BCS
What is the most important intervention to slow COPD progression?
Smoking cessation
Name the two medications that were initially prescribed to Peter? What is their pharmacological class?
Salbutamol (SABA) and Ipratropium (SAMA)
What does prolonged expiratory phase on auscultation indicate?
Airflow obstruction (classic in COPD)
What is the first-line treatment for anaphylaxis?
IM adrenaline (epinephrine)
Which genetic disorder causes early-onset panacinar emphysema?
Alpha-1 antitrypsin deficiency
Which intercostal muscles are primarily active during forced expiration?
Internal intercostals
How would you explain “emphysema” to a patient in simple terms?
“The air sacs in your lungs are damaged, so it’s harder to breathe out and get fresh air in.”
Name two compensatory mechanisms the body uses in chronic heart failure.
1. Increased sympathetic activity
2. Activation of RAAS
What are target SpO2 saturations in COPD patient's and why?
88-92. To avoid suppressing hypoxic respiratory drive and worsening CO₂ retention.
What type of emphysema is most strongly associated with smoking?
Centrilobular emphysema
What ABG findings suggest compensated type 2 respiratory failure?
Low pO₂, high pCO₂, high HCO₃⁻, normal pH
What vitamin is deficient in pernicious anaemia and why?
Vitamin B12, due to lack of intrinsic factor from autoimmune gastritis
Explain why chronic COPD can lead to secondary polycythaemia.
Chronic hypoxaemia stimulates erythropoietin release, increasing RBC production
Why does alpha-1 antitrypsin deficiency also cause liver disease?
Misfolded AAT accumulates in hepatocytes, causing hepatotoxicity and cirrhosis
How would you distinguish between obstructive and restrictive lung disease using spirometry?
Obstructive: ↓FEV₁/FVC ratio; Restrictive: ↓FVC with normal/high FEV₁/FVC
What immunophenotypic markers are commonly expressed in B-cell lymphoma?
CD19, CD20, and surface immunoglobulin
What is cor pulmonale and how does it relate to COPD?
Right-sided heart failure due to chronic pulmonary hypertension from lung disease
Why is Peter’s lung disease considered obstructive and not restrictive, despite alveolar destruction?
Because airflow is limited due to air trapping, not reduced lung volume — FEV₁/FVC is reduced
Describe three classic CXR findings in emphysema.
Flattened diaphragms, hyperlucent lungs (decreased vascular markings), narrow cardiac silhouette
What is the physiological cause of hypoxaemia in pulmonary embolism?
Ventilation-perfusion (V/Q) mismatch due to obstruction of pulmonary arterial flow