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Respiratory > Clinical Respiratory medicine > Flashcards

Clinical Respiratory medicine Flashcards

1
Q

COPD

A

Chronic bronchitis and emphysema

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2
Q

Alpha-1-antiprotease deficiency

A

Inherited enzyme deficiency of alpha-1-antiprotease resulting in emphysema

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3
Q

Chronic bronchitis

A

Inflamed bronchial tube leading to cough production of sputum most day in at least 3 consecutive months for 2 or more years.

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4
Q

Complicated chronic bronchitis

A

Acute infective exacerbation of chronic bronchitis - sputum green/yellow

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5
Q

Emphysema

A

Increased size of airwaves distal to the terminal bronchioles arising from dilation or destructive of alveolar walls and without obvious fibrosis.

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6
Q

Centracinar emphysema

A

Lossof alveolar walls in upper half of acinar

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7
Q

Panacinar

A

Massive destruction of acinar, almost all alveolar tissue destroyed

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8
Q

Bullous emphysema

A

Emphysematous space >1cm, can burst and lead to spontaneous pneumothorax

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9
Q

Peak expiratory flow rate

A

Simple test that measures peak rate of flow during expiration

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10
Q

Type I respiratory failure

A

PaO2 <8kPa (CO2 normal or low)

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11
Q

Type II respiratory failure

A

PaCO2 >6.5kPa (O2 usually low)

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12
Q

Pulmonary hypertension

A

Increased blood pressure in pulmonary circulation due to vasoconstriction as a result of hypoxic condition

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13
Q

Cor Pulmonale

A

hypertrophy of the right ventricle of the heart caused by a primary disorder of the respiratory system.

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14
Q

Short acting bronchodilators

A

SABA (salbutamol and SAMA (ipratropium)

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15
Q

Long acting bronchodilators

A

LAMA - for COPD (umeclidinium and tioptropium) and LABA (salmeterol)

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16
Q

Asthma

A

Increased responsiveness of the airways to various stimuli and causes widespread narrowing of airways that changes in severity either spontaneously or as a result of therapy

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17
Q

Atopy

A

Inherited tendency towards IgE response to allergens

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18
Q

Occupational asthma

A

Symptoms related to work exposure and no prior history of asthma. Accounts for 10-15% of adult onset asthma, most common in bakers.

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19
Q

Work-excerbated asthma

A

Asthma symptoms related to work exposure with prior history of asthma.

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20
Q

Pulmonary function test

A

Lung volume and CO gas transfer tests

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21
Q

Pulsus paradoxus

A

Change in blood pressure with inspiration/expiration

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22
Q

Leukotriene receptor antagonist

A

Add on therapy if asthma symptoms not controlled with LABA and ICS alone

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23
Q

Theophylline

A

Non-Specific phosphodiesterase inhibit and adenosine receptor antagonist. Add on asthma therapy.

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24
Q

‘Wet lung’

A

Lungs fails to rapidly shift from fluid secreting to fluid absorbing organ at birth

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25
Q

Barker hypothesis

A

Lung infection shortly after birth restricts total no of alveoli and effects lung function throughout life

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26
Q

Chronic Neonatal Lung Disease

A

Can develop after RDS and features bronchopulmonary dysplasia. Produces asthma like symptoms and effects lung function later in life.

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27
Q

Respiratory Distress Syndrome

A

Lack of surfactant production in neonates. Treated with artificial surfactant, oxygen and CPAP.

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28
Q

Primary Microorganisms

A

Most pathogenic organisms, can infect health and unhealthy people

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29
Q

Facultative Microorganisms

A

Fairly pathogenic microorganisms - infect people with slightly weakened immune systems

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30
Q

Opportunistic Microorganisms

A

Only infect people with weakened immune systems

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31
Q

Coryza/Rhinitis

A

Common cold

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32
Q

Macrophage-mucocillary escalator

A

Cellular debris and macrophages are moved up out of the respiratory tract by cilia.

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33
Q

Community acquired pneumonia

A

Pneumonia acquired in primary care

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34
Q

Nosocomial pneumonia

A

Hospital acquired pneumonia, tends to be more aggressive

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35
Q

Atypical pneumonia

A

Pneumonia caused by unusual infectious agents

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36
Q

Aspirational pneumonia

A

Infection by inhalation of gastric contents,

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37
Q

Bronchopneumonia

A

Diffuse area of infection throughout lung but does not normally affect pleura.

