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)
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
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
4
Q
What is pharyngitis + main cause + what is it commonly assoiciated with?
A
Sore throat + adenovirus + common cold/ coryza
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
6
Q
Incubation period for coryza?
A
1 - 5 days
7
Q
Incubation period for influenza?
A
1-3 days
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
9
Q
Which influenza is responsible for pandemics + why?
A
Influenza A + rapid antigenic shift
10
Q
Who is the influenza vaccine contraindicated for?
A
People with an egg allergy
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
12
Q
What is rhinitis + time scale for acute vs chronic?
A
Inflammation of the nasal mucosa + < 6 weeks (acute) and > 6 weeks (chronic)
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
14
Q
Causes of non-allergic rhinits + vasomotor rhinitis ?
A
Bacterial or viral infection + smells, temperature, emotion
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
16
Q
Summary of allergic rhinitis immunology?
A
IgE binds to mast cells and causes degranulation which releases histamine
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
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
19
Q
What is oxymetazoline + action + what common disease is it used for?
A
alpha 1 agonist + vasoconstriction + rhinorrhoea in rhinitis
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
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
22
Q
What type of organism is bordatella pertussis and h. influenzae?
A
Gram -ve coccobacilli
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
24
Q
Main immunological cause of chronic vs acute infection?
A
Hypogammaglobulinemia (chronic) vs IgA deficiency (acute)
25
2 conditions that cause abnormal cilia?
Young's + Kartenager's syndrome
26
What 2 things is Kartenager's syndrome?
Situs inversus + abnormal cilia
27
What 3 things is Young's syndrome?
Bronchiectasis + sinusitis + abnormal cilia
28
What is chronic asthma + 3 hallmarks?
Irreversible airway obstruction + thickening of the basement membrane, collagen deposits in submucosa and hypertrophy of smooth muscle
29
2 key features about the timing of asthma symptoms?
Diurnal variation + worse episodes at night
30
4 common asthma symptoms?
Dry cough, wheeze, reflux and intermittent dyspnoea
31
2 key findings in asthma history?
FH of asthma/atopy + PMH of atopy e.g. eczema
32
3 exam finding for asthma?
Bilateral wheeze, hyperinflated chest + hyperresonance
33
Asthma vs COPD response to bronchodilator?
> 15% increase in FEV1 or PEFR vs < 15%
34
FEV1, FEV, FEV1/FEV and PEFR for asthma?
Decreased FEV1, normal FEV, decreased FEV1/FEV and decreased PEFR
35
4 features of a moderate asthma attack?
PEFR 50-75%, normal speech, RR < 25 and pulse < 110
36
4 features of a severe asthma attack?
PEFR 33-50%, unable to speak, RR > 25 and pulse > 110
37
Features of a life-threatening asthma attack?
PEFR <33%, cyanosis, unconscious, confusion, SaO2 < 92 %
38
2 main drugs that cause asthma?
NSAIDs and beta agonists
39
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)
40
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
41
Beta 2 agonist mode of action?
Activates AC and cAMP production to promote SM relaxation
42
SABA examples + 4 S/Es + used more than ... times/week needs a review?
Salbutamol + hypokalaemia, headaches, tremors and palpitations + 3
43
Atopic asthma has a ... response and non-atopic/severe has a ... response?
TH2 and TH1
44
LABA examples + 3 S/Es + what is it good for?
Salmeterol and formoterol + worsens asthma as monotherapy, tremors and palpitations + nocturnal asthma
45
Ultra-LABA examples?
Indacaterol and olodaterol
46
3 inhaled steroid example + 5 S/Es?
Beclomethasone, budesonide, flucastisone + oral candidas, osteoporosis, stunted growth, thinning of skin and hoarseness
47
Oral steroid example + 3 S/Es?
Prednisolone + adrenal insufficiency, peptic ulcers and osteoporosis
48
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
49
Cromone example + route of drug + mechanism + best effective in?
