Disease + Pathology + Pharmacology Flashcards
Signs, symptoms, tests & treatment
What is coryza + 3 causes (+ most common) + 5 complications + treatment?
- Viral URTI
- Rhinovirus (most common), adenovirus and RSV
- Acute sinusitis, pharyngitis, bronchitis, laryngitis and otitis media
- None (can take NSAIDs)
What is sinusitis + treatment for bacterial and viral sinusitis + chronic sinusitis is a sign of?
Infection of the facial sinuses + amoxicillin for bacterial and none for viral + CF
What is laryngitis + what it causes + treatment for bacterial and viral?
Oedema of the vocal cords + hoarseness + amoxicillin for bacterial and none for viral
What is pharyngitis + main cause + what is it commonly assoiciated with?
Sore throat + adenovirus + common cold/ coryza
What is acute bronchitis + key symptom + causes in healthy vs lung disease patients + treatment?
Infection of the bronchi + productive cough + viral (healthy) and bacterial (lung disease) + NO ANTIOBIOTICS unless has existing lung condition
Incubation period for coryza?
1 - 5 days
Incubation period for influenza?
1-3 days
4 key symptoms of influenza + diagnosis + complication + treatment?
Fever, malaise, myalgia and cough + naso swab and PCR + secondary pneumonia via strep, staph or haemophilus + < 48 hrs = oseltamivir or zanamivir OR > 48 hrs = fluids, NSAIDs, bed rest
Which influenza is responsible for pandemics + why?
Influenza A + rapid antigenic shift
Who is the influenza vaccine contraindicated for?
People with an egg allergy
What is epiglottitis + key pathogen + x-ray sign + complication + treatment?
Severe upper airway obstruction + h. influenzae thumbprint x-ray sign + septicaemia + intubation, IV abx, adrenaline and oxygen
What is rhinitis + time scale for acute vs chronic?
Inflammation of the nasal mucosa + < 6 weeks (acute) and > 6 weeks (chronic)
4 main symptoms of rhinits + 2 types of allergic + causes?
Rhinorrhoea, sneezing, itching and congestion + seasonal (SAR) = pollen/ hayfever + perennial (PAR) = dust mite excretion
Causes of non-allergic rhinits + vasomotor rhinitis ?
Bacterial or viral infection + smells, temperature, emotion
Key feature commonly seen with all type of rhinitis + what they are + respond well to?
Nasal polyps + pale outgrowths of the sinus mucosa that contain mast cells and eosinophils + oral steroids
Summary of allergic rhinitis immunology?
IgE binds to mast cells and causes degranulation which releases histamine
Most effective rhinitis treatment + drug examples + additional 4 drugs that can be used?
Steroids (beclomethasone) + H1 antihistamine (loratadine, cetirizine) + LTRAs, oxymetazoline, ipratropium and cromones
Which types of H1 antagonists are preferred + 2 reasons why?
2nd generation as they do not cross the BBB or cause sedation
What is oxymetazoline + action + what common disease is it used for?
alpha 1 agonist + vasoconstriction + rhinorrhoea in rhinitis
Who does bronchiolitis present + 2 key symptoms + diagnosis + 2 organisms + treatment?
Child < 18 months + poor feeding and cough/wheeze + naso swab and PCR + RSV and metapneumovirus + palivuzimab and oxygen
What is whooping cough + key pathogen + classic presentiation + duration of being infective + treatment?
Trachea-bronchitis + bordatella pertussis + initial cold-like symptoms then sudden whoop coughing fits + 2 weeks + macrolide
What type of organism is bordatella pertussis and h. influenzae?
Gram -ve coccobacilli
What is croup + key pathogen + key symptom + x-ray sign + treatment?
Laryngotracheobronchitis + human parainfluenza virus (HPIV) + barking cough + steeple sign + IV adrenaline, steroid and oxygen
Main immunological cause of chronic vs acute infection?
Hypogammaglobulinemia (chronic) vs IgA deficiency (acute)
2 conditions that cause abnormal cilia?
Young’s + Kartenager’s syndrome
What 2 things is Kartenager’s syndrome?
Situs inversus + abnormal cilia
What 3 things is Young’s syndrome?
Bronchiectasis + sinusitis + abnormal cilia
What is chronic asthma + 3 hallmarks?
Irreversible airway obstruction + thickening of the basement membrane, collagen deposits in submucosa and hypertrophy of smooth muscle
2 key features about the timing of asthma symptoms?
Diurnal variation + worse episodes at night
4 common asthma symptoms?
Dry cough, wheeze, reflux and intermittent dyspnoea
2 key findings in asthma history?
FH of asthma/atopy + PMH of atopy e.g. eczema
3 exam finding for asthma?
Bilateral wheeze, hyperinflated chest + hyperresonance
Asthma vs COPD response to bronchodilator?
> 15% increase in FEV1 or PEFR vs < 15%
FEV1, FEV, FEV1/FEV and PEFR for asthma?
