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Year 1 MBChB Respiratory > Disease + Pathology + Pharmacology > Flashcards

Disease + Pathology + Pharmacology Flashcards

Signs, symptoms, tests & treatment

1
Q

What is coryza + 3 causes (+ most common) + 5 complications + treatment?

A
  • Viral URTI
  • Rhinovirus (most common), adenovirus and RSV
  • Acute sinusitis, pharyngitis, bronchitis, laryngitis and otitis media
  • None (can take NSAIDs)
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2
Q

What is sinusitis + treatment for bacterial and viral sinusitis + chronic sinusitis is a sign of?

A

Infection of the facial sinuses + amoxicillin for bacterial and none for viral + CF

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3
Q

What is laryngitis + what it causes + treatment for bacterial and viral?

A

Oedema of the vocal cords + hoarseness + amoxicillin for bacterial and none for viral

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4
Q

What is pharyngitis + main cause + what is it commonly assoiciated with?

A

Sore throat + adenovirus + common cold/ coryza

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5
Q

What is acute bronchitis + key symptom + causes in healthy vs lung disease patients + treatment?

A

Infection of the bronchi + productive cough + viral (healthy) and bacterial (lung disease) + NO ANTIOBIOTICS unless has existing lung condition

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6
Q

Incubation period for coryza?

A

1 - 5 days

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7
Q

Incubation period for influenza?

A

1-3 days

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8
Q

4 key symptoms of influenza + diagnosis + complication + treatment?

A

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

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9
Q

Which influenza is responsible for pandemics + why?

A

Influenza A + rapid antigenic shift

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10
Q

Who is the influenza vaccine contraindicated for?

A

People with an egg allergy

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11
Q

What is epiglottitis + key pathogen + x-ray sign + complication + treatment?

A

Severe upper airway obstruction + h. influenzae thumbprint x-ray sign + septicaemia + intubation, IV abx, adrenaline and oxygen

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12
Q

What is rhinitis + time scale for acute vs chronic?

A

Inflammation of the nasal mucosa + < 6 weeks (acute) and > 6 weeks (chronic)

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13
Q

4 main symptoms of rhinits + 2 types of allergic + causes?

A

Rhinorrhoea, sneezing, itching and congestion + seasonal (SAR) = pollen/ hayfever + perennial (PAR) = dust mite excretion

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14
Q

Causes of non-allergic rhinits + vasomotor rhinitis ?

A

Bacterial or viral infection + smells, temperature, emotion

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15
Q

Key feature commonly seen with all type of rhinitis + what they are + respond well to?

A

Nasal polyps + pale outgrowths of the sinus mucosa that contain mast cells and eosinophils + oral steroids

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16
Q

Summary of allergic rhinitis immunology?

A

IgE binds to mast cells and causes degranulation which releases histamine

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17
Q

Most effective rhinitis treatment + drug examples + additional 4 drugs that can be used?

A

Steroids (beclomethasone) + H1 antihistamine (loratadine, cetirizine) + LTRAs, oxymetazoline, ipratropium and cromones

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18
Q

Which types of H1 antagonists are preferred + 2 reasons why?

A

2nd generation as they do not cross the BBB or cause sedation

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19
Q

What is oxymetazoline + action + what common disease is it used for?

A

alpha 1 agonist + vasoconstriction + rhinorrhoea in rhinitis

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20
Q

Who does bronchiolitis present + 2 key symptoms + diagnosis + 2 organisms + treatment?

A

Child < 18 months + poor feeding and cough/wheeze + naso swab and PCR + RSV and metapneumovirus + palivuzimab and oxygen

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21
Q

What is whooping cough + key pathogen + classic presentiation + duration of being infective + treatment?

A

Trachea-bronchitis + bordatella pertussis + initial cold-like symptoms then sudden whoop coughing fits + 2 weeks + macrolide

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22
Q

What type of organism is bordatella pertussis and h. influenzae?

A

Gram -ve coccobacilli

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23
Q

What is croup + key pathogen + key symptom + x-ray sign + treatment?

A

Laryngotracheobronchitis + human parainfluenza virus (HPIV) + barking cough + steeple sign + IV adrenaline, steroid and oxygen

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24
Q

Main immunological cause of chronic vs acute infection?

A

Hypogammaglobulinemia (chronic) vs IgA deficiency (acute)

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25
Q

2 conditions that cause abnormal cilia?

A

Young’s + Kartenager’s syndrome

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26
Q

What 2 things is Kartenager’s syndrome?

