p.15
Symptoms and Signs of Asthma
What causes cough in COPD patients?
Airflow obstruction and mucus hypersecretion.
p.8
Diagnosis and Investigation of Asthma
What does an elevated CRP level suggest?
It indicates inflammation and infection.
p.9
Management Principles for Asthma
What vaccinations are recommended for asthma management?
COVID-19 vaccination, pneumococcal vaccine, and yearly influenza vaccine.
p.26
Symptoms and Signs of Asthma
What is a genito-urinary symptom associated with cystic fibrosis in males?
Bilateral absence of vas deferens leading to male infertility.
p.27
Clinical Features of Asthma
What does a low BMI indicate in patients with Cystic Fibrosis?
Malabsorption/malnutrition.
p.18
Diagnosis and Investigation of Asthma
What does a sputum culture help identify in COPD?
The infectious cause if suspected.
p.27
Clinical Features of Asthma
What is the purpose of supplemental oxygen in Cystic Fibrosis?
To treat chronic hypoxia.
p.23
Risk Factors and Triggers for Asthma
What are common risk factors for Bronchiectasis?
Previous lung infections, CF, and immune system disorders.
p.9
Management Principles for Asthma
What is the role of a reliever in asthma management?
To provide quick relief as needed, often using low-dose ICS-Formoterol +/- SABA.
p.8
Complications and Prognosis of Asthma
What is concerning about normal CO2 levels during an asthma exacerbation?
It suggests that air is moving through the airways appropriately, which is unusual in exacerbations.
p.4
Asthma Severity Assessment
Why is it important to ask about previous exacerbations in asthma patients?
To assess control, number of exacerbations, and hospital admissions.
p.19
Complications and Prognosis of Asthma
What does BNP indicate in severe COPD?
Cor pulmonale, which is part of the criteria for starting LTOT.
p.18
Diagnosis and Investigation of Asthma
What does a decrease in eosinophils signify in the context of COPD?
It is part of the DECAF score for severity.
p.18
Diagnosis and Investigation of Asthma
What does an elevated CRP level indicate in COPD?
It indicates infective exacerbations.
p.11
Complications and Prognosis of Asthma
What is a significant risk associated with asthma in Ireland?
One person dies from asthma per week.
p.13
Clinical Features of Asthma
What are the most important clinical features to recognize in a patient with COPD?
Clinical features include chronic cough, sputum production, and dyspnea.
p.24
Pathogenesis and Aetiology of Asthma
What is bronchiectasis?
A chronic lung disease characterized by abnormal, irreversible dilatation of the bronchi due to destruction of elastic and muscular tissue by recurrent infection and inflammation.
p.7
Differential Diagnosis of Asthma
What conditions can cause cough aside from asthma?
Sinusitis and post-nasal drip, GORD, Bronchiectasis.
p.28
Risk Factors and Triggers for Asthma
What congenital conditions are associated with bronchiectasis?
Kartagener’s syndrome, Young’s syndrome, and Cystic Fibrosis.
p.3
Pathogenesis and Aetiology of Asthma
What do eosinophils release that contributes to inflammation?
ECP (Eosinophil Cationic Protein), MBP (Major Basic Protein), and MMP-9 (Matrix Metalloproteinase-9).
p.23
Differential Diagnosis of Asthma
What is a differential diagnosis for Cystic Fibrosis?
Bronchiectasis, asthma, and chronic obstructive pulmonary disease (COPD), each justified by overlapping symptoms.
p.17
Risk Factors and Triggers for Asthma
What are the common gene variants related to Alpha-1 antitrypsin deficiency?
M (normal), S or Z (deficient).
p.1
Asthma Severity Assessment
What clinical parameters indicate asthma severity?
Parameters include frequency of symptoms, nighttime awakenings, and the need for rescue medication.
p.26
Symptoms and Signs of Asthma
What is a common pulmonary symptom of cystic fibrosis?
Chronic productive cough.
p.19
Asthma Severity Assessment
What do the GOLD Criteria assess in COPD?
Symptoms and exacerbations to guide management.
p.20
Complications and Prognosis of Asthma
What does a DECAF score assess in COPD patients?
It is used to prognosticate in-hospital mortality during acute exacerbations.
p.20
Complications and Prognosis of Asthma
What does a high BODE index score indicate?
It correlates with low 4-year survival in COPD patients.
p.20
Complications and Prognosis of Asthma
What are the components of the DECAF score?
Dyspnoea, Eosinopenia, Consolidation, Acidaemia, Fibrillation.
p.9
Management Principles for Asthma
What does inhaler therapy for asthma follow?
GINA guidelines in a step-wise approach.
p.23
Clinical Features of Asthma
What are key clinical features of a patient with Cystic Fibrosis?
