Respiratory

Question 1

Risk factors for developing asthma

Answer 1

Allergic rhinitis
Food allergies
Obesity
PMH + FHx Atopy
Male
Low BW
Airway hypersensitivity

Question 2

Pathophysiology of RSV infection

Answer 2

Narrowing distal airways
Sloughed necrotic endothelium
Mucus secretion and mucus plugging
Alveolar hypoxia –> apnoea

Question 3

Pathophysiology asthma

Answer 3

Variable obstruction to small and mod sized airways
Eosinophilic and neutrophilic inflammation
Contraction of bronchial SM
Airway hypersensitivity and bronchospasm

Question 4

Causes of interstitial lung disease

Answer 4

• Genetic - Abnormalities in surfactant, thyroid transcription factor, extrinsic allergic alveolitis, drug reaction (methotrexate, azothioprine)

Question 5

Interstitial lung disease on CXR + spirometry

Answer 5

Ground glass shadowing
Restrictive pattern lung function tests

Question 6

Pathology and presentation of primary ciliary dyskinesia

Answer 6

Defect in structure / function of cilia –> mucus retention
Recessive
- Recurrent sinusitis / otitis media
- Nasal polyps
- +/- Hydrocephalus
- Infertility
- Moist cough –> eventual bronchiectasis
- Situs invertus
- Lung function tests = obstructive / mixed
- Ix: EM / ciliary studies, reduced exhaled NO

Question 7

Pathophysiology cystic fibrosis

Answer 7

Recessive genetic defect to CFTR gene (Ch 7) –> defective CFTR protein (ATP-regulated channel esp chloride)
–> accumulation of viscous mucus –> organ damage.
Esp delta F508 mutation. More white europeans.

Question 8

Presentation of CF

Answer 8

LRTI infections
Malabsorption
Raised chloride on sweat test

Question 9

Restrictive lung function tests

Answer 9

Reduced FEV1 <80% pred.
Reduced FVC <80% pred.
Normal FEV1:FVC

Question 10

Obstructive lung function tests

Answer 10

Reduced FEV1 <80% pred
Normal FVC
Reduced FEV1:FVC <0.7

Question 11

Causes of restrictive lung function tests

Answer 11

Pulmonary fibrosis
Pulmonary oedema
Lobectomy
Connective tissue disease
NMD
Skeletal
Obesity

Question 12

Causes of obstructive lung function tests

Answer 12

Asthma - reversible= >9% response
Bronchiectasis
CF
COPD
Emphysema