Key facts that I may have forgotten Flashcards
What does COPD do to the large airways ?
Hyperplasia of goblet and mucous cells
Short term inflammation
Fibrosis
What does COPD do to the small airways ?
Creates the appearance of goblet cells
Long term inflammation
Fibrosis
What causes emphysema ?
As macrophages and nutrophils work they release elastase enzymes which are harmful and cause loss of surface area in the lungs. Anti-elastase enzymes are also found in the lungs to prevent the elastase enzymes from having this effect however in emphysema there is a lack of these enzymes
Is emphysema obstructive ?
yes
What is an obstructive condition ?
Problems with expiration
What is an restrictive condition ?
Problems with inspiration
What does emphysema cause ?
Reduction in gas exchange Vasoconstriction Fibrosis Thickening of blood Backup of blood Increase of resistance Cor Pulmonale
What are the different types of emphysema ?
Centri-acinar Starts with dilation of the bronchi and then causes loss of surface area in the proximal acini. This occurs in the tops of the lungs. This is common in smokers.
Panacinar Dilation of the whole acini in a whole area of the lung. Generally found at the base of the lobes. Caused by genetics.
Periacinar Dilation of the distal acini. This is very close to the edge of the lung and sometimes it bursts into the pleura and causes an pnumothroax.
Scar emphysema forms around a scar in the lungs and is clinically insignificant
What can periacinar emphysema develop into ?
pnumothroax
What is Alpha 1 Anti-trypsin deficiency ?
Causes early onset of emphysema
Alpha 1-antiprotease deficiency ?
Results in emphysema alone
What is another name for excess carbon dioxide ?
Hypercapnia
Does COPD cause clubbing?
No
How do you know if hyperinflation is present on a CXR ?
Anteriorly there are more than 6 ribs visible and posteriorly there are more than 10 ribs visible
What spirometry reading suggests it might be COPD?
FEV1/FVC < 0.7
What scale can be used to help investigate COPD ?
mMRC breathlessness scale
What is the mMRC breathlessness scale say ?
0 - breathless on extreme exercise
1 - Breathless when hurrying on the flat or walking up hill slightly
2 - Breathless when walking at your own pace
3 - Stopping for breath every hundred yards or breathless when doing normal activities
4 - Doesn’t leave house due to breathlessness
What can be used to classify the severity of COPD ?
GOLD classification
Describe the GOLD classification
Stage 1 Mild - FEV1 of predicted > 0.8
Stage 2 Moderate - FEV1 of predicted 0.5 - 0.8
Stage 3 Severe - FEV1 of predicted 0.3 - 0.5
Stage 4 very severe - FEV1 of predicted < 0.3
What is the normal FEV1/FVC score for a healthy person?
FEV1/FVC = 0.7
Describe the treatment pathway of COPD with breathlessness
SABA (Daily use) \+ LAMA (Continues breathlessness) \+ LABA No further treatment
Describe the treatment pathway of COPD with exacerbations
SABA + LAMA (Continued exacerbations) \+ LABA (Continued exacerbations) \+ referral to specialists and ICS No further treatment
What % of children have asthma ?
10-15%
What % of adults have asthma ?
5-10%
Will FeNO be high or low in asthma ?
High
Treatment of asthma in children
SABA and very low dose ICS (Use more then 2 times a week) \+ LABA (Use more then 2 times a week) \+ Low dose ICS or LTRA refer to specialist
Treatment of asthma in adults
SABA and low dose ICS (Use more then 2 times a week) \+ LABA (Use more then 2 times a week) \+ Moderate dose ICS or LTRA Refer to specialist
What asthma treatment should be given to under 5s ?
LTRA
What causes the development of bronchiectasis ?
Insult to the endothelium
What damage is caused the the endothelium in bronchiectasis ?
Loss of Eleatic fibres which causes dilation and loss of cilia which leaves the site vulnerable to infection
What nail condition can exist along side bronchiectasis ?
Yellow nail syndrome
What investigation is used to diagnose bronchiectasis ?
High resolution CT
What ratio is used to investigate bronchiectasis?
bronchoarterial ration. if it is greater then 1 then there is bronchiectasis
What are the different types of bronchiectasis ?
Cylindrical - Dilated long section
Varicose - Multiple small sections of dilation
Cystic - Multiple large sections of dilation
Three main types of treatment for bronchiectasis
Non-pharmacological i.e. chest physiotherapy
Antibiotics
Surgery
Conditions which involve exacerbations
COPD
Asthma
Bronchiectasis
How many hours after admission is the development of pneumonia considered to be hospital acquired ?
48
What are the different types of pneumonia ?
Bronchopulmonary - Small segments of pneumonia around the lung
Segmental - Pneumonia which affects the whole of a bronchopulmonary segment
Lobar - Pneumonia which affects the whole of a lobe segment
What can be used to determine the severity of pneumonia ?
CURB 65
What does CURB 65 say ?
C = Confusion U = Urea > 7 mmol/l R = RR > 30 B = BP, Systolic < 90 Diastolic < 60 65 = Age >65
Antibiotics used in pneumonia
CURB 1 - Amoxicillin or Clarithromycin or doxycycline if penicillin resistant
CURB 2 Amoxicillin and Clarithromycin and levofloxacin in penicillin resistant
CURB 3-5 - Co-Amoxiclav and Clarithromycin and or levofloxacin or co-trimoxazole
What can TB result in ?
Bronchopneumonia Miliary TB (Blood)
What test is used to determine the presence of a mycobacterium ?