A

Situs inversus + abnormal cilia

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27
Q

What 3 things is Young’s syndrome?

A

Bronchiectasis + sinusitis + abnormal cilia

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28
Q

What is chronic asthma + 3 hallmarks?

A

Irreversible airway obstruction + thickening of the basement membrane, collagen deposits in submucosa and hypertrophy of smooth muscle

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29
Q

2 key features about the timing of asthma symptoms?

A

Diurnal variation + worse episodes at night

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30
Q

4 common asthma symptoms?

A

Dry cough, wheeze, reflux and intermittent dyspnoea

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31
Q

2 key findings in asthma history?

A

FH of asthma/atopy + PMH of atopy e.g. eczema

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32
Q

3 exam finding for asthma?

A

Bilateral wheeze, hyperinflated chest + hyperresonance

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33
Q

Asthma vs COPD response to bronchodilator?

A

> 15% increase in FEV1 or PEFR vs < 15%

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34
Q

FEV1, FEV, FEV1/FEV and PEFR for asthma?

A

Decreased FEV1, normal FEV, decreased FEV1/FEV and decreased PEFR

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35
Q

4 features of a moderate asthma attack?

A

PEFR 50-75%, normal speech, RR < 25 and pulse < 110

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36
Q

4 features of a severe asthma attack?

A

PEFR 33-50%, unable to speak, RR > 25 and pulse > 110

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37
Q

Features of a life-threatening asthma attack?

A

PEFR <33%, cyanosis, unconscious, confusion, SaO2 < 92 %

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38
Q

2 main drugs that cause asthma?

A

NSAIDs and beta agonists

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39
Q

5 routine tests for asthma + why?

A

Spirometry (initial), PEFR (diurnal variation), bloods (eosinophils), exhaled NO (eosinophilia or steroid response) and IgE skin test (check for antigens on skin)

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40
Q

TH2 cells release which 3 ILs in asthma + what they do?

A

IL-4 activates B cells to produce IgE, IL-5 activates eosinophils + IL-13 increases mast cell IgE receptors

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41
Q

Beta 2 agonist mode of action?

A

Activates AC and cAMP production to promote SM relaxation

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42
Q

SABA examples + 4 S/Es + used more than … times/week needs a review?

A

Salbutamol + hypokalaemia, headaches, tremors and palpitations + 3

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43
Q

Atopic asthma has a … response and non-atopic/severe has a … response?

A

TH2 and TH1

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44
Q

LABA examples + 3 S/Es + what is it good for?

A

Salmeterol and formoterol + worsens asthma as monotherapy, tremors and palpitations + nocturnal asthma

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45
Q

Ultra-LABA examples?

A

Indacaterol and olodaterol

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46
Q

3 inhaled steroid example + 5 S/Es?

A

Beclomethasone, budesonide, flucastisone + oral candidas, osteoporosis, stunted growth, thinning of skin and hoarseness

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47
Q

Oral steroid example + 3 S/Es?

A

Prednisolone + adrenal insufficiency, peptic ulcers and osteoporosis

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48
Q

Steroid mechanism of action 4 step summary?

A
  • 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
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49
Q

Cromone example + route of drug + mechanism + best effective in?

A

Sodium cromoglicate + inhaled + stabilises mast cells + children

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50
Q

Methylxanthine examples + routes of drugs + mechanism + drug interaction + 2 S/Es?

A

Theophylline and aminophylline + theophylline (oral/IV) and aminophylline (IV) + blocks PDE + P450 metabolised drugs e.g. macrolides + hypotension and CNS effects

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51
Q

2 specialist treatment for severe asthma?

A

Omalizumab (anti-IgE) + mepolizumab (anti-IL-5)

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52
Q

LTRA example + route of drug + mechanism?

A

Montelukast + oral + blocks CysLT1 receptors on inflammatory cells

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53
Q

5 step asthma treatment?

A
  • SABA
  • SABA + ICS
  • SABA + ICS + LTRA (1st choice) or LABA (2nd choice)
  • Low dose prednisolone + SABA + ICS + LTRA/LABA
  • Refer for anti-IgE
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54
Q

Treatment for severe asthma attack + routes of the drugs?

A

Oxygen + salbutamol (nebulised) + hydrocortisone (IV) + ipratropium (nebulised) + theophylline/aminophylline (IV) + magensium sulphate (IV) + anesthetist

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55
Q

What is ACOS + how is it defined + responds well to?