Sodium cromoglicate + inhaled + stabilises mast cells + children
50
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
51
2 specialist treatment for severe asthma?
Omalizumab (anti-IgE) + mepolizumab (anti-IL-5)
52
LTRA example + route of drug + mechanism?
Montelukast + oral + blocks CysLT1 receptors on inflammatory cells
53
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
54
Treatment for severe asthma attack + routes of the drugs?
Oxygen + salbutamol (nebulised) + hydrocortisone (IV) + ipratropium (nebulised) + theophylline/aminophylline (IV) + magensium sulphate (IV) + anesthetist
55
What is ACOS + how is it defined + responds well to?
Asthma and COPD overlap syndrome + COPD with eosinophilia > 4% + inhaled steroids
56
Key WBC in asthma + COPD?
Eosinophil + neutrophil
57
Key T cell in asthma + COPD?
CD4+ + CD8+
58
3 main COPD symptoms?
Dyspnoea + cough +/- sputum + frequent exacerbations
59
FEV1, FEV and FEV1/FEV for COPD?
Decreased FEV1, normal FVC, decreased FEV1/FEV
60
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)
61
COPD is a combination of what + key features of them?
Chronic bronchitis (sputum, increased goblet cells, loss of cilia) + emphysema (stiff and dilated alveoli)
62
2 types of emphysema + where the affect + main cause?
- Centroacinar = central alveoli with undamaged peripheral + link to smoking
- Panacinar = whole alveoli + A1AT abnormality
63
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
64
Metaplasia associated with COPD?
Columnar to squamous epithelium
65
SAMA example + mechanism?
Ipratropium + non-selective blocker of M1,2 and 3
66
Why are selective muscarinic antagonists preferred?
Blocking M2 increases Ach release
67
LAMA example + mechanism + feature that prevents systemic parasympathetic block?
Tiotropium + M3 blocker + quaternary ammonium/atropine group
68
3 drugs used in asthma exercise testing?
Histamine, methacholine and mannitol
69
What is roflumilast used for + mechanism?
COPD + PDE4 inhibitor
70
Oxygen mask + % for COPD in hospital environment?
Venturi + 24% then increase to 28%
71
Home oxygen therapy for COPD is especially beneficial in extending life in cases with?
Cor pulmonale
72
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
73
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
74
4 main infective organisms for bronchiectasis?
Strep, staph, h. influenza and pseudomonas
75
Pseudomonas is seen in bronchiectasis with underlying what?
Cystic fibrosis
76
Chronic bronchial sepsis presentation + patients commonly seen in?
- Presents like bronchiectasis but NO HRCT SPREAD
| - Young women in childcare jobs
77
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
78
Examples of CF symptoms and signs?
Cough, recurrent infection, swollen sinuses, salty sweat, clubbing, foul stools, male infertility, chronic sinusitis
79
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
80
2 key tests for CF + key value?
Sweat test and genetic test + sweat test with chlorine > 60 mmol/L
81
Expensive drug for CF + what is is effective for + CI?
Ivacaftor + G551D muations with normal CFTR but non-functional channel + grapefruit
82
What is sleep apnoea + when is it worse + why?
Upper airway collapse + rapid eye movement (REM) sleep + only the diaphragm muscle is active
83
5 key risk factors for sleep apnoea?
Alcoholism, obesity, wide neck, hypothyroidism and enlarged tonsils
84
4 key symptoms of sleep apnoea?
Loud snoring, daytime fatigue, morning headaches and decreased libido
85
Morning headaches are usually a sign of?
Hypercapnia
86
2 key tests for sleep apnoea + key values?
Sleep study (10-15 apnoeas in an hour) + Epworth score (>10)
87
Treatment for sleep apnoea?
CPAP + weight loss + alcohol/smoking cessastion
88
What is tracheomalacia + what can it cause + treatment?
