Obstructive Lung Diseases

Question 1

What causes asthma

Answer 1

Chronic inflammation

Question 2

Is airflow limitation variable in asthma or COPD

Answer 2

Asthma

Question 3

Asthma symptoms

Answer 3

Wheeze
Shortness of breath
Chest tightness
Cough

Question 4

What limits airflow in asthma

Answer 4

Narrowed airways from chronic inflammation

Question 5

How does chronic inflammation impact airways

Answer 5

Thickening basement membrane
Airway smooth muscle hypertrophy
Leukocyte infiltration
Goblet cell hyperplasia
Mucus hypersecretion

Question 6

Which type of cells are central in asthma pathology

Answer 6

TH2

Question 7

What molecules do allergens activate in asthma pathology

Answer 7

Sensitised mast cells

Question 8

Which bronchoconstrictor mediators are released by sensitised mast cells when allergens bind to them

Answer 8

Histamine
Cysteinyl leukotrienes
Prostaglandin D2

Question 9

What do TH2 cells do in asthma pathology

Answer 9

Release inflammatory mediators

Question 10

What inflammatory mediators are released by TH2 cells in asthma pathology

Answer 10

IL-4
IL-5
IL-9
IL-13

Question 11

Types of asthma

Answer 11

Allergic asthma
Exercise induced asthma
Late onset eosinophilic asthma
Very late onset asthma
Obesity associated asthma
Smoking related neutrophilic asthma
Smooth muscle mediated paucigranulocytic asthma

Question 12

Does T2 type asthma usually appear in childhood or adulthood

Answer 12

Childhood

Question 13

Does non t2 type asthma usually appear in childhood or adulthood

Answer 13

Adulthood

Question 14

What can cause variation in asthma symptoms

Answer 14

Time of day
Season
Environment

Question 15

Why is predictive value of isolated asthma signs and symptoms poor

Answer 15

Symptoms are not specific to asthma

Question 16

Wheeze

Answer 16

Continuous high pitch musical sound coming from chest

Question 17

What is involved in asthma diagnosis

Answer 17

Previous medical history
Current medical history
Lung function tests

Question 18

What symptoms on assessment suggest possible asthma

Answer 18

Wheeze
Cough
Breathlessness
Chest tightness

Question 19

What characteristics from history suggest possible asthma

Answer 19

Recurrent symptom episodes
Symptom variability
Absence of alternative diagnosis symptoms
Recorded observation of wheeze
History of atopy
Historical variable PEF or FEV1

Question 20

Which patients would be sent for tests to confirm asthma

Answer 20

Intermediate probability patients

Question 21

How does badly managed asthma effect spirometry

Answer 21

Decr FEV1 and FVC

Question 22

Does the upper portion of a flow volume graph show inspiration or expiration

Answer 22

Expiration

Question 23

How does the flow volume graph of an asthma patient and person without asthma differ

Answer 23

Asthma causes scalloped line during expiration due to reduced flow rate

Question 24

Why does asthma decrease flow rate

Answer 24

Small airways collapse

Question 25

What spirometry result indicates asthma

Answer 25

Obstructive spirometry with positive bronchodilator reversibility, although spirometry may be normal in asymptomatic patients

Question 26

How many PEF attempts are used to calculate a value

Answer 26

3

Question 27

How much variability in PEF and FEV1 suggests asthma

Answer 27

20%+ PEF 12%FEV1

Question 28

How does PEF change in asthma exacerbation

Answer 28

Decrease

Question 29

Asthma management goals

Answer 29

Control disease No daytime symptoms No night wakening No need for rescue medication No daily activity limitation Norma, lung function Minimal drug side effects Invariable PEF

