cystic fibrosis Flashcards

1
Q

what type of gene disorder causes CF

A

autosomal recessive- requires 2 mutated genes (homozygous)

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2
Q

chances of CF if both parents are carriers

A

1 in 4

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3
Q

how does CF occur

A

a mutation in the transmembrane conductance regulator protein (CFTR)

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4
Q

where is the CFTR gene coded for

A

chromosome 7

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5
Q

what does the CFTR mutation cause

A

chloride gets trapped in the cell

causes water and sodium to enter cell too

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6
Q

excess water, sodium and chloride in cells causes

A
  • Dehydrates airway surface and mucous layer
  • Thick mucous sticks to mucosal surface, causing shearing
  • Difficult to cough up
  • Mucous collects bacteria, reduced ability to fight infection
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7
Q

how many mutation classes are there
and how bad are each

A

6

1-3 are severe
4-6 are milder

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8
Q

most common mutation

A

DeltaF508a

class 2 mutation,

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9
Q

antenatal testing happens when

A

a CF carrying parent or sibling is found

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10
Q

what’s included in antenatal testing

A
  • Pre-implantation genetic diagnosis
  • Chorionic villous sampling
  • Amniocentesis
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11
Q

neonatal testing includes

A

Newborn bloodspot day 5 (Guthrie test)

Screen positive -referred for clinical assessment and sweat test

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12
Q

tests for children

A

sweat test

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13
Q

what does the sweat test look for and numbers

A

Measures the concentration of chloride excreted in sweat. Elevated in CF.

> 60 millimoles per litre, high chance CF

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14
Q

3 examples of where CF can effect the body

A

Pancreatic insufficiency
Diabetes
infection and Bronchiectasis

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15
Q

pancreatic insufficiency causes

A
  1. Malabsorption
  2. Abnormal stools -pale, offensive, float
  3. Failure to thrive
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16
Q

CF classes and effects on pancreas

A
  • Class 1-111 are pancreatic insufficient.
  • Class IV-V1 have some pancreatic function

only need 5% CFTR function for adequate pancreatic function

17
Q

recurrent chest infections causes

A

–Pneumonia
–Bronchiectasis
–Scarring
–Abscesses

18
Q

why are infections so frequent?

A

dry airway surfaces means mucus can’t slide up and down easily

decreased mucociliary clearance

Mucous sticks to mucosal surface and causes shearing and inflammation

increased access to bacteria

decreased bacteria killing

19
Q

late CF findings on CT

A
  • Tramlines
  • Signet rings
  • Mucous plugging
  • Consolidation (infection)
20
Q

treatment of pancreatic insufficiency

A

boosting nutrition:

  1. REPLACE ENZYMES: (CREON)
  2. DIET: High energy plus high calorie supplement drinks
  3. NUTRITIONAL SUPPLEMENTS: Fat-soluble vitamin and mineral supplements
21
Q

Treatment of Respiratory features of CF: mucus obstruction

A

Airway clearance via physiotherapy, Mucolytics and Bronchodilators

22
Q

Treatment of Respiratory features of CF: mucus obstruction

A

Airway clearance via physiotherapy, Mucolytics and Bronchodilators

23
Q

Treatment of Respiratory features of CF: infection

A

antibiotics

oral, IV or nebulised

24
Q

Treatment of Respiratory features of CF: increased inflammation

A

azithromycin

25
Q

Treatment of Respiratory features of CF: fibrosis/scarring/bronchiectasis

A

Supportive treatment and management of symptoms

26
Q

other things CF can cause

A
  • Diabetes
  • Osteoporosis
  • Pneumothorax
  • Haemoptysis
27
Q

main type of diabetes in CF

A

Type 2

Not enough insulin from pancreas, or insulin is not working properly

28
Q

osteoporosis in CF causes and treatment

A

Bone mineral density (BMD) falls in patients with CF

bone protection drugs, weight bearing exercise

29
Q

causes of heamoptysis in CF

A

Bronchial wall destruction

minor cases very common

30
Q

massive haemoptysis signs and what do to

A
  • May be preceded by gurgling in chest
  • Admit, Resuscitate
  • May need bronchial angiogram and embolisation
31
Q

risk factors for heamoptysis

A
  • Severity of CF
  • High number of exacerbations
  • fungal lung infection
  • liver disease, Vit K deficiency or on anticoagulants (all can thin the blood)
32
Q

benefits of modulators

A

Small benefits in lung function.

More significant benefit is fall in chest exacerbations,

rise in weight and improved QOL.

33
Q

indications for lung transplant

A

Rapidly deteriorating lung function

FEV1 < 30% predicted

Life threatening exacerbations

Estimated survival <2 years

Other: recurrent pneumothorax, recurrent severe haemoptysis

34
Q

contraindications for lung transplant

A

•Other organ failure

  • Malignancy within 5 years
  • Significant peripheral vascular disease
  • Drug, nicotine, alcohol dependency

•Active systemic infection

•Microbiological issues (eg. M. abscessus)

35
Q

cornerstones of CF treatment

A
  • Prevention and Proactive treatment of infection
  • Treatment of complications
  • Good nutrition
  • Active lifestyle
  • Holistic approach