Chronic cough, recurrent lung infections, and difficulty breathing.
p.8
Clinical Features of Asthma
What characterizes acute severe asthma?
Feeble respiratory effort, cyanosis, exhaustion, and reduced GCS.
p.29
Diagnosis and Investigation of Asthma
What does an increased white cell count (WCC) indicate in cystic fibrosis?
It indicates an infective exacerbation.
p.31
Management Principles for Asthma
What are the principles of management for Cystic Fibrosis and Bronchiectasis?
Treat symptoms, treat infections early and aggressively, optimise lung function, optimise weight & nutrition, ensure transplant eligibility.
p.3
Pathogenesis and Aetiology of Asthma
What triggers neutrophilic asthma?
Particulates, pollutants, viruses, and endotoxins activating Toll-like receptors (TLR).
What is the commonly used nebulised bronchodilator for COPD?
Combivent (Salbutamol + Ipratropium).
p.6
Risk Factors and Triggers for Asthma
How can smoking affect asthma?
It is a trigger for asthma exacerbations.
p.16
Management Principles for Asthma
What are nasal prongs used for in COPD management?
They may be used for long-term oxygen therapy (LTOT) or for acute exacerbation.
p.11
Complications and Prognosis of Asthma
What is status asthmaticus?
A severe asthma attack that does not respond to standard treatments.
p.15
Asthma Severity Assessment
Why is it important to ask about previous exacerbations in COPD patients?
It is important for GOLD staging and management.
p.1
Pathogenesis and Aetiology of Asthma
What is the difference between asthmatic and normal airways?
In asthmatic airways, the muscle tightens, the lining is swollen, and there is excess mucus compared to normal airways.
p.22
Management Principles for Asthma
What signs indicate chronic hypoxaemia for LTOT?
Pulmonary HTN, right heart failure, leg oedema, or polycythaemia (HCT > 55%).
p.4
Symptoms and Signs of Asthma
What is a common diurnal variation symptom in asthma?
Wheeze and chest tightness.
p.31
Management Principles for Asthma
What does the acronym F.A.C.E.D. stand for in the context of Cystic Fibrosis and Bronchiectasis?
F - FEV1, A - Age, C - Chronic colonisation with Pseudomonas, E - Extension (No. of lobes affected), D - Dyspnoea (mMRC scale).
p.2
Pathogenesis and Aetiology of Asthma
What is the definition of asthma?
A chronic inflammatory disease of the airways characterized by reversible airflow obstruction.
p.34
Emergency Management of Asthma
What is the first step in managing Massive Haemoptysis?
Stabilise the patient with volume +/- vasopressors.
p.7
Diagnosis and Investigation of Asthma
What is the primary method for diagnosing asthma?
Clinical diagnosis based on intermittent typical symptoms and presence of wheeze.
p.9
Management Principles for Asthma
What is the progression of controller medications in asthma management?
From low-dose ICS-Formoterol to medium/high-dose ICS-LABA, possibly adding Tiotropium, Biologics, or oral corticosteroids.
p.30
Diagnosis and Investigation of Asthma
What serology tests are relevant for bronchiectasis?
Pertussis and Measles serology.
p.3
Pathogenesis and Aetiology of Asthma
What is the role of NF-kB in neutrophilic asthma?
It results in oxidative stress and IL-8 production.
What should be considered for decompensated type 2 respiratory failure?
Non-invasive ventilation (NIV) or BiPAP.
p.1
Diagnosis and Investigation of Asthma
What is an investigation plan to determine asthma diagnosis?
An investigation plan may include spirometry, peak flow monitoring, and allergy testing.
p.1
Management Principles for Asthma
What are the principles of management for asthma?
Management principles include avoiding triggers, using inhalers, and monitoring symptoms.
p.8
Diagnosis and Investigation of Asthma
What is the purpose of the IgE RAST panel?
To screen for triggers like house mites, pet dander, and pollen.
p.1
Pathogenesis and Aetiology of Asthma
What happens to the muscle in asthmatic lungs?
The muscle tightens in asthmatic lungs.
p.11
Complications and Prognosis of Asthma
What is the prognosis for adult-onset asthma?
Adult-onset asthma usually persists.
p.20
Symptoms and Signs of Asthma
What is the significance of the mMRC scale in COPD?
It measures dyspnoea severity.
p.20
Management Principles for Asthma
What are some non-pharmacological management strategies for COPD?
Physiotherapy, chest physiotherapy, and pulmonary rehabilitation.
p.13
Management Principles for Asthma
What are the principles of management for COPD?
Management includes smoking cessation, bronchodilators, corticosteroids, and pulmonary rehabilitation.
p.20
Management Principles for Asthma
What vaccinations are recommended for COPD patients?
Pneumococcal vaccine, COVID-19 vaccine, and annual influenza vaccine.
What are the methods to deliver oxygen in acute COPD management?
