Respiratory - obstructive diseases

Question 1

What structures are affected by obstructive and restrictive diseases

Answer 1

airways are affected by obstructive diseases
Lungs are affected by restrictive diseases

Question 2

What characteristics of asthma can be used to classify the condition (4)

Answer 2

level of type 2 cytokines
Onset
(Non)atopic
Extrinsic or intrinsic

Question 3

What is the triad associated with asthma

Answer 3

reversible airflow obstruction
Airway hyper responsiveness
T2 airway

Question 4

What are the hallmarks of airway remodelling (3)

Answer 4

thickening of the basement membrane
Collagen deposits in submucosa
Hypertrophy of smooth muscle

Question 5

Describe the inflammatory cascade of asthma (4)

Answer 5

inherited acquired factors trigger a response
Eosinophilic inflammation
Mediators are released (TH2 cytokines)
Hypperreactivity of smooth muscle

Question 6

What are the different methods that can be used to manage the steps of the inflammatory cascade (4)

Answer 6

Avoiding the precipitating
Anti-inflammatory medication
Anti-Leukotrienes/anti-histamines
Bronchodilators

Question 7

Describe the characteristics of asthma (4)

Answer 7

episodic symptoms
Diurnal variability
Non-productive cough
Wheeze

Question 8

how is asthma managed (3 lines of treatment)

Answer 8

1st line: SABA
2nd line: add ICS
3rd line: add LABA/CystLT1/cromoglicate/methylxanthines/increased steroid dose/omalizumab

Question 9

Presence of what indicates that an individual has asthma (4)

Answer 9

Raised eosinophils
Raised FeNO
Diurnal variation of peak flow
Reduced forced expiratory ratio

Question 10

What can be used to diagnoses asthma (3)

Answer 10

history
Examination
Provocation testing

Question 11

What is the main symptom of COPD

Answer 11

Breathlessness

Question 12

What are the components of COPD (2)

Answer 12

chronic bronchitis
Emphysema

Question 13

Describe chronic bronchitis (6)

Answer 13

chronic neutrophilic inflammation
Hypersecretion of mucus
Mucocilliary dysfunction
Altered lung biome
Smooth muscle spasms
Smooth muscle Hypertrophy

Question 14

Describe emphysema (3)

Answer 14

Alveolar destruction
Impaired exchange of gases
Loss of bronchial support

Question 15

Which component of COPD is irreversible

Answer 15

Emphysema

Question 16

What are the characteristics of COPD (5)

Answer 16

chronic (not episodic)
Worsened by smoking
Non-atopic
Productive cough
Exacerbated by infection

Question 17

Describe the chronic cascade of COPD (5)

Answer 17

progressive and fixed airflow obstruction
Impaired alveolar gas exchange
Respiratory failure
Pulmonary hypertension
Right ventricular Hypertrophy or failure

Question 18

What is ACO

Answer 18

Asthma-COPD overlap syndrome
Raised eosinophils

Question 19

What are the symptoms of rhinitis (4)

Answer 19

Rhinorrhoea
Sneezing
Itching
Nasal congestion and obstruction

Question 20

What causes swelling of the nasal cavity

Answer 20

Dilation of blood vessels

Question 21

What causes difficulty breathing in rhinitis (3)

Answer 21

increased mucosal blood flow
Increased blood vessel permeability
Increased volume of nasal mucosal

Question 22

How can drugs be transported across the nasal epithelium (4)

Answer 22

Transcellular diffusion
Paracellular diffusion
Carrier mediated transport
Vesicle mediated transport

Question 23

What is stridor

Answer 23

an inspiratory wheeze caused by obstruction of large airways

Question 24

What are possible causes of stridor

Answer 24

infection
Foreign bodies
Anaphylaxis/angioneurotic oedema
Neoplasms
Goitre
Trauma

Question 25

What investigations can be used for stridor (5)

Answer 25

laryngoscopy Bronchoscopy Flow volume loops CXR CT scan (thyroid)

Question 26

How is stridor treated (4)

Answer 26

Treat underlying cause Mask ventilation with high flow oxygen Cricothryoidotomy Tracheostomy

Question 27

How can malignant airway obstruction be treated (5)

Answer 27

removal of tumour Tumour compression Radiotherapy Chemotherapy Corticosteroids

Question 28

What type of hypersensitivity is involved in anaphylaxis

Answer 28

type 1 (immediate, IgE mediated)

Question 29

What are the signs of anaphylaxis

Answer 29

flushing Itching Hives Angioneurotic oedema Abdominal pain + vomiting Hypotension (circulatory collapse) Stridor Wheeze Respiratory failure

Question 30

How can anaphylaxis be treated (5)

Answer 30

IM epinephrine IV antihistamine High flow oxygen Nebulised bronchodilators Endotracheal intubation

Question 31

How can anaphylaxis be treated long term (3)

Answer 31

avoiding allergen Desensitisation Self-administration of epinephrine

Question 32

Describe obstructive sleep apnoea (2)

Answer 32

intermittent upper airway collapse in sleep Resulting in recurrent arousals/sleep fragmentation

Question 33

What are some risk factors for obstructive sleep apnoea

Answer 33

enlarged tonsils Obesity Retronathia Acromegaly, hypothyroidism Oropharyngeal deformity Stroke/MS Drugs Post-operation

Question 34

What are consequences of obstructive sleep apnoea (3 day-to-day, 4 biochemical)

Answer 34

excessive daytime sleepiness Cognitive/function impairment Personality change Activated sympathetic system Raised CRP Impaired endothelial function Impaired glucose tolerance

Question 35

How can obstructive sleep apnoea be diagnosed (3)

Answer 35

raised Epworth score Overnight sleep study (oximetry and domiciliary recording) Polysomnography

Question 36

how can obstructive sleep apnoea be treated (4)

Answer 36

removal of cause CPAP Mandibular advancement devices Surgery

Question 37

What is used to treat acute asthma

Answer 37

oxygen Oral corticosteroid Nebulised salbutamol hydrocortisone Ipratropium Theophylline/aminophylline Magnesium sulphate Anaesthetist