A

Asthma and COPD overlap syndrome + COPD with eosinophilia > 4% + inhaled steroids

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56
Q

Key WBC in asthma + COPD?

A

Eosinophil + neutrophil

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57
Q

Key T cell in asthma + COPD?

A

CD4+ + CD8+

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58
Q

3 main COPD symptoms?

A

Dyspnoea + cough +/- sputum + frequent exacerbations

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59
Q

FEV1, FEV and FEV1/FEV for COPD?

A

Decreased FEV1, normal FVC, decreased FEV1/FEV

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60
Q

2 main signs of a COPD exacerbation + 3 tests + treatment?

A

Sputum is more purlulent and more out of breath + SaO2%, ABGs and sputum/blood culture + iSOAP (abx are amoxicillin or doxycycline)

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61
Q

COPD is a combination of what + key features of them?

A

Chronic bronchitis (sputum, increased goblet cells, loss of cilia) + emphysema (stiff and dilated alveoli)

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62
Q

2 types of emphysema + where the affect + main cause?

A
  • Centroacinar = central alveoli with undamaged peripheral + link to smoking
  • Panacinar = whole alveoli + A1AT abnormality
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63
Q

2 point COPD immunology summary + how metaplasia occurs?

A
  • 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
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64
Q

Metaplasia associated with COPD?

A

Columnar to squamous epithelium

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65
Q

SAMA example + mechanism?

A

Ipratropium + non-selective blocker of M1,2 and 3

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66
Q

Why are selective muscarinic antagonists preferred?

A

Blocking M2 increases Ach release

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67
Q

LAMA example + mechanism + feature that prevents systemic parasympathetic block?

A

Tiotropium + M3 blocker + quaternary ammonium/atropine group

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68
Q

3 drugs used in asthma exercise testing?

A

Histamine, methacholine and mannitol

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69
Q

What is roflumilast used for + mechanism?

A

COPD + PDE4 inhibitor

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70
Q

Oxygen mask + % for COPD in hospital environment?

A

Venturi + 24% then increase to 28%

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71
Q

Home oxygen therapy for COPD is especially beneficial in extending life in cases with?

A

Cor pulmonale

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72
Q

5 step treatment for COPD?

A
  • SABA or SAMA
  • FEV1 > 50 % = LABA or LAMA + SABA
  • FEV1 < 50% = LAMA or LABA + ICS
  • LAMA + LABA or ICS
  • Pulmonary rehab, HOT or transplant
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73
Q

What is bronchiectasis + 4 key symptoms + PMH finding + 3 main tests (1st line) 4 step treatment?

A

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

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74
Q

4 main infective organisms for bronchiectasis?

A

Strep, staph, h. influenza and pseudomonas

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75
Q

Pseudomonas is seen in bronchiectasis with underlying what?

A

Cystic fibrosis

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76
Q

Chronic bronchial sepsis presentation + patients commonly seen in?

A
  • Presents like bronchiectasis but NO HRCT SPREAD

- Young women in childcare jobs

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77
Q

Genetic inheritance of CF + what the mutation affects + how many people have the gene + which chromosome is affected?

A

Autosomal recessive + CFTR channel + 1 in 25 + chromosome 7

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78
Q

Examples of CF symptoms and signs?

A

Cough, recurrent infection, swollen sinuses, salty sweat, clubbing, foul stools, male infertility, chronic sinusitis

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79
Q

How does a CFTR mutation affect the lungs?

A
  • 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
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80
Q

2 key tests for CF + key value?

A

Sweat test and genetic test + sweat test with chlorine > 60 mmol/L

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81
Q

Expensive drug for CF + what is is effective for + CI?

A

Ivacaftor + G551D muations with normal CFTR but non-functional channel + grapefruit

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82
Q

What is sleep apnoea + when is it worse + why?

A

Upper airway collapse + rapid eye movement (REM) sleep + only the diaphragm muscle is active

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83
Q

5 key risk factors for sleep apnoea?

A

Alcoholism, obesity, wide neck, hypothyroidism and enlarged tonsils

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84
Q

4 key symptoms of sleep apnoea?

A

Loud snoring, daytime fatigue, morning headaches and decreased libido

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85
Q

Morning headaches are usually a sign of?

A

Hypercapnia

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86
Q

2 key tests for sleep apnoea + key values?

A

Sleep study (10-15 apnoeas in an hour) + Epworth score (>10)

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87
Q

Treatment for sleep apnoea?

A

CPAP + weight loss + alcohol/smoking cessastion

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88
Q

What is tracheomalacia + what can it cause + treatment?

