Disease Overviews

Question 1

What is miliary tuberculosis?

Answer 1

Tuberculosis that has undergone haemotogenous spread, with foci of infections in the organs such as the lungs. Can be associated with choroidal granulomata in the eyes.
Miliary means ‘millet seeds’ which describes its small but numerous nodular appearance in the lungs.

Question 2

Name the types of cancers under the umbrella of non-small cell lung cancers?

Answer 2

Adenocarcinoma, squamous cell carcinoma and large cell carcinomas.

Question 3

Name the symptoms associated with non-small cell lung cancers?

Answer 3

Hoarseness, haemoptysis, wheeze, recurrent infections such as pneumonia. Weight loss and a loss of appetite. Fatigue, cough and chest pain.

Question 4

Describe the management and treatment of non-small cell carcinomas.

Answer 4

First of all the tumour has to be staged. This is done using the TNM staging process. The T- describes tumour size. The N-describes spreading of cancer to regional lymph nodes and the M- describes metastases.
Surgery is the first line of treatment. Tumour will only be operated on if it is more than 2cm away from the carina. Also if any metastases are present it will not happen.
Non-small cell lung cancers are less responsive to chemotherapy than small cell lung carcinomas. Radiotherapy is another option

Question 5

What is sarcoidosis?

Answer 5

Multi-system granulomatous (abnormal collection of inflammatory cells) disorder. Commonly affects adults under 40. Higher incidence in Afro-Caribbean population.

Question 6

What would an X-ray of an individual with sarcoidosis show?

Answer 6

X-ray would show bilateral hilar lymphenopathy (bilateral enlargement of the lymph nodes of the pulmonary hilar)

Question 7

What symptoms would an individual with sarcoidosis show?

Answer 7

Ocular and skin presentations- bluish red nodules on anterior shins. Also weight loss and fatigue.

Question 8

What is Lambert- Eaton Myasmenic syndrome (LEMS)?

Answer 8

Paraneoplastic disorder associated with malignancy, especially in small cell lung carcinoma. The antibodies are directed towards the pre-synaptic voltage gated calcium channels and can lead to reduced release of neurotransmitter acetylcholine at neuromuscular junctions.

Question 9

Symptoms of LEMS

Answer 9

Muscle weakness, depressed reflexes, autonomic dysfunction.

Question 10

Describe tuberculosis. And when does it occur?

Answer 10

Tuberculosis is an infection by mycobacterium tuberculosis. It generally occurs when an individual is immuno-supressed or immune deficient.

Question 11

Symptoms of tuberculosis

Answer 11

Persistent cough (usually brings up phlegm), night sweats, high temperature, tiredness and fatigue, loss of appetite, new swellings that havent gone away for weeks

Question 12

On examination, what would you find to indicate tuberculosis?

Answer 12

Upper zone crackles.

Question 13

Name the types of carcinoma that are under the umbrella term small cell lung carcinomas.

Answer 13

Small cell carcinoma (oat cell) and combined small cell carcinoma.

Question 14

Describe small cell carcinoma’s treatment and why?

Answer 14

Small cell carcinomas respond relatively well to chemotherapy because the disease is very rapidly dividing. However this also means there are early metastases and therefore surgery is generally not an option.

Question 15

Describe coryza (the common cold).

Answer 15

The nose is said to not be working as well in the cold. The immune system becomes sluggish and therefore a mild viral infection of the upper airways occurs.

Question 16

Name the four types of upper airway tract infections.

Answer 16

Sinusitis, epiglottis, pharyngitis and coryza

Question 17

Symptoms of the common cold.

Answer 17

Sore throat, mild fever

Question 18

Describe acute sinusitis.

Answer 18

The sinuses (small air filled cavities) become inflamed. Usually mucus within the sinuses drains through small channels however these are blocked in sinusitis from inflammation.

Question 19

Treatment of sinusitis.

Answer 19

Generally self- limiting. Occasionally people may need antibiotics to help.

Question 20

Describe diphtheria.

Answer 20

Very contagious bacterial infection spread by direct contact, contact with something the infected individual has touched or coughing.

Question 21

What are the symptoms of diphtheria?

Answer 21

Thick grey/black coating at the back of the throat. Fever, sore throat, breathing difficulties.

Question 22

Treatment of diphtheria.

Answer 22

Antibiotics and antitoxins.

Question 23

What is a pulmonary embolism?

Answer 23

A DVT has come and blocked one of the veins supplying the lungs.

