Block 13 - Cardiorespiratory systems (resp) Flashcards
How does environmental radon cause cancer?
Racioactive gas emits alpha particles
How can the diaphragm become paralysed in lung cancer?
Invasion of the phrenic nerve
Define pancoast tumour
Tumour in the pulmonary apex
Define paraneoplastic syndrome
Secondary to hormones produced by tumour cells
What do the hormones \_\_\_\_ cause? ADH ACTH Parathyroid hormone Calcitonin Gonadotropin Serotonin and Bradykinin
ADH: hyponatremia ACTH: cushing-syndrome Parathyroid hormone: hypercalcaemia Calcitonin: hypocalcaemia Gonadotropin: gynae comastia Serotonin and Bradykinin: carcinoid syndrome
What happens in Lambert-Eaton myaesthenic syndrome?
Autoantibodies against neuronal Ca channels
Explain the WHO classification of lung carcinoma?
Primary: epithelial, mesenchymal, lymphonistiocytic, ectopic
Benign/Malignant
Metastatic
Explain the classification of epithelial tumours
How are they treated?
Small cell carcinoma (chemotherapy) Non-Small cell carcinoma (surgery) - Adeno - Squamous cell - Large cell
Explain the formation of adenocarcinoma
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
Is adenocarcinoma curable?
Why?
Yes
Less than 3cm and localised
Explain the formation of small cell carcinoma
Normal respiratory epithelia >
Squamous metaplasia >
Squamous dysplasia (mild > moderate > severe) >
Small cell carcinoma
What is the normal respiratory epithelia?
Pseudostratified columnar-shaped ciliated cells
What are the characteristics of small cell carcinoma?
Small, round, blue cell tumour
‘Scanty cytoplasm’
Neurosecretory granules
What are the characteristics of squamous cell carcinoma?
Cytoplasm discoloured and elongated (triangle)
Invasive (can haemorrhage)
Keratinisation and bridges
What can cause malignant mesothelioma other than asbestos?
Radiotherapy from breast cancer
What is an asbestos body?
Fibres coated with an iron containing protein
Explain the WHO classification of mesothelioma
Primary: Mesothelial, Mesenchymal, Lymphoproliferative
Malignant
Metastatic
What are the 4 classifications of mesothelial tumours?
Epithelioid
Sarcomatoid
Biphasic
Desmoplastic
What is the treatment for malignant mesothelioma?
Pleurodesis: Pleural space artificially obliterated
Surgery: Pneumectomy, Pleurectomy
Radiotherapy, Chemotherapy, Immunotherapy (MAB)
What antibodies are found in the upper airway and blood vessels?
Upper airway = IgA
Blood vessels = IgG and IgM
Are eosinophils and APC part of the innate or adaptive immune system?
Innate
Is BALT part of the innate or adaptive immune system?
What does it stand for?
Adaptive
Bronchus associated lymphoid tissue
Define commensalism
One benefits and the other is unaffected
Bacteria which cause pneumonia:
- 4 common bacteria
- 3 unusual bacteria
Which can you not use antibiotics for - why?
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
Other pathogens which cause pneumonia
1 mycobacterium
3 viruses
2 fungi
Mycobacteria e.g. TB
Viruses e.g. Influenza, Rhinovirus, Respiratory syncytical virus
Fungi e.g. Aspergillus, Pneumocystis jiovecii
4 symptoms of acute bronchitis
Cough, SOB, wheeze, chest pain
Difference between a CXR showing acute bronchits and pneumonia
Acute bronchitis has no consolidation
Pneumonia has consolidation and an air bronchogram (black outline of the broncus seen on the consolidation)
4 bacterial and 4 viral causes of acute bronchitis
Viral: Rhinovirus, Coranavirus, Adenovirus, Influenza
Bacterial: S. aureus, S. pneumoniae, H.influena, Mycoplasma pneumoniae
What is the difference between bronchopneumonia and lobar pneumonia?
Lobar: Bacterial cause involving a large area of lobe
Bronchopneumonia: Any organism > inflammation of bronchi
3 causes of cavitating pneumonia
S.aureus, TB, Klebsiella
What type of bacteria is streptococcus pneumoniae?