AAFB
Describe how timescale for TB treatment
4 drugs for 2 months
then
2 drugs for 4 months
Name and describe the TB drugs
Isoniazid (H) - 6 months - Caused peripheral neuropathy (peripheral nerve damage), may cause hepatitis and a rash
Pyrazinamide (Z) - 2 months
- May cause gout and hepatitis and a rash
Rifampicin (R) - 2 months
- Orange ‘Irn Bru’ urine, makes oral contraception methods ineffective. prednisolone, anticonvulsants, can cause hepatitis and rash
Ethambutol (E) - 6 months
- May cause optic neuropathy (damage to eye nerves) and a rash
What does SABA stand for ?
Short acting B agonist
What does LAMA stand for ?
Long acting muscarinic antagonist
What does LABA stand for ?
Long acting B agonist
What does LTRA stand for ?
Leukotriene receptor antagonists
What are primary and secondary pneumothorax ?
A primary spontaneous pneumothorax occurs mainly in tall, thin, healthy, young men. A small puncture in an alveoli creates a small collection of air in the surrounding tissue. This can busrt releasing air into the pleura creating a pneumothorax. A secondary spontaneous pneumothorax occurs as a result of an underlying health condition such as COPD, asthma, interstitial lung disease, cystic fibrosis etc.
What is the surgery which can be offered to pneumothorax patients ?
Pleurodesis
When is pleurodesis offered ?
Still leaking air after 5-7 days
Lung has no expanded after 5-7 days
Air pilots and other very specific occupations
recurrent pneumothorax
Are class 1-3 cystic fibrosis severe or mild ?
Severe
What conditions often co-exist with cystic fibrosis ?
Diabetes
Osteoporosis
Pneumothorax
tests for cystic fibrosis
Antenatal test if parent or sibling with the disease
Guthrie test
Sweat test
Faecal elastase will also be elevated
Treatment for cystic fibrosis
- Antibiotics for infections
- Chest physio
- High protein high calory diet
- Replacement pancreatic enzymes
- transplants
- Bronchodilators
describe how peripheral stem cells cause cancer to develop
peripheral stem cells
adenomatous hyperplasia
adenocarcinoma
invasive adenocarcinoma
describe how central stem cells cause cancer to develop
central stem cells
hyperplasia
squamous dysplasia and carcinoma in situ
invasive squamous carcinoma
What is the main cause of lung cancer involving the central stem cells
smoking
What is the doubling time of non-small cell lung cancer?
129 days
What is the doubling time of small cell lung cancer?
29 days
describe T in cancer staged ?
Tx - unable to measure size T0 - no tumour T1 - <3cm T2 - 3-5cm T3 - 5-7cm T4 - > 7cm
describe N in cancer staged ?
N0 - No nodal involvement
N1 - Involvement of the immediate lymph nodes on the side of the tumour =
N2 - Involvement of the thoracic lymph nodes on the side of the tumour
N3 - Involvement of the thoracic lymph nodes on the other side from the tumour
describe M in cancer staged ?
M1a - Tumour on other side of thorax
1b - Tumour other side the thorax
1c - Multiple tumours outside the thorax
Names of the three types of non-small cell lung cancer
Adenocarcinoma
Squamous cells
Large cell carcinoma
Types of lung cancer surgery
Wedge resection - Removal of just the tumour
Lobectomy - Removal of a lobe of the lung
Pneumonectomy - removal of one lung
Open and close thoracotomy
FEV1 score required for a lobectomy
> 1
FEV1 score required for a pneumonectomy
> 2
What is the normal course for radiotherapy ?
55Gy in 20 fractions
What is the normal course length for a course of SABR
54Gy in 3 fractions
What is the most common cause of acute epiglottitis
Group A streptococcus
What causes rusty brown sputum in pneumonia ?
streptococcus
What is another name for acute epiglottitis in adults ?
supraglottis
What is the treatment for acute epiglottitis
IV antibiotics, anaesthetic, and sometimes steroids
What is the treatment of croup ?
Oral dexamethasone to all patients. Nebulised adrenaline in sever cases.
What is the treatment of tracheitis ?
Antibiotics Augmentin
What conditions might you not need to treat ?
Bronchitis Bronchiolitis Pneumothorax Sarcoidosis Laryngomalacia Tracheomalacia
What is the treatment of emphyema ?
IV antibiotics and sometimes a chest drain
What criteria can be used to differentiate between exudate and transudate effusions?
pleural effusion vs serum protein. < 0.5 then transudate
Pleural effusion to serum LDL ratio. <0.6 the transudate
Pleural effusion to the upper limit of normal LDL. < 2/3 then transudate
Is sarcoidosis restrictive or obstructive ?
restrictive
What is used to investigate sleep apnoea ?
Epworth questionnaire
Classifications of sleep apnoea
per hour Severe = 30 Moderate = 15-30 Mild = 5-15 unconquering 0-5
What score is used in pulmonary embolism ?
Well score
What does the wells score say
recent surgery = 1.5 symptoms = 3 previous PE or DVT = 1.5 Haemoptysis = 1 Malignancy = 1 HR > 25 = 1.5 More likely than other diagnosis =3 greater then 4 means PE is likely
Describe how a PE is diagnosed.
Draw it
What is the bench mark for what pulmonary hypertension is ?
> 25mmHg
treatment for tonsillitis/Pharyngitis
10 days of penicillin if bacterial
All the different blood pressure in hypertension
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MI timeline
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What other bio markers can be used when looking for MI other than troponin
CK/MB and myoglobin
What is the CCS ?
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What are the different types of stroke ?
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What is the New York classification score ?
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What are the ranges of LVEF results ?
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Two types of chronic heart failure and there code names
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