AKT Respiratory Flashcards
Total volume of air in the lungs after full inspiration
Total lung capacity (TLC)
The volume of air left in the lungs at the end of normal tidal expiration
Functional residual capacity (FRC)
Amount of air left in the lungs after maximum expiration
Residual volume (RV)
The volume of air expelled by full expiration after full inspiration
Vital capacity (VC)
The volume of air that enters and leaves the lungs during normal breathing
Tidal volume (TV)
The extra volume of air that can be inspired over and beyond the normal tidal volume
Inspiratory reserve (IRV)
The extra volume of air that can be forcefully expired after the end of a normal tidal expiration
Expiratory reserve (ERV)
Spirometry test for an asthmatic patient would show a ____________ FEV1/FVC ratio of less than ____%.
reduced, 70
What finding on peak expiratory flow homework suggests a diagnosis of asthma?
Diurnal variation with 20% or more variability.
In obstructive lung diseases such as asthma, the FEV1 is significantly __________
reduced
In restrictive lung disease, the FEV1/FVC is ______________
normal or slightly high
Diffusing capacity to carbon monoxide is abbreviated as
TLCO
Name the two types of conditions where TLCO is significantly reduced
Emphysema and intra-pulmonary restrictive diseases
The abbreviation for “carbon monoxide transfer coefficient” is
KCO (the tranfer factor per unit alveolar volume)
Air trapping and hyperinflation are features of _________ lung diseases
obstructive
The pacemaker for breathing is located in the ___________ complex of the medulla.
Pre-Botzinger
Chest Xray in latent TB will likely be _________
normal
Cavitations in the upper lobes/zones of the lung on CXR might indicate which two conditions?
TB or small cell lung cancer
List the symptoms of ACTIVE pulmonary Tuberculosis
Productive cough that doesn’t improve with abx, haemoptysis, breathlessness, fever, night sweats, fatigue, chest pain, weight loss
Acute presentation of TB is similar to the acute presentation of __________
sarcoidosis
Erythema nodosum and phlyctenular conjunctivitis are signs of which two disorders?
Acute TB or Sarcoidosis
Type of hypersensitivty reaction in acute TB?
Type 1- antibody mediated. IgE causes degranulation of mast cells and inflammatory response
TB is associated with which other chronic viral infection?
HIV (8% of TB patients have co-infection with HIV)
What is the commonest cause of infectious disease-related mortality worldwide?
TB
Causative agent in TB?
Mycobacterium tuberculosis
How is TB spread?
Spread by droplet cough by people with pulmonary TB
TB graunulomas + enlarged lymph nodes are known as
Gohn complex
Granulomas are features of which two lung disorders?
TB or sarcoidosis
What characteristic finding can be identified after staining the MTB?
“Acid-fast bacillus”
Name 4 possible initial investigations for diagnosing TB
- CXR- upper lobe predilection
- Sputum culture or bronchoalveolar lavage (acid fast bacilli)
- Mantoux or Tuberculin test
- IGRA or T-spot test
Name two important diagnostic tests for TB
- Zeil-Neelson stain
- Culturing bacteria for 6-8 weeks (confirms diagnosis)
Can also do nucleic acid amplification and PCR test
What type of stain shows bright red bacilli on a blue background?
Ziehl-Neelsen stain (for MTB)
What is the major difference between the granulomas of TB vs sarcoidosis?
TB has CASEATING granulomas
A grade 3 or 4 Mantoux/Tuberculin test (skin induration of >5mm to >15mm) reflects what type of hypersensitivty response?
Type IV
Bilateral hilar LAO, pleural effusion (with exudate), and consolidation of the upper lobes of the lungs are CXR features of what condition?
TB
The Mantoux test and IGRA tests are both ________ in latent and active ______ infection
positive, TB
In latent TB, the sputum smear and culture are
Negative
Can a person with latent TB transmit the infection?
No. They have no symptoms and the infection is spread through respiratory droplets via cough.
Name three conditions that feature “B symptoms” (fever, drenching night sweats, weight loss)
- TB (miliary/disseminated)
- Lymphoma
- Sarcoidosis
Another name for disseminated TB is
miliary TB
Approximately how many months of antibiotic treatment will initial infection with TB require?
six months of antibiotic treatment
TB meningitis requires 12
What is the largest public health risk posed by TB?