Nasal prongs, venturi masks, or 100% non-rebreather mask if severe hypoxia.
p.31
Management Principles for Asthma
What preventative treatments are recommended for Cystic Fibrosis and Bronchiectasis?
Smoking cessation and vaccination against COVID-19, influenza, and pneumococcus.
p.28
Differential Diagnosis of Asthma
What are some differential diagnoses for bronchiectasis?
Asthma, COPD, ABPA, Coeliac disease, and malabsorption.
p.14
Clinical Features of Asthma
What defines Chronic Bronchitis?
Productive cough on most days for at least 3 months for at least 2 consecutive years.
What is the purpose of EPAP in BiPAP?
To keep alveoli patent on expiration and aid increased gas exchange.
p.14
Risk Factors and Triggers for Asthma
What are the common gene variants associated with AATD?
M (normal), S, and Z are the most common deficiency variants.
p.30
Asthma Severity Assessment
What does the CF ABLE Score assess?
Prognosis and outcomes in cystic fibrosis.
p.1
Clinical Features of Asthma
What are the key clinical features of a patient presenting with asthma?
Key clinical features include wheezing, shortness of breath, chest tightness, and coughing.
p.11
Complications and Prognosis of Asthma
What are some complications of asthma?
Impaired quality of life, missing work or school, side effects from treatment, recurrent inflammation leading to airway remodeling, status asthmaticus, hypoxic brain injury, and death.
p.9
Management Principles for Asthma
What are the aims of asthma treatment?
Freedom from frequent symptoms, maintenance of normal daily activity, minimising number of exacerbations, and minimal need for reliever inhaler.
p.3
Diagnosis and Investigation of Asthma
What is the purpose of a peak flow meter?
To measure the peak expiratory flow rate in asthma patients.
p.7
Differential Diagnosis of Asthma
What are some other causes of airway obstruction besides asthma?
COPD, Bronchiectasis, Cystic Fibrosis, Airway Tumour, Goitre, Foreign Body.
p.9
Management Principles for Asthma
What is a key non-pharmacological management strategy for asthma?
Avoidance of known triggers.
p.26
Symptoms and Signs of Asthma
What is a common symptom of bronchiectasis?
Productive cough with mucus production, possibly with haemoptysis.
p.28
Risk Factors and Triggers for Asthma
Which autoimmune disorders are risk factors for bronchiectasis?
Rheumatoid arthritis and Sjögren’s Syndrome.
p.13
Diagnosis and Investigation of Asthma
What investigations are used for diagnosing COPD?
Spirometry, chest X-ray, and CT scans.
p.10
Management Principles for Asthma
What do GINA guidelines recommend regarding SABA only therapy?
They no longer recommend it due to increased mortality in asthmatics prescribed SABA only.
p.26
Symptoms and Signs of Asthma
What atypical symptoms may patients with cystic fibrosis present with in later life?
Infertility and gastrointestinal symptoms.
p.24
Pathogenesis and Aetiology of Asthma
What type of disease is cystic fibrosis?
An autosomal recessive multi-system disease.
p.18
Diagnosis and Investigation of Asthma
What is the purpose of an echocardiogram (ECHO) in COPD?
To assess for right heart failure (cor pulmonale).
p.13
Clinical Features of Asthma
What does the term 'pink puffer' refer to in COPD?
It refers to patients with emphysema who are typically thin and have difficulty breathing but maintain normal oxygen levels.
p.23
Diagnosis and Investigation of Asthma
What investigations are used for diagnosing CF and Bronchiectasis?
Sweat test for CF and CT scan for Bronchiectasis.
p.34
Emergency Management of Asthma
What imaging technique is used to localise the source of bleeding in Massive Haemoptysis?
CT angio guided IR selective bronchial artery embolisation.
p.23
Management Principles for Asthma
What are the management principles for treating CF and Bronchiectasis?
Airway clearance techniques, antibiotics for infections, and management of complications.
p.19
Complications and Prognosis of Asthma
What can ABG results show in COPD patients?
Type 2 respiratory failure.
p.20
Management Principles for Asthma
What is the GOLD classification used for in COPD?
It is used for classification and management of Chronic Obstructive Pulmonary Disease.
p.20
Management Principles for Asthma
What pharmacological therapies are recommended for GOLD D classification?
LAMA, LAMA + LABA, LABA + ICS, LABA + LAMA + ICS.
p.4
Symptoms and Signs of Asthma
What are the classical clinical features of asthma?
Wheeze, chest tightness, cough, and dyspnoea.
p.11
Complications and Prognosis of Asthma
How does childhood asthma typically progress?
Childhood asthma frequently remits.
p.7
Differential Diagnosis of Asthma
What are some causes of eosinophilic lung disease?