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38
Q

Lobar pneumonia

A

1 lobe of lung is infected

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39
Q

Hypostatic pneumonia

A

Collection of fluid in lungs that makes them more susceptible to infection

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40
Q

Obstructive pneumonia

A

Abscess that obstructs bronchus

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41
Q

Pleurisy

A

Inflammation of pleura

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42
Q

Empyema

A

Infection of pleural space

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43
Q

Lung abscess

A

Collection of pus produced by necrosis of tissue

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44
Q

Pyaemia

A

Pus forming bacteria in blood

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45
Q

Bronchiectasis

A

Pathological dilation of bronchi and build up of mucous, most commonly idiopathic

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46
Q

Causes of recurrent lung infection

A

Local bronchial obstruction, local pulmonary damage (bronchiectasis), generalised lung damage (CF, COPD), non-respiratory disease (HIV, aspiration)

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47
Q

Viral respiratory infectious agents

A

Adenovirus, influenze A and B, Parainfluenzae I and III, RSV, rhinovirus

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48
Q

Bacterial respiratory agents

A

Haemophillus influenzae, M catarrhalis, mycoplasma, staph aureus, streptococci

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49
Q

Otitis Media

A

Infection of ear drum by primary viral infection and then secondary infection with pneumococcus/H. influenzae

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50
Q

Tonsilitis/pharyngitis

A

Inflammation of tonsils/ back of throat

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51
Q

Stridor

A

a harsh vibrating noise when breathing, caused by obstruction of the trachea or larynx

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52
Q

Croup

A

Whooping cough, infection by parainfluenza virus

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53
Q

Pneumonia

A

Infection of lung tissue (alveoli), most commonly by streptococcus pneumoniae

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54
Q

Purulent sputum

A

Green/yellow sputum

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55
Q

Pleuritic Chest pain

A

Sharp pain when breathing in

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56
Q

CURB 65

A

Severity scoring of pneumonia
Confusion, blood urea >7, respiratory rate >30, diastolic blood pressure <60 and age >65 (1-2 requires hospital, 3-5 requires ITU)

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57
Q

Septicaemia

A

Infection of blood

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58
Q

Immotile cilia syndrome

A

Genetic condition causing lack of motile cilia which are unable to clear out mucous. Causes of bronchiectasis

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59
Q

Tracheitis

A

Infection of trachea causing swelling and constriction , presents similar to croup but with persistent fever and malaise.

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60
Q

Bronchitis

A

Infection of the bronchi by viral infection and then secondary infection by bacteria due to disrupted mucociliary clearance. Presents with loose rattly cough, self limiting and does not require treatment.

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61
Q

Bronchiolitis

A

Infection of the bronchioles usually by RSV usually in young children, often confused with asthma. Maximal observation and minimum intervention.

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62
Q

Detection methods of infective organisms

A

Microscopy and culture of sputum/blood, antigen detection, PCR, serology

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63
Q

Microbiological test for TB

A

ZN stain, extended culture

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64
Q

Antigen detection methods

A

Agglutination, ELISA, immuno-fluroescence

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65
Q

Legionella pneumophila

A

Detection by urinary antigen and sputum culture

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66
Q

Multi-hit theory of carcinogenesis

A

Between 3-12 genomic changes required to produce invasive phenotype

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67
Q

Main pathways of carcinogenesis in lungs

A

Lung periphery - adenocarcinoma

Central airways - squamous cell carcinoma

68
Q

KRAS gene

A

Common gene associated with adenocarcinoma and induced by smoking

69
Q

Non-smoking related lung cancer genes

A

EGFR, BRAF, HER2, ALK rearrangements

70
Q

Types of carcinoid tumour

A

Squamous cell, adenocarcinoma, small cell carcinoma, large cell carcinoma

71
Q

Tumours of bronchial glands

A

Adenoid cystic carcinoma, mucoepidermoid carcinoma, bengin adenomas

72
Q

Local effects of lung cancer

A

Bronchial obstruction, pleura inflammation and invasion, direct invasion of mediastinum and nerves,

73
Q

Common metastasis sites of lung cancer

A

Liver, adrenals, bone, brain, skin

74
Q

Non-metastatic effects

A

Endocrine effects, hyper-calcemia, inflammatory changes

75
Q

Prognostic factors of lung cancer

A

Progression, classification

76
Q

Performance Status

A

Scores fitness of patient for treatment from 0-4 (0 being fully active and 4 being bed bound). Stages 0-2 are fit for chemotherapy.

