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ICL Block Year 3 > Week 3 - COPD, ILD, sarcoidosis, bronchiectasis > Flashcards

Week 3 - COPD, ILD, sarcoidosis, bronchiectasis Flashcards

1
Q

Which neurotransmitter mediates the sympathetic innervation of bronchiolar smooth muscle?

A

Noradrenaline

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2
Q

Which neurotransmitter mediates the parasympathetic innervation of bronchiolar smooth muscle?

A

Acetylcholine

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3
Q

Which receptor does noradrenaline act on during the sympathetic innervation of bronchiolar smooth muscle?

A

Beta receptors

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4
Q

Which receptor does acetylcholine act on during the parasympathetic innervation of bronchiolar smooth muscle?

A

Muscarinic receptors

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5
Q

What effect does noradrenaline have on bronchiolar smooth muscle during sympathetic innervation?

A

Bronchodilation

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6
Q

What effect does acetylcholine have on bronchiolar smooth muscle during parasympathetic innervation?

A

Bronchoconstriction

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7
Q

What is the function of Type 1 alveolar cells ?

A

Gas exchange between alveoli and capillaries

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8
Q

What is the function of Type 2 alveolar cells ?

A

Secrete surfactant to lower surface tension

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9
Q

What is the appearance of Type 1 alveolar cells ?

A

Large squamous cells

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10
Q

What is the appearance of Type 2 alveolar cells ?

A

Smaller cuboid-shaped cells

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11
Q

Are there more or less Type 1 Vs Type 2 alveolar cells ?

A

More type 2 than type 1

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12
Q

Are there secretory organelles present in Type 1 alveolar cells?

A

No

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13
Q

Are there secretory organelles present in Type 2 alveolar cells?

A

Yes

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14
Q

The pulmonary arteries supply deoxygenated blood from where, to where?

A

From the right ventricle to the alveolar capillary network

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15
Q

The pulmonary veins supply oxygenated to where?

A

To the left atrium

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16
Q

Do the bronchial arteries supply oxygenated or deoxygenated blood to the lungs ?

A

Oxygenate d

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17
Q

The bronchial arteries supply blood from where, to where?

A

From the thoracic aorta to the lung tissues

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18
Q

The bronchial veins supply blood to where?

A

The pulmonary and systemic venous systems

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19
Q

What are the main conditions that fall under the respiratory system that cause the symptom of breathlessness?

A
  • asthma
  • COPD
  • PE
  • lung fibrosis
  • sarcoidosis
  • lung cancer
  • pneumothorax
  • pneumonia
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20
Q

What are the main conditions that fall under the cardiac system that cause the symptom of breathlessness?

A
  • heart valve disorders
  • congestive heart failure (CHF)
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21
Q

What is the main condition that falls under the haematological system that can cause the symptom of breathlessness?

A

Anaemia

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22
Q

What does the MRC dyspnoea scale depict ?

A

The degree of breathlessness related to activities

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23
Q

How many levels are there on the MRC dyspnoea scale ?

A

5

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24
Q

What does a level 1 mean on the MRC dyspnoea scale ?

A

1 = not troubled by breathlessness unless on strenuous exercise

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25
Q

What does a level 2 mean on the MRC dyspnoea scale ?

A

2 = SOB when hurrying or walking up a slight hill

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26
Q

What does a level 3 mean on the MRC dyspnoea scale ?

A

3 = walks slower than counterparts on level ground due to SOB, or has to stop for breath when walking at own pace

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27
Q

What does a level 4 mean on the MRC dyspnoea scale ?

A

4 = stops for breath after walking 100 metres/after a few mins on level ground

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28
Q

What does a level 5 mean on the MRC dyspnoea scale ?

A

5 = too breathless to leave the house, or SOB when dressing/undressing

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29
Q

What system pathology might be indicated of SOB is worse when lying flat?

A

Cardiac pathologies
e.g CHF

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30
Q

What condition(s) is indicated if the patient describes night-time symptoms of SOB?

A
  • Asthma
  • COPD/Asthma overlap syndrome
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31
Q

What condition(s) is indicated if the patient describes ankle swelling paired with SOB?

A
  • CHF (bilateral swelling)
  • PE/DVT (unilateral swelling)
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32
Q

What condition(s) is indicated if the patient describes lightheadedness paired with SOB?