Multi-drug resistant forms of TB that develop after FTT with first line drugs
What is considered the “cornerstone” of TB control?
Contact tracing
Which of these is a risk factor for developing TB?
a. living in low altitude
b. male gender
c. malnutrition
d. obesity
e. smoking
c. malnutrition
Normal chest x ray plus +ve IGRA test =
latent infection. Treat with 3 months of Isoniazid and Rifampicin
What differentiates between active and latent TB?
AFB in sputum
Commonest cause of the common cold?
Rhinovirus
Common causes of pharyngitis?
Staph aureus, Strep pneumonia, MRSA
Commonest cause of tonsilitis?
Streptococcus Group A
What causes bronchiolitis?
RSV
Common causes of bronchitis?
Strep pneumonia, H.influenza
Common causes of pneumonia?
Strep pneumonia, H.influenza, Legionella pneumonia, and Mycoplasma pneumonia
PE findings in influenza?
Pyrexia (can be around 38-41 degrees), but otherwise unremarkable
Complications of influenza?
Viral pneumonia, secondary bacterial pneumonia, CNS dz, or death in a very small amount of cases (0.13%)
What peptide is mainly responsible for the symptoms of the common cold?
Bradykinin
Causes of influenza?
Influenza A or Influenza B virus
Which influenza surface protein binds to sialic acid receptors on the surface of the host cell, which allows the virus to enter the cell?
Haemagglutinin (H)
Which Influenza surface protein cleaves the sialic acid bonds on the host cell, allowing the virus to escape detection from the immune system?
Neuraminidase (N)
What type of chest pain will a patient with pneumonia have?
Pleuritic
Describe the some of the clinical signs of pneumonia
- Tachypnea
- Decreased chest expansion
- Dullness on percussion
- Increased vocal resonance
- Bronchial breathing
- HYPOXIA
This type of change to a virus’s surface proteins are caused by point mutations in a single gene, that lead to minor, continual changes. May result in epidemics.
Antigenic drift
This type of change to a virus’s surface proteins are caused by exchange of an entire gene segment, that creates viruses with entirely new antigens. Major, abrupt changes that can result in a pandemic.
Antigenic shift
Which infection is associated with the following signs/symptoms: Productive cough with rusty brown sputum, fever, haemoptysis, rigors, pleuritic chest pain, dyspnoea, night sweats, myalgia, headache, N/V/D
Pneumonia
Xray findings in pneumonia?
Infiltrates, or white shadowing in the lungs. Heart borders or diaphragm can be obscured
What classification of bacteria is Strep pneumonia?
Gram positive cocci
Antimicrobial treatment for bacterial pneumonia?
Amoxicillin or Clarithromycin, or co-amoxiclav in severe CAP
What type of scoring system is used to assess the severity of CAP?
"CURB" score- Confusion Urea RR BP
Which antibiotic is used for Haemophilus influenza infection? (A Gram negative anaerobe)
Doxycyline (tetracycline)
Which antibiotic is used for Mycoplasma pneumonia infections?
Macrolides or Tetracyclines
Which antibiotic is used for Legionella pneumonia infections?
Macrolides or quinolones
P.aeruginosa, K.pneumonia, E.coli, and MRSA are associated with which type of pneumonia?
Hospital-acquired
What type of antibiotic treatment is often needed for hospital-acquired pneumonia?
Vancomycin
Describe the pleural aspiration findings in empyema
Pus, low pH, exudates, and bacteria
An atypical fungus that can cause opportunistic infections in immunocompromised patients
Pneumocystis jiroveci (PCP)
CXR findings in P.jiroveci infection?
Bilateral interstitial ground glass shadowing in a bat’s wing appearance
A benign, non-cancerous change in response to irritation and inflammation
metaplasia
The “T” in the TNM cancer staging system stands for
Tumor SIZE
If a lung cancer patient has a hoarse voice, it may be a sign that the cancer has spread in the neck and is affecting the…
left recurrent laryngeal nerve
Horner’s syndrome is associated with lung cancer metastasis affecting the…
sympathetic chain
Meiosis, ptosis, enopthalmos, and anhidrosis are features of…
Horner’s syndrome
Exposure to what substances significantly increases the risk of lung cancer in smokers?
