Answer 82

Beta blockers and NSAIDs

Question 83

Describe the diurnal variation which may be seen in asthma?

Answer 83

Worse through the night and on wakening

Question 84

Between episodes of asthma, there are usually no clinical signs. However, during periods of poor control, what may be audible?

Answer 84

Expiratory wheeze

Question 85

During symptomatic periods of asthma, what may spirometry show?

Answer 85

Reduced FEV1: FVC ratio, and improvement in FEV1 by > 15% after bronchodilator therapy

Question 86

What medication is required for all patients diagnosed with asthma?

Answer 86

SABA

Question 87

What happens to the residual volume and total lung capacity in COPD?

Answer 87

Increased (as a result of air trapping)

Question 88

What are some clinical signs of emphysema?

Answer 88

Accessory muscle use, cachexia, hyperinflated 'barrel' chest

Question 89

What is a potential complication of emphysema?

Answer 89

Pneumothorax

Question 90

Describe what the FEV1: FVC ratio should be to diagnose COPD?

Answer 90

Decreased, < 75%

Question 91

Name three bacteria which may colonise individuals with COPD?

Answer 91

Haemophilus influenzae, Strep pneumoniae, Moraxella catarrhalis

Question 92

If an infection is suspected in somebody with COPD, what microbiology investigations may be required?

Answer 92

Sputum +/- blood cultures

Question 93

What investigation is used to diagnose COPD?

Answer 93

Spirometry

Question 94

Patients with severe COPD may show what on an ECG?

Answer 94

Signs of right heart strain

Question 95

What investigation should be performed in all acute cases of COPD, and in those chronic cases showing hypoxia?

Answer 95

ABG

Question 96

Name the non-pharmacological treatment options for COPD?

Answer 96

Smoking cessation, pulmonary rehab, non-invasive ventilation, palliative care input

Question 97

Which COPD patients are offered ambulatory oxygen therapy?

Answer 97

Those with a PaO2 < 7.3kPa on two blood gas samples, two weeks apart