Weakening of the trachealis muscle + stridor or airway collapse + CPAP
89
Inhaled foreign bodies most commonly lodge in the?
Right main bronchus
90
What tests should be avoided in epiglottitis?
Laryngoscopy/bronchoscopy
91
What is pneumonia + what type of exudate?
Inflammation and consolidation of the distal airways + fibrin-rich exudate
92
5 key signs of pneumonia?
SoB, productive cough, fever and confusion
93
Effusions/consolidation produce what type of percussion sound?
Stony dull
94
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
```
95
Specific blood test for pneumonia or other suspected infections?
CRP
96
Suspected atypical pneumonia or known atypical epidemic requires?
Blood/sputum sampling
97
Urine testing in pneumonia cases can detect?
Legionella antigens
98
3 common pathogens in CAP?
Strep, mycoplasma, h. influenzae,
99
Main pathogens for HAP?
Gram -ve bacteria and staph aureas/MRSA
100
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)
101
Treatment for staph aureas?
Flucloxacillin
102
Treatment for MRSA or C. difficile?
Gentamicin/vancomycin/teicoplanin
103
Treatment for Legionella?
Fluoro/quinolones or macrolides
104
Treatment for Pseudomonas?
Ciprofloxacin or cephalasporin (fluoroquinolone or cephalaspoin)
105
Treatment for mycoplasma?
Tetracycline or macrolide
106
What cases is lobar pneumonia vs bronchopneumonia usually seen in?
Young healthy adults with CAP vs older patients with existing disease and atypical bacteria
107
Common lobe affected by aspiration pneumonia?
Right lower/middle lobe
108
2 types of cases staphylococcus pneumonia presents in?
Post-influenza (less commonly that strep) + IV drug users
109
When can strep be a secondary pneumonia + 3 key symptoms?
Post-influenza (more commonly than staph a.) + oral herpes, rusty sputum, dry cough
110
2 common pathogens in COPD + pneumonia?
H. influenzae and Moraxella
111
2 common pathogens in alcoholic pneumonia?
Klebsiella and strep. pneumoniae
112
Who does mycoplasma pneumonia present in + a disadvantage + 2 key symptoms?
Young adults + amoxicillin resistant (no outer wall) + dry cough and myalgia
113
Who does Legionella pneumonia present in + key words + 2 complications?
Older people with co-morbidities + flu-like syptoms, dry then bloody cough, holiday, infected water, GI disturbance + hypontraemia and lymphopenia
114
2 points about klebsiella pneumonia?
Red jelly sputum and cavitates
115
3 points about coxiella burnetii pneumonia?
Farm animals, Q fever, endocarditis
116
Chlamydophilia psittaci pneumonia is commonly associated with?
Birds
117
Who does pseudomonas pneumonia present in + complication?
Older people and CF + commonly cavitates
118
Pneumonia associated with immunocompromised patients + treatment?
Pneumocystic jiroveci + co-trimoxazole
119
What is allergic bronchopulmonary aspergillosis + what 2 things does it cause?
Aspergillosis growing in walls of bronchi + eosinophillic pneumonias and apical fibrosis
120
What is invasive aspergillisos ?
Aspergilliosis growth in previously damaged lung tissue
121
Most common interstitial lung disease?
Idiopathic pulmonary fibrosis
122
Sarcoidosis histology + type of hypersensitivity + 2 risk groups + 4 key signs + 2 raised bloods + treatment?
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
What are granulomas?
Middle of macrophages with pathogens and outer ring of lymphocytes
124
What type of hypersensitivity is HP + type of allergen + examples + CXR sign + treatment?
Type 3 and 4 hypersensitivity + protein + bird fanciers, farmers, malt workers, sugar workers lung + fluffy shadows + steroids if breathless
125
What type of hypersensitivity is pneumoconiosis + allergen + 3 types?
Type III + metal or dust + coal workers, silicosis and asbestosis
126
3 key points about silicosis?