Decreased FEV1, normal FEV, decreased FEV1/FEV and decreased PEFR
4 features of a moderate asthma attack?
PEFR 50-75%, normal speech, RR < 25 and pulse < 110
4 features of a severe asthma attack?
PEFR 33-50%, unable to speak, RR > 25 and pulse > 110
Features of a life-threatening asthma attack?
PEFR <33%, cyanosis, unconscious, confusion, SaO2 < 92 %
2 main drugs that cause asthma?
NSAIDs and beta agonists
5 routine tests for asthma + why?
Spirometry (initial), PEFR (diurnal variation), bloods (eosinophils), exhaled NO (eosinophilia or steroid response) and IgE skin test (check for antigens on skin)
TH2 cells release which 3 ILs in asthma + what they do?
IL-4 activates B cells to produce IgE, IL-5 activates eosinophils + IL-13 increases mast cell IgE receptors
Beta 2 agonist mode of action?
Activates AC and cAMP production to promote SM relaxation
SABA examples + 4 S/Es + used more than … times/week needs a review?
Salbutamol + hypokalaemia, headaches, tremors and palpitations + 3
Atopic asthma has a … response and non-atopic/severe has a … response?
TH2 and TH1
LABA examples + 3 S/Es + what is it good for?
Salmeterol and formoterol + worsens asthma as monotherapy, tremors and palpitations + nocturnal asthma
Ultra-LABA examples?
Indacaterol and olodaterol
3 inhaled steroid example + 5 S/Es?
Beclomethasone, budesonide, flucastisone + oral candidas, osteoporosis, stunted growth, thinning of skin and hoarseness
Oral steroid example + 3 S/Es?
Prednisolone + adrenal insufficiency, peptic ulcers and osteoporosis
Steroid mechanism of action 4 step summary?
- Binds GR alpha in the cytoplasm
- Heat shock protein HSP90 dissociates
- GR alpha moves to nucleus and binds GRE
- GRE modifies DNA (de-acetylation) so it can’t be unwound
Cromone example + route of drug + mechanism + best effective in?
Sodium cromoglicate + inhaled + stabilises mast cells + children
Methylxanthine examples + routes of drugs + mechanism + drug interaction + 2 S/Es?
Theophylline and aminophylline + theophylline (oral/IV) and aminophylline (IV) + blocks PDE + P450 metabolised drugs e.g. macrolides + hypotension and CNS effects
2 specialist treatment for severe asthma?
Omalizumab (anti-IgE) + mepolizumab (anti-IL-5)
LTRA example + route of drug + mechanism?
Montelukast + oral + blocks CysLT1 receptors on inflammatory cells
5 step asthma treatment?
- SABA
- SABA + ICS
- SABA + ICS + LTRA (1st choice) or LABA (2nd choice)
- Low dose prednisolone + SABA + ICS + LTRA/LABA
- Refer for anti-IgE
Treatment for severe asthma attack + routes of the drugs?
Oxygen + salbutamol (nebulised) + hydrocortisone (IV) + ipratropium (nebulised) + theophylline/aminophylline (IV) + magensium sulphate (IV) + anesthetist
What is ACOS + how is it defined + responds well to?
Asthma and COPD overlap syndrome + COPD with eosinophilia > 4% + inhaled steroids
Key WBC in asthma + COPD?
Eosinophil + neutrophil
Key T cell in asthma + COPD?
CD4+ + CD8+
3 main COPD symptoms?
Dyspnoea + cough +/- sputum + frequent exacerbations
FEV1, FEV and FEV1/FEV for COPD?
Decreased FEV1, normal FVC, decreased FEV1/FEV
2 main signs of a COPD exacerbation + 3 tests + treatment?
Sputum is more purlulent and more out of breath + SaO2%, ABGs and sputum/blood culture + iSOAP (abx are amoxicillin or doxycycline)
COPD is a combination of what + key features of them?
Chronic bronchitis (sputum, increased goblet cells, loss of cilia) + emphysema (stiff and dilated alveoli)
2 types of emphysema + where the affect + main cause?
- Centroacinar = central alveoli with undamaged peripheral + link to smoking
- Panacinar = whole alveoli + A1AT abnormality
2 point COPD immunology summary + how metaplasia occurs?
- Irritiants activates airway macrophages which release IL-8 and leukotriene B4
- Neutrophils arrive and release elastases which can destroy alveolar connective tissue due to A1AT abnormality
- Epithelium ulcer and metaplasia from columnar to squamous epithelium
Metaplasia associated with COPD?
Columnar to squamous epithelium
SAMA example + mechanism?
Ipratropium + non-selective blocker of M1,2 and 3
Why are selective muscarinic antagonists preferred?
Blocking M2 increases Ach release
LAMA example + mechanism + feature that prevents systemic parasympathetic block?