Question 30

What medication is used as rescue medication for symptomatic asthma

Answer 30

Inhaled short acting beta 2 agonist

Question 31

What drugs are used in asthma management

Answer 31

Inhaled short acting beta 2 agonist Inhaled corticosteroids

Question 32

What is SMART

Answer 32

combined maintenance and reliever therapy

Question 33

In What age children should spacers be considered for inhalers

Answer 33

5-12yrs

Question 34

Should aerosol inhalers be inhaled slow and steady or quick and deep

Answer 34

Slow and steady

Question 35

Should dry powder inhalers be inhaled slow and steady or quick and depo

Answer 35

Quick and deep

Question 36

Corticosteroids

Answer 36

Broad spectrum anti inflammatory drugs

Question 37

What receptors do ICSs bind to in the cytoplasm

Answer 37

Glucocorticoid receptor

Question 38

What does the corticosteroid-glucocorticoid receptor complex bind to

Answer 38

Glucocorticoid response element on DNA

Question 39

What is released as a result of glucocorticoids binding to DNA

Answer 39

CXCL8 IL-6 TNF-alpha

Question 40

Why should corticosteroid use be limited

Answer 40

Can block other immune pathways

Question 41

What do beta 2 agonists cause

Answer 41

Airway smooth muscle relaxation

Question 42

What do beta 2 agonists bind to

Answer 42

Beta 2 adrenergic receptors on smooth muscle

Question 43

What medications are used in asthma combination therapy

Answer 43

Beta 2 agonists ICS

Question 44

What does COPD cause

Answer 44

Progressive airflow limitation

Question 45

COPD risk factors

Answer 45

Smoking Genetics Occupational chemicals Frequent lung infections as child Indoor smoke Occupational Dust

Question 46

What causes COPD

Answer 46

Chronic inflammation Small airway disorders Emphysema Systemic effects

Question 47

Emphysema

Answer 47

Bronchoconstriction and alveoli destruction

Question 48

How does cigarette smoke cause COOD

Answer 48

Irritated and activates epithelial cells + macrophages -> inflammatory mediators -> inflammatory cascade

Question 49

What proteases are released by TC1 and neutrophils in COPD and what do they do

Answer 49

Metalloproteinase 9 - elastin degradation Neutrophil elastase - mucus hypersecretion

Question 50

Which cells secrete transforming growth factor beta in COPD

Answer 50

epithelial cells Macrophages

Question 51

What is the role of transforming growth factor beta in COPD

Answer 51

Stimulates fibroblast proliferation causing fibrosis in small airways

Question 52

How do asthma and COPD respond to steroids

Answer 52

Asthma - good COPD - poor

Question 53

What is the difference between asthma and COPD airflow limitation

Answer 53

Asthma - variable COPD - progressive

Question 54

Is atopy a characteristic of asthma or COPD

Answer 54

Asthma

Question 55

COPD symptoms

Answer 55

Shortness of breath Dyspnoea - progressive, worse w exercise Chronic cough Phlegm Wheezing Chest tightness Recurrent lower Respiratory infection

Question 56

What is involved in COPD diagnosis

Answer 56

Previous history Current history Lung function tests Spirometry Age >40

Question 57

What 3 things are involved in COPD assessment

Answer 57

Symptom severity Extent of lung function decline Exacerbations

Question 58

What expiratory ratio indicates COPD

Answer 58

<0.7

Question 59

How does COPD affect FEV1 and FVC

Answer 59

Decrease

Question 60

What framework is used for deciding COPD treatment

Answer 60

ABCD tool

Question 61

What decides where a COPD patient is placed on the ABCD tool

Answer 61

Annual moderate exacerbations with or without hospital admission Breathlessness questionnaire and COPD assessment test

Question 62

What is the first line maintainable treatment for COPD

Answer 62

Long acting bronchodilator

Question 63

What drugs are used in COPD treatment

Answer 63

LAMA LABA ICS bronchodilator

Question 64

LAMA

Answer 64

Long acting muscarinic antagonist

Question 65

LABA

Answer 65

long acting beta 2 agonist

Question 66

Which group on the COPD ABCD tool has elevated bloody eosinophils and may need triple therapy

Answer 66

Group D

Question 67

What drugs make up COPD triple therapy

Answer 67

LAMA LABA ICS

Question 68

How do LAMAs inhibit smooth muscle contraction

Answer 68

Block ACh binding to M3 muscarinic receptors

Question 69

What do LAMAs do

Answer 69

Inhibit smooth muscle contraction

Question 70

Asthma first line therapy

Answer 70

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