Gram negative diplococci
Give 6 unusual bacteria which can cause CAP
Mycoplasma pneumoniae Legionella pneumophilia Chlamydophila pneumoniae Chlamydophila psittaci (birds) Coxiella burnetti (Q fever - cows) Staphlococcus aureus
What inflamamtory marker is increased with infection?
C reactive protein (CRP)
Demographics of mycoplasma pneumonie infections
2 specific symptoms
CXR
Children and young adults
Otis media and congunctivitis
CXR findings are more severe than clinical
What syndrome can legionnaire’s cause?
6 symptoms of severe legionnaire’s disease
Potanic syndrome
Fever, diarrhoea, headache, mental state changes, increased liver enzymes, reduced Na
What does a CXR and urine sample of someone with legionnaire’s look ike?
CXR = patchy consolidation Urine = antigens
4 pathogens which cause HAP
Klebseilla, E.coli, S.aureus/MRSA
Gram negative aerobes
Severe symptom of HAP
Sepsis
How do you assess the severity of pneumonia?
CURB-65 score
6 risk factors for pneumonia
Cigarette Alcohol Sepsis Immunosupression Drugs e.g. PPI Reduced consciousness (compromise the epiglottis)
Does TB grow fast or slow?
Slow
How is TB transmitted?
Small airbourne droplets
What are the 2 cytokines associated with TB?
What do they do?
TNF-alpha
IFN-gamma
Kill the TB
What is a ‘gohn focus’
Scarring causes by latent TB
7 risk factors for TB reactivation
HIV Diabetes Renal failure Silicosis Macrophages release it Transplant TNF-alpha blockers e.g chemotherapy (turns off immune system)
What are the 2 most common TB pathogens?
What causes the 2nd most common?
- Mycobacterium tuberculosis
2. Mycobacterium Bovis (unpasteurised milk)
Where does TB multiply?
In the alveolar space and macrophages
What happens if there is a small or large antigen load?
Small = orgaisation of immune cells Large = disorganisation of immune cells causing necrosis
What happens to unstable granulomas?
They break causing more replication
What is specific about the TB cough?
Lasts longer than 3 weeks
What symptom of TB is similar to cancer?
Weight loss
Where are TB CXR abnormalities found?
Apical and posterior upper lobe (cavitation and consolidation)
Superior lower lobe
Define miliary disease
Blood-bourne spread
If the infection is cleared, what is the only evidence that the patient had it?
How does this work?
Positive heaf skin test
Inject antigens and look for a hypersensitivity reaction
Define post-primary TB
Caused as the granulomas break up due to immunodeficiency and the TB is spread
4 main places TB can spread to and what happens?
Spine = pain and gibbus (bone gives way)
Kidneys = blood in urine
Brain = meningitis
Lymph nodes = burst and discharge forming a sinus
How long do you need to culture TB for?
6 weeks
Give 3 examples of faster TB diagnosis methods
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
Define MDR-TB
Resistant to Isonizad and Rifampicin
Define XDR-TB
Resistant to fluroquinolone and at least 1 of the 2nd line injectable drugs
What is the TB treatment schedule?
All (+/-) E for 2 months
Then R and I for 4 months
5 things you test for after initiating TB treatment?
Drug resistance HIV Hepatitis Baseline liver and renal Visual acuity and colour vision when Ethambutole used
Give 7 groups at risk of MDR-TB
History of TB Inadequate treatment Poor compliance Single-drug therapy Drug malabsorption Prescribing/dispensing errors Smear positive after 2 months
Which T cell is involved in asthma?
Th1 is reduced in asthma by IL released by Th2 (it usually releases IgG)
Th2 is increased as it produced IgE
5 acute and 2 chronic airway changes in asthma
Acute: smooth muscle constriction, mucus hypersecretion, plasma leakage, oedema, sensory nerve activation
Chronic: smooth muscle hypertrophy, subepithelial fibrosis
Define chronic bronchitis
3 characteristics meaning it is not COPD
Cough and sputum for 3 months in 2 consecutive years
Pathological evidence
No obstruction
Normal spirometry
2 factors of chronic bronchitis pathophysiology
Mucus gland and smooth muscle hypertrophy
Inflammatory cell infiltrate
Explain what happens in emphysema
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
Which spirometry value is reduced the most in emphysema?
FEV1
Explain how air trapping occurs
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
How do you calculate resistance?
