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MAY MEDICINE 1 REVISION > Key facts that I may have forgotten > Flashcards

Key facts that I may have forgotten Flashcards

1
Q

What does COPD do to the large airways ?

A

Hyperplasia of goblet and mucous cells
Short term inflammation
Fibrosis

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2
Q

What does COPD do to the small airways ?

A

Creates the appearance of goblet cells
Long term inflammation
Fibrosis

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3
Q

What causes emphysema ?

A

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

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4
Q

Is emphysema obstructive ?

A

yes

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5
Q

What is an obstructive condition ?

A

Problems with expiration

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6
Q

What is an restrictive condition ?

A

Problems with inspiration

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7
Q

What does emphysema cause ?

A 
Reduction in gas exchange 
Vasoconstriction 
Fibrosis 
Thickening of blood 
Backup of blood 
Increase of resistance
Cor Pulmonale
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8
Q

What are the different types of emphysema ?

A

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

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9
Q

What can periacinar emphysema develop into ?

A

pnumothroax

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10
Q

What is Alpha 1 Anti-trypsin deficiency ?

A

Causes early onset of emphysema

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11
Q

Alpha 1-antiprotease deficiency ?

A

Results in emphysema alone

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12
Q

What is another name for excess carbon dioxide ?

A

Hypercapnia

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13
Q

Does COPD cause clubbing?

A

No

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14
Q

How do you know if hyperinflation is present on a CXR ?

A

Anteriorly there are more than 6 ribs visible and posteriorly there are more than 10 ribs visible

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15
Q

What spirometry reading suggests it might be COPD?

A

FEV1/FVC < 0.7

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16
Q

What scale can be used to help investigate COPD ?

A

mMRC breathlessness scale

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17
Q

What is the mMRC breathlessness scale say ?

A

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

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18
Q

What can be used to classify the severity of COPD ?

A

GOLD classification

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19
Q

Describe the GOLD classification

A

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

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20
Q

What is the normal FEV1/FVC score for a healthy person?

A

FEV1/FVC = 0.7

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21
Q

Describe the treatment pathway of COPD with breathlessness

A 
SABA 
(Daily use)
\+ LAMA 
(Continues breathlessness)
\+ LABA 
No further treatment
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22
Q

Describe the treatment pathway of COPD with exacerbations

A 
SABA + LAMA 
(Continued exacerbations)
\+ LABA 
(Continued exacerbations)
\+ referral to specialists and ICS
No further treatment
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23
Q

What % of children have asthma ?

A

10-15%

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24
Q

What % of adults have asthma ?

A

5-10%

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25
Q

Will FeNO be high or low in asthma ?

A

High

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26
Q

Treatment of asthma in children

A 
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
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27
Q

Treatment of asthma in adults

A 
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
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28
Q

What asthma treatment should be given to under 5s ?

A

LTRA

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29
Q

What causes the development of bronchiectasis ?

A

Insult to the endothelium

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30
Q

What damage is caused the the endothelium in bronchiectasis ?

A

Loss of Eleatic fibres which causes dilation and loss of cilia which leaves the site vulnerable to infection

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31
Q

What nail condition can exist along side bronchiectasis ?

A

Yellow nail syndrome

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32
Q

What investigation is used to diagnose bronchiectasis ?

A

High resolution CT

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33
Q

What ratio is used to investigate bronchiectasis?

A

bronchoarterial ration. if it is greater then 1 then there is bronchiectasis

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34
Q

What are the different types of bronchiectasis ?

A

Cylindrical - Dilated long section
Varicose - Multiple small sections of dilation
Cystic - Multiple large sections of dilation

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35
Q

Three main types of treatment for bronchiectasis

A

Non-pharmacological i.e. chest physiotherapy
Antibiotics
Surgery

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36
Q

Conditions which involve exacerbations

A

COPD
Asthma
Bronchiectasis

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37
Q

How many hours after admission is the development of pneumonia considered to be hospital acquired ?

A

48

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38
Q

What are the different types of pneumonia ?

A

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

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39
Q

What can be used to determine the severity of pneumonia ?

A

CURB 65

40
Q

What does CURB 65 say ?

A 
C = Confusion 
U = Urea > 7 mmol/l
R = RR > 30 
B = BP, Systolic < 90 Diastolic < 60
65 = Age >65
41
Q

Antibiotics used in pneumonia

A

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

42
Q

What can TB result in ?

A 
Bronchopneumonia
Miliary TB (Blood)
43
Q

What test is used to determine the presence of a mycobacterium ?

A

AAFB

44
Q

Describe how timescale for TB treatment

A

4 drugs for 2 months
then
2 drugs for 4 months

45
Q

Name and describe the TB drugs

A

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

46
Q

What does SABA stand for ?

A

Short acting B agonist

47
Q

What does LAMA stand for ?

A

Long acting muscarinic antagonist

48
Q

What does LABA stand for ?