Asbestos exposure (increase of 93x)
Hypertrophic pulmonary osteoarthropathy is associated with which type of lung cancer?
Adenocarcinoma
What would cause an INCREASE in vocal resonance?
Increased tissue density, as in areas of consolidation (eg pneumonia), a tumour, or lobar collapse
What would cause a DECREASE in vocal resonance?
Decreased tissue density, or the presence of either air or fluid outside of the lung (eg pleural effusion, emphysema, pneumothorax)
This type of lung cancer arises from mucin-producing glandular epithelium
Adenocarcinoma
What is the most common type of lung cancer?
Non-small cell lung cancer (NSCLC)
Which type of lung cancer has a better prognosis- NSCLC or SCLC?
NSCLC
What type of lung cancer arises from neuroendocrine cells?
SCLC
Cells from this type of lung cancer often secretes hormones such as ADH or ACTH
SCLC
What conditions would have decreased chest expansion on physical examination?
Fibrosis, consolidation, effusion, or pneumothorax
How do you differentiate consolidation from pleural effusion clinically?
Both have dullness to percussion, though pleural effusion is classically “stony dull.”
In consolidation, vocal resonance is INCREASED
Which conditions would result in a tracheal deviation AWAY FROM the affected side?
Tension pneumothorax or massive pleural effusion (trachea shifts away from the side with an increase in pressure)
Which conditions would result in a tracheal deviation TOWARDS the affected side?
Upper lobe or lung collapse, pneumonectomy
What is the FEV1/FVC ratio in restrictive lung pathologies?
Normal or slightly increased
What is the primary site of injury in fibrosis of the parenchyma?
the interstitium
List some examples of interstitial (parenchymal) lung diseases
Idiopathic interstitial pneumonia
Idiopathic pulmonary fibrosis
Pneumonconiosis
Sarcoidosis
In intersitital lung diseases, what is the pathophysiology of fibrosis? (5 steps from injury to fibrosis)
- Injury to the lung tissue
- Cytokine release
- WBC’s release leukotrienes
- Migration of fibroblasts to the area
- Formation of fibroblastic foci –> fibrosis
Describe the symptoms of diffuse parenchymal lung disease
progressively worsening breathlessness cough fatigue weight loss (if cause is auto-immune, could have difficulty swelling, cold hands, joint pain, skin rash)
Certain drugs such as amiodarone, nitrofurantoin, and chemotherapy drugs could predispose someone to develop what type of lung condition?
Diffuse parenchymal lung disease
Tachypnea at rest, clubbing, low O2 sats, fine bibasal crackles, and desaturation on exertion are clinical signs of what lung condition?
Diffuse parenchymal lung disease
Older male patient presenting with progressively worsening SOB x 2 years, with dry cough, clubbing, crackles, weight loss, and hypoxia. No significant occupational exposure or autoimmune component. Top differential?
Idiopathic pulmonary fibrosis
HRCT finding of traction bronchial dilation and honeycombing at the base of the lungs points to what type of lung disease?
Idiopathic pulmonary fibrosis
Median length of survival for IPF?
2.5-3.5 years
Non specific interstital pneumonia is associated with which two other diseases?
Auto immune disease (RA, SLE, Sceroderma/CREST) and or collagen vascular diseases
Female patient, aged 45, has previous dx of RA. PTC with worsening breathlessness, fatigue, and cough x one year. PE findings = crackles, clubbing, weight loss. CXR shows small lung fields with reticulo-nodular changes. Chest CT shows ground glass changes. Top differential?
Non-specific interstitial pneumonia
Which restrictive lung disease responds better to immunosupression- IPF or NSIP?
NSIP
Sarcoidosis is characterised by ______________ granulomas
non-caseating
Which organ is primarily affected by granulomas in sarcoidosis?
the lungs
What is the most common interstitial lung disease in the UK?
Sarcoidosis
What condition is associated with Loefgren’s syndrome- erythema nodosum and hilar LAO?
Sarcoidosis
In which conditions might you find hilar LAO?
Sarcoidosis TB Lymphoma or lung carcinoma Silicosis/Berylliosis Bird fancier's lung
Describe the epidemiology of sarcoidosis
- tends to affect F>M
- younger patients, aged 20-50 (with smaller peak >60 years)
- higher in people of Scandanavian, Afro-Caribbean or Afro-American ethnicity
Best treatment for sarcoidosis?
Oral prednisolone. Good prognosis
What do lung function tests show in sarcoidosis patients?
Mixed restrictive and obstructive patterns (obstructive pattern d/t endobronchial lesions)
Which lung disease can also present with bone pain, skin lesions, and renal stones (in addition to cough, fatigue, etc)?
Sarcoidosis
Hypercalcemia is a feature of about 10% of sarcoidosis cases. High levels of calcium in the urine –> renal stones
Describe radiological staging for sarcoidosis
Stage 0: Normal CXR
Stage I: Bilateral hilar LAO
Stage II: Nodes + parenchymal disease upper zones
Stage III: Parenchymal disease of the upper zones
Stage IV: End-stage pulmonary fibrosis
Main differential for radiological stage I and II in sarcoidosis?
TB
What are “Light’s criteria,” and what do they determine?
They determine whether aspirated pleural fluid is an exudate or transudate. Criteria include:
- Levels of protein
- LDH
- Serum protein
- Serum LDH
Name some causes of pleural exudate
Malignancy, infection, auto-immune disease, chylothorax
These clinical findings might describe what type of lung condition? Decreased chest wall movement on affected side, dullness to percussion on affected side, DECREASED tactile/vocal fremitus, and tracheal deviation AWAY from the affected side.
Large pleural effusion (remember in pneumonia/consolidation, vocal fremitius would be increased, and it would not likely cause tracheal deviation)
Marfan’s syndrome, asthma, or collagen vascular diseases can predispose someone to what type of spontaneous, acute lung condition?
Pneumothorax
Smoking can lead to what two conditions, resulting in combination obstructive and restrictive patterns on LFT’s?
Emphysema + pulmonary fibrosis
Name three clinical conditions that show mixed obstructive & restrictive patterns on LFT’s
- Smoking –> emphysema & pulmonary fibrosis
- Obese smoker with COPD
- Pulmonary sarcoidosis (endobronchial sarcoidosis + fibrosis)
What are the three types of pneumoconiosis?
Coal worker’s lung, asbestosis, and silicosis
What is the most common occupational lung disease?
Occupational asthma- characterised by breathlessness and wheeze in the work-place which improves when away from that environment.
Which type of asbestos fibre is more harmful- amphibole or serpentine?
Amphibole (particularly the CROCIDOLITE; blue asbestos)
Remember BLUE AMPHIBian CROCODILES are harmful!
Calcified pleural plaques and benign pleural thickening/effusion are CT signs for what condition?
Asbestos-related lung disease
Asbestos exposure increases the risk of developing what types of malignant lung diseases?
Mesothelioma or lung cancer
What is mesothelioma?
A malignancy of the pleura and peritoneum
What are the primary pollutants from fossil fuels (particularly diesel), and what is the effect on health?
Sulphur dioxide and nitrogen oxide.
Increased risk of CV disease, respiratory morbidity and mortality. Exacerbates asthma and COPD. Adversely affects lung development in children who live in polluted urban areas.
Affinity of haemoglobin for CO is how many times greater than the affinity for oxygen?
200-250x greater
How does smoking cause hypoxia?
CO displaces O2 in haemoglobin, as the affinity for CO is so much greater
How does smoking make people more susceptible to lung infections?
Irritation from cigarette smoke leads to hyperplasia of goblet cells, leading to increased mucous production, which is a breeding ground for bacteria. The muco-ciliary escalator is also impaired, which prevents the removal of mucous/bacteria from the respiratory tract.
Other than lung cancer and mesothelioma, what other diseases does smoking increase the risk of?
Bladder cancer, renal cell cancer, COPD, interstitial lung disease, PVD, IHD, cerebrovascular disease, and also can result in foetal growth retardation.
What is the defective protein in cystic fibrosis?
CFTR
What cellular effect does the mutation in the CFTR protein have in patients with CF?
CFTR mutation impairs transport of chloride out of the cell. The buildup of chloride in the cell attracts excess sodium, and thus water, into the cell. Mucous becomes dry, thick, and sticky.
What is the extent of the middle lobe of the right lung on the anterior aspect of the chest wall?
4th-6th rib