Resistance is inversely proportional to the radius 4
What is the difference in CO2 retention between a blue bloater and a pink puffer?
Blue bloater = CO2 retaining
Pink puffer = normal CO2
When will a pink puffer become cyanosed and get oedema?
In their final stages
Will a blue bloater or a pink puffer get cor pulmonale?
Blue bloater
What is the main cause of COPD mortality?
Why?
Cardiac
Increased atherogenic events
What does pulmonary hypertension cause?
Cor pulmonale
Right sided heart failure due to chronic lung disease
Explain what actually happens in bronchiectasis
2 causes
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)
How do you calculate minute ventilation
Tidal volume x Respiratory rate
Define ventilation capacity
Max ventilation that can be maintained with out respiratory muscle fatigue
Define ventilation demand
Spontaneous minute ventilation needed to maintain a normal PCO2
What increases airway resistance?
Airway disease causes a narrow airway and increased resistance
Define lung compliance
Ability to expand
pressure changes
Define flow rate
Flow rate = volume/time
Inversely proportional to the radius of the airway 4
Draw the flow volume loop for:
normal
obstructive
restrictive
Google the images bitch i’m not rich enough to buy pro
What law of diffusion is shown in the lungs?
Fick’s law
2 methods of measuring perfusion
CT pulmonary angiogram
Echocardiogram
What is the normal paO2
What value is oxygen delivery seriously compromised?
95%
90%
4 signs of CO2 retention
Sleepy
CO2 flap
Headache
Rebounding pulse
Is bronchiectasis an obstructive or restrictive disease?
Obstructive
Why will a patient with COPD struggle to breathe in more than breathing out?
When you breathe in everything is pulled open making it easier
When you breathe out the airways become squished making it harder
3 causes of gas trapping
Hyperexpansion
Increased residual volume
V/Q mismatch
Why is the lung volume reduced in restrictive disease?
The chest is compressed
4 causes of restrictive diseases
Pulmonary fibrosis
Obesity
Chest wall deformities
Neuromuscular disorders
What is the FVC:FEV1 ratio like in restrictive diseases?
Normal or raised
What is the pathology behind restrictive diseases?
Fibrosis or lung scarring
Thick alveolar membrane reduces diffucion
Small lungs reduces compliance
2 causes of normal V/ reduced Q
R to L cardiac shunt
Pulmonary emboli
3 causes of reduced V/ normal Q
Pneumothorax
Obstructive e.g. asthma
Pneumonia (infection needs blood but alveoli have an inflammatory exudate in them)
Define bulla
A large hole in the lung which compresses the rest of the lung
What can chronic stress do to the body? (7)
Increased HPA axis Nervous system dysfunction Obesity Hypertension Inflammation Endocrine and ovarian dysfunction Reduced bone density
What happens if you are frequently exposed to stress?
Anticipation
What are the 5 stages of cognitive appraisal?
Event > Appraisal > Moderating factors e.g. personality, support > Coping stragegies > Outcome
Define appraisal
What is the difference between primary and secondary appraisal?
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
What does ICIDH stand for?
International Classification of Impairment, Disabilities and Handicaps
What does ICF stand for?
What approach does it take?
International Classification of Functioning
Holistic approach
What are the 5 stages of the grief response model?
Denial > Anger > Bargaining > Depression > Acceptance
Define loss orientated
Intrusion of grief
Denial, avoidance, breaking ties
Define restoration orientated
Attending to life changes
Doing new things
New role and identity
What is cardiac neurosis?
Heart complaints with no organic cause or physical disease
How is cardiac neurosis managed?
Pharmacology
Education
Lifestyle
Psychological support
Define clinical sequale
Pathological condition from a prior disease, injury or attack
Define physiological sequale
Response to the initial situation
(is it a harm, challenge or benefit?)
(thoughts, mood, behaviour, lifestyle)
6 modifiers of the sequale
Stress Social support Self-esteem Self-confidence Personality Psychological problems
What are the 6 phases of the stages of change model?
Pre-contemplation > Contemplation > Determination > Action > Relapse > Maintenance
Explain the heath belief model
The likelihood of engaging in health promoting behaviour depends on the perceived seriousness and susceptibility of an event and the barriers to changing
What is it important to educate in rehabilitation?
What caused the illness and how the patient can make changes to their lifestyle
Address psychological support which may be needed
