respiratory 1 2 and 3

Question 1

FEV1

Answer 1

forced expiratory vol in 1 sec

Question 2

FVC

Answer 2

forced vital capacity over 6-12 secs

Question 3

diagnose COPD

Answer 3

FEV1/FVC less than 70%

Question 4

chronic bronchitis

Answer 4

3/12 productive cough for more than 2 consecutive yrs

Question 5

symptoms of chronic COPD

Answer 5

SOBOE
Wheeze
Cough
Weight loss

Question 6

symptoms of acute/exacerbation COPD

Answer 6

Acute sob/wheeze
Worsening sputum production
Fever
Drowsiness/CO2 narcosis

Question 7

signs of COPD

Answer 7

Cachexia
	Use of accessory muscles
	Pursed lips
	Cyanosis
	CO2 flap
	Drowsiness in CO2 narcosis
Hyper-expanded chest – barrel shaped
	Hyperesonant – percuss on the chest, sounds echo like
	Reduced breath sounds
	Wheeze
	Elevated JVP & peripheral oedema in late 	disease

if you have COPD likely to have other issues

Question 8

what can be used to measure SOB

Answer 8

MRC breathlessness scale

Question 9

treatment once diagnosis of COPD

Answer 9

prevention i.e. stop smoking
SABA/SAMA
then LABA (If asthma then also inhaled steroid) LAMA ifnot

asthmatic and not working, triple therapy LAMA/LABA and ICS
theophylline can be symptomatic relief
inhaled steroid not for use on its own

Question 10

what increases risk of pneumonia

Answer 10

inhaled steroids

Question 11

management of stable COPD

Answer 11

address muscle deconditioning
improve QoL
non pharmacological intervention
smoking cessation
oral theophylline

Question 12

prevention of COPD exacerbations

Answer 12

seasonal influenza vaccination 
inhaled steoids
anticholinergics
mucolytics
pulmonary rehabilitation

Question 13

hypoxic drive

Answer 13

body is used to CO2

usually the more CO2 , you breath more to reduce the CO2 but not a driver with some

Question 14

types and causes of respiratory failure

Answer 14

I - pneumonia, asthma, fibrosing lung disease

2 - overdose trauma ,COPD, neuromuscular

Question 15

asthma

Answer 15

tightening of smooth muscle

Question 16

what to look for when diagnosing asthma

Answer 16

recurrent episode of symptms
symtom varaibiloty 
wheeze
personal history of atophy
historical record of variable FEV1

• see if there is a response to tx

Question 17

symptoms of asthma

Answer 17

Wheeze
Cough
Chest tightness
Dyspnea
Nocturnal duration

Question 18

triggers for asthma

Answer 18

Exertion
	Dust
	Change in temperature
	Emotional situations
	Occupation

Question 19

signs of asthma

Answer 19

Eczema
Nasal polyps
Cushingoid
Wheeze

Question 20

asthma treatment pyramid

Answer 20

regular preventer SABA - low dose ICS (B2 agonists)
add on - inhaled LABA and low dose ICS

additional- LABA not working increase ICS dose and try LAMA etc (or leukocyte receptor agonist)

high dose
- increase ICS, addition of 4th drug

oral steroids (monoclonal Ab) - maintain high ICS

Question 21

method of delivery of inhaled drugs

Answer 21

metered dose inhaler (SABA/LABA/ICS)

spacer (10 puff salbutamol equiveland to nebuliser, 4 initials, 2 puff every 2 min max 10)

Question 22

types of lung cancer

Answer 22

non small vs small

Question 23

non small cell lung cancer subtypes

Answer 23

squamous cell
adenocarcinoma
adenocarcinoma in situ

can metasize

Question 24

lung cancer chest conditions

Answer 24

Sob – lobar collapse, effusion, lymphangitis
Chest pain – rib involvelement, chest wall invasion
Cough
Haemoptysis – usually due to endobronchial involvement

Question 25

paraneoplastic syndromes of lung cancer

Answer 25

High calcium (PTH release or bone involvement) – nausea, confusion, abdo pain & constipation SIADH – confusion, fits, lethargy Hypertrophic pulmonary osteoarthropathy Lambert Eaton Syndrome - neuromuscular weakness

Question 26

signs of lung cancer

Answer 26

``` Finger nail clubbing Cachexia Horner’s syndrome (wasting of muscles between thumb and finger) Neck nodes Chest signs Palpable liver SVCO (superior vena cava obstruction) ```

Question 27

diagnosis of lung cancer

Answer 27

tissue biopsy bronchoscopy throacoscopy surgical

Question 28

treatment of lung cancer

Answer 28

RT or surgery for limited disease chemo immunotheray

Question 29

treatment of small cell lung cancer

Answer 29

cisplatin based chemotherapy tend to present late however due to wide spread disease if localised RT

Question 30

types of interstitial lung disease

Answer 30

- interstitial lung disease diffuse parenchymal lung disease lung fibrosis

Question 31

how to classify interstitial lung disease

Answer 31

Idiopathic Drug reaction Extrinsic Allergic Alveolitis/Hypersensitivity Pneumonitis Associated with rheumatological disease

Question 32

symptoms of intersistial lung disease

Answer 32

``` Dyspnea Cough Constitutional symptoms Onset of symptoms may identify aetiology EAA – post exposure IdiopathicPF – chronic AIP – rapid onset ```

Question 33

signs associated with intersistial lung disease

Answer 33

Signs associated with CTD/RA Nail clubbing Sclerodactyly Signs of steroid use Chest – audible crackles; distribution may influence diagnosis Chest - squeaks - suggest small airways disease

Question 34

idiopathic pulmonary fibrosis

Answer 34

Associated with clubbing Mainly lower zone preponderance Classically restrictive spirometry and reduced transfer factor Diagnosis can be made from CT

Question 35

hypersensitivity pneumonitis

Answer 35

causes lots of cysts triggered tx - allergen avoidance trial of corticoid steroid therapy

Question 36

sleep apnea

Answer 36

excessive daytime sleepiness with disordered nocturnal irregular breathing

Question 37

apnea

Answer 37

when you stop breathing for 10 secs

Question 38

hypopnea

Answer 38

reduction in nasal flow in 10 secs

Question 39

types of sleep apnea

Answer 39

obstructive (high BMI and wide neck collar) central (CV disease) mixed

Question 40

risk factors for obstructive SleepApnonea

Answer 40

``` Obesity >17inch collar Men x2-3 likely Age Cranio-facial & upper airway abnormalities e.g short mandible, tonsillar/adenoid hypertrophy, wide craniofacial base ```

Question 41

sleep apnea symptoms

Answer 41

``` excessive daytime sleepiness impair conc snoring choking episodes during sleep restless sleep irritability ```

Question 42

diagnosis of SApnea

Answer 42

polysomnography and pulse oximetry Central apnea Cessation of nasal flow Ceccessation of lung movement Obstructive (movement of lung will try to happen, cessation of nasal flow as there is upper blockage)

Question 43

tx for SApnea

Answer 43

Weight loss/lifestyle change Continuous Positive Airway Pressure (CPAP) Mandibular Advancement Device (MAD) Pharmocotherapy & surgery?

Question 44

short acting bronchodilators

Answer 44

relief of symptoms used inCOPD and asthma immediate bronchodialtion increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muslce

Question 45

side effects of SABA

Answer 45

``` Increased HR & palpitations Tremor Hypokalaemia Headache Nervousness ```

Question 46

LABA

Answer 46

alternative to increase steroid dose selectivity for B2 adenoceptor in pulmonary tissue not used in monotherapy in asthma

Question 47

anticholinergic agents and side effects

Answer 47

relief of symptoms usually for COPD block of muscarinic receptors M1-3 Possible effect on urinary retention Dry mouth Possible adverse cardiovascular effects

Question 48

inhaled steroids

Answer 48

prevents symptoms reduces risk of exacerbations reduces cytokines, bronchoconstriction and airwa inflammation Side effect - ORAL CANDIDA

Question 49

oral steroids w side effects

Answer 49

acute or chronic severe asthma ``` side effects Weight gain Hyperglycaemia Skin change Hypertension Eye change Mood change Reduce bone mineral density ```

Question 50

theophyllines w side effects

Answer 50

acute/chronic asthma tablets and IV ``` side effects Nausea Vomiting Palpitations Headaches Dyspepsia Arrhythmias Confusion ```

Question 51

antileukotrines

Answer 51

chronic asthma tx | but only limited pt benefit