Allergic Bronchopulmonary Aspergillosis (ABPA), Eosinophilic granulomatosis with polyangiitis.
p.8
Clinical Features of Asthma
What are the clinical findings for moderate asthma?
Unable to complete sentences.
p.22
Management Principles for Asthma
How many hours per day should LTOT be used?
A minimum of 15 hours per day.
p.9
Management Principles for Asthma
What is the first step in the inhaler treatment approach for asthma?
As needed low-dose ICS-Formoterol (e.g., Symbicort).
p.18
Diagnosis and Investigation of Asthma
What can a chest X-ray (CXR) reveal in COPD patients?
COPD changes, pneumonia, pneumothorax, or consolidation contributing to the DECAF score.
p.4
Symptoms and Signs of Asthma
What atopic features are associated with asthma?
Hay-fever, eczema, rhinitis, and acid reflux.
p.14
Clinical Features of Asthma
What are the two clinical sub-types of COPD?
Chronic Bronchitis and Emphysema.
p.20
Complications and Prognosis of Asthma
What does the BODE index stand for?
BMI, Airflow Obstruction (FEV1), Dyspnoea (mMRC), Exercise capacity (6-minute walk test).
p.7
Diagnosis and Investigation of Asthma
What does a Peak Flow Diary demonstrate in asthma diagnosis?
More than 20% diurnal variation.
p.31
Emergency Management of Asthma Exacerbations
What is included in the acute management of Bronchiectasis/Cystic Fibrosis exacerbations?
Respiratory support (oxygen supplementation, NIV, ICU referral), and early aggressive antimicrobial therapy.
p.13
Clinical Features of Asthma
What does the term 'blue bloater' refer to in COPD?
It refers to patients with chronic bronchitis who are often overweight and may have cyanosis due to low oxygen levels.
p.13
Management Principles for Asthma
How is A1AT deficiency managed?
Management includes augmentation therapy and addressing lung health through lifestyle changes.
p.10
Emergency Management of Asthma Exacerbations
What is the role of Hydrocortisone in acute asthma management?
100mg IV to reduce inflammation.
p.5
Symptoms and Signs of Asthma
What does tripoding indicate in asthma patients?
Severe or life-threatening asthma.
p.35
Complications and Prognosis of Asthma
Is there a cure for Cystic Fibrosis (CF)?
Currently, there is no cure for CF.
p.26
Symptoms and Signs of Asthma
What is a key symptom of cystic fibrosis that may be detected through screening?
Diagnosis may pre-date symptoms.
p.16
Clinical Features of Asthma
What characterizes a 'Pink Puffer' in COPD?
Purse-lip breathing and being thin, typically associated with emphysema.
p.16
Clinical Features of Asthma
What does a 'Blue Bloater' indicate in COPD?
Cyanosis and barrel chest.
p.19
Asthma Severity Assessment
What factors are considered in the GOLD Criteria?
FEV1 score, CAT score or mMRC score, and number of exacerbations/hospital admissions.
p.18
Diagnosis and Investigation of Asthma
What can a CT Thorax reveal in COPD patients?
Emphysematous bulla, bronchial wall thickening, air trapping, and airway enlargement.
p.13
Pathogenesis and Aetiology of Asthma
What is Alpha1 Anti-Trypsin (A1AT) deficiency?
A genetic condition that can lead to COPD due to insufficient levels of the protein that protects the lungs.
p.1
Pathogenesis and Aetiology of Asthma
What is the condition of mucus in asthmatic lungs?
There is excess mucus in asthmatic lungs compared to a normal amount in healthy lungs.
p.17
Risk Factors and Triggers for Asthma
What environmental exposure is a risk factor for COPD?
Environmental smoke exposure from cooking or heating sources.
p.14
Pathogenesis and Aetiology of Asthma
What is Chronic Obstructive Pulmonary Disease (COPD)?
A preventable disease characterized by airflow obstruction that is not fully reversible and persistent symptoms of dyspnoea and productive cough.
p.8
Asthma Severity Assessment
What indicates life-threatening asthma?
Unable to speak and PEFR <33% of predicted.
In which populations is asthma more prevalent?
Higher incidence in Western and urban societies.
p.13
Complications and Prognosis of Asthma
What are the complications of COPD?
Complications can include respiratory infections, heart problems, and lung cancer.
p.23
Symptoms and Signs of Asthma
What clinical features indicate an acute exacerbation of CF or Bronchiectasis?
Increased cough, sputum production, and worsening shortness of breath.
p.10
Management Principles for Asthma
What is Omalizumab?
An anti-IgE monoclonal antibody given every 4 weeks subcutaneously for severe asthma with high IgE levels.
p.14
Clinical Features of Asthma
What characterizes Emphysema?
Abnormal and permanent enlargement of the airways distal to the terminal bronchiole.
p.10
Emergency Management of Asthma Exacerbations
What is the first step in managing an acute asthma exacerbation?
