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Respiratory - pathology > Deck 2 > Flashcards

Deck 2 Flashcards

1
Q

Q. Name two sterile and two non-sterile areas of the body

A

A. Sterile – lung(?), gall bladder, kidney, bladder, ureter (not urethra), sinuses
B. Non-sterile – Gi tract, stomach, colon, vagina

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2
Q

Q. What epithelium lines the lungs?

A

A. Respiratory epithelium – ciliated pseudostratified columnar epithelium
B. Ciliated cells, goblet cells, basal cells

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3
Q

Q. Name some signs suggestive of pneumonia

A

A. High pulse, temperature, respiratory rate, dehydration
B. Low BP, fever
C. Signs of lung consolidation on percussion and auscultation

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4
Q

Q. Name some symptoms suggestive of pneumonia

A

A. Fever, sweats, rigors, cough, sputum, SOB, pleuritic chest pain (worse on deep breathing), weakness (extra-pulmonary features – neurological, gastro, rash with mycoplasma)
B. ?Delerium - sepsis

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5
Q

Q. What investigations may aid diagnosis of pneumonia?

A

A. XR chest – air bronchogram ?multilobar ?multiabcesses ?airfluid ?interstitual or diffuse shadowing ?pleural collections
B. Full blood count – WBC
C. Biochem – urea (renal impairment – complication), electrolytes, LFTs
D. C-reactive protein
E. Pulse oximetry
F. Microbiology

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6
Q

Q. Which groups are at a higher risk of pneumonia?

A

A. Infants and the elderly, those with asthma and other chronic lung diseases (e.g. CF), patients who are immunocompromised, nursing home residents, alcoholics and intravenous drug users and those who have impaired swallow, congestive heart disease and diabetes

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7
Q
  1. Q. Describe the assessment used to access CAP severity. What is it used for?
A 
A.	CURB65
B.	Is the patient confused?
C.	Urea > 7mmol/L
D.	Is the resp rate > 30/min
E.	Blood pressure higher than systolic <90mm/Hg, diastolic <60mm/Hg
F.	Predicts mortality

**Notes: Score of 0-1 = OP care, 2 = IV Abx. + admission, IO/observational, 4/5 = ITU/HDU admission

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8
Q

Q. Which antimicrobials should be used to treat pneumonia?

A

A. Depends on the pathogen; narrowest spectrum possible
B. Amoxicillin x3 a day PO
C. Clarithromycin if penicillin allergic

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9
Q

Q. Which pathogen has flu-like symptoms and is associated with travel to hotter places e.g. spain

A

A. Legionella spp. – Legion’s disease

B. Diarrhoea, abnormal LFTs, hyponatremia

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10
Q

Q. Which microbiology tests may be used to aid diagnosis and guide treatment?

A 
A.	Sputum culture
B.	Blood culture
C.	Serology
D.	Urinary antigen
E.	PCR
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11
Q

Q. What is mesothelioma? Name some associated clinical features

A

A. Type of cancer affecting the pleural mesothelioma, can also affect peritoneal mesothelioma
B. Breathlessness, chest pain, weight loss, sweating, superior vena cava obstruction, abdo pain
C. Cxr, CT scan, pleural aspiration, pleural biopsy, vats plueral biopsy
D. Symptom control, palliative chemo/radio

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12
Q
  1. Q. Name two causes of lung cancer
A

A. Smoking, asbestos, randon, iron oxide

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13
Q
  1. Q. What lung cancer cell types are there?
A 
A.	Small cell lung cancer
B.	Non-small cell lung cancer 80% of lung cancers
a.	Squamous
b.	Adenocarcinoma
c.	Large cell
d.	NOS
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14
Q
  1. Q. Name three symptoms associated with lung cancer.
A

A. Weight loss, fatigue, bone pain
B. Symptoms due to local disease + metastatic disease + paraneoplastic:
C. Cough, SOB, wheeze, haemoptysis, chest pain
D. Lymph nodes, bone, brain, liver, adrenal glands (headaches, bone pain seizures)
E. Finger clubbing, anorexia, cachexia and weight loss, hypercalcaemia

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15
Q
  1. Q. What is the preferred method of radiotherapy for lung cancer?
A