Tiotropium + M3 blocker + quaternary ammonium/atropine group
3 drugs used in asthma exercise testing?
Histamine, methacholine and mannitol
What is roflumilast used for + mechanism?
COPD + PDE4 inhibitor
Oxygen mask + % for COPD in hospital environment?
Venturi + 24% then increase to 28%
Home oxygen therapy for COPD is especially beneficial in extending life in cases with?
Cor pulmonale
5 step treatment for COPD?
- SABA or SAMA
- FEV1 > 50 % = LABA or LAMA + SABA
- FEV1 < 50% = LAMA or LABA + ICS
- LAMA + LABA or ICS
- Pulmonary rehab, HOT or transplant
What is bronchiectasis + 4 key symptoms + PMH finding + 3 main tests (1st line) 4 step treatment?
Permanently dilated bronchi from chronic inflammation + productive cough, fever, haemoptysis and clubbing + PMH of CF or autoimmunity + HRCT (1st line), bloods and sputum culture + airway clearance, exercise, diet and abx
4 main infective organisms for bronchiectasis?
Strep, staph, h. influenza and pseudomonas
Pseudomonas is seen in bronchiectasis with underlying what?
Cystic fibrosis
Chronic bronchial sepsis presentation + patients commonly seen in?
- Presents like bronchiectasis but NO HRCT SPREAD
- Young women in childcare jobs
Genetic inheritance of CF + what the mutation affects + how many people have the gene + which chromosome is affected?
Autosomal recessive + CFTR channel + 1 in 25 + chromosome 7
Examples of CF symptoms and signs?
Cough, recurrent infection, swollen sinuses, salty sweat, clubbing, foul stools, male infertility, chronic sinusitis
How does a CFTR mutation affect the lungs?
- CFTR inhibits Na into the cell and promotes Cl out of the cell
- Mutation causes intracellular Cl and Na meaning water flows in to cells and lungs become dry
2 key tests for CF + key value?
Sweat test and genetic test + sweat test with chlorine > 60 mmol/L
Expensive drug for CF + what is is effective for + CI?
Ivacaftor + G551D muations with normal CFTR but non-functional channel + grapefruit
What is sleep apnoea + when is it worse + why?
Upper airway collapse + rapid eye movement (REM) sleep + only the diaphragm muscle is active
5 key risk factors for sleep apnoea?
Alcoholism, obesity, wide neck, hypothyroidism and enlarged tonsils
4 key symptoms of sleep apnoea?
Loud snoring, daytime fatigue, morning headaches and decreased libido
Morning headaches are usually a sign of?
Hypercapnia
2 key tests for sleep apnoea + key values?
Sleep study (10-15 apnoeas in an hour) + Epworth score (>10)
Treatment for sleep apnoea?
CPAP + weight loss + alcohol/smoking cessastion
What is tracheomalacia + what can it cause + treatment?
Weakening of the trachealis muscle + stridor or airway collapse + CPAP
Inhaled foreign bodies most commonly lodge in the?
Right main bronchus
What tests should be avoided in epiglottitis?
Laryngoscopy/bronchoscopy
What is pneumonia + what type of exudate?
Inflammation and consolidation of the distal airways + fibrin-rich exudate
5 key signs of pneumonia?
SoB, productive cough, fever and confusion
Effusions/consolidation produce what type of percussion sound?
Stony dull
Test for initial pneumonia presentation + values?
CURB 65: Confusion Urea > 7 mmol/L RR > 30 BP systolic < 90 or diastolic < 60 65 years old or over
Specific blood test for pneumonia or other suspected infections?
CRP
Suspected atypical pneumonia or known atypical epidemic requires?
Blood/sputum sampling
Urine testing in pneumonia cases can detect?
Legionella antigens
3 common pathogens in CAP?
Strep, mycoplasma, h. influenzae,
Main pathogens for HAP?
Gram -ve bacteria and staph aureas/MRSA
Treatment for CAP CURB 0-2 + 3-5 + ICU + HAP?
- amoxicillin or doxycycline (0-2)
- co-amoxiclav + doxycycline (3-5)
- co-amoxiclav + clarithromycin (step down to doxycycline) (ICU)
- amox/gentamicin/metronidazole (HAP)
Treatment for staph aureas?
Flucloxacillin
Treatment for MRSA or C. difficile?
Gentamicin/vancomycin/teicoplanin
Treatment for Legionella?
Fluoro/quinolones or macrolides
Treatment for Pseudomonas?
Ciprofloxacin or cephalasporin (fluoroquinolone or cephalaspoin)
Treatment for mycoplasma?
Tetracycline or macrolide
What cases is lobar pneumonia vs bronchopneumonia usually seen in?
Young healthy adults with CAP vs older patients with existing disease and atypical bacteria
Common lobe affected by aspiration pneumonia?
Right lower/middle lobe
2 types of cases staphylococcus pneumonia presents in?
Post-influenza (less commonly that strep) + IV drug users