Repeatedly administer nebulized Salbutamol 5mg.
p.2
Pathogenesis and Aetiology of Asthma
What are the two inflammatory phenotypes of asthma?
Eosinophilic and non-eosinophilic (e.g., neutrophilic and other sub-groups).
p.23
Pathogenesis and Aetiology of Asthma
How does bronchiectasis affect the airway structure?
It causes dilated, ectatic airways due to damage from chronic inflammation.
p.2
Pathogenesis and Aetiology of Asthma
What characterizes eosinophilic asthma?
Thickening of the basement membrane and steroid responsiveness.
p.28
Diagnosis and Investigation of Asthma
What does a positive Nasal Potential Difference indicate?
Positive in Cystic Fibrosis.
p.18
Diagnosis and Investigation of Asthma
What does an increased white cell count (WCC) indicate in COPD?
It indicates an infective exacerbation.
p.19
Complications and Prognosis of Asthma
What ECG signs indicate cor pulmonale?
Tall P-wave, RBBB, and right axis deviation.
p.8
Diagnosis and Investigation of Asthma
What do arterial blood gas (ABG) results show in severe asthma?
Decreased PaO2 and increased PaCO2.
p.18
Diagnosis and Investigation of Asthma
What imaging findings are associated with hyperinflated lungs in COPD?
More than 6 anterior or 10 posterior ribs in the mid-clavicular line at lung diaphragm level or flattened hemidiaphragms.
p.3
Diagnosis and Investigation of Asthma
What does spirometry assess in asthma patients?
It assesses lung function through pulmonary function tests (PFTs).
p.28
Risk Factors and Triggers for Asthma
What conditions can lead to bronchiectasis?
Chronic lung inflammation or recurrent infections.
p.18
Diagnosis and Investigation of Asthma
What is the purpose of measuring IgE levels in COPD?
To investigate for asthma aetiology.
p.29
Diagnosis and Investigation of Asthma
What imaging test confirms bronchiectasis?
High Resolution CT (HRCT) showing airway dilatation and mucus plugging.
p.22
Management Principles for Asthma
What is recommended for bone protection in COPD patients with frequent steroid use?
Calcichew and/or bisphosphonates.
p.29
Diagnosis and Investigation of Asthma
What blood test result is associated with malabsorption of B12 and folate in cystic fibrosis?
Decreased hemoglobin (Hb).
p.6
Risk Factors and Triggers for Asthma
What is a significant risk factor for developing asthma?
History of Atopy (e.g., Eczema, Hayfever, Allergic Rhinitis).
p.24
Pathogenesis and Aetiology of Asthma
What gene mutation causes cystic fibrosis?
A mutation in the gene encoding CF Transmembrane Conductance Regulator (CFTR).
p.27
Clinical Features of Asthma
What does clubbing signify in respiratory diseases?
Suppurative lung disease.
p.24
Pathogenesis and Aetiology of Asthma
How does bronchiectasis commonly occur?
Due to recurrent or chronic airway infection/inflammation.
p.17
Differential Diagnosis of Asthma
Which condition should be considered if COPD onset is younger?
Alpha-1 antitrypsin deficiency.
p.6
Risk Factors and Triggers for Asthma
What role do pets play in asthma?
Pets with fur can trigger asthma exacerbations.
p.27
Clinical Features of Asthma
What does pallor in the palmar crease suggest?
Anaemia due to malabsorption of iron/B12.
What medications are used to treat inflammation in COPD?
Oral prednisolone or IV hydrocortisone.
p.24
Epidemiology of Asthma
What is the most common mutation in cystic fibrosis in Ireland?
The Δ F508 mutation in the homozygous state.
p.30
Asthma Severity Assessment
What factors are included in the CF ABLE Score?
Age, BMI, Lung Function (FEV1), and Exacerbations.
p.5
Symptoms and Signs of Asthma
What respiratory rate change is associated with exacerbation?
Increased respiratory rate.
p.14
Risk Factors and Triggers for Asthma
What is the risk of developing COPD for individuals with Homozygous ZZ AATD?
Higher risk of developing COPD even in the absence of smoke exposure.
What is the role of Roflumilast in COPD management?
It is a phosphodiesterase 4 inhibitor (adjunct to inhaler).
p.32
Management Principles for Asthma
What is Creon used for in Cystic Fibrosis?
It is a pancreatic enzyme replacement therapy.
p.26
Symptoms and Signs of Asthma
How do symptoms and severity of cystic fibrosis vary?
They vary widely between patients depending on the type of mutations and the degree of CFTR dysfunction.
p.26
Symptoms and Signs of Asthma
What gastrointestinal symptoms can occur in infants with cystic fibrosis?