A
  • cardiac pathologies e.g aortic stenosis
  • anxiety
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33
Q

What condition(s) is indicated if the patient describes exposure/secondhand exposure to asbestos paired with SOB?

A
  • asbestosis
  • mesothelioma
  • lung cancer (adenocarcinoma)
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34
Q

What condition(s) is indicated if the patient has pet birds paired with SOB?

A

Hypersensitivity pneumonitis

repeated inhalation of avian antigens

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35
Q

How do you calculate a persons ‘pack year’ smoking history ?

A

no. cigs per day X no. years smoked for

e.g 20 cpd = 1 pack year, for 40 years…
So, 1 X 40 = 40 pack years

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36
Q

What is the likelihood of someone being a smoker/ex smoker if they are diagnosed with
A) asthma ?
B) COPD?

A

Asthma = potentially a smoker but not necessarily
COPD = nearly every patient is a smoker/ex smoker

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37
Q

Asthma Vs COPD…

Is it often or rare for symptoms to present under the age of 35?

A

Asthma = often
COPD = rare

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38
Q

Asthma Vs COPD…

How common is a chronic productive cough?

A

Asthma= uncommon
COPD = common

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39
Q

Asthma Vs COPD…

What is the characteristics of the breathlessness?

A

Asthma = variable
COPD = persistent and progressive

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40
Q

Asthma Vs COPD…

How common is night time waking with SOB/wheeze ?

A

Asthma = common
COPD = uncommon

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41
Q

Asthma Vs COPD…

How common is day-to-day symptom variability ?

A

Asthma = common
COPD = uncommon

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42
Q

What are the hall mark symptoms of COPD?

A
  • SOB
  • chronic cough
  • sputum production

Others include…
- wheeze
- winter exacerbations

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43
Q

What are some physical signs of COPD to look for on examination?

A
  • pursed lip breathing
  • accessory muscle use (for breathing)
  • wheeze on auscultation
  • barrel chest (chest hyper expansion)
  • palpable liver (due to hyperinflation or CHF)
  • tar staining on hands/fingers
  • ankle oedema (indicated right sided heart failure due to cor pulmonary)
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44
Q

What is the most common lung disease in the UK ?

A

Asthma

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45
Q

What is the second most common lung disease in the UK ?

A

COPD

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46
Q

Which gender (between male and female) are most likely to
A) be diagnosed with COPD?
B) die from COPD?

A

Men for both :(

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47
Q

Is age a risk factor for COPD?

A

Yes

it is uncommon under the age of 40 and gets more prevalent with age

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48
Q

What are the main risk factors for COPD?

A
  • cigarette smoking
  • cannabis smoking
  • indoor air pollution (e.g firewood, animal dung, cooking coal…)
  • alpha-1 antitrypsin deficiency (a rare genetic condition)
  • being male
  • age (>40)
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49
Q

True or false…

Quitting smoking is a requirement for home oxygen therapy ?

A

True

oxygen is flammable, so smoking near oxygen tanks pose a risk of explosion and faire hazards

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50
Q

True or false…

Quitting smoking is true only intervention that will slow the disease progression into COPD?

A

True

smoking cessation reverts the rate of lung function decline back to the background rate

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51
Q

Does smoking cessation reverse some of the damage already done to the lungs by smoking?

A

no it only reduces the rate of further decline

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52
Q

What in the pathogens is of COPD causes the cough and sputum?

A

Goblet cell hyperplasia

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53
Q

What in the pathogens is of COPD causes the SOB and wheeze ?

A

Airway narrowing

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54
Q

What in the pathogens is of COPD causes the SOB ?

A

Alveolar destruction

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55
Q

What is the gold standard investigation for diagnosis and grading the severity of COPD ?

A

Spirometry

56
Q

What reading on a post-bronchodilator FEV1/FVC ratio confirms COPD/a persistent airflow obstruction ?

A

FEV1/FVC <0.7

57
Q

What FEV1 reading indicates mild COPD ?

A

> /=80%

58
Q

What FEV1 reading indicates moderate COPD ?

A

50-79%

59
Q

What FEV1 reading indicates severe COPD ?

A

30-49%

60
Q

What FEV1 reading indicates very severe COPD ?

A

<30%

61
Q

What is the progression of cor pulmonale, starting with hypoxia?

