Respiratory System and Diseases 2

Question 1

What is COPD?

Answer 1

Chronic Obstructive Pulmonary Disease

Question 2

How is COPD characterised?

Answer 2

by poor reversible airflow limitation which is usually progressive

Question 3

What is COPD associated with?

Answer 3

persistent inflammatory response of the lung

Question 4

What is COPD caused by?

Answer 4

predominantly cause by smoking in developed countries

Question 5

COPD Epidemiology

Answer 5

• develops over many years - rarely symptomatic before middle age
• common in UK - 18% of male smokers - 14% of female smokers - one of the leading causes of lost working days

Question 6

Aetiology of COPD

Answer 6

smoking is the dominant causal agent

Question 7

Pathogenesis of COPD

Answer 7

cigarette smoke -> macrophage epithelial cells ->chemotactic factors -> granulocytes -> proteases -> damage

Question 8

Factors causing COPD

Answer 8

atmospheric pollution
- a minor role compared to smoking

alpha 1 - antitrypsin deficiency
- a rare cause of early-onset emphysema

Question 9

Pathology of chronic bronchitis - COPD

Answer 9

• chronic inflammation of the airways
  (predominantly lymphocytes)
• enlargement of mucus-secreting glands of trachea and bronchi
• airway narrowing and hence airflow limitation

Question 10

Pathology of Emphysema - COPD

Answer 10

• dilation and destruction of the lung tissue and distal to terminate bronchioles
• loss of elastic recoil - expiratory airflow limitation and airtrapping

Question 11

Characteristic symptoms of COPD

Answer 11

cough

sputum

breathlessness

wheeze

Question 12

Signs of COPD

Answer 12

tachypnoea

use of accessory muscles of respiration

hyperinflation

poor expansion

others - cyanosis - cor pulmonale

Question 13

Investigations of COPD

Answer 13

• lung function tests
• chest x-ray
• arterial blood gases
• haemoglobin and PCV
• ECG or achocardiology

Question 14

COPD results of lung function tests

Answer 14

decreased FEV1

decreased FEV/FVC

Question 15

COPD results of chest x-ray

Answer 15

lungs hyperinflated

Question 16

COPD results of arterial blood gases

Answer 16

normal or hypoxia and hypercapnia

Question 17

COPD results of haemoglobin and PCV

Answer 17

high levels

Question 18

ECG or achocardiology of COPD

Answer 18

to assess cardiac status if clinical features of cor pulmonale

Question 19

Treatment of COPD

Answer 19

• smoking cessation
• drug therapy - bronchodilators, corticosteroids, antibiotics etc
• treatment of respiratory failure
• other measures - heart failure, secondary polycythaemia

Question 20

Complications of COPD

Answer 20

• respiratory failure
• cor pulmonale - right heart failure secondary to lung disease

Question 21

Prognosis of COPD

Answer 21

• 50% patients with severe breathlessness die with in 5 years

Question 22

Asthma

Answer 22

a common chronic inflammatory condition of the lungs

Question 23

What is asthma?

Answer 23

hyper-reactivity of bronchial tree with paroxysmal narrowing of the airway

Question 24

What are the three characteristics of asthma?

Answer 24

• airflow limitation
• airway hyper-responsiveness
• inflammation of the bronchi

Question 25

Are airflow limitation reversible in asthma?

Answer 25

yes

Question 26

Epidemiology of asthma

Answer 26

increasing prevalence geographical variation more common now in developed countries much rarer in far easter countries

Question 27

Aetiology/development of asthma

Answer 27

atopy and allergy - readily develop IgE against common environmental antigens - genetic and environmental factors affect IgE levels increased responsiveness of the airways of the lungs (a fall in FEV1) stimuli

Question 28

Pathogensis of asthma

Answer 28

Primary Abnormality - narrowing of the airway - thickening of the airway wall - secretions within the airway lumen Inflammation - cellular components eosinophils, t-lymphocytes, macrophages and mast cells -> release inflammatory mediators Remodelling - structural changes in the airway

Question 29

Precipitating factors of asthma

Answer 29

Occupational Sensitisers Non-specific factors which may cause when you sneeze -> drugs, cold air, exercise, viral infections Rare cause of asthma - airborne spores of aspergillum fumigates - a soil mould

Question 30

Clinical Features of asthma

Answer 30

wheezing attacks episodic shortness of breath some have one or two attacks a year - others have chronic symptoms on examination during attack - reduced chest expansion, prolonged expiratory time and bilateral expiratory polyphonic wheeze

Question 31

Treatment of Asthma

Answer 31

Control of extrinsic factors Drug treatment - bronchodilators - anti-inflammatory agents

Question 32

Examples of Bronchodilators used to treat asthma

Answer 32

beta2 adrenergic agonists animuscarinic bronchodilators theophyllines

Question 33

Examples of Anti-Inflammatory used to treat Asthma

Answer 33

Steroids Chromones Leukotriene receptors antagonist Immunosuppressive agents

Question 34

Types of Lung Tumours

Answer 34

Primary Secondary

Question 35

What percentage of primary lung tumours are primary carcinoma?

Answer 35

95%

Question 36

Factors about primary carcinoma of lungs?

Answer 36

- most common malignant tumour in the world - poor prognosis - 5 year survival rate <10%

Question 37

Major risks of primary carcinoma?

Answer 37

- directly related to smoking - associated with occupational exposure to carcinogens - pulmonary fibrosis

Question 38

Primary carcinoma pathology

Answer 38

- most arising from bronchi - hilum - main histological types -> squamous cell carcinoma -> small cell lung carcinoma -> adenocarcinoma -> large cell undifferentiated carcinoma

Question 39

Clinical Features of Primary Carcinoma

Answer 39

cough chest pain haemoptysis weight loss

Question 40

Diagnosis of Primary Carcinoma

Answer 40

Chests x-ray CT Biopsy and cytology

Question 41

Treatment of Primary Carcinoma

Answer 41

surgical resection - non small cell lung cancer chemotherapy - small cell lung cancer radiotherapy - localised tumours poor prognosis