A

Weakening of the trachealis muscle + stridor or airway collapse + CPAP

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89
Q

Inhaled foreign bodies most commonly lodge in the?

A

Right main bronchus

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90
Q

What tests should be avoided in epiglottitis?

A

Laryngoscopy/bronchoscopy

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91
Q

What is pneumonia + what type of exudate?

A

Inflammation and consolidation of the distal airways + fibrin-rich exudate

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92
Q

5 key signs of pneumonia?

A

SoB, productive cough, fever and confusion

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93
Q

Effusions/consolidation produce what type of percussion sound?

A

Stony dull

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94
Q

Test for initial pneumonia presentation + values?

A 
CURB 65:
Confusion
Urea > 7 mmol/L
RR > 30
BP systolic < 90 or diastolic < 60
65 years old or over
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95
Q

Specific blood test for pneumonia or other suspected infections?

A

CRP

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96
Q

Suspected atypical pneumonia or known atypical epidemic requires?

A

Blood/sputum sampling

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97
Q

Urine testing in pneumonia cases can detect?

A

Legionella antigens

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98
Q

3 common pathogens in CAP?

A

Strep, mycoplasma, h. influenzae,

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99
Q

Main pathogens for HAP?

A

Gram -ve bacteria and staph aureas/MRSA

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100
Q

Treatment for CAP CURB 0-2 + 3-5 + ICU + HAP?

A
  • amoxicillin or doxycycline (0-2)
  • co-amoxiclav + doxycycline (3-5)
  • co-amoxiclav + clarithromycin (step down to doxycycline) (ICU)
  • amox/gentamicin/metronidazole (HAP)
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101
Q

Treatment for staph aureas?

A

Flucloxacillin

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102
Q

Treatment for MRSA or C. difficile?

A

Gentamicin/vancomycin/teicoplanin

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103
Q

Treatment for Legionella?

A

Fluoro/quinolones or macrolides

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104
Q

Treatment for Pseudomonas?

A

Ciprofloxacin or cephalasporin (fluoroquinolone or cephalaspoin)

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105
Q

Treatment for mycoplasma?

A

Tetracycline or macrolide

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106
Q

What cases is lobar pneumonia vs bronchopneumonia usually seen in?

A

Young healthy adults with CAP vs older patients with existing disease and atypical bacteria

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107
Q

Common lobe affected by aspiration pneumonia?

A

Right lower/middle lobe

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108
Q

2 types of cases staphylococcus pneumonia presents in?

A

Post-influenza (less commonly that strep) + IV drug users

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109
Q

When can strep be a secondary pneumonia + 3 key symptoms?

A

Post-influenza (more commonly than staph a.) + oral herpes, rusty sputum, dry cough

110
Q

2 common pathogens in COPD + pneumonia?

A

H. influenzae and Moraxella

111
Q

2 common pathogens in alcoholic pneumonia?

A

Klebsiella and strep. pneumoniae

112
Q

Who does mycoplasma pneumonia present in + a disadvantage + 2 key symptoms?

A

Young adults + amoxicillin resistant (no outer wall) + dry cough and myalgia

113
Q

Who does Legionella pneumonia present in + key words + 2 complications?

A

Older people with co-morbidities + flu-like syptoms, dry then bloody cough, holiday, infected water, GI disturbance + hypontraemia and lymphopenia

114
Q

2 points about klebsiella pneumonia?

A

Red jelly sputum and cavitates

115
Q

3 points about coxiella burnetii pneumonia?

A

Farm animals, Q fever, endocarditis

116
Q

Chlamydophilia psittaci pneumonia is commonly associated with?

117
Q

Who does pseudomonas pneumonia present in + complication?

A

Older people and CF + commonly cavitates

118
Q

Pneumonia associated with immunocompromised patients + treatment?

A

Pneumocystic jiroveci + co-trimoxazole

119
Q

What is allergic bronchopulmonary aspergillosis + what 2 things does it cause?

A

Aspergillosis growing in walls of bronchi + eosinophillic pneumonias and apical fibrosis

120
Q

What is invasive aspergillisos ?

A

Aspergilliosis growth in previously damaged lung tissue

121
Q

Most common interstitial lung disease?

A

Idiopathic pulmonary fibrosis

122
Q

Sarcoidosis histology + type of hypersensitivity + 2 risk groups + 4 key signs + 2 raised bloods + treatment?