A
  1. Hypoxia
  2. Pulmonary artery vasoconstriction
  3. Increased pulmonary artery pressure
  4. Right ventricular hypertrophy
  5. Right ventricular failure
62
Q

What inhaled medications can be offered to COPD a patients for relief or during exercise …

A

SABA or SAMA

to cause bronchodilation

63
Q

What systems do steroids interact with/effect?

A
  • Protein, fat and carb metabolism
  • blood pressure (hypertension)
64
Q

How do steroids interact with protein metabolism and what symptoms does this cause?

A

increases protein metabolism

  • thin skin
  • leaky vessels = bruising
  • osteoporosis
  • kyphosis (hunched back)
  • muscle wasting
65
Q

How do steroids interact with lipid metabolism and what symptoms does this cause?

A

decreases lipid metabolism

causing weight gain on the face, back and tummy

66
Q

How do steroids interact with carb metabolism and what symptoms does this cause?

A

increases carb metabolism

causing diabetes

67
Q

What are the most common causes of COPD exacerbations?

A

50% Respiratory viruses
50% bacterial infections

68
Q

What do ‘coryzal symptoms’ mean?

A

Symptoms of a cold

69
Q

What are the symptoms of a COPD exacerbation ?

A
  • preceding coryzal symptoms
  • increased breathlessness
  • increased cough
  • increased sputum
  • purulent sputum
  • ankle swelling

- potential chest pain

70
Q

What investigations would you do during a suspected COPD exacerbation ?

A
  • CXR (rule out pneumothorax etc)
  • ABGs (to see which reps failure it is)
  • ECG
  • bloods (FBC, CRP, U+E, LFTs)
  • sputum culture if purulent
71
Q

What’s the initial treatment for a COPD exacerbation ?

A
  • O2 (to give SaO2 no more than 92%)
  • nebulised SABAs (high dose)
  • corticosteroids (high dose, usually prednisone)
  • antibiotics (if purulent sputum)

reassess after an hour

72
Q

If, after an hour, the initial treatment hasn’t resolved the COPD exacerbation, what do you do next?

A
  • IV bronchodilator (salbutamol, theophylline)
  • urgent ICU opinion
  • non-invasive ventilation
  • intubation and assisted ventilation
73
Q

What is the difference between Type 1 and Type 2 respiratory failure ?

A

Type 1 = low PaO2 normal pH and HCO3

Type 2 = low PaO2, high PaCO2 can have low pH and high HCO3

high HCO3 in type 2 suggests long standing resp failure causing compensation

74
Q

What are the clinical features on hypercapnia ?

A
  • altered mental state
  • dilated pupils
  • flushes skin
  • bounding pulse
  • asterixis (flapping tremor)
75
Q

What CXR findings might indicate COPD ?

A
  • flattened diaphragm
  • hyper inflated lungs (can be spotted by horizontal ribs and smaller heart size)
  • nipple shadows
76
Q

What respiratory conditions are associated with nail clubbing?

A
  • lung cancer
  • bronchiectasis
  • cystic fibrosis
  • interstitial lung disease
77
Q

What would a CXR look like for interstitial lung disease?

A

Often normal

sometimes some mild basal interstitial changes (white markings between the ribs

78
Q

What are the major investigations/tests to do for a diagnosis of Interstitial lung disease (ILD)?

A
  • blood tests
  • CXR
  • HRCT (high resolution CT)
  • Spirometry / lung function tests
79
Q

Does interstitial lung disease show a
A) restrictive pattern of lung function ?
B) obstructive pattern of lung function ?

A

ILD = Restrictive

80
Q

What changes are seen in ILD, to the
A) FVC
B) FEV1
C) FVC/FEV1 ratio

A

FVC = low
FEV1 = low

*these are proportional, so the FVC/FEV1 ratio = normal *

81
Q

How is lung volume affected in interstitial lung disease (ILD) ?

A

Lung volume is decreased

82
Q

What is meant by the lungs ‘transfer factor’ (DLCO) ?

A

The lungs ability to soak up oxygen into the blood stream

83
Q

What happens to the transfer factor in ILD ?

A

Decreased

= less ability to soak up oxygen

84
Q

What might you see on a CT for interstitial lung disease ?

A
  • basal lung fibrosis
  • honeycombing
85
Q

Is interstitial lung disease one thing or a term to cover multiple conditions ?

