Pulmonology Flashcards

Question

How does primary ciliary dyskinesia present?

Answer 1

Usually from birth Blocked nose in neonatal period Term with resp distress Middle ear infections, sinusitis, sinus invertus Bronchiectasis

Answer 2

CF related Non-CF related - focal >FB >endobronchial masses - generalised >HIV related >TB >primary immunodeficiency >primary ciliary dyskinesia >aspiration (cleft palate)

Answer 3

Trigger (infection) → inflammation of airway → ineffective pulmonary defense → sputum hypersecretion → impaired ciliary clearance → lung damage (dilation and distortion)→ infection...

Answer 4

Clubbing Chest deformities Air trapping Failure to thrive Stunting Cor-pulmonary Pulmonary hypertension

Answer 5

Halitosis Cough (productive and chronic) Haemoptysis

Answer 6

Physio daily Antibiotics for acute exacerbations (2/52 amoxicillin-clav) Immunisations Immuno-modulation of airway inflammation with azithromycin (only in some patients) Lobectomy Treat underlying cause

Answer 7

A disease caused by a defect in the Cl- channel (mutation in CFTR gene on chromosome 7) leading to movement of Cl- intracellularly followed by Na and water leading to viscous, concentrated luminal contents. Leads to mucus plugging and recurrent infections.

Answer 8

Chronic infiltration of lymphocytes due to a dysregulated immune response with HIV/EBV interaction

Answer 9

Anaphylaxis is a medical emergency which requires prompt recognition and treatment. It occurs due to a massive release of inflammatory mediators from mast cells and basophils commonly triggered by some foods, drugs, insect venom and latex. Or A severe life threatening generalised or systemic hypersensitivity reaction

Answer 10

Hens eggs Peanuts Milk Tree nuts Fish Shellfish Seeds

Answer 11

Swelling of tongue, lips +- throat Runny nose CVS - fast/slow HR, low BP Skin - hives, itching, flushing CNS - LOC, dizziness, confusion, headache, anxiety GI - abdominal pain, diarrhoea, vomiting Genitourinary - loss of bladder control Resp - SOB, wheeze/stridor, hoarseness, cough, pain on swallowing

Answer 12

One of 3 ① acute onset illness with involvement of skin/mucosa AND airway compromise /hypotension ② two + after allergen exposure: > skin/mucosa > resp compromise > hypotension /associated signs > GI sx ③ hypotension after exposure to a known allergen = low bp for age or >30% in systolic bp

Answer 13

Adrenalin Alpha 1 = smooth muscle contraction → peripheral vasoconstriction, improves coronary artery perfusion Alpha 2 = smooth muscle contraction, inhibits release inflam mediators Beta = increases myocardial contraction, smooth muscle relaxation, bronchodilator

Answer 14

Eliminate exposure Give 0,01ml/kg Adrenalin IM stat (repeat every 5min as needed) Call for help Place in recumbent position with lower limbs elevated Give supplemental O2 Administer IV fluids for resus

Answer 15

Hydrocortisone every 4-8hrs for 24hrs Asthmatic = bronchodilators (acute max still adrenaline) Antihistamine - flushing, purities, urticaria Glucagon - positive ionotropic affect on heart

Answer 16

Fixed doses Junior = 0,15mg Adult = 0,3mg Single dose

Answer 17

Previous severe anaphylaxis to food/latex/aeroallergens Coexistence unstable/severe asthma with food allergy Exercise induced anaphylaxis Idiopathic anaphylaxis Untreated venom allergy with systemic reactions Underlying mast cell disorder with previous systemic reactions

Answer 18

Fixed doses Expensive Single dose Limited shelf life Limited availability

Answer 19

Any reproducible, abnormal, non-physiologically mediated reaction to food. (Immune = food allergy/non-immune related = food intolerance)

Answer 20

Adverse health reaction arising from a specific immune response that occurs reproducibly on exposure to given food

Answer 21

Non-immune mediated reaction to food that include toxic, metabolic, pharmacological and undefined mechanisms

Answer 22

The presence of IgE antibodies, induced in a susceptible individual after exposure to allergens. (Doesn’t necessarily or relate with clinical symptoms)

Answer 23

Atopic eczema (severe and early onset) Prolonged allergen avoidance Dietary factors - vitamin D deficiency - reduced intake omega 3 poly-unsaturated fatty acids - reduced consumptions of antioxidants - obesity Increased hygiene and reduced exposure to microbes

Answer 24

IgE mediated Non IgE mediated Mixed

Answer 25

Which food suspected How long after ingestion is reaction (IgE normally 20min-2hrs) - non-IgE mediated usually >48hrs Description of reaction Route of exposure (aero/ingestion/skin) Any reaction of other foods Any associated allergic disease/drugs/history

Answer 26

Immediate onset (minutes -2hrs) Skin - acute urticaria and angioedema, pruritis, flushing GI - vomiting, diarrhoea, abdo cramps, itching of lips and mouth Resp - wheeze, stridor, rhinitis Multisystemic - anaphylaxis Behavioural - “feeling of impending doom” in adults, child irritable

Answer 27

Delayed response Food protein-induced enterocolitis syndrome -vomiting, diarrhoea, hypotonia, pallor severe -associated rice, soya, oats, fish, Allergic proctocolitis -fresh bloody/mucous stool in thriving baby -cows milk Coeliac disease -autoimmune of small intestine -malabsorption, bloating, anaemia -gluten protein = gliden Food protein-induced pulmonary haemosiderosis -bleeds into GI tract and lungs -iron def anaemia -failure to thrive -Pulmonary haemosiderosis -cows milk

Answer 28

Eosinophilia oesophagitis Oesinophilic gastroenteritis Asthma Atopic dermatitis

Answer 29

Oral food challenge = gold standard ** done b6 specialist/ experienced doctor Skin testing IgE specific IgE testing by specialist

Answer 30

Blind (anxious patients/caregivers) Open

Answer 31

No specific tests Elimination-reintroduction diet History Endoscopy Biopsy

Answer 32

Milder reaction = prompt dose of quick acting antihistamine Sx of anaphylaxis = IM injection Adrenalin ABC

Answer 33

Education - not curable, read food labels, early recognition, how to treat themselves Emergency plan Dietary - cornerstone. avoid food

Answer 34

1) call a cold a cold 2) cough + no tachypnoea = URTI 3) use AB only if really needed 4) high dose 5) short course 6) treat acute otitis media if severe otalgia/red drum 7) acute bacterial sinusitis diagnose only if sx >10days 8) healthy children get frequent URTI’s 9) avoid OTC medications 10) practice hand sneeze hygiene

Answer 35

Progressive increase in typical asthma symptoms not relieved by normal bronchodilator therapy

Answer 36

Asthma attack with associated resp arrest/hypercapnia

Answer 37

1) Any sign of severe/life threatening asthma 2) moderately severe asthma not responding to B-agonist therapy 3) home circumstances which do not allow for safe/reliable treatment

Answer 38

1) