respiratory disease - COPD, asthma, and lung cancer

Question 1

COPD includes

Answer 1

chronic bronchitis
emphysema
asthma
bronchiectasis

Question 2

COPD definition

Answer 2

airflow obstruction caused by small airways disease and parenchymal destruction

Question 3

emphysema risk factors

Answer 3

alpha-1-antitrypsin deficiency
coal dust
cadmium toxicity

Question 4

COPD risk factors

Answer 4

middle aged men
cigarette smoke
occupational dust and chemicals
pollution
low socio-economic status
childhood infections
genetics

Question 5

clinical definition of COPD

Answer 5

cough and sputum for 3 months in 2 consecutive years

Question 6

pathology of COPD

Answer 6

mucous hypersecretion with bronchial mucous gland hypertrophy
loss of ciliated cells, squamous metaplasia
respiratory bronchiolitis

Question 7

later stages of COPD

Answer 7

hypercapnia, hyperaemia, cyanosis

carcinogenic - dysplastic metaplastic squamous epithelium

Question 8

clinical signs of COPD

Answer 8

cough
dyspnoea/tachypnoea
shortness of breath
hyperinflation 
use of accessory muscles on inhalation
low PaO2
high PaCO2 (low alveolar ventilation)

Question 9

why do patients with COPD get pulmonary hypertension?

Answer 9

obliteration and vasoconstriction

Question 10

pink puffer

Answer 10

weight loss
breathless
emphysematous
maintained pO2

Question 11

blue bloater

Answer 11

cough
phlegm
cor pulmonale
respiratory failure (type 2)

Question 12

complications of COPD

Answer 12

cor pulmonale - pulmonary hypertension and fluid overload

Question 13

COPD spirometry

Answer 13

always abnormal

Question 14

diagnosis of COPD

Answer 14

FEV1 <80% of predicted

FEV1:FVC ratio <70% predicted

Question 15

staging of COPD

Answer 15

1. FEV1 >80%
2. FEV1 50-79%
3. FEV1 30-49%
4. FEV1 <30%

Question 16

treatment for patients with upper lobe predominant emphysema

Answer 16

lung reduction surgery

Question 17

treatment for mild COPD (stage 1)

Answer 17

ipratropium bromide

Question 18

treatment for moderate COPD (stage 2)

Answer 18

tiotropium

Question 19

treatment for severe COPD (stage 3)

Answer 19

glucocorticosteroid (beclamethasone diproprionate)

Question 20

treatment for very severe COPD (stage 4)

Answer 20

home O2

Question 21

first line treatments for COPD

Answer 21

stop smoking
exercise
ß2 agonists

Question 22

atopy

Answer 22

tendency to develop IgE mediated reactions to common aeroallergens

Question 23

incidence of asthma

Answer 23

1 in 11 children

1 in 12 adults

Question 24

definition of asthma

Answer 24

increased irritability of bronchi causing spasm, paroxysmal attacks, over-distended lungs, mucous plugs in bronchi, and enlarged bronchial mucous glands

Question 25

short-term/acute pathology of asthma

Answer 25

trigger --> IgE mediated type 1 hypersensitivity --> mast cell degranulation --> histamine and cytokines released --> bronchoconstriction, mucous production, and inflammation (increased vascular permeability)

Question 26

long-term/chronic pathology of asthma

Answer 26

airways remodelling and repeated airway constriction --> smooth muscle hyperplasia and hypertrophy + mucous gland hyperplasia and metaplasia --> increased in goblet cells

Question 27

clinical signs of asthma

Answer 27

``` intermittent dyspnoea chest tightness cough (nocturnal) sputum tachypnoea polyphonic wheeze hyper inflated chest hyper resonance ```

Question 28

what is associated with later onset asthma?

Answer 28

nasal polyposis and aspirin sensitivity

Question 29

why does asthma have a diurnal variation?

Answer 29

natural dip in catecholamines in the middle of the night

Question 30

which patients are at risk of asthma death?

Answer 30

on 3 or more medications frequently hospitalised previous near fatal disease psychosocial factors

Question 31

diagnosis of asthma using peak expiratory flow

Answer 31

>20% variation on >3 days/week for 2-4 weeks

Question 32

diagnosis of asthma using bronchodilator reversibility testing

Answer 32

baseline spirometry --> salbutamol --> repeat spirometry after 15 minutes --> FEV1 increase by >15%

Question 33

diagnostic tests for asthma

Answer 33

``` peak expiratory flow bronchodilator reversibility testing spirometry FBC (eosinophils) test for allergies and atopy chest XR O2 sats lung function testing ```

Question 34

treatment for asthma

Answer 34

ß2 agonist - salbutamol corticosteroid - beclomethasone bronchial thermoplasty

Question 35

what is the role of steroids in the treatment of asthma?

Answer 35

they reduce inflammation and mortality

Question 36

treatment of severe eosinophilic asthma

Answer 36

anti-IgE anti-IL5 oral steroids additional immunosuppressants

Question 37

treatment of acute asthma

Answer 37

high flow O2 and emergency ß agonists

Question 38

risk factors for lung carcinoma

Answer 38

smoking (20 cigarettes a day increases risk by 10x) asbestos metallic toxins other occupational exposures

Question 39

where does small cell carcinoma arise?

Answer 39

peribronchial locations --> infiltrates the bronchial submucosa

Question 40

clinical signs of lung carcinoma

Answer 40

``` late presentation cough dyspnoea weight loss debility central tumour mass nerve palsies (recurrent laryngeal and phrenic) Horner's syndrome weight loss loss of appetite fatigue metastatic signs ```

Question 41

what percentage of patients already have metastases when diagnosed with small cell carcinoma?

Answer 41

70%

Question 42

complications of lung small cell carcinoma

Answer 42

paraneoplastic syndromes | metastasis to lymph nodes, liver, bones, adrenal glands, and brain

Question 43

paraneoplastic syndromes with lung carcinoma

Answer 43

secretion of PTH SIADH secretion of ACTH and other hormones hypertrophic pulmonary osteoporosis-arthropathy myasthenic syndrome (Eaton Lambert) finger clubbing migratory thrombophlebitis (red and painful swelling of skin) non-infective endocarditis (Libman Sacks) disseminated intravascular coagulation (DIC)

Question 44

small cell carcinoma definition

Answer 44

an undifferentiated neoplasm composing of primitive appearing cells

Question 45

lung small cell carcinoma treatment

Answer 45

radiation and combination chemotherapy

Question 46

what percentage of lung cancers are non-small cell carcinoma?

Answer 46

85%

Question 47

two types of lung non-small cell carcinoma

Answer 47

adenocarcinoma | squamous cell carcinoma

Question 48

signs on CXR of lung carcinoma

Answer 48

``` pulmonary nodule mass or infiltrate mediastinal widening atelectasis hilar enlargement pleural effusion ```

Question 49

diagnostic tests for lung carcinoma

Answer 49

``` physical examination FBC CXR bronchoscopy sputum cytology mediastinoscopy thoracentesis thoracoscopy transthoracic needle biopsy ```

Question 50

non-small cell lung carcinoma treatment

Answer 50

surgery and chemotherapy lobectomy - removing a section of lung pneumonectomy - removing the entire lung wedge resection - removing part of a lobe

Question 51

risk factors for mesothelioma

Answer 51

asbestos exposure

Question 52

pathology of mesothelioma

Answer 52

tumour of the lung pleura

Question 53

diagnosis of mesothelioma

Answer 53

pleural thickening or effusion on CXR bloody pleural fluid histology diagnosis is often made post mortem

Question 54

treatment of mesothelioma

Answer 54

pemetrexed and cisplatin intrapleural drain (very high death rate)