Egg-shell hilar calcification, acute progresses to chronic and TB risk factor
127
Caplan's syndrome is?
RA + pneumoconiosis
128
The 4 Cs of pulmonary fibrosis?
Clubbing, cyanosis, cough and crepitations
129
What type of hypersensitivty is Goodpasture's syndrome + where does it affect + type of collagen affected + key antibody?
Type 2 + lungs and kidneys + alpha 3 chain of type IV collagen + anti-AGM
130
TB organism + 2 risk groups + 3 key symptoms + 2 CXR signs?
Mycobacterium TB + Asian and TH1 defective immunity + cough, fever and night sweats + apical cavitating lesion and BHL
131
2 types of focus in TB + where they are in the lung?
Ghon focus = peripheral (dormant)
| Assman focus = apical (active)
132
TB immunology 3 point summary including reactivation + immunological system that overcomes TB?
- 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
What is Mililary TB + where is affects?
TB that spreads through blood + lungs and can spread to liver and GI organs
134
Key test for TB + how to get a sample?
Alcohol-fast bacillus staining with Ziehl Neelson + take bloods
135
Treatment for active TB?
RIPE for 2 months or RI for 4 months
136
Treatment for latent TB?
RI for 3 months or I for 6 months
137
S/Es of TB drugs?
R = orange tears + hepatitis, I = polyneuropathy, P = gout + hepatitis, E = eye disturbance
138
Red flags for lung cancer?
Haemoptysis, chronic cough, weight loss, chest pain, hoarseness and dysphagia
139
What is cannonball metastases a sign of?
Primary renal cell carcinoma
140
Most common type of lung cancer (not cell type) + 6 common places of metastasis (SLABB)?
Bronchial carcinoma + skin, lung, adrenals, brain and bone
141
4 local invasion of lung cancer sites + effects?
Laryngeal nerve (hoarseness), oesophagus (dysphagia), pleura (effusion) and pericardium (AF)
142
What is Eaton-Lambert syndrome + which cancer is it associated with?
Paraneoplastic syndrome causing weakness + small cell lung cancer
143
What cell does SCLC originate from + 3 key features + 2 complications + treatment?
Endocrine cells + rapid/early spread, central and ACh release + chemo/radiotherapy + SIADH (excess ADH) and Cushing's syndrome
144
Who does adenocarcinoma present in + location of tumour + unique gene expression?
Non-smokers + peripheral + TTF1
145
Squamous cell carcinoma location of tumour + secretion + unique gene expression + 3 complications?
Central + PTH release + P63 + hypertrophic pulmonary osteoarthropathy, hypercalcaemia and commonly cavitates
146
2 key features of large cell carcinoma?
Worst prognosis and peripheral
147
2 types of central lung cancer?
SCLC and squamous cell carcinoma
148
What are Pancoast tumours + 2 complications and where they affect?
NSCLC non-metastatic tumours that press on apical structures + limb pain (brachial plexus) and Horner's syndrome (sympathetic trunk)
149
What does Horner's syndrome presents as?
Flushing (no sweat), eyelid drooping and small pupil on one side of the face
150
How does mesothelioma present + treatment?
Bloody effusions and pleural thickening + chemo/radiotherapy + permanent chest drain
151
Why is pleural fluid a poor diagnostic tool?
Low cytological yield
152
Treatment for NSCLC?
Surgery (lobectomy or pneumonectomy), chemo + radio
153
Used for lobectomies + lung biopsies?
Uniportal VATs
154
Test for lung tumour position, lymph node involvement and metastases?
Bronchoscopy, mediastinoscopy/EBUS and CT chest and abdo or PET
155
Score to assess patient fitness for chemotherapy?
ECOG
156
Virchow's triad?
Venous stasis + endothelial dysfunction + hypercoagulability
157
A PE can be caused by what a blockage by what 4 things + most common?
