cardiovascular questions Flashcards
3 things objectively tested for in asthma diagnosis
REVERSABLE AIRWAY OBSTRUCTION
EOSINOPHILIC INFLAMMATION
PRESENCE OF ALLERGEN SENSITIZATION
After exposure to the allergen in asthma what happens in terms of:
a) cell recruitment
b) epithelial changes
c) structural changes
d) muscle changes
EOSINOPHILS AND INFLAMMATOrY CELLS
MORE GOBLET CELLS
MORE MATRIX
MUSCLE HYPERTROPHY AND INCREASED PROLIFERATION
2 genes that are increased in asthma
il33
OSDMB
3 ILs involved in asthma?
IL4 - COVERSION OF B CELLS TO PLASMA CELLS (MSKING IGE)
IL5 - EOSINIPHILIA
IL13 - MUCUS SECRETION
3 ways in which eosinophilia may be detected in stable disease?
blood test
exhaled NO
sputum test
what is needed for asthma diagnosis?
SYMPTOMS AND 2 TESTS
- CLINICAL ASSESSMENT
- 2 OBJECTIVE TESTS (FENOM SPIROMETRY (OVER 35/40), REVERSABLE AIRWAY OBSTRUCTION)
in the management of asthma, which 2 things reduce airway eosinophilic inflammation?
LEUKOTREINE AGONISTS AND INHALED CORTICSTERIODS
2 things given in asthma for symptomatic relief
b2 agonists
anticholinergic therapies
2 steroid sparing therapies given in severe asthma
IL5 Agonist
anti IGE and
4 things that come together and cause an acute lung attack?
pollution
allergy
smoke
pathogen
3 conditions for omalizumab ( anti ige)
- 6 OVER
- SERUM IGE 30-200
- OTHER THERAPIES NOT WORKING
how does anti il5 ab therapy work?
stops eosinophil recruitment
what is needed for anti il5 ab therapy
REDUCTION IN ATTACKS BY 50%
SERUM EOSINIPILIA MORE THAN 300
5 causes of lung cancer other than smoking
FUMES RADON GAS ASBESTOS CHRONIC LUNG DISEASE IMMUNODEFICIENCY
what types of cancer are small cell cancers
neuroendocrine cells
what focal symptoms are seen in advanced lung cancer
HEADACHE, SIEZUREM WEAKNESS, BEHAVIORUAL CHANGE
what paraneoplastic syndromes are seen in lung cancer?
CLUBBING, HYPERCALAEMIA, HYPONATRAEMIA, CUSHINGS
what is the ultimate method for diagnosis and staging liung cancer? for each area of lung
central airway BRONCHOSCOPTY
mediastinum and lymph nodes
ENDOBRONCHIAL USS
periperal lung tumours
CT GUIDED LUNG BIOPSY
what is sabr
stereotactic ablative body radiotherapy
what 3 genes fors oncogene directed chemo target?
EGFR
ALK
ROS1
3 SIDE EFFECTS OF ONCOGENE DIRECTED DRUGS?
RASH, DIARRHOEA, PNEUMONITIS
how does immunotherapy work?
SWITCHES OFF DEATH LIGANDS ON TUMOUR CELLS SO T CELLS ARE NOT REMOVED SO THEY CAN KILL CANCER CELLS
what is offered in each lung cancer treatment stage?
early stage -SURGERY/SABR
locally advanced disease SURGERY AND CHEMO OR RADIOTHERAPY AND CHEMO
metastatic disease - a. targetable mutation] ONCOGENE DIRECTED (TYROSINE KINASE INHIBITOR)
b. no mutation byt pdl positive I
MMUNOTHERAPY
no mutation and pdl neg IMMONO AND CHEMO
symptoms of lower resp tract infection
FEVER, PRODUCTIVE COUGH, WHEEZING BREATHLESSNESS
symtoms of pnsuemonia
CHEST PAIN CYANOSIS HIGH FEVER SEVERE
5 conditions which may increase risk of pneumonia?
COPD,
ASTHMA
HIV
IMMUNOSUPPRESION DIABETES
4 most common bacterial agents for resp infection
HAEMOPHILIUS INFLUENZAE,
STREP PNEUMONIAE, MYXOPLASMA P.
TB
5 viruses commonly causing resp infection?
RHINOVIRUS,
INFLUENZA, CORONAVIRUS,
RESPIROTY SYNCITIAL VIRUS
bacterial cause of atypical pneumonia
chlamydia pneumoniae
how is pneumonia graded in primary care?
age over 65
rr >30
bp <90/60
confusion
how does the resp epithelium provide defence?
SECRETES ANTIMICROBIALS CILLIA MUCUS MAKES CYTOKINES AND UPREGULATE IFS TIGHT JUNCTIONS
5 symptoms of rsv broncholitis
TACHYNPOEA
CYANOSIS
CHEST WALL RETRACTIONS
NASAL FLARING WHEEZINGM
3 antiinflammatory drugs given for rsv bronchilitis
dexamethazone
anti il6/il6 r
what is ards
SUDDEN SEVERE INFLAMMATION OF THE LUNGS
4 things used to classify ards
CXR
ORIGIN OF OEDEMA
TIMING - WITHIN 1 WEEK OF ACUTE INSULT
OXYGENATION
3 pulmonary causes of acute lung failure
infection, aspiration
3 extrapulmonary causes of acute lung failire?
trauma
pancreatitis
sepsis
3 pulmonary causes of chronic lung failure
copd
cf
lung fibrosis
what is type 3 lung failure?
perioperative
POOR POSITIONING AND ANAESTHETIC TECHNIQUE LEADS TO ABNORMAL MOVEMENT OF CHEST WALL AND AIRWAY COLLAPSE DUE TO LOW
FUNCTIONAL RESIDUAL CEPACITY
what is type 4 lung failure
shock INTUBATION - POOLING BLOD, LESS PERFUSION
OUTLINE THE INFLAMMATORY RESPONSE IN ARDS
IL6, 8 TNF ALPHA RELEASED.
INCREASES INFLAMMATION AND OEDEMA AROUND ALVIOLI, LARGER DIATANCE FOR GAS EXCHANGE.
ALSO INCREASED NEUTROPHILS SECRETING INFLAMMATORY MEDIATORS
What damps are released in ards
HMGB1
RAGE
ANG2
3 steps of ards management
TREAT UNDERLYING DISEASE
RESP SUPPORT
MULTIPLE ORGAN SUPPOERT
what is needed for ECMO referral?
murray score over 3
what does a murray score assess?
IMAGING,
COMPLIANCE,
02 SATS ON 100% OXYGEN
PEEP (MINIMIMUM BASELINE VENTILATORY PRESSIRE NEEDED FOR ALVEOLI RECRUITMENT - INCREASES IN ARDS),
3 causes of thrombocytopenia
BONE MARROW FAILURE
INCREASED CONSUMPTION
SPLENOMEGALY - POOLING
what is glanzmans thrombasthenia
lac of GP11B/111A RECEPTOR
what is bernard soulier syndrome
LOSS OF WVF RECEPTOR (gP1B)
what is storage pool disease
reduction of granular contents
what thigns can cause abnormalities in vessel wall?
INHEREDED: COLLAGEN ABNORMALITY (ED)
ACQUIRED: LONG TERM STERIODS (COLLAGEN ATROPHY), AGING, VASCULITIS, SCURVY
3 tests for disorders of primary haemostsis?
platelet morphology
PFA100
VWF assays
what does tranexamic acid do?
binds plasminogen so it cant bind to lysine
3 symptoms of hameophilia?
HAEMARTHROSIS, SPONTANEOUS
JOINT BLEEDING,
EASILY MUSCLE WASTING
what is associated with DIC?
raised d dimer
what is the pathophysiology of DIC
REPEATED COAGULATION SPONTNANOUSLY AND THEN ANTICOAGULATION
DEPOSITION OF FIBRIN IN VESSELS CAUESE PRGAN FAILURE