77
Q

Systematic CXR review

A
  1. Name, marker, rotation, penetration
  2. Lines/metal work
  3. Heart
  4. Mediastinum
  5. Lungs
  6. Diaphragm
  7. Soft tissues
  8. Bones
78
Q

Pulmonary nodule

A

An opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis

79
Q

Pulmonary mass

A

An opacity in the lung >3cm with no mediastinal adenopathy or atelectasis

80
Q

Stage 1 Lung Cancer

A

Tumour <5cm or involves main bronchus or visceral pleura or associated with atelectasis

81
Q

Stage 2 Lung Cancer

A

Tumour <5cm or involves main bronchus or visceral pleura or associated with atelectasis and involves ipsilateral peribronchial, hilar or intrapulmonary lymph nodes.
Or Tumour <7cm, or directly invades chest wall, phrenic nerve or parietal pericardium but no nodal involvement.

82
Q

Stage 3 Lung Cancer

A

Tumour <7cm, or directly invades chest wall, phrenic nerve or parietal pericardium and involves lymph nodes.
Or tumour >7cm and invades any major chest structures with or without nodal involvement.

83
Q

Stage 4 Lung Cancer

A

Distant metastasis present

84
Q

Criteria for surgery of lung cancer

A

No metastasis, and no N2 or N3 nodes involved. Must be fit for surgery - lung function, CVS, psychiatric health

85
Q

Fatal complications of lung surgery

A

ARDS, bronchopneumonia, MI, PTE, pneumothorax, intrathoracic bleeding

86
Q

Non-fatal complications of lung surgery

A

Empyema, post-thoactomy wound pain, broncho pleural fistula, AF, MI, post-op respiratory insuffiency

87
Q

Hamartoma

A

Benign lung tumour, made up of cellular compenents normally found in organ.

88
Q

Teratoma

A

Tumour made up of cells not normally found in organ, can be benign or malignant.

89
Q

Tyrosine kinase inhibitors

A

Targeted therapy for adenocarcinomas (erlotinib, gefitinib, afatinib)

90
Q

ZN stain

A

Used to identify acid and alcohol fast bacilli, namely mycobacterium tuberculosis

91
Q

Mycobacteria Bovis

A

Mycobacteria that infects cows and can spread to humans via consumption of milk.

92
Q

Ghon focus

A

Calcified nodule caused by macrophages ingesting TB. Mycobacteria proliferate inside macrophage and cause inflammatory response. Tissue necrosis and formation of granuloma with central caseating necrosis follows. Caseating necrosis eventually heals by calcification and creates Ghon focus containing dormant mycobacteria.

93
Q

Primary complex

A

Initial lesion and local lymph node involvement in primary TB disease which normally heals and form Ghon focus

94
Q

Tuberculosis bronchopneumonia

A

Advanced primary infection in which primary focus cavities and enlarged lymph nodes discharge into bronchus.

95
Q

Miliary TB

A

spread of bacilli to multiple sites resulting in systemic upset (respiratory symptoms in majority of cases) . Occurs 6-12 months after infection.

96
Q

Post-primary TB

A

Occurs after reactivation of mycobacterium or re-infection from outside source. Can affect any tissue in the body.

97
Q

Treatment regime of TB

A

4 months - rifampicin, isoniazid, ethambutol and pyrazinamide
2 months - rifampicin and isoniazid

98
Q

Side effects of rifampicin

A

Orange urine and tears, induces liver enzymes (OC ineffective), hepatitis

99
Q

apnoea

A

Temporary cessation of breathing for at least 10s

100
Q

Sleep apnoea

A

Recurrent episodes of upper airway obstruction leading to apnoea during sleep

101
Q

Hypopnoeas

A

Almost complete cessation of breathing

102
Q

Causes of sleep apnoea

A

Narrow pharynx, obesity, muscle relaxation

103
Q

Severity scoring of sleep apnoea

A 
Apnoeas per hr
0-5: normal 
5-15: mild
15-30: moderate
>30: severe
104
Q

Narcolepsy

A

Neurological disorder that causes a person to fall asleep in appropriate times. Features hypnogogic hallucinations, cataplexy and sleep paralysis compared to sleep apnoea which does not.