A. CHART – continuous hyper fractionated accelerated radio therapy
B. 7 days a week, 3 a day
C. small fractions = reduced long term normal tissue morbidity
D. Conformal radiotherapy = conformation of volume more accurately to the shape of the tumour
E. Stereotactic ablative radiotherapy (SABR) = conformal radiotherapy plus allowance for normally breathing motion – allows dose escalation

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16
Q

Q. Name three side effects of chemotherapy

A

A. Alopecia
B. Nausea and vomiting
C. Peripheral neuropathy
D. Constipation and diarrhoea

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17
Q
  1. Q. Name two functions of the pleura
A

A. Allows movement of the lung against the chest wall
B. Coupling system between the lung and chestwall
C. Clears fluid from the pulmonary interstitum (produced and reabsorbed)

18
Q
  1. Q. What is a pleural effusion? What can cause it?
A

A. Fluid within plural space
B. Wide variety of causes; Transudateis fluid pushed through the capillary due to high pressure within the capillary.Exudateis fluid that leaks around the cells of the capillaries caused by inflammation.
C. Transudate – heart/fenal failure, nephrotic syndrome, liver cirrhosis, hypoalbuminaemia
D. Exudate – malignany (lung, breast, mesothelioma), infection (lung, pleural, abdo), inflammatory (RA, sSLE), PE, Benign asbestos related
E. (Empyema – microorganisms in fluid)

19
Q
  1. Q. Whats the best way to diagnose pleural effusion?
A

A. Thoracoscopy – tube is inserted into the chest through a small incision
B. Diagnostic and therapeutic
C. More sensitive than image guided cutting needle pleural biopsy

20
Q
  1. Q. What occurs in pneumothorax? What can cause it?
A

A. Air in the pleural space

B. Trauma, spontaneous – COPD, marfans, pulmonary fibrosis, infections

21
Q
  1. Q. What occurs in pO2 and pCo2 in type one and type two respiratory failure? What can cause each type?
A

A. Type 1 – low O2 levels, normal or low Co2, hypoxemic – most common type - acute
B. Can be caused by: hypoventilation, diffusion impairment, a shunt, ventilation-perfusion impairment, high altitude, diseases that damage lung tissue: pneumonia, pulmonary oedema, pulmonary fibrosis, asthma, pneumothorax,
C. Type 2- low O2 levels, alveolar hyperventilation increase in Co2 levels, hypercapnia
D. Can be caused by: COPD< severe asthma, drug overdose, obesity, pulmonary odema, adult resp distress syndrome, hypothyroidism

22
Q
  1. Q. Describe two signs of hypercapnia
A

A. Bounding pulse, flapping tremor, confusion, drowsiness, reduced consciousness

23
Q
  1. Q. Which receptors respond to Co2 levels and where in the body are they found?
A

A. Chemo receptors – found in the medulla oblongata (central), carotid bodies, aortic bodies – oxygen and co2 (peripheral)
B. Chemoreceptors detect changes of pH in CSF (Co2 + H20 = H2CO3 = HCO3- + H+)
C. Stretch receptors in the lung – mechanoreceptors – prevents overinflation

24
Q

Q. Where is the conscious control of breathing in the brain?

A

A. Breathing centre is found in the cerebral cortex
B. Medulla oblongata is the subconscious control of breathing found in the brain stem – sends nervous impulses to the external intercostal muscles and the diaphragm

25
Q

Q. How does COPD occur?

A

A. Persistent airway obstruction – usually progressive, predominately caused by smoking – enhanced airway inflammation
B. Exacerbations and comorbidities contribute to overall severity in individual patients
C. FEV1 < 80% predicted and FEV1/FVC < 0.7
D. Airway inflammation, fibrosis, plugs = increased airway resistance
E. Parenchymal destruction = loss of alveolar attachments, decrease of elastic recoil
F. Neutrophils

26
Q

Q. Describe the expected presentation of COPD

A
  1. . Old patients, smokers, male predominance
    A. SOB, cough, phlegm, wheeze, raised resp rate, hyperexpansion, cyanosis, weight loss
    B. Risk factors: genes, infections, aging population, socio-economic factors
27
Q
  1. Q. Name two therapeutic options for COPD
A