Meconium ileus, failure to thrive, rectal prolapse, volvulus, steatorrhoea, anaemia, pancreatitis, and symptoms of cirrhosis.
p.22
Management Principles for Asthma
What are the indications for Long-Term Oxygen Therapy (LTOT) in COPD?
PaO2 ≦ 7.3 kPa or PaO2 between 7.3 and 8 kPa with signs of chronic hypoxaemia.
p.23
Pathogenesis and Aetiology of Asthma
What is the pathophysiology of Cystic Fibrosis (CF)?
CF leads to pulmonary and extra-pulmonary organ dysfunction due to thick, sticky mucus production that obstructs airways and glands.
p.7
Differential Diagnosis of Asthma
What are some causes of dyspnoea that should be considered?
Pulmonary Embolus, Pneumothorax, Heart Failure.
p.17
Risk Factors and Triggers for Asthma
What genetic condition is associated with an increased risk of COPD?
Alpha-1 antitrypsin deficiency.
p.30
Diagnosis and Investigation of Asthma
What condition may low levels of Alpha1 antitrypsin indicate?
Alpha1 Antitrypsin Deficiency (AATD).
p.34
Emergency Management of Asthma
What should be done for airway protection in cases of Massive Haemoptysis?
Ensure airway protection.
p.10
Management Principles for Asthma
What is Montelukast used for?
It is a leukotriene receptor antagonist useful in asthma with allergic rhinitis.
p.30
Diagnosis and Investigation of Asthma
What does sputum culture test for in bronchiectasis?
AFB and drug-resistant organisms like MRSA and Pseudomonas aeruginosa.
p.22
Complications and Prognosis of Asthma
What are some complications of COPD?
Impaired quality of life, infective exacerbations, chronic type 2 respiratory failure, cor pulmonale, secondary polycythaemia, osteoporosis, diabetes, and hearing impairment.
p.30
Diagnosis and Investigation of Asthma
What imaging findings may be seen in bronchiectasis?
Situs inversus (Kartagener’s syndrome) or cavitating lesions in TB.
p.31
Management Principles for Asthma
Which antibiotics are recommended for Pseudomonas aeruginosa and Staphylococcus aureus?
Co-amoxiclav for S. aureus; ticarcillin/clavulanic acid, ceftazidime, or Tazocin for P. aeruginosa.
p.22
Complications and Prognosis of Asthma
What is the prognosis for late-stage COPD?
High morbidity and mortality.
p.2
Pathogenesis and Aetiology of Asthma
What is a characteristic of neutrophilic asthma?
It may be relatively steroid resistant and associated with more severe disease.
p.34
Emergency Management of Asthma
What should be assessed during the initial assessment of a patient with Massive Haemoptysis?
Airway compromise, Breathing, Circulation & assessment for hypovolaemic shock.
p.6
Risk Factors and Triggers for Asthma
How can exercise affect asthma?
Exercise can be a trigger for asthma exacerbations.
p.6
Risk Factors and Triggers for Asthma
What is the impact of viral infections on asthma?
Viral infections can trigger asthma exacerbations.
p.6
Risk Factors and Triggers for Asthma
What environmental factors can trigger asthma?
Dust, mould, mildew, and strong smells.
p.27
Clinical Features of Asthma
What does the presence of amyloid deposits indicate in Bronchiectasis?
Amyloidosis affecting multiple organs.
p.5
Symptoms and Signs of Asthma
What does central cyanosis indicate?
A life-threatening sign (look under the tongue).
p.16
Symptoms and Signs of Asthma
What does Hoover’s Sign indicate in COPD?
Lower rib-cage moves abnormally inwards.
p.4
Asthma Severity Assessment
What should be inquired about regarding asthma control?
Number of exacerbations, hospital admissions, ICU admissions, and steroid/antibiotic courses per year.
p.24
Pathogenesis and Aetiology of Asthma
What are some infections that can lead to bronchiectasis?
Tuberculosis, measles, pertussis, and primary ciliary dyskinesia.
p.22
Complications and Prognosis of Asthma
What scores can predict higher mortality in COPD patients?
High DECAF score or high BODE score.
p.6
Risk Factors and Triggers for Asthma
How does air pollution relate to asthma?
Air pollution is a trigger for asthma exacerbations.
p.31
Management Principles for Asthma
What long-term respiratory management strategies are recommended for Cystic Fibrosis?
Oxygen optimisation, portable oxygen for exertion desaturation, and non-invasive ventilation at night.
p.29
Diagnosis and Investigation of Asthma
What does a faecal elastase test indicate?
It indicates pancreatic insufficiency.
p.24
Diagnosis and Investigation of Asthma
What screening method has been used since 2011 for cystic fibrosis?
Neonatal heel-prick screens measuring immune-reactive trypsinogen.
p.17
Diagnosis and Investigation of Asthma
What is the significance of reversibility < 12% in spirometry?