A

Non-caseating granulomatous + type 4 + non-smokers and black + uveitis, erythema nodosum, BHL, arthritis + ACE and hypercalcaemia + steroid and immunosuppressants only if organs are affected

123
Q

What are granulomas?

A

Middle of macrophages with pathogens and outer ring of lymphocytes

124
Q

What type of hypersensitivity is HP + type of allergen + examples + CXR sign + treatment?

A

Type 3 and 4 hypersensitivity + protein + bird fanciers, farmers, malt workers, sugar workers lung + fluffy shadows + steroids if breathless

125
Q

What type of hypersensitivity is pneumoconiosis + allergen + 3 types?

A

Type III + metal or dust + coal workers, silicosis and asbestosis

126
Q

3 key points about silicosis?

A

Egg-shell hilar calcification, acute progresses to chronic and TB risk factor

127
Q

Caplan’s syndrome is?

A

RA + pneumoconiosis

128
Q

The 4 Cs of pulmonary fibrosis?

A

Clubbing, cyanosis, cough and crepitations

129
Q

What type of hypersensitivty is Goodpasture’s syndrome + where does it affect + type of collagen affected + key antibody?

A

Type 2 + lungs and kidneys + alpha 3 chain of type IV collagen + anti-AGM

130
Q

TB organism + 2 risk groups + 3 key symptoms + 2 CXR signs?

A

Mycobacterium TB + Asian and TH1 defective immunity + cough, fever and night sweats + apical cavitating lesion and BHL

131
Q

2 types of focus in TB + where they are in the lung?

A

Ghon focus = peripheral (dormant)

Assman focus = apical (active)

132
Q

TB immunology 3 point summary including reactivation + immunological system that overcomes TB?

A
  • TB proliferates inside macrophages
  • Macrophages release cytokines and present to T helper cells
  • Granulomas form but can be disrupted by new infection or immunosuppresion
  • IL-12 and IFN gamma
133
Q

What is Mililary TB + where is affects?

A

TB that spreads through blood + lungs and can spread to liver and GI organs

134
Q

Key test for TB + how to get a sample?

A

Alcohol-fast bacillus staining with Ziehl Neelson + take bloods

135
Q

Treatment for active TB?

A

RIPE for 2 months or RI for 4 months

136
Q

Treatment for latent TB?

A

RI for 3 months or I for 6 months

137
Q

S/Es of TB drugs?

A

R = orange tears + hepatitis, I = polyneuropathy, P = gout + hepatitis, E = eye disturbance

138
Q

Red flags for lung cancer?

A

Haemoptysis, chronic cough, weight loss, chest pain, hoarseness and dysphagia

139
Q

What is cannonball metastases a sign of?

A

Primary renal cell carcinoma

140
Q

Most common type of lung cancer (not cell type) + 6 common places of metastasis (SLABB)?

A

Bronchial carcinoma + skin, lung, adrenals, brain and bone

141
Q

4 local invasion of lung cancer sites + effects?

A

Laryngeal nerve (hoarseness), oesophagus (dysphagia), pleura (effusion) and pericardium (AF)

142
Q

What is Eaton-Lambert syndrome + which cancer is it associated with?

A

Paraneoplastic syndrome causing weakness + small cell lung cancer

143
Q

What cell does SCLC originate from + 3 key features + 2 complications + treatment?

A

Endocrine cells + rapid/early spread, central and ACh release + chemo/radiotherapy + SIADH (excess ADH) and Cushing’s syndrome

144
Q

Who does adenocarcinoma present in + location of tumour + unique gene expression?

A

Non-smokers + peripheral + TTF1

145
Q

Squamous cell carcinoma location of tumour + secretion + unique gene expression + 3 complications?

A

Central + PTH release + P63 + hypertrophic pulmonary osteoarthropathy, hypercalcaemia and commonly cavitates

146
Q

2 key features of large cell carcinoma?

A

Worst prognosis and peripheral

147
Q

2 types of central lung cancer?

A

SCLC and squamous cell carcinoma

148
Q

What are Pancoast tumours + 2 complications and where they affect?

A

NSCLC non-metastatic tumours that press on apical structures + limb pain (brachial plexus) and Horner’s syndrome (sympathetic trunk)

149
Q

What does Horner’s syndrome presents as?

A

Flushing (no sweat), eyelid drooping and small pupil on one side of the face

150
Q

How does mesothelioma present + treatment?

A

Bloody effusions and pleural thickening + chemo/radiotherapy + permanent chest drain

151
Q

Why is pleural fluid a poor diagnostic tool?

A

Low cytological yield

152
Q

Treatment for NSCLC?