105
Q

Causes of chronic ventilatory failure

A

Airways disease (sleep apnoea, COPD), chest wall abnormalities (kyphoscoliosis), resp muscle weakness (motor neurone, muscle dystrophy), central hypoventilation (obesity hypoventilation syndrome, central hypoventilation syndrome)

106
Q

Normal sleeping pattern of newborns

A

16-18hrs sleep, sleep-wakes states alternate in 3-4hr cycles. Periodic breathing is normal.

107
Q

Polysomnography

A

gold standard in sleep investigations, not normally required.

108
Q

Primary snoring

A

Snoring without apnoea, hypoventilation, hypoxia, hypercarbia or any daytime symptoms.

109
Q

Pleural effusion

A

Abnormal collection of fluid in the pleural space

110
Q

Transudate

A

Pleural effusion with protein <30g/l

111
Q

Exudate

A

Pleural effusion with protein > 30g/l

112
Q

Common causes of transudates

A

Left ventricular failure, liver cirrhosis, hypoalbuminaemia, peritoneal dialysis

113
Q

Common causes of exudates

A

Malignancy, parapneumonic (lung abscess, pneumonia, bronchiectasis)

114
Q

Pneumothorax

A

Breach of the parietal or visceral pleura and entry of air into pleura cavity causing collapse of the lung.

115
Q

Tension pneumothorax

A

Break in surface of lung forms 1 way valve that pushes air into pleural space and compresses lung

116
Q

Primary spontaneous pneumothorax

A

No clinically apparent disease, due to weight of lung inducing apical blebs that rupture

117
Q

Secondary spontaneous pneumothorax

A

Patients has pre-existing lung disease

118
Q

Traumatic pneumothorax

A

Due to physical damage of pleura either non-iatrigenic or iatrogenic.

119
Q

Management of tension pneumothorax

A

Cannula into 2nd intercostal space, mid-clavicular line then insertion of chest drain

120
Q

Management of secondary pneumothorax

A

Chest drain into 4th intercostal space, mid-axillary line if lung does not re-inflate apply suction to drain. (high vol, low pressure) If still no re-inflation then thoracoscopic inspection of pleura and potential pleurodhesis

121
Q

Pleurodhesis

A

Attachment of lungs to pleura

122
Q

Effect of Asbestos

A

Pleural or peritoneal malignancy

123
Q

Presentation of pleural malignancy

A

Dyspnoea, chest wall pain, pleural thickening. Almost uniform mortality.

124
Q

Interstitum

A

Connective tissue space around the airways, vessels and the space between the basement membranes of the alveolar walls

125
Q

Functional consequences of restrictive lung disease

A

Reduced lung compliance, reduced gas transfer, ventilation/perfusion imbalance, reduction in total lung volume

126
Q

Honeycomb lung

A

injury to interstitial lung tissue causing chronic inflammatory response and general diffuse damage to lungs.

127
Q

Diffuse Alveolar Damage (ARDS)

A

Acute alveolar damage associated with severe pathological change and huge damage to alveoli. Lungs become solid mass of fibrous tissue.

128
Q

Pathological changes in diffuse alveolar damage

A

Pulmonary oedema, formation of fibrin and hyaline membranes, denuded BM, epithelial and fibroblast proliferation and chronic scarring.

129
Q

Sarcoidosis

A

Multi-system granulomatous disorder of unknown aetiology

130
Q

Differentiation between Sarcoid and TB

A

TB features caseation and necrosis in granulomas

131
Q

Hypersensitivity Pneumonitis

A

Group of diseases caused by inhalations of organic macro-moleculer antigens or microorganisms to which host has become sensitised.

132
Q

Potential antigens in hypersensitivity Pneumonitis

A

Thermophilic actinomycetes, bird/animal proteins, fungi, chemicals

133
Q

Usual Interstitial Pneumonitis

A

Idiopathic patchy interstitial chronic inflammation, type II pneumocytes hyperplasia and smooth muscle and vascular proliferation

134
Q

Alveolar Hypoventilation

A

Lack of air moved in and out of lungs/ poor breathing. Treated with increase of fraction of inspired oxygen in air.