It suggests a fixed obstruction typical of COPD.
What is the full name of SABA?
Short-acting beta agonist.
What is an example of a long-acting beta agonist?
Salmeterol or Formoterol.
p.32
Complications and Prognosis of Asthma
What is contraindicated for lung transplant in Cystic Fibrosis patients?
Burkholderia cepacia complex colonization and BMI less than 17.
p.5
Symptoms and Signs of Asthma
What oral condition can result from steroid use in asthma patients?
Candidiasis in the mouth.
p.6
Risk Factors and Triggers for Asthma
What are common triggers for asthma exacerbations?
Smoking, viral illnesses, air pollution, dust and dust mites, pets, hay fever, food allergies, exercise, and weather changes.
p.28
Diagnosis and Investigation of Asthma
What is required for the clinical diagnosis of Cystic Fibrosis?
Clinical history and one positive test.
p.29
Diagnosis and Investigation of Asthma
What liver function test (LFT) result is common in cystic fibrosis?
Deranged LFTs associated with biliary disease.
p.29
Complications and Prognosis of Asthma
What does a DEXA scan assess in cystic fibrosis patients?
Osteoporosis due to malnutrition.
p.32
Management Principles for Asthma
What are the main airway clearance techniques for Cystic Fibrosis?
Physiotherapy, short-acting bronchodilators, and mucolytics like DNAase and hypertonic saline.
p.24
Epidemiology of Asthma
What is the incidence of cystic fibrosis in Ireland?
1 in 19 people are carriers of a mutated CFTR gene.
p.32
Management Principles for Asthma
What inhaled antibiotics are used for Pseudomonas colonization in Cystic Fibrosis?
Tobramycin, Colomycin, Aztreonam, and Levofloxacin.
p.2
Risk Factors and Triggers for Asthma
What triggers increased airway inflammation in asthma?
Environmental insults (triggers).
p.27
Clinical Features of Asthma
What does reduced chest expansion suggest?
Dilated bronchi and air trapping.
p.5
Symptoms and Signs of Asthma
What can drowsiness indicate in an asthma patient?
Life-threatening condition due to hypercapnia.
p.25
Pathogenesis and Aetiology of Asthma
What happens in Class III CFTR mutations?
CFTR reaches the cell surface but does not function properly (e.g., G551D).
p.31
Management Principles for Asthma
What should be considered when administering antimicrobial therapy for Cystic Fibrosis?
It should be done in conjunction with the most recent sputum culture and sensitivity results.
p.7
Diagnosis and Investigation of Asthma
What does a positive Methacholine challenge indicate?
Bronchial hyper-responsiveness in asthma.
p.7
Diagnosis and Investigation of Asthma
What is the significance of a negative Methacholine challenge result?
It is useful in ruling out a diagnosis of asthma.
p.2
Pathogenesis and Aetiology of Asthma
What is the effect of airway smooth muscle contraction in asthma?
It results in goblet cell hypertrophy and increased mucus secretion.
p.32
Management Principles for Asthma
What is the purpose of Lumacaftor in Cystic Fibrosis therapy?
It moves the defective CFTR protein to the cell surface where it can function.
p.5
Symptoms and Signs of Asthma
What is pulsus paradoxus?
A life-threatening sign in asthma.
p.32
Management Principles for Asthma
What nutritional support is recommended for Cystic Fibrosis patients?
Calcium and Vitamin D supplementation, and PEG insertion with nocturnal feeding if necessary.
p.25
Pathogenesis and Aetiology of Asthma
What characterizes Class I CFTR mutations?
No functional CFTR is created.
p.14
Risk Factors and Triggers for Asthma
What is Alpha1 Antitrypsin Deficiency (AATD)?
An autosomal co-dominant genetic condition that can result in emphysematous changes.
p.16
Complications and Prognosis of Asthma
What can lower limb pitting edema indicate in late-stage COPD?
Right heart failure (cor pulmonale).
p.29
Complications and Prognosis of Asthma
What is the highest risk of vitamin deficiency in cystic fibrosis?
Vitamins A, D, E, and K due to fat malabsorption.
p.10
Emergency Management of Asthma Exacerbations
What is the purpose of Magnesium Sulphate in acute asthma management?
To provide a single dose of 1.2-2.4g IV over 20 minutes to help relax the airways.
p.30
Asthma Severity Assessment
What does a FACED score indicate?
The severity of non-CF bronchiectasis.
What is the full name of LAMA?
Long-acting muscarinic antagonist.
p.25
Pathogenesis and Aetiology of Asthma
What is the result of mutations in the CFTR gene?
Abnormal transport of sodium and chloride, leading to thickened secretions.
p.27
Clinical Features of Asthma
What is a key tip regarding the effects of Cystic Fibrosis?