A

umbrella term for hundreds of lung diseases affecting the parenchyma

86
Q

What are the 2 main classes of interstitial lung diseases ?

A
  • primarily inflammatory
  • primarily fibrotic
87
Q

What can be heard on auscultation to indicate fibrotic lung disease ?

A

velcro-like crackles

bi-basal, fine, end-inspiratory crepitations

88
Q

What are some types of ILDs that have no known causes ?

A
  • idiopathic pulmonary fibrosis (IPF)
  • sarcoidosis
  • cryptogenic organising pneumonia (COP)
89
Q

What are some known occupational causes of IDLs?

A
  • Asbestos exposure
  • Silicosis
90
Q

What are some known environmental/social causes of ILDs?

A
  • smoking
  • birds
  • hypersensitivity pnuemonities
  • drugs
91
Q

What are some known medications to cause interstitial lung diseases ?

A
  • Methotrxate
  • Amiodarone
  • Nitrofurantoin
  • Bleomycin
92
Q

How do you treat idiopathic pulmonary fibrotic (IPF) disease ?

A
  • antifibrotics (pirfenidone, nintedanib)
  • oxygen if needed
  • meds to help with side effects of antifibrotics
93
Q

Do antifibrotics cure IPF?

A

No they slow it down by about 50% to give the patient a longer life

94
Q

What are the main side effects of antifibrotics ?

A
  • GI upset (nausea, vomiting, diarrhoea)
  • Acid reflux
  • skin rashes/UV sensitivities
95
Q

What are the clinical features of systemic sclerosis ?

A
  • reynauds
  • telangiectasia (spider veins)
  • puckering round the mouth
  • sclerodactyly (tightness of skin on hands, pulling fingers in)
96
Q

What would lung function test results look like in systemic sclerosis ?

A
  • FVC = normal
  • FEV1 = normal
  • FVC/FEV1 ratio = showing restrictive
  • DLCO = very low
97
Q

What would be seen on a CT scan of systemic sclerosis ?

A

bilateral basal changes

ground glass abnormalities (looks like cotton wool) in early stages

severe basal fibrosis, traction bronchiectasis in later stages

98
Q

What would you here on auscultation of systemic sclerosis ?

A

Fine, bi-basal, end-inspiratory crepitations

99
Q

What is the mean survival time after a diagnosis of interstitial lung disease?

A

2.5 - 5 years without treatment

2-3 years extra with treatment

100
Q

What is sarcoidosis ?

A

An inflammatory disease in which the immune system overreacts, causing granulomas (inflamed tissue clusters) in the lungs/organs

101
Q

What can be seen on a CXR for sarcoidosis ?

A
  • bi-hilar lymphadenopathy
  • diffuse inflammatory infiltrates
102
Q

What systems are often involved in sarcoidosis ?

A
  • visual
  • nervous
  • salivary glands
103
Q

What are the features of uveoparotid fever/Heerfordt’s syndrome ?

A
  • acute uveitis (eye inflammation)
  • fever
  • parotid gland swelling

this is a form of neurosarcoidosis

104
Q

What is the most typical presentation of acute sarcoidosis?

A
  • Afro Caribbean (not necessarily, but more common)
  • young female
  • no red flag symptoms
  • cough, SOB, chest pain (pulmonary specifically)
  • mild ankle swelling/pain
  • feeling generally run down/tired
  • no resp symptoms
  • feels hot but no fever
  • erythema nodosum (tender redness on shins symmetrically)
105
Q

Who is most at risk from sarcoidosis ?

A
  • Afro Caribbean heritage
  • young adult (30-40)
  • women
106
Q

What are the top diagnoses for a complaint of weight loss and night sweats ?

A

Cancer
TB

107
Q

What does erythema nodosum indicate ?

A

systemic disease

  • sarcoidosis
  • TB
  • bacterial/deep fungal infection
  • cancer
  • inflammatory bowel disease
108
Q

What tests are done for suspected sarcoidosis ?

A
  • bloods (inflammatory markers)
  • urine tests
  • lung function
  • CXR
  • CT
  • ECG
  • biopsy
109
Q

How do the stages of pulmonary sarcoidosis show on a CXR ?

