Lectures Flashcards
How do cromones work? e.g. cromoglycate
Mast cell stabiliser
Which drug is effective in atopic children?
Cromoglycate
Leukotriene receptor antagonists
Which leukotriene plays a big role in asthma?
LTD4
How is montelukast taken?
Orally, once daily
What is omalizumab?
Anti-IgE monoclonal antibody
How is omalizumab given?
Given as an injection every 2-4 weeks
What are Mepolizumab and Reslizumab?
Anti-IL5
Injection every 4 weeks
Name a mucolytic
Carbocisteine, ersoteine
reduce sputum viscosity, aid sputum expectoration
Is asthma better in the morning or night?
Better in the night
Raised ACE and Ca
Sarcoid
Erythema nodosum
Non-caseating granuloma
Bilateral hilar lymphadenopathy
Sarcoidosis
Which drugs could you use for bronchial challenge testing?
Metacholine, histamine, mannitol
How do you test static lung volume?
Use helium dilution/N2 washout
Increased total lung capacity in emphysema (hyperinflation)
Decreased total lung capacity in restrictive lung disease
How would you monitor treatment in interstitial lung disease?
TLCO
How would you measure airway resistance?
Either with whole body plethysmography or impulse oscillometry
What do high levels of exhaled NO mean?
Reflect uncontrolled asthmatic inflammation
Why can you not use exhaled nitric oxide in COPD?
Nitric oxide suppressed by smoking
Thermophilic bacteria
Farmers lung
Avian proteins
Bird fanciers lung
Fungi EAA
Malt workers lung
Blood finding in sarcoidosis
Hypercalcemia
What is pneumoconiosis
Lung disease caused by mineral dust (e.g. asbestos, coal workers lung, silicosis)
Which type of asbestos is highly dangerous
Amiphibole (straight fibres)
What is Cor pulmonale?
Pulmonary hypertension complicating lung disease
PTH
Sqaumous cell cancer
ACTH
Small cell lung cancer
Keratinising cancer
Squamous cell
Gland forming
Adenocarcinoma
Lung cancer treatment
Small cell - chemotherapy
All others - surgery
Which type of cancer expresses TTF (thyroid transcription factor)
Adenocarcinoma
Which type of cancer expressed p63 and high molecular weight cytokeratins?
Squamous cell
Name 3 oncogenes
myc
K-ras
Her2(neu)
Name a tumour suppressor gene
P53
Talk to me about the EGFR gene mutation
Seen almost exclusively in adenocarcinomas (especially in non smokers and in asian populations)
These tumours respond to tyrosine kinase inhibitors (erlotinib)
What type of hypersensitivity reaction is sarcoidosis?
Type IV
Non-caseating granuloma
Sarcoidosis
Activity marker for Sarcoidosis?
ACE (activity level not diagnostic test)
Treatment for sarcoidosis
Usually self-limiting
Steroids if vital organ affected/chronic
What type of hypersensitivity reaction is EAA?
Type III (immune complex deposition)
CXR - pulmonary fibrosis most commonly in the upper zones
EAA
reticulonodular fibrotic shadowing, worse at the lung bases, and periphery. Traction bronchiectasis. Honey-combing cystic changes
Idiopathic pulmonary fibrosis
What is Caplans syndrome?
Rheumatoid pneumoconiosis (pulmonary nodules)
What is simple pneumoconiosis?
chest X-ray abnormality only (no impairment of lung function - often associated with chronic obstructive pulmonary disease)
Egg shell calcification of hilar nodes
Silicosis
Chemotherapy side effects
Nausea and vomiting Tiredness Bone marrow suppression (infection/anaemia) Hair loss Pulmonary fibrosis
Most common type of lung cancer in non-smokers
adenocarcinoma
i think adenocarcinoma is also the most common type overall now
Most common type of lung cancer in smokers
Sqaumous
Which nerve involved in hoarseness?
Recurrent laryngeal nerve
What causes a pancoast tumour?
Brachial plexus invasion - wasting of the muscles of the hand etc
Why might you get distended external jugular vein, puffy eyelids and headache in lung cancer?
Involvement of the SVC
Which type of lung cancer most frequently associated with paraneoplastic syndrome?
Small cell
Why might you see thrombophelbitis in cancer patients?
because their blood is hypercoagulable
What investigation MUST you do in anyone with new onset finger clubbing?
MUST do a CXR
Which type of lung cancer would you usually see hypercalcaemia in?
Squamous cell
Which type of cancer would you usually see SIADH in?
Small cell
Treatment for SIADH in lung cancer
Treat underlying cause
Fluid restriction (1.5L/day)
Sometimes need demeclocycline
Frist line investigation of DVT
Ultrasound doppler scane
Name 2 direct inhibitors of Xa
Rivaroxiban
Apixaban
ABG in PE
Type 1 resp failure = decreased PaO2, decreased SaO2, normal or low PaCO2
Good test for small peripheral emboli
V/Q scan
Name three type of granulocyte?
BEN
Basophils
Eosinophils
Neutrophils
Name two type of agranulocytes
Lymphocytes, monocytes
What do developing red cells need?
Developing red cells still have a nucleus and need vitamin B12 and folate for the nucleus to mature before its removal
Microcytic anaemia
Iron deficiency (i.e. chronic blood loss)
Macrocytic anaemia
Vitamin B12/folate deficiency (nuclear defects)
Alcohol excess, liver disease, hypothyroidism
Normocytic anaemia
Acute blood loss
Anaemia of chronic disease (e.g. inflammation, infection)
Causes of raised platelets
Acute or chronic blood loss
Inflammation
Malignancies
Causes of low platelets
Liver disease
Consumption (autoimmune or fibrin clot)
“trapping” (enlarged spleen)
Target cells
Liver disease
Red cell fragments
Valvular heart disease
What is secondary haemostasis
Fibrin clot formation
What is primary haemostasis?
When a platelet plug forms
Innate immune system
Macrophages
Neutrophils
Mast cells
Natural killer cells
Complement proteins
Acute phase proteins
Cytokines
Acquired immune system
T lymphocytes
B lymphocytes
What is Kostmann syndrome?
Severe congenital neutropenia
The most severe form of SCID?
Reticular dysgenesis (primary failure to produce neutrophils)
Kostmann syndrome inheritance pattern
Autosomal recessive
Kostmann syndrome management
Prophylactic antibiotics, antifungals
Stem cell transplantation
Granulocyte colony stimulating factor
Characteristic finding of diptheria
Diptheria
What is a normal Epworth scale?
<10/24
