passmed qs Flashcards
What is transfer factor
describes the rate at which a gas will diffuse from alveoli into blood
Carbon monoxide is used to test the rate of diffusion.
causes of raised transfer factor
asthma
pulmonary haemorrhage (Wegener’s, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
what causes a lower tlco
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
what would cor pulmonale show on ecg
peaked p waves
allergy related asthma would lead to an increase in what type of immune cell
eosinophills
typical spirometry results for asthma
FEV1 - significantly reduced
FVC - normal
FEV1% (FEV1/FVC) < 70%
life threatening feature of an asthma attack
silent chest
what does IL 4 5 13 do in asthma
IL-4: Facilitates class switching to IgE
IL-5: Facilitates release of eosinophils
IL-13: Stimulates mucus production
type 2 resp failure ?
low PaO2 and high PaCO2)
feautures of a severe asthma attack
oxygen saturations <90%, peak expiratory flow rate <33% of best, silent chest, bradycardia, hypotension, exhaustion
what can be seen on histology for asthma
Curschmann spirals can be seen on histology, which are where shed epithelium becomes whorled mucous plugs
a wedge shaped opacification on cxr would indicate
Pulmonary embolism
meigs syndrome is characterised by
benign ovarian tumor
pleural effusion
ascites
How can marfans cause a spontaneous pneumothorax
- increases rf
- increased stress on the lungs from being tall
most common organisms isolated from patients with bronchiectasis
haemophilus influenzae - mc
p aeruginosa
klebs
s pneumoniae
patient with recurrent bronchiectasis should be treated with ?
prophylactic abx
common finding on auscultation for pneumonia
increased tactile vocal fremitus and dull percussion note
flu like illness, dry cough, erythema multiforme and evidence of anaemia would suggest
lower resp tract infection with mycoplasma pneumonia
most likely causative organism for patients with pneumonia returning from holiday
Legionella pneumophilia
- inhalation or aspiration of unsanitary water such as in showers supplied by poorly maintained water tanks
patients who are allergic to penicillin cant also have ?
co - amixoclav
best investigation for atypical pneumonia
polymerase chain reaction
infective resp symptoms + alcohol=
klebsiella
upper lobe
what stain would you use for pneumocystitis jiroveci
silver stain
mechanism of rifampic
inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA
Reactivation of tuberculosis is/are most characteristically caused by:
corticosteroids
infliximab
etanercept
Isoniazid mechanism and SE
inhibits mycolic acid synthesis
peripheral neuropathy
quadruple therapy drugs for tb
ethambutol, isoniazid, pyrazinamide, rifampicin
what tb drug can cause visual acuity and color vision difficulties
ethambutamol
cavitating lesions are common in what type of lung cancer
squamous cell carcinoma
svc obstruction due to small cell lung cancer treatment ?
iv dexamethasone
patients with sclc and LEMS would present with
- limb weakness normally lower limbs
- dry mouth
- impotence
- difficulty urinating
PTHrp and hypercalcaemia are associated with lung cancer
Squamous cell carcinoma
Small cell lung cancer can cause what paraneoplastic syndrome
Cushings
Addisons
Where does adenocarcinoma arise from
Bronchial glands
fine end inspiratory crackles on auscultation and clubbing?
pulmonary fibrosis
right sided pleuritic chest pain
pneumonia
normal fev1/ fvc ratio
70%
does sarcoidosis feature caesating or non caseating granuloma
non caseatign
typocal px of sarcoidosis
Black female 20-40 , dry dough, erthema nodosum, worsening dyspnoea
raised ACE levels think ?
sarcoidosis
Which ECG feature would be most consistent with a diagnosis of pulmonary hypertension?
p pulmonaelae
what is bosentan and what should be monitored alongside
endothelin -a receptor agonist
liver function tests
What bacteria is most likely to cause Otis media
Streptococcus pneumonias
Haemophilia influenzas
A patient as ptosis, anhydrosis and miosis ?
Horner syndrome
Pancoast tumor that affects the apex
Ipsilateral
Thick and dark green sputum would make you think ?
Bronchiectasis
tb on cxr would show
Bilateral hilar lymphadenopahty
ghon focus
ranke complex
what conditions cause finger clubbing
bronchiectasis
mesotheliona
idopathic pulmonary fibrosis
lung abscess
tumor marker for liver cancer
ca-19-9