CF can affect anywhere from nose to knees.
p.25
Pathogenesis and Aetiology of Asthma
What is the issue with Class IV CFTR mutations?
Faulty protein ion channel.
p.33
Complications and Prognosis of Asthma
What are some psychological supports recommended for patients?
Psychology/psychiatry for anxiety/depression and patient advocacy groups.
p.6
Risk Factors and Triggers for Asthma
What type of weather changes can trigger asthma?
Cold weather and other weather changes.
p.27
Clinical Features of Asthma
What does a barrel chest indicate?
Dilated bronchi and air trapping.
p.6
Risk Factors and Triggers for Asthma
What are some food-related triggers for asthma?
Food allergies can trigger asthma exacerbations.
p.2
Pathogenesis and Aetiology of Asthma
What results from increased airway inflammation in asthma?
Bronchial hyper-responsiveness and bronchoconstriction.
p.32
Management Principles for Asthma
What is the role of Ivacaftor in Cystic Fibrosis treatment?
It helps open the CFTR channel and is useful for patients with the G551D mutation.
p.25
Pathogenesis and Aetiology of Asthma
What does the CFTR gene regulate?
A chloride channel located in exocrine tissue.
p.14
Management Principles for Asthma
How does AAT intravenous replacement therapy affect prognosis?
It dramatically improves prognosis.
p.25
Pathogenesis and Aetiology of Asthma
What are the two factors required for the development of bronchiectasis?
An infectious insult and impaired drainage, obstruction, or a defect in host defense.
p.5
Symptoms and Signs of Asthma
What does a hyperinflated chest indicate?
Increased anterior-posterior diameter due to airway obstruction.
p.25
Pathogenesis and Aetiology of Asthma
What characterizes Class V CFTR mutations?
Insufficient quantities of functional CFTR.
What is the role of nebulised saline in COPD management?
To treat mucus hypersecretion.
What are the types of inhalers used in long-term management of COPD?
SABA, SAMA, LABA, LAMA, ICS, ICS-LABA, PDE4i, Theophylline.
p.10
Emergency Management of Asthma Exacerbations
What initial assessments should be made during an asthma emergency?
Assess airway compromise, breathing, circulation, and for hypovolaemic shock.
p.14
Pathogenesis and Aetiology of Asthma
What is the role of Alpha-1 Antitrypsin (AAT) in the lungs?
It inhibits neutrophil elastase, which, at high levels, destroys lung connective tissue.
p.25
Pathogenesis and Aetiology of Asthma
What triggers the immune response in bronchiectasis?
Neutrophils, reactive oxygen species, and inflammatory cytokines.
p.25
Pathogenesis and Aetiology of Asthma
What is a characteristic of Class II CFTR mutations?
Modified CFTR that does not reach the cell surface (e.g., Δ F508).
p.34
Emergency Management of Asthma
What lab tests are important in the management of Massive Haemoptysis?
ABG, Lactate, Hb level, Coag screen, Group & Crossmatch.
p.29
Diagnosis and Investigation of Asthma
What type of pulmonary function test (PFT) results are expected in cystic fibrosis?
Mixed restrictive and obstructive features.
p.32
Management Principles for Asthma
What are CFTR potentiators used for in Cystic Fibrosis?
They help open CFTR channels, improving mucociliary clearance.
p.34
Emergency Management of Asthma
What is important to assess in the focused history and examination of a patient with Massive Haemoptysis?
Likely cause and quantify volume of haemoptysis.
p.27
Clinical Features of Asthma
What is the purpose of a PEG tube in Cystic Fibrosis?
To provide nutritional supplements.
p.33
Differential Diagnosis of Asthma
What are some differential diagnoses for haemoptysis?
Lung cancer, lung abscess, tuberculosis, and bronchiectasis.
p.5
Symptoms and Signs of Asthma
What does a reduced peak flow indicate?
Airway obstruction based on age, gender, and height.
p.17
Diagnosis and Investigation of Asthma
What does a reduced FEV1 indicate in the context of COPD?
Obstructive lung disease.
p.14
Epidemiology of Asthma
What is the prevalence of COPD in smokers?
Approximately 50%, with a dose-dependent risk based on pack-year history.
p.25
Pathogenesis and Aetiology of Asthma
What gene is associated with Cystic Fibrosis?
The CFTR gene located on chromosome 7.
p.32
Complications and Prognosis of Asthma
When is lung transplant referral considered for Cystic Fibrosis patients?
When baseline FEV1 is less than 30% of predicted.
p.25
Pathogenesis and Aetiology of Asthma
What is the consequence of the immune response in bronchiectasis?
Progressive destruction of normal lung architecture.
p.5
Symptoms and Signs of Asthma
What may be observed during a physical examination of a well asthma patient?
There may be no physical exam findings.