A

Surgery (lobectomy or pneumonectomy), chemo + radio

153
Q

Used for lobectomies + lung biopsies?

A

Uniportal VATs

154
Q

Test for lung tumour position, lymph node involvement and metastases?

A

Bronchoscopy, mediastinoscopy/EBUS and CT chest and abdo or PET

155
Q

Score to assess patient fitness for chemotherapy?

156
Q

Virchow’s triad?

A

Venous stasis + endothelial dysfunction + hypercoagulability

157
Q

A PE can be caused by what a blockage by what 4 things + most common?

A

Thrombus (most common), fat, gas or tumour

158
Q

Key sign of a DVT + 1st line test?

A

Red, hot and swollen calf + US

159
Q

Most and least likely veins to embolise?

A

Ileofemoral (most) and popliteal (least)

160
Q

5 risk factors for DVT?

A

Pregnancy, contraceptive + smoker, thrombophilia, HRT and post-surgery

161
Q

Symptoms of a small PE vs large PE?

A

May be asymptomatic or breathlessness +/- chest pain vs anywhere from breathlessness to sudden death

162
Q

2 scores used for PE presentation and what values indicate risk of PE?

A

Well’s (>2) Geneva (>4)

163
Q

Gold standard test for PE + additional lung test + ECG finding + blood test?

A

CTPA + V/Q scan + RV strain pattern + D-dimer

164
Q

2 initial tests for PE in pregnancy?

A

Ultrasound + half/dose V/Q scan (recommended over CPTA)

165
Q

RV strain pattern?

A

Right axis deviation + inverted T waves in V1-4

166
Q

Treatment for a large PE vs small PE?

A

Thrombolysis vs IV LMWH + warfarin or rivaroxiban

167
Q

What INR does warfarin get stopped at?

168
Q

Normal MAP in the lungs vs pulmonary hypertension value?

A

12-20 mm Hg vs > 25 mm Hg

169
Q

What is cor pulmonale?

A

Right-sided heart failure due to pulmonary hypertension

170
Q

5 clinical findings of pulmonary hypertension/cor pulmonale?

A

Peripheral oedema, central cyanosis, tricuspid regurgitation, JVP V wave and extra S2 sound

171
Q

What is an additional S2 sound caused by?

A

Delayed pulmonary valve closure

172
Q

5 tests for cor pulmonale?

A

CXR, ECG, right-heart catheter, ECHO and bloods

173
Q

What key blood is raised in cor pulmonale?

174
Q

2 drugs for cor pulmonale/ pulmonary hypertension treatment + what is 1st line?

A

CCB (1st line) + anticoagulant

175
Q

What is Riociguat + what can it be used for?

A

Pulmonary artery vasodilator + pulmonary hypertension

176
Q

Self-reactive T and B cells are removed by?

A

Central or periperhal tolerance mecahnisms

177
Q

Example of lymphocyte tolerance mechanism?

A

Inactivation by TREG cells

178
Q

What type of mutation is IPEX syndrome + what cell it affects + gene affected by mutation + definitive treatment?

A

Monogenetic X-linked + TREG cells + FOXP3 + HSCT

179
Q

What is type I hypersensitivity + Ig?

A

Allergic reactions + IgE

180
Q

Main test for anaphylactic shock + treatment?

A

Serum tryptase + adrenaline and oxygen

181
Q

What is type II hypersensitivity + Igs + 2 examples?

A

Self-reactive antibodies that affect the lungs and kidneys + IgM/IgG + Goodpature’s and Grave’s

182
Q

What happens in Grave’s disease?

A

Self-reactive antibodies bind to thyroid stimulating hormone receptors

183
Q

Ig involved in type III hypersensitivity?

184
Q

What is type IV hypersensitivty + cell + 4 examples?

A

Delayed hypersensitivty + T cell + type 1 diabetes, RA, TB and sarcoidosis

185
Q

What type of virus is HIV + mechanism + 2 modes of transmission?

A

Retrovirus + kills CD4+ T cells + transmitted by sex or sharing needles

186
Q

Key CXR feature of RDS?

A

Ground glass appearance

187
Q

Cause of adult RDS + neonatal RDS + common complication of adult RDS?

A

Inflammation destroys and stiffens alveoli (sepsis) + premature babies lack surfactant and alveoli collapse

188
Q

Treatment for adult RDS + neonatal?

A

CPAP and antibiotics + steroids and oxygen support

189
Q

What is an abscess + how is it allowed to form + 3 symptoms?