Question 24

Symptoms of pulmonary embolism.

Answer 24

Shortness of breath, chest pain (usually acute in onset). Leg pain/swelling. Collapse. Haemoptysis. Hypoxia, blood pressure low.

Question 25

On investigation of a patient with a PE you would find.

Answer 25

Raised D-dimers, ECG will confirm acute right heart strain, v/q mismatch will show a dead space (lack of perfusion). CT pulmonary angiogram will show pulmonary artery filling defects.

Question 26

Risk factors for PE

Answer 26

Pregnancy
Immobility
Malignancy
Trauma
Surgery
Pelvic Obstruction
Smoking
Oral contraceptive
Obesity
Thrombophillia- the blood has increased tendency to form clots
Pulmonary hypertension/vasculitis

Question 27

Treatment of PE

Answer 27

Fibrinolytic- to dissolve clot. Anticoagulant to stop further clots forming (heparin and warfarin).
Warfarin should be given for 3-6 months.

Question 28

Describe pneumonia

Answer 28

Infection involving the distal airspaces usually with inflammatory exudation. The fluid filled spaces lead to consolidation which is the solidifying of the exudate.

Question 29

Describe community acquired pneumonia.

Answer 29

Pneumonia in a community setting.

Question 30

Symptoms of pneumonia

Answer 30

Cough- could be dry, productive or involve haemoptysis.
(NOTE: pneumococcal pneumonia the sputum is rust coloured).
Coarse crackles- due to consolidation of the lung parenchyma.
Fever
Chest pain- commonly pleuritic (on inspiration). Due to inflammation of the pleura.
Confusion (CURB 65)
Extra pulmonary features- headache, myalgia, abdominal pain, diarrhoea, vomiting.

Question 31

Describe mycoplasmal pneumoniae.

Answer 31

Common cause of CAP. Generally occurs in the first two decades of life. Transfer of disease is person to person via droplets.
Tends to last longer than other forms of pneumonia.

Question 32

Symptoms of mycoplasmal pneumoniae.

Answer 32

Fever, malaise, persistent slowly worsening cough. Headache, chills, sore throat, sore chest and tracheal tenderness, pleuritic chest pain and wheezing.

Question 33

Chlamydophila pneumonias, chlamydophila psittaci and chlamydophila trachomatis (describe in general)

Answer 33

Small gram negative obligate intracellular organisms. Causes mild pneumonia or bronchitis. Very common in the elderly.

Question 34

How is chlamydophila pneumonia spread? What symptoms does it show? How is it diagnosed?

Answer 34

Spread by human to human contact.
Most patients remain fairly a-symptomatic. Generally display upper resp tract infection symptoms.
Fever, cough, scant sputum production, malaise, hoarseness.
Diagnosed using PCR and serological tests.

Question 35

How is chlamydophiila psittaci spread? And what symptoms will it show? Also, how is it diagnosed?

Answer 35

Exposure to birds.
Abrupt in onset.
Fever, non-productive cough, chest pain.
Diagnosed using serological tests.

Question 36

Describe Chlamydophilla trachomatis pneumonia? What are the symptoms and what would the examination show?

Answer 36

Usually infects pregnant women and infants.
Neonates present with clinical conjunctivitis.
Symptoms include nasal obstruction, cough, tachypnea.
On examination scattered crackles will be heard, good breath sounds and no wheezing.

Question 37

Name three causes of pulmonary hypertension.

Answer 37

Mitral regurgitation, ischaemic LSDV and cardiomyopathy.

Question 38

Signs of pulmonary hypertension.

Answer 38

Multiple PE’s. Hypoxic, vasculitis

Question 39

Describe bronchial asthma.

Answer 39

Inflammatory condition in which there is recurrent, reversible airway obstruction in response to irritant stimuli.

Question 40

Symptoms of bronchial asthma.

Answer 40

Shortness of breath. Wheezing. Sometimes cough.

Question 41

Name the asthma triad.

Answer 41

Airway obstruction- collagen forming scar tissue
Inflammation
Smooth muscle hyperresponsiveness

Question 42

Describe the asthma cascade of inflammation.

Answer 42

1) complex set of genes encodes for susceptibility to asthma
2) Environmental factors such as pollen, viruses, cold air, animals etc will cause eosinophillic response.
3) this causes inflammation in the airways.
4) If the inflammation continues, histamine and interleukin will be released which causes further inflammation.
5) airway smooth muscle may become twitchy due to the helper 2 and mediators sensitising them.