Thrombus (most common), fat, gas or tumour
158
Key sign of a DVT + 1st line test?
Red, hot and swollen calf + US
159
Most and least likely veins to embolise?
Ileofemoral (most) and popliteal (least)
160
5 risk factors for DVT?
Pregnancy, contraceptive + smoker, thrombophilia, HRT and post-surgery
161
Symptoms of a small PE vs large PE?
May be asymptomatic or breathlessness +/- chest pain vs anywhere from breathlessness to sudden death
162
2 scores used for PE presentation and what values indicate risk of PE?
Well's (>2) Geneva (>4)
163
Gold standard test for PE + additional lung test + ECG finding + blood test?
CTPA + V/Q scan + RV strain pattern + D-dimer
164
2 initial tests for PE in pregnancy?
Ultrasound + half/dose V/Q scan (recommended over CPTA)
165
RV strain pattern?
Right axis deviation + inverted T waves in V1-4
166
Treatment for a large PE vs small PE?
Thrombolysis vs IV LMWH + warfarin or rivaroxiban
167
What INR does warfarin get stopped at?
INR > 2
168
Normal MAP in the lungs vs pulmonary hypertension value?
12-20 mm Hg vs > 25 mm Hg
169
What is cor pulmonale?
Right-sided heart failure due to pulmonary hypertension
170
5 clinical findings of pulmonary hypertension/cor pulmonale?
Peripheral oedema, central cyanosis, tricuspid regurgitation, JVP V wave and extra S2 sound
171
What is an additional S2 sound caused by?
Delayed pulmonary valve closure
172
5 tests for cor pulmonale?
CXR, ECG, right-heart catheter, ECHO and bloods
173
What key blood is raised in cor pulmonale?
BNP
174
2 drugs for cor pulmonale/ pulmonary hypertension treatment + what is 1st line?
CCB (1st line) + anticoagulant
175
What is Riociguat + what can it be used for?
Pulmonary artery vasodilator + pulmonary hypertension
176
Self-reactive T and B cells are removed by?
Central or periperhal tolerance mecahnisms
177
Example of lymphocyte tolerance mechanism?
Inactivation by TREG cells
178
What type of mutation is IPEX syndrome + what cell it affects + gene affected by mutation + definitive treatment?
Monogenetic X-linked + TREG cells + FOXP3 + HSCT
179
What is type I hypersensitivity + Ig?
Allergic reactions + IgE
180
Main test for anaphylactic shock + treatment?
Serum tryptase + adrenaline and oxygen
181
What is type II hypersensitivity + Igs + 2 examples?
Self-reactive antibodies that affect the lungs and kidneys + IgM/IgG + Goodpature's and Grave's
182
What happens in Grave's disease?
Self-reactive antibodies bind to thyroid stimulating hormone receptors
183
Ig involved in type III hypersensitivity?
IgM/IgG
184
What is type IV hypersensitivty + cell + 4 examples?
Delayed hypersensitivty + T cell + type 1 diabetes, RA, TB and sarcoidosis
185
What type of virus is HIV + mechanism + 2 modes of transmission?
Retrovirus + kills CD4+ T cells + transmitted by sex or sharing needles
186
Key CXR feature of RDS?
Ground glass appearance
187
Cause of adult RDS + neonatal RDS + common complication of adult RDS?
Inflammation destroys and stiffens alveoli (sepsis) + premature babies lack surfactant and alveoli collapse
188
Treatment for adult RDS + neonatal?
CPAP and antibiotics + steroids and oxygen support
189
What is an abscess + how is it allowed to form + 3 symptoms?
Liquefactive necrosis + previous disease (e.g. necrotising pneumonia) creates cavities + fever, cough, weight loss
190
What is an empyema + 2 abxs for intial treatment?
Type of pleural effusion with pus pockets + amox or metronidazole
191
How to tell between abscess or empyema + which bedside teat is preferred to diagnose either?