A

Liquefactive necrosis + previous disease (e.g. necrotising pneumonia) creates cavities + fever, cough, weight loss

190
Q

What is an empyema + 2 abxs for intial treatment?

A

Type of pleural effusion with pus pockets + amox or metronidazole

191
Q

How to tell between abscess or empyema + which bedside teat is preferred to diagnose either?

A

CXR - empyema will have D shape + US

192
Q

How are pleural effusions catagorised + values for Light’s criteria?

A

By protein concentration + transudates < 30 g/L and exudates > 30 g/L

193
Q

3 causes of transudates vs 2 causes of exudates?

A

Increased venous pressure, hypothyroidism and heart failure vs infection or malignancy

194
Q

pH of pleural effusion that indicates empyema/ requires a chest drain?

195
Q

Cause of pneumothorax in healthy lungs?

A

Bullae rupture

196
Q

5 symptoms of large pneumothorax?

A

Reduced chest expansion, short of breath, hyperesonant, tracheal deviation and hypotension

197
Q

Small + large pneumothorax measurement + where is the measurement taken?

A

Small = < 2 cm and large = > 2 cm + between lung and parietal pleura AT HILAR LEVEL

198
Q

Treatment for tension pneumothorax + position of insertion?

A

Needle aspiration + 2nd intercostal space mid-clavicular line

199
Q

Large pneumothorax treatment + position of insertion + maximum value + persistent treatment?

A

Aspiration + 4th intercostal space midaxillary line + 2.5 L + drain

200
Q

Small pneumothorax treatment?

A

Oxygen + follow up at clinic

201
Q

2 types of endobronchial treatment?

A

Stenting and photodynamic laser therapy

202
Q

Complications of radiotherapy + better type of radiotherapy

A

Inflammation/fibrosis + SABR

203
Q

Acronym used for immunodeficiency presentations?

A

SPUR - serious, persistent, unusual and recurrent infection

204
Q

Are primary or secondary immunodeficiencies rarer?

205
Q

What are PIDs + what is the most common type + 4 examples?

A

Rare genetic disorders + primary antibody deficiencies (PADs) + SCID, XLA, IgA and CVA

206
Q

3 common respiratory manifestations of PIDs?

A

Sinusitis, otitis media and pneumonia

207
Q

Disorder behind laryngeal oedema?

A

Complement system disorder

208
Q

Other name for severe combined neutropenia + inheritance + what it causes + presentation + treatment?

A

Kostmann syndrome + autosomal recessive + low neutrophils + recurrent infections with no pus + recombinant G-CSF

209
Q

Mutation that causes leukocyte adhesion deficiency + inheritance + definitive treatment?

A

CD18 integrin + autosomal recessive + HSCT

210
Q

Mutation that causes chronic granulomatous disease + effect + most common inheritance?

A

NADPH component + no ROS to kill pathogens + X-linked

211
Q

What is reticular dysgenesis + mutation?

A

No production of all WBCs + mitochondrial mutation

212
Q

Most common form of SCID + what is causes + definitive treatment?

A

X-linked + low T cells and normal B cells + HSCT

213
Q

DiGeorge syndrome affects which WBCs + DiGeorge chromosome?

A

T cells + 22

214
Q

What is the XLA mutation + effect?

A

Mutation of tyrosine kinase + causes low B cells production

215
Q

What are ANCAs + what 2 organs do they affect?

A

Anti-neutrophil cytoplasmic antibodies + lungs and kidneys

216
Q

2 symptoms of Wegener’s/ granulomatosis with polyangitis + blood test findings + complication?

A

Haemoptysis and haematuria + positive cANCA + necrotising microvascular glomerulonephritis

217
Q

Triad of Churg-Strauss + other symptom + what sex is more commonly affected + blood test result?

A

Asthma, eosinophilia, systemic vasculitis + haematuria + males + positive pANCA

218
Q

What 2 pneumonias commonly cavitate?

A

Klebsiella and pseudomonas

219
Q

What type of NSCLC commonly cavitates?

A

Sqaumous cell carcinoma

220
Q

Which lung cancer releases Ach vs PTH?

A

SCLC = Ach + squamous cell carcinoma = PTH

221
Q

Difference between extrinsic and instrinsic asthma?

A

Extrinsic = whole body IgE response + Intrinsic = local IgE response

222
Q

DLCO/TLCO is low in …. and ….. and normal or high in …. ?

A

COPD + restrictive lung disease + asthma

223
Q

2 skeletal conditions that cause restrictive lung disease + what they are?