A

Long acting B agonist

49
Q

What does LTRA stand for ?

A

Leukotriene receptor antagonists

50
Q

What are primary and secondary pneumothorax ?

A

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.

51
Q

What is the surgery which can be offered to pneumothorax patients ?

A

Pleurodesis

52
Q

When is pleurodesis offered ?

A

Still leaking air after 5-7 days
Lung has no expanded after 5-7 days
Air pilots and other very specific occupations
recurrent pneumothorax

53
Q

Are class 1-3 cystic fibrosis severe or mild ?

A

Severe

54
Q

What conditions often co-exist with cystic fibrosis ?

A

Diabetes
Osteoporosis
Pneumothorax

55
Q

tests for cystic fibrosis

A

Antenatal test if parent or sibling with the disease
Guthrie test
Sweat test
Faecal elastase will also be elevated

56
Q

Treatment for cystic fibrosis

A
  • Antibiotics for infections
  • Chest physio
  • High protein high calory diet
  • Replacement pancreatic enzymes
  • transplants
  • Bronchodilators
57
Q

describe how peripheral stem cells cause cancer to develop

A

peripheral stem cells
adenomatous hyperplasia
adenocarcinoma
invasive adenocarcinoma

58
Q

describe how central stem cells cause cancer to develop

A

central stem cells
hyperplasia
squamous dysplasia and carcinoma in situ
invasive squamous carcinoma

59
Q

What is the main cause of lung cancer involving the central stem cells

A

smoking

60
Q

What is the doubling time of non-small cell lung cancer?

A

129 days

61
Q

What is the doubling time of small cell lung cancer?

A

29 days

62
Q

describe T in cancer staged ?

A 
Tx - unable to measure size 
T0 - no tumour 
T1 - <3cm
T2 - 3-5cm 
T3 - 5-7cm 
T4 - > 7cm
63
Q

describe N in cancer staged ?

A

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

64
Q

describe M in cancer staged ?

A

M1a - Tumour on other side of thorax
1b - Tumour other side the thorax
1c - Multiple tumours outside the thorax

65
Q

Names of the three types of non-small cell lung cancer

A

Adenocarcinoma
Squamous cells
Large cell carcinoma

66
Q

Types of lung cancer surgery

A

Wedge resection - Removal of just the tumour
Lobectomy - Removal of a lobe of the lung
Pneumonectomy - removal of one lung
Open and close thoracotomy

67
Q

FEV1 score required for a lobectomy

A

> 1

68
Q

FEV1 score required for a pneumonectomy

A

> 2

69
Q

What is the normal course for radiotherapy ?

A

55Gy in 20 fractions

70
Q

What is the normal course length for a course of SABR

A

54Gy in 3 fractions

71
Q

What is the most common cause of acute epiglottitis

A

Group A streptococcus

72
Q

What causes rusty brown sputum in pneumonia ?

A

streptococcus

73
Q

What is another name for acute epiglottitis in adults ?

A

supraglottis

74
Q

What is the treatment for acute epiglottitis

A

IV antibiotics, anaesthetic, and sometimes steroids

75
Q

What is the treatment of croup ?

A

Oral dexamethasone to all patients. Nebulised adrenaline in sever cases.

76
Q

What is the treatment of tracheitis ?

A

Antibiotics Augmentin

77
Q

What conditions might you not need to treat ?

A 
Bronchitis 
Bronchiolitis 
Pneumothorax 
Sarcoidosis 
Laryngomalacia 
Tracheomalacia
78
Q

What is the treatment of emphyema ?

A

IV antibiotics and sometimes a chest drain

79
Q

What criteria can be used to differentiate between exudate and transudate effusions?

A

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

80
Q

Is sarcoidosis restrictive or obstructive ?

A

restrictive

81
Q

What is used to investigate sleep apnoea ?

A

Epworth questionnaire

82
Q

Classifications of sleep apnoea

A 
per hour 
Severe = 30 
Moderate = 15-30 
Mild = 5-15 
unconquering 0-5
83
Q

What score is used in pulmonary embolism ?

A

Well score

84
Q

What does the wells score say

A 
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
85
Q

Describe how a PE is diagnosed.

A

Draw it

86
Q

What is the bench mark for what pulmonary hypertension is ?

A

> 25mmHg

87
Q

treatment for tonsillitis/Pharyngitis

A

10 days of penicillin if bacterial

88
Q

All the different blood pressure in hypertension

A

-

89
Q

MI timeline

A

-

90
Q

What other bio markers can be used when looking for MI other than troponin

A

CK/MB and myoglobin

91
Q

What is the CCS ?

A

-

92
Q

What are the different types of stroke ?

A

-

93
Q

What is the New York classification score ?

A

-

94
Q

What are the ranges of LVEF results ?

A

-

95
Q

Two types of chronic heart failure and there code names

A

-

MAY MEDICINE 1 REVISION (23 decks)

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