CXR - empyema will have D shape + US
192
How are pleural effusions catagorised + values for Light’s criteria?
By protein concentration + transudates < 30 g/L and exudates > 30 g/L
193
3 causes of transudates vs 2 causes of exudates?
Increased venous pressure, hypothyroidism and heart failure vs infection or malignancy
194
pH of pleural effusion that indicates empyema/ requires a chest drain?
< 7.2
195
Cause of pneumothorax in healthy lungs?
Bullae rupture
196
5 symptoms of large pneumothorax?
Reduced chest expansion, short of breath, hyperesonant, tracheal deviation and hypotension
197
Small + large pneumothorax measurement + where is the measurement taken?
Small = < 2 cm and large = > 2 cm + between lung and parietal pleura AT HILAR LEVEL
198
Treatment for tension pneumothorax + position of insertion?
Needle aspiration + 2nd intercostal space mid-clavicular line
199
Large pneumothorax treatment + position of insertion + maximum value + persistent treatment?
Aspiration + 4th intercostal space midaxillary line + 2.5 L + drain
200
Small pneumothorax treatment?
Oxygen + follow up at clinic
201
2 types of endobronchial treatment?
Stenting and photodynamic laser therapy
202
Complications of radiotherapy + better type of radiotherapy
Inflammation/fibrosis + SABR
203
Acronym used for immunodeficiency presentations?
SPUR - serious, persistent, unusual and recurrent infection
204
Are primary or secondary immunodeficiencies rarer?
Primary
205
What are PIDs + what is the most common type + 4 examples?
Rare genetic disorders + primary antibody deficiencies (PADs) + SCID, XLA, IgA and CVA
206
3 common respiratory manifestations of PIDs?
Sinusitis, otitis media and pneumonia
207
Disorder behind laryngeal oedema?
Complement system disorder
208
Other name for severe combined neutropenia + inheritance + what it causes + presentation + treatment?
Kostmann syndrome + autosomal recessive + low neutrophils + recurrent infections with no pus + recombinant G-CSF
209
Mutation that causes leukocyte adhesion deficiency + inheritance + definitive treatment?
CD18 integrin + autosomal recessive + HSCT
210
Mutation that causes chronic granulomatous disease + effect + most common inheritance?
NADPH component + no ROS to kill pathogens + X-linked
211
What is reticular dysgenesis + mutation?
No production of all WBCs + mitochondrial mutation
212
Most common form of SCID + what is causes + definitive treatment?
X-linked + low T cells and normal B cells + HSCT
213
DiGeorge syndrome affects which WBCs + DiGeorge chromosome?
T cells + 22
214
What is the XLA mutation + effect?
Mutation of tyrosine kinase + causes low B cells production
215
What are ANCAs + what 2 organs do they affect?
Anti-neutrophil cytoplasmic antibodies + lungs and kidneys
216
2 symptoms of Wegener's/ granulomatosis with polyangitis + blood test findings + complication?
Haemoptysis and haematuria + positive cANCA + necrotising microvascular glomerulonephritis
217
Triad of Churg-Strauss + other symptom + what sex is more commonly affected + blood test result?
Asthma, eosinophilia, systemic vasculitis + haematuria + males + positive pANCA
218
What 2 pneumonias commonly cavitate?
Klebsiella and pseudomonas
219
What type of NSCLC commonly cavitates?
Sqaumous cell carcinoma
220
Which lung cancer releases Ach vs PTH?
SCLC = Ach + squamous cell carcinoma = PTH
221
Difference between extrinsic and instrinsic asthma?
Extrinsic = whole body IgE response + Intrinsic = local IgE response
222
DLCO/TLCO is low in .... and ..... and normal or high in .... ?
COPD + restrictive lung disease + asthma
223
2 skeletal conditions that cause restrictive lung disease + what they are?
