PBL Flashcards

1
Q

what are the causes of CF

A

genetic mutation in CFTR

which is recessively inherited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

classes of CF

A

there are 5 classes of CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

class 1 CF

A

shortened protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

class 2 CF

A

F508del, the CFTR protein is not being transported to the surface of the cells in which it is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

class 3 CF

A

CFTR protein forms a channel in the cell surface, the gate at the end of the channel doesn’t open and close at the right time .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

class 4 CF

A

changes in the shape of the protein channel so chloride ions cannot move easily in and out of the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

class 5 CF

A

results in reduced amount of CFTR protein produced by the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the most common CFTR mutation?

A

f508del - loss of phenylalnine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

another common CFTR mutation

A

Gly551Asp which causes a mutant chloride ion channel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the symptoms of CF?

A
recurring chest infections due to increased production of sputum 
coughing
wheezing
SOB
jaundice
diarrhoea
constipation
difficulty putting on weight and growing
damage to airways - bronchiectasis 
bowel obstruction in newborns
diabetes
infertility
weakened bones 
gasto oesophageal reflux disease due to increased coughing, delayed emptying of the stomach and high fat diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

underlying cause of the symptoms of CF

A

thick, sticky mucus clogs the lungs
restricted lung function due to thickening of the walls of the airways
tubes transporting enzymes from pancreas to small intestine become blocked by mucus and so enzymes build up and causes the pancreas to become inflamed and the enzymes cannot digest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

treatment and management of CF

A
no cure
regular appointments to monitor the condition 
care plan
antibiotics for chest infections
medicines to make the mucus thinner - dornase alfa, hypertonic saline and mannitol dry powder 
medicine to reduce mucus - ivacaftor and lumacaftor 
bronchodilators
steroids
vaccinations 
physio 
nutrition advice 
high calorie diet
supplements
pancreatic enzyme replacement therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

physio for CF

A

active cycle of breathing techniques - deep breathing, huffing, coughing and relaxed breathing to remove mucus
autogenic drainage - gentle controlled breathing techniques
airway clearance devices - vibration and air pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CF appointments

A

seen in outpatients by an MDT every 2 months. Symptoms and growth is assessed, screened for chest infections and medication reviewed .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pneumonia

A

inflammation of the tissue in one or both lungs caused by bacterial infection most often . the alveolar sacs become inflamed and fill with fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the causes of pneumonia?

A
bacteria
fungi
virus
aspiration
hospital acquired
ventilator associated
17
Q

what are risk factors for pneumonia?

A

babies/ very young children
elderly
smokers
people with other health conditions - asthma, CF, heart/ kidney/ liver conditions
people with weakened immune systems - recent illness, HIV/AIDs, chemotherapy or immunosuppressant use

18
Q

symptoms of pneumonia

A
coughing 
SOB
fever
tachycardia
difficulty breathing 
tiredness
loss of appetite
chest pain that is worse when coughing
headaches
wheezing
joint and muscle pain
confusion 
coughing up blood 
sweating
shivering 
nausea
19
Q

diagnosis of pneumonia

A
respiratory history
respiratory examination
check vitals
auscultation
percussion
chest x-ray
blood test
sputum test
pulse oximetry
CT scan and pleural fluid = rare
20
Q

treatment for pneumonia

A

mild can be treated at home with rest, antibiotics and hydration
cough medicine
aspirin and ibuprofen to reduce fever
ITU if ventilation needed
different antibiotics are used depending on infection, PMH, patterns of local antibiotic resistance, cost, age, weight, allergies and previous antibiotic use

21
Q

what are first line antibiotics for pneumonia?

A

macrolide - clarithromycin

tetracycline - doxycycline

22
Q

complications of pneumonia

A
common in young children and those with pre-existing health conditions
pleurisy
lung abscess
blood poisoning - sepsis
requires admission to hospital
23
Q

what is popcorn lung?

A

nickname for bronchiolitis obliterans. Damages the smallest airways.
Bronchioles and alveoli become irritated and inflamed, causing scarring and narrowing of bronchioles

24
Q

what are the symptoms of bronchiolitis obliterans?

A

coughing - dry
SOB
wheeze with no other explanation
tired with no other explanation

25
Q

diagnosis of bronchiolitis obliterans

A

respiratory history - occupation/ social is important
lung function tests
CT of chest
biopsy

26
Q

treatment of bronchiolitis obliterans

A
protection from harmful chemicals
antibiotics and steroids to ease inflammation
immunosuppressants 
cough medicine
bronchodilators
oxygen
27
Q

who makes up a respiratory specialist team?

A
respiratory physician
career grade doctors
doctors in training
ward-based and outpatient nurses
respiratory nurse specialists
respiratory physiologists
clinical scientists
physios
psychologists
28
Q

kalydeco

A

ivacaftor
improves the transport of chloride ions through the channel by binding to the channels directly to induce a non-conventional mode of gating which increases the probability that channel is open

29
Q

issues with Kalydeco

A

UK agencies estimated cost per QALY between £335,000 and £1,274,000 - way above the NICE threshold

30
Q

when to seek genetic counselling?

A

when a genetic test is done
before and after presymptomatic testing
before and after diagnostic testing
when there is family history of a genetic condition
abnormal results from routine prenatal testing
amniocentesis identifying chromosomal defect
inherited disease present in close family member
multiple pregnancy losses
couple are both carriers of a genetic disorder
carrier of chromosomal abnormalities
member of certain ethnic groups
pregnancy involves blood relatives/ incest
older mother
mothers blood tests show increase risk of neural tube defects, downs or trisomy 18
baby/ parental exposure to harmful substances - radiation, infection, drugs and chemicals
older father
infertility
couples who need fertility treatments

31
Q

what are the short-term effects of smoking?

A
bad breath
fatigue
decrease in energy 
reduction in taste and smell
coughing
SOB
irritation of trachea and larynx 
wheezing
32
Q

what are the long-term effects of smoking?

A
problems with heart and blood vessels
reduced lung function
swelling and narrowing of airways
excessive mucus production 
build up of poisonous substances
lung irritation and damage 
increased risk of lung infection
wheezing
asthma
coughing
COPD
lung cancer
emphysema
33
Q

what factors affect drug administration?

A

the type of substance the drug is
pharmacokinetics
practical factors - unconscious/ breathless etc.
dosage