A. Smoking cessation!
B. Pharmacotherapy and nicotine replacement
C. Exercise training programmes
D. Bronchodilators – beta 2 agonists, anticholinergics, theophylline or combination therapy
E. Long-acting inhaled = convenient and more effective for symptoms relief
F. Inhaled corticosteroids = improves symptoms, lung function and quality of life and reduced frequency of exacerbations
G. Combination improves efficacy and decreases side effects
H. Other treatments: oxygen and ventilator support, lung volume reduction surgery

28
Q
  1. Q. What occurs in paraneoplasia?
A

A. Rare disorder triggered by the immune system in response to neoplasm
B. May reflect secretion of parathormone, the syndrome of inappropriate ADH and ACTH secretion

29
Q
  1. Q. What is a haematoma?
A

A. Irregular proliferations of benign/normal tissues that are not normally found in this pattern within lung tissue. The commonest is the lung is that of the chondriod hamartoma, incorporating cartilage, glandular tissue, fat, fibrous tissue and blood vessels

30
Q
  1. Q. What are the two main pleural neoplasia conditions?
A

A. Pleural fibroma: soft tissue neoplasm of the pleura. Most are benign some are malignant, can cause compression on lung tissues
B. Malignant mesothelioma: associated with asbestos, high grade malignancy

31
Q
  1. Q. What can cause occupational asthma?
A

A. Sensitisation – agent inhaled at work (90%)
B. Massive accidental irritant exposure at work – direct airway injury
C. Varies at work and at home etc
D. Hypersensitivity reaction

32
Q
  1. Q. What is TB? Name two features of the pathogen
A

A. Tubercle bacillus/ mycobacterium tuberculosis
B. Thick waxy capsule – can be targeted by dyes - acid fast
C. Grows slowly – harder to grow, kill and treat
D. Can resist phagolysomal killing by macrophages and hence form granulomas

33
Q
  1. Q. Which ethnic groups have the highest rates of TB in the UK?
A

A. Indian, black-african, Pakistani, Bangladeshi

34
Q
  1. Q. Name some risk factors of TB infection in the UK
A

A. Born in a high prevalence area, IVDU, homelessness, alcohol abuse, prisons, HIV+ve

35
Q
  1. Q. How is TB spread?
A

A. Aerosol droplets – or from spitting/sneezing on plates or hands
B. M.bovis can also cause abdo TB – can be contracted by butchers/abattoir workers – external spread (through milk)

36
Q
  1. Q. What occurs in pulmonary TB infection?
A

A. Bacilli settle in lung apex and then macrophages and lymphocytes seal in and contain/kill the majority of the infecting bacilli (apex has more air and less blood supply/immune cells)
B. Bacilli and macrophages coalesce to form a granuloma – primary ghon focus
C. Granuloma grows and develops into a cavity – cavity is full of TB bacilli which are expelled when patient coughs
D. Bacilli taken to hilar lymph nodes

37
Q
  1. Q. Which areas may be affected in TB infection?
A

A. Lymph nodes, milliary TB, bone, abdominal, genito-urinary, CNS

38
Q
  1. Q. What symptoms are associated with TB?
A

A. Weight loss, anorexia, night sweats, malaise
B. Pulmonary TB: cough, chest pain, breathlessness,
C. May be associated with: consolidation, collapse, pleural effusion, pericardial effusion, granuloma/lymph nodes and rupture
D. Chronic illness with fever and weight loss

39
Q
  1. Q. What occurs in a tuberculin skin test?
A

A. Tuberculin skin tests are used to diagnose latent TB
B. TB protein is injected intradermally, this stimulates a type 4 delayed hypersensitivity reaction
C. Only moderately specific
D. Not sensitive – if immunosuppressed or military TB test will show a false negative

40
Q
  1. Q. What other way can TB be detected?
A

A. Interferon gamma release assays (IGRAs)
B. Using antigens specific to TB, quantiferon TB measures IFN-g released by cells
C. Demonstrates exposure to TB not an active infection

41
Q
  1. Q. How should active TB be treated?
A

A. 4 drugs for 6 months
B. Rifampicin, isoniazid, pyrazinamide, ethambutol
C. Adherence important! To prevent resistance and reactivation

Respiratory - pathology (5 decks)

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