Thoracic kyphoscoliosis (spine bends wrong way) + anklosing spondylitis (inflammation of the spine)
224
2 drugs that can cause alveolitis and lung fibrosis?
Amiodarone and methotrexate
225
Name 2 anti-fibrotic agents used in lung disease e.g. pulmonary fibrosis?
Perfenidone and nintedanib
226
First line drug given in an asthma attack?
Nebulised SABA
227
Hypercalcaemia is associated with which type of cancer + why?
Squamous cell + PTH controls calcium distribution
228
Why is diptheria uncommon in the UK + characteristic finding in cases?
Vaccination + a pseudomembrane
229
Name 3 immunosuppresant drugs?
Azathioprine, anti-TNF and methotrexate
230
Name 2 drugs used to correct pancreatic insufficiency in CF?
Creon and insulin
231
Right sided pleuritic chest pain?
Pneumonia
232
Ground glass CXR?
RDS of the newborn or pulmonary fibrosis
233
Postitive AGM-antibodies?
Goodpasture's
234
Positive CCP-antibodies?
RA
235
Bronchi widening + signet ring appearance on CXR?
Bronchiectasis
236
Non-smoker lung cancer?
Adenocarcinoma
237
What is rheumatic fever caused by?
Group A beta-haemolytic streptococci
238
Complication of anti-TNF used for RA?
Active TB infection
239
Narrowest part of the larynx where foreign bodies block first?
Rima glottidis
240
Vomiting, dehydrated and not taking insulin?
DKA or metabolic acidosis
241
Mucin producing cancer?
Adenocarcinoma
242
Pink puffer?
Emphysema
243
Samter's triad?
Asthma, salicylate/aspirin sensitivity and nasal polyps
244
Where is the middle lobe auscultated?
Mid-clavicular line on the right between rib 4 and 6
245
Sail sign on CXR?
Left lower lobe collapse
246
Type 1 respiratory failure is characterised by?
Hypoxaemia < 8 kPa
246
Persistent PEs would suggest need to investigate for?
Malignancy
247
Type 2 respiratory failure is characterised by?
Hypoxaemia < 8 kPa and hypercapnia > 6 kPa
249
Rheumatoid disease presents as which 3 things in the lungs + key blood finding?
Pleural thickening, fibrosis and various size of rheumatoid nodules + anti-CCP
250
Where the lung apex is auscultated?
Superior to the lateral 1/3rd of the clavicle
251
Where is the lung base auscultated posterior?
Scapular line at T11 level
252
Pink frothy sputum?
Pulmonary oedema
253
Antibiotics for gram -ve aerobes + anaeorobes?
Gentamicin + metronidazole
254
2 antibiotics used for COPD exacerbation?
Amoxicillin or doxycycline
255
2 CIs for a contrast CT?
Renal impairment and anaphylaxis
256
Herceptin and erlotinib targets what + common mutation in what type of cancer?
EGFR + adenocarcinoma
257
Yellow, well-defined lump in the bronchus?
Carcinoid tumour
258
ALP is abnormal in which type of metastasis?
Liver
259
Most common type of lung cancer?
Adenocarcinoma
260
H5N1 + H1N1 flu strain?
Avian flu + swine flu
261
Mantoux skin test?
TB infection
262
Asbestosis causes which 2 types of lung cancer?
Mesothelioma and adenocarcinoma
263
Volume of fluid needed to be clinically vs CXR detected?
500 ml and 300 ml
264
Popliteal synovial rupture?
Baker's cyst
265
Hygiene hypothesis?
Sterile environments predispose childhood hypersensitivty
266
Always aspirate pleural effusion if not caused by?
Cardiac failure
267
Pleural click?
Pneumothorax
268
Pleural rub + increased vocal resonance?
Pneumonia
269
Ending of drugs that inhibit tyrosine kinases?
Nib
270
Wedge-shaped infarct?
Pulmonary embolism