A
  1. Normal CXR
  2. Just hilar lymphadenopathy
  3. Lymphadenopathy and parenchyma involvement
  4. Just parenchymal involvemnt
  5. Pulmonary fibrosis
110
Q

Which stages of sarcoidosis could spontaneously resolve without treatment ? Which need treatment ?

A
  1. Resolve
  2. Resolve
  3. Resolve
  4. Treatment
  5. Treatment
111
Q

Roughly, what % of patients with pulmonary sarcoidosis present as symptomatic on CXR ?

A

30-60%

112
Q

What results would you find from lab tests in the incidence of sarcoidosis ?

A
  • raised inflam markers (ESR)
  • leukopenia
  • hypercalcaemia
  • hypercaliuria
  • elevated ACE levels (not diagnostic)
113
Q

Why is it important to wean steroid treatment rather than abrupt stop ?

A

Giving exogenous steroids suppresses endogenous cortisol synthesis by the adrenal glands, so an abrupt stop could cause an adrenal crisis

114
Q

What is the treatment for sarcoidosis ?

A
  • monitor if mild
  • exclude all other potential diagnoses
  • steroids if must
115
Q

What types of sarcoidosis must you treat with steroids immediately ?

A

Neurosarcoidosis
Cardiosarcoidosis
Renalsarcoidosis

because these are life threatening

116
Q

What features are consistent with bronchiectasis on CXR ?

A
  • mucus plugging
  • consolidation
  • tram-track opacity
  • ring shadow
117
Q

What are tram-track opacities seen on a CXR?

A

dilated airway seen in the longitudinal plane

118
Q

What are ‘ring opacities’ seen on CXR?

A

Dilated airways seen end-on

119
Q

What investigations would you do to diagnose bronchiectasis?

A
  • bloods
  • ABGs
  • CXR (not diagnostic by itself)
  • CT (diagnostic)
120
Q

What is bronchiectasis?

A
  • Chronic condition
  • bronchial tree irreversibly dilated
  • bronchial walls thickened and inflamed
  • bronchial tree builds up excess mucus

makes lungs vulnerable to infection

121
Q

Is bronchiectasis an acute or chronic condition ?

A

Chronic

122
Q

How are CF and bronchiectasis related ?

A

CF is an inherited form of bronchiectasis

123
Q

What are the most common causes of non-CF bronchiectasis?

A
  • Idiopathic (most common)
  • post infective (e.g bacterial pneumonia)
  • allergic (to mould/fungus…)
  • autoimmune (associated with connective tissue diseases)
  • immunodeficiency (e.g HIV)
  • obstruction (secondary to severe asthma/COPD)
124
Q

Are males or females more often effected by bronchiectasis?

A

Females

125
Q

At what age are the majority (60%) of bronchiectasis diagnoses made?

A

Over 70s

prevalence increases with age

126
Q

Does bronchiectasis tend to affect the more deprived or least deprived areas ?

A

Least deprived areas

different to other resp disorders

127
Q

Which investigation is usually the diagnostic tool for bronchiectasis?

A

HRCT scan

128
Q

What is the favoured screening test for suspected CF ?

A

Sweat test

129
Q

What is the treatment for bronchiectasis?

A
  • short course of antibiotics for exacerbations/chest infections
  • physiotherapy for airway cleaning
  • cough assist devices
  • smoking cessation
  • flu/pneumococcal vaccines
  • lobectomy if localised and debilitating rare
130
Q

What is a ‘sail sign’ on CXR ?

A

Triangular opacity overlying the cardiac shadow

131
Q

What is a ‘sail sign’ indicative of on CXR?

A

left lower lobe collapse

132
Q

What aspect of bronchiectasis could cause a left lower lobe collapse ?

A

Mucus plugging

133
Q

What classes as a bronchiectasis exacerbation ?

A

Deterioration in 3 or more of the following for >48hrs…
- cough
- sputum volume and/or consistency
- sputum purulence
- breathlessness and/or exercise tolerance
- fatigue and/or malaise
- haemoptysis

134
Q

What is the most common prognosis of bronchiectasis?

A

Most patients have few day-to-day symptoms and normal life expectancy. Some chest infections are common

135
Q

What are some uncommon complications of bronchiectasis ?

A
  • cor pulmonale
  • pulmonary hypertension
  • massive haemoptysis

ICL Block Year 3 (4 decks)

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