135
Q

Abnormal states associated with hypoxaemia

A

Alveolar hypoventilation, shunt, ventilation/perfusion imbalance, diffusion impairment

136
Q

Fibroblastic foci

A

Fibrous tissue that develops in alveolar wall

137
Q

Restrictive spirometry

A

FVC < 80% of predicted normal. Normal FEV1/FVC ratio

138
Q

Non interstitial causes of restrictive lung disease

A

Pleural effusion, pneumothorax, amyotrophic lateral sclerosis, rib fractures, obesity, pregnancy

139
Q

Embolism

A

Embolism travelling from 1 part of body to another

140
Q

Risk factors of pulmonary embolism

A

Major trauma, surgery, pregnancy, cancer, cardiopulmonary disease (MI, COPD), inherited thrombophilia

141
Q

Symptoms and signs of isolated blood clot in peripheral pulmonary artery

A

Pleuritic chest pain, cough, haemoptysis, pyrexia, pleural rub and stone dullness at base on percussion

142
Q

Symptoms and signs of small, bilateral PE

A

Acute dyspnoea, tachycardia, tachypnoea, hypoxia

143
Q

Symptoms and signs of large PE

A

Syncope, cardiac arrest, tachycardia, hypotension, tachypnoea, hypoxia, shock

144
Q

Pulmonary hypotension

A

Elevated blood pressure in the pulmonary arterial tree (>25mmHg)

145
Q

Causes of secondary pulmonary hypotension

A

Chronic respiratory disease (causing hypoxia and arterial constriction), left heart disease, chronic thromboembolisms

146
Q

Surgical treatment for lung abscess

A

Chest drain

147
Q

Surgical treatment for empyema

A

Chest drain, pleurectomy and decortication

148
Q

Open pneumothorax

A

Major traumatic injury, hole in chest wall is greater in diameter than trachea. Treated with a wet swab creating airtight seal.

149
Q

Surgical treatment of spontaneous pneumothorax

A

Pleurodhesis or pleurectomy

150
Q

Diseases that can lead to need for lung transplantations

A

CF (double), pulmonary fibrosis, emphysema

151
Q

Criteria for lung transplantation

A

<65, not overweight or diabetic, no renal failure or mental illness and good social support network

152
Q

Commonest mutation in CF

A

phe508del

153
Q

Channel involved in CF

A

Cystic Fibrosis Transmembrane Conductance Regulator - Cl active transport channel and regulates liquid volume of epithelial surface

154
Q

Pathological changes in CF

A

Increased absorption of Na, decreased excretion of Cl. Leads to less excretion of water, increasing viscosity of secretions. This leads to cilia collapse and inflammation.

155
Q

Guthrie Test

A

Screening test for CF. Tests for immuno-reactive trypsinogen

156
Q

Treatment of pancreatic insufficiency in CF

A

Enteric coated enzyme pellets, high energy, low far diet, fat soluble vitamin and mineral supplements and H2 antagonist or proton pump inhibitors

157
Q

Effects of recurrent bronchopulmonary infection in CF

A

Scarring (decline lung function) and abscesses

158
Q

Cardinal features of CF

A

Pancreatic insufficiency and recurrent bronchopulmonary infection

159
Q

Non-respiratory manifestations of CF

A

Crohn’s, coeliac, hepatopathy, diabetes, bilateral abscess of vas deferens, heat exhaustion

160
Q

Respiratory complications of CF

A

Bronchiectasis, recurrent LRTI, airflow obstruction, V/Q mismatch, respiratory failure, chronic lung sepsis, pneumothorax

161
Q

Common infectious agents in CF

A

Pseudomonas Aerugonosa, Burkholderia cepacia, Strenotrophomonas maltophilia, Mycobacterium abscessus

162
Q

Cepacia syndrome

A

Infection of CF patients with Burkholderia cepacia - over activation of immune system and associated with rapid detonation and high mortality rates

163
Q

Treatment of psudeomonas aeruginosa in CF patients

A

Oral ciprofloxacin and nebuliser colomycin

164
Q

Indications for lung transplant in CF patients

A

Rapidly deteriorating lung function, FEV1 <30% predicated, hypoxia at rest, life-threatening exacerbations

165
Q

Multi-discplinary CF team

A

CF nurses, consultants, dieticians, physiotherapists, psychologist, pharmacist, microbiologist, genetics staff, GP

166
Q

Contra-inidcations for lung transplant in CF

A

Other organ failure, malignancy within 5 yrs, peripheral vascular disease, drug, nicotine or alcohol dependency, active systemic infection (or infection with Mycobacterium abscessus)

Respiratory (4 decks)

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