A

Thoracic kyphoscoliosis (spine bends wrong way) + anklosing spondylitis (inflammation of the spine)

224
Q

2 drugs that can cause alveolitis and lung fibrosis?

A

Amiodarone and methotrexate

225
Q

Name 2 anti-fibrotic agents used in lung disease e.g. pulmonary fibrosis?

A

Perfenidone and nintedanib

226
Q

First line drug given in an asthma attack?

A

Nebulised SABA

227
Q

Hypercalcaemia is associated with which type of cancer + why?

A

Squamous cell + PTH controls calcium distribution

228
Q

Why is diptheria uncommon in the UK + characteristic finding in cases?

A

Vaccination + a pseudomembrane

229
Q

Name 3 immunosuppresant drugs?

A

Azathioprine, anti-TNF and methotrexate

230
Q

Name 2 drugs used to correct pancreatic insufficiency in CF?

A

Creon and insulin

231
Q

Right sided pleuritic chest pain?

232
Q

Ground glass CXR?

A

RDS of the newborn or pulmonary fibrosis

233
Q

Postitive AGM-antibodies?

A

Goodpasture’s

234
Q

Positive CCP-antibodies?

235
Q

Bronchi widening + signet ring appearance on CXR?

A

Bronchiectasis

236
Q

Non-smoker lung cancer?

A

Adenocarcinoma

237
Q

What is rheumatic fever caused by?

A

Group A beta-haemolytic streptococci

238
Q

Complication of anti-TNF used for RA?

A

Active TB infection

239
Q

Narrowest part of the larynx where foreign bodies block first?

A

Rima glottidis

240
Q

Vomiting, dehydrated and not taking insulin?

A

DKA or metabolic acidosis

241
Q

Mucin producing cancer?

A

Adenocarcinoma

242
Q

Pink puffer?

243
Q

Samter’s triad?

A

Asthma, salicylate/aspirin sensitivity and nasal polyps

244
Q

Where is the middle lobe auscultated?

A

Mid-clavicular line on the right between rib 4 and 6

245
Q

Sail sign on CXR?

A

Left lower lobe collapse

246
Q

Type 1 respiratory failure is characterised by?

A

Hypoxaemia < 8 kPa

246
Q

Persistent PEs would suggest need to investigate for?

A

Malignancy

247
Q

Type 2 respiratory failure is characterised by?

A

Hypoxaemia < 8 kPa and hypercapnia > 6 kPa

249
Q

Rheumatoid disease presents as which 3 things in the lungs + key blood finding?

A

Pleural thickening, fibrosis and various size of rheumatoid nodules + anti-CCP

250
Q

Where the lung apex is auscultated?

A

Superior to the lateral 1/3rd of the clavicle

251
Q

Where is the lung base auscultated posterior?

A

Scapular line at T11 level

252
Q

Pink frothy sputum?

A

Pulmonary oedema

253
Q

Antibiotics for gram -ve aerobes + anaeorobes?

A

Gentamicin + metronidazole

254
Q

2 antibiotics used for COPD exacerbation?

A

Amoxicillin or doxycycline

255
Q

2 CIs for a contrast CT?

A

Renal impairment and anaphylaxis

256
Q

Herceptin and erlotinib targets what + common mutation in what type of cancer?

A

EGFR + adenocarcinoma

257
Q

Yellow, well-defined lump in the bronchus?

A

Carcinoid tumour

258
Q

ALP is abnormal in which type of metastasis?

259
Q

Most common type of lung cancer?

A

Adenocarcinoma

260
Q

H5N1 + H1N1 flu strain?

A

Avian flu + swine flu

261
Q

Mantoux skin test?

A

TB infection

262
Q

Asbestosis causes which 2 types of lung cancer?

A

Mesothelioma and adenocarcinoma

263
Q

Volume of fluid needed to be clinically vs CXR detected?

A

500 ml and 300 ml

264
Q

Popliteal synovial rupture?

A

Baker’s cyst

265
Q

Hygiene hypothesis?

A

Sterile environments predispose childhood hypersensitivty

266
Q

Always aspirate pleural effusion if not caused by?

A

Cardiac failure

267
Q

Pleural click?

A

Pneumothorax

268
Q

Pleural rub + increased vocal resonance?

269
Q

Ending of drugs that inhibit tyrosine kinases?

270
Q

Wedge-shaped infarct?

A

Pulmonary embolism

Year 1 MBChB Respiratory (3 decks)

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