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Medicine - Year 2 > Block 13 - Cardiorespiratory systems (resp) > Flashcards

Block 13 - Cardiorespiratory systems (resp) Flashcards

1
Q

How does environmental radon cause cancer?

A

Racioactive gas emits alpha particles

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2
Q

How can the diaphragm become paralysed in lung cancer?

A

Invasion of the phrenic nerve

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3
Q

Define pancoast tumour

A

Tumour in the pulmonary apex

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4
Q

Define paraneoplastic syndrome

A

Secondary to hormones produced by tumour cells

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5
Q 
What do the hormones \_\_\_\_ cause?
ADH
ACTH
Parathyroid hormone
Calcitonin
Gonadotropin
Serotonin and Bradykinin
A 
ADH: hyponatremia
ACTH: cushing-syndrome
Parathyroid hormone: hypercalcaemia
Calcitonin: hypocalcaemia
Gonadotropin: gynae comastia
Serotonin and Bradykinin: carcinoid syndrome
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6
Q

What happens in Lambert-Eaton myaesthenic syndrome?

A

Autoantibodies against neuronal Ca channels

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7
Q

Explain the WHO classification of lung carcinoma?

A

Primary: epithelial, mesenchymal, lymphonistiocytic, ectopic
Benign/Malignant
Metastatic

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8
Q

Explain the classification of epithelial tumours

How are they treated?

A 
Small cell carcinoma (chemotherapy)
Non-Small cell carcinoma (surgery)
 - Adeno
- Squamous cell 
- Large cell
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9
Q

Explain the formation of adenocarcinoma

A

Atypical adenomatous hyperplasia (small tumour with mutations lined by atypical cuboidal cells)

Adenocarcinoma: Abnormal glandular structures producing mucin; lined by atypical columnar cells and associated inflammation

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10
Q

Is adenocarcinoma curable?

Why?

A

Yes

Less than 3cm and localised

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11
Q

Explain the formation of small cell carcinoma

A

Normal respiratory epithelia >
Squamous metaplasia >
Squamous dysplasia (mild > moderate > severe) >
Small cell carcinoma

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12
Q

What is the normal respiratory epithelia?

A

Pseudostratified columnar-shaped ciliated cells

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13
Q

What are the characteristics of small cell carcinoma?

A

Small, round, blue cell tumour
‘Scanty cytoplasm’
Neurosecretory granules

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14
Q

What are the characteristics of squamous cell carcinoma?

A

Cytoplasm discoloured and elongated (triangle)
Invasive (can haemorrhage)
Keratinisation and bridges

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15
Q

What can cause malignant mesothelioma other than asbestos?

A

Radiotherapy from breast cancer

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16
Q

What is an asbestos body?

A

Fibres coated with an iron containing protein

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17
Q

Explain the WHO classification of mesothelioma

A

Primary: Mesothelial, Mesenchymal, Lymphoproliferative
Malignant
Metastatic

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18
Q

What are the 4 classifications of mesothelial tumours?

A

Epithelioid
Sarcomatoid
Biphasic
Desmoplastic

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19
Q

What is the treatment for malignant mesothelioma?

A

Pleurodesis: Pleural space artificially obliterated
Surgery: Pneumectomy, Pleurectomy
Radiotherapy, Chemotherapy, Immunotherapy (MAB)

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20
Q

What antibodies are found in the upper airway and blood vessels?

A

Upper airway = IgA

Blood vessels = IgG and IgM

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21
Q

Are eosinophils and APC part of the innate or adaptive immune system?

A

Innate

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22
Q

Is BALT part of the innate or adaptive immune system?

What does it stand for?

A

Adaptive

Bronchus associated lymphoid tissue

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23
Q

Define commensalism

A

One benefits and the other is unaffected

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24
Q

Bacteria which cause pneumonia:

  • 4 common bacteria
  • 3 unusual bacteria

Which can you not use antibiotics for - why?

A

S. aureus, S. pneumonia, H. influenzae and Neisseria meningitidis
Gram negative gut bacteria (klebseiella)
Legionella, mycoplasma, chlamydophilia) - cannot use antibiotics as they live in macrophages so have no cell wall

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25
Q

Other pathogens which cause pneumonia
1 mycobacterium
3 viruses
2 fungi

A

Mycobacteria e.g. TB
Viruses e.g. Influenza, Rhinovirus, Respiratory syncytical virus
Fungi e.g. Aspergillus, Pneumocystis jiovecii

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26
Q

4 symptoms of acute bronchitis

A

Cough, SOB, wheeze, chest pain

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27
Q

Difference between a CXR showing acute bronchits and pneumonia

A

Acute bronchitis has no consolidation

Pneumonia has consolidation and an air bronchogram (black outline of the broncus seen on the consolidation)

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28
Q

4 bacterial and 4 viral causes of acute bronchitis

A

Viral: Rhinovirus, Coranavirus, Adenovirus, Influenza
Bacterial: S. aureus, S. pneumoniae, H.influena, Mycoplasma pneumoniae

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29
Q

What is the difference between bronchopneumonia and lobar pneumonia?

A

Lobar: Bacterial cause involving a large area of lobe
Bronchopneumonia: Any organism > inflammation of bronchi

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30
Q

3 causes of cavitating pneumonia

A

S.aureus, TB, Klebsiella

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31
Q

What type of bacteria is streptococcus pneumoniae?

A

Gram negative diplococci

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32
Q

Give 6 unusual bacteria which can cause CAP

A 
Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydophila pneumoniae
Chlamydophila psittaci (birds)
Coxiella burnetti (Q fever - cows)
Staphlococcus aureus
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33
Q

What inflamamtory marker is increased with infection?

A

C reactive protein (CRP)

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34
Q

Demographics of mycoplasma pneumonie infections
2 specific symptoms
CXR

A

Children and young adults
Otis media and congunctivitis
CXR findings are more severe than clinical

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35
Q

What syndrome can legionnaire’s cause?

6 symptoms of severe legionnaire’s disease

A

Potanic syndrome

Fever, diarrhoea, headache, mental state changes, increased liver enzymes, reduced Na

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36
Q

What does a CXR and urine sample of someone with legionnaire’s look ike?

A 
CXR = patchy consolidation
Urine = antigens
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37
Q

4 pathogens which cause HAP

A

Klebseilla, E.coli, S.aureus/MRSA

Gram negative aerobes

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38
Q

Severe symptom of HAP

A

Sepsis

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39
Q

How do you assess the severity of pneumonia?

A

CURB-65 score

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40
Q

6 risk factors for pneumonia

A 
Cigarette
Alcohol
Sepsis
Immunosupression
Drugs e.g. PPI
Reduced consciousness (compromise the epiglottis)
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41
Q

Does TB grow fast or slow?

A

Slow

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42
Q

How is TB transmitted?

A

Small airbourne droplets

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43
Q

What are the 2 cytokines associated with TB?

What do they do?

A

TNF-alpha
IFN-gamma

Kill the TB

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44
Q

What is a ‘gohn focus’

A

Scarring causes by latent TB

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45
Q

7 risk factors for TB reactivation

A 
HIV
Diabetes
Renal failure
Silicosis
Macrophages release it
Transplant 
TNF-alpha blockers e.g chemotherapy (turns off immune system)
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46
Q

What are the 2 most common TB pathogens?

What causes the 2nd most common?

A
  1. Mycobacterium tuberculosis

2. Mycobacterium Bovis (unpasteurised milk)

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47
Q

Where does TB multiply?

A

In the alveolar space and macrophages

48
Q

What happens if there is a small or large antigen load?

A 
Small = orgaisation of immune cells
Large = disorganisation of immune cells causing necrosis
49
Q

What happens to unstable granulomas?

A

They break causing more replication

50
Q

What is specific about the TB cough?

A

Lasts longer than 3 weeks

51
Q

What symptom of TB is similar to cancer?

A

Weight loss

52
Q

Where are TB CXR abnormalities found?

A

Apical and posterior upper lobe (cavitation and consolidation)
Superior lower lobe

53
Q

Define miliary disease

A

Blood-bourne spread

54
Q

If the infection is cleared, what is the only evidence that the patient had it?
How does this work?

A

Positive heaf skin test

Inject antigens and look for a hypersensitivity reaction

55
Q

Define post-primary TB

A

Caused as the granulomas break up due to immunodeficiency and the TB is spread

56
Q

4 main places TB can spread to and what happens?

A

Spine = pain and gibbus (bone gives way)
Kidneys = blood in urine
Brain = meningitis
Lymph nodes = burst and discharge forming a sinus

57
Q

How long do you need to culture TB for?

A

6 weeks

58
Q

Give 3 examples of faster TB diagnosis methods

A

Liquid medium (2 weeks)

Cephaid test: PCR gives results in 90 minutes

IFN-gamma tests: Mix blood and antigens, sensitised T cells produced IFN if they have previously encountered TB and levels are measured

59
Q

Define MDR-TB

A

Resistant to Isonizad and Rifampicin

60
Q

Define XDR-TB

A

Resistant to fluroquinolone and at least 1 of the 2nd line injectable drugs

61
Q

What is the TB treatment schedule?

A

All (+/-) E for 2 months

Then R and I for 4 months

62
Q

5 things you test for after initiating TB treatment?

A 
Drug resistance
HIV
Hepatitis
Baseline liver and renal
Visual acuity and colour vision when Ethambutole used
63
Q

Give 7 groups at risk of MDR-TB

A 
History of TB
Inadequate treatment
Poor compliance
Single-drug therapy
Drug malabsorption
Prescribing/dispensing errors
Smear positive after 2 months
64
Q

Which T cell is involved in asthma?

A

Th1 is reduced in asthma by IL released by Th2 (it usually releases IgG)
Th2 is increased as it produced IgE

65
Q

5 acute and 2 chronic airway changes in asthma

A

Acute: smooth muscle constriction, mucus hypersecretion, plasma leakage, oedema, sensory nerve activation
Chronic: smooth muscle hypertrophy, subepithelial fibrosis

66
Q

Define chronic bronchitis

3 characteristics meaning it is not COPD

A

Cough and sputum for 3 months in 2 consecutive years
Pathological evidence
No obstruction
Normal spirometry

67
Q

2 factors of chronic bronchitis pathophysiology

A

Mucus gland and smooth muscle hypertrophy

Inflammatory cell infiltrate

68
Q

Explain what happens in emphysema

A

Abnormal enlargement of airspace distal to the terminal bronchiole
Destruction of walls with no obvious fibrosis
Alveoli become a ‘soggy lump’ with reduced gas exchange
Increased in upper lobes

69
Q

Which spirometry value is reduced the most in emphysema?

A

FEV1

70
Q

Explain how air trapping occurs

A

When you breathe out the airways are kept open by the alveolar walls (this is traction)
Loss of alveoli > pressure outside the airway is more positive than inside > airway narrowing and collapse
You cannot expel the air causing air trapping

71
Q

How do you calculate resistance?

A

Resistance is inversely proportional to the radius 4

72
Q

What is the difference in CO2 retention between a blue bloater and a pink puffer?

A

Blue bloater = CO2 retaining

Pink puffer = normal CO2

73
Q

When will a pink puffer become cyanosed and get oedema?

A

In their final stages

74
Q

Will a blue bloater or a pink puffer get cor pulmonale?

A

Blue bloater

75
Q

What is the main cause of COPD mortality?

Why?

A

Cardiac

Increased atherogenic events

76
Q

What does pulmonary hypertension cause?

A

Cor pulmonale

Right sided heart failure due to chronic lung disease

77
Q

Explain what actually happens in bronchiectasis

2 causes

A

Paradox of airway narrowing in a disease defined by bronchial dilation
Chronic purulent sputum > increased infection risk
Obstruction due to secretions and fibrosis in small airways
(CF and childhood diseases)

78
Q

How do you calculate minute ventilation

A

Tidal volume x Respiratory rate

79
Q

Define ventilation capacity

A

Max ventilation that can be maintained with out respiratory muscle fatigue

80
Q

Define ventilation demand

A

Spontaneous minute ventilation needed to maintain a normal PCO2

81
Q

What increases airway resistance?

A

Airway disease causes a narrow airway and increased resistance

82
Q

Define lung compliance

A

Ability to expand

pressure changes

83
Q

Define flow rate

A

Flow rate = volume/time

Inversely proportional to the radius of the airway 4

84
Q

Draw the flow volume loop for:
normal
obstructive
restrictive

A

Google the images bitch i’m not rich enough to buy pro

85
Q

What law of diffusion is shown in the lungs?

A

Fick’s law

86
Q

2 methods of measuring perfusion

A

CT pulmonary angiogram

Echocardiogram

87
Q

What is the normal paO2

What value is oxygen delivery seriously compromised?

A

95%

90%

88
Q

4 signs of CO2 retention

A

Sleepy
CO2 flap
Headache
Rebounding pulse

89
Q

Is bronchiectasis an obstructive or restrictive disease?

A

Obstructive

90
Q

Why will a patient with COPD struggle to breathe in more than breathing out?

A

When you breathe in everything is pulled open making it easier
When you breathe out the airways become squished making it harder

91
Q

3 causes of gas trapping

A

Hyperexpansion
Increased residual volume
V/Q mismatch

92
Q

Why is the lung volume reduced in restrictive disease?

A

The chest is compressed

93
Q

4 causes of restrictive diseases

A

Pulmonary fibrosis
Obesity
Chest wall deformities
Neuromuscular disorders

94
Q

What is the FVC:FEV1 ratio like in restrictive diseases?

A

Normal or raised

95
Q

What is the pathology behind restrictive diseases?

A

Fibrosis or lung scarring
Thick alveolar membrane reduces diffucion
Small lungs reduces compliance

96
Q

2 causes of normal V/ reduced Q

A

R to L cardiac shunt

Pulmonary emboli

97
Q

3 causes of reduced V/ normal Q

A

Pneumothorax
Obstructive e.g. asthma
Pneumonia (infection needs blood but alveoli have an inflammatory exudate in them)

98
Q

Define bulla

A

A large hole in the lung which compresses the rest of the lung

99
Q

What can chronic stress do to the body? (7)

A 
Increased HPA axis
Nervous system dysfunction
Obesity
Hypertension
Inflammation
Endocrine and ovarian dysfunction
Reduced bone density
100
Q

What happens if you are frequently exposed to stress?

A

Anticipation

101
Q

What are the 5 stages of cognitive appraisal?

A

Event > Appraisal > Moderating factors e.g. personality, support > Coping stragegies > Outcome

102
Q

Define appraisal

What is the difference between primary and secondary appraisal?

A 
Appraisal = How patients perceive their diagnosis and manage their disease
Primary = challenge, threat, harm, benefit
Secondary = Resources, usefulness of coping strategies, how you address the challenge
103
Q

What does ICIDH stand for?

A

International Classification of Impairment, Disabilities and Handicaps

104
Q

What does ICF stand for?

What approach does it take?

A

International Classification of Functioning

Holistic approach

105
Q

What are the 5 stages of the grief response model?

A

Denial > Anger > Bargaining > Depression > Acceptance

106
Q

Define loss orientated

A

Intrusion of grief

Denial, avoidance, breaking ties

107
Q

Define restoration orientated

A

Attending to life changes
Doing new things
New role and identity

108
Q

What is cardiac neurosis?

A

Heart complaints with no organic cause or physical disease

109
Q

How is cardiac neurosis managed?

A

Pharmacology
Education
Lifestyle
Psychological support

110
Q

Define clinical sequale

A

Pathological condition from a prior disease, injury or attack

111
Q

Define physiological sequale

A

Response to the initial situation
(is it a harm, challenge or benefit?)
(thoughts, mood, behaviour, lifestyle)

112
Q

6 modifiers of the sequale

A 
Stress
Social support
Self-esteem
Self-confidence
Personality 
Psychological problems
113
Q

What are the 6 phases of the stages of change model?

A

Pre-contemplation > Contemplation > Determination > Action > Relapse > Maintenance

114
Q

Explain the heath belief model

A

The likelihood of engaging in health promoting behaviour depends on the perceived seriousness and susceptibility of an event and the barriers to changing

115
Q

What is it important to educate in rehabilitation?

A

What caused the illness and how the patient can make changes to their lifestyle
Address psychological support which may be needed

Medicine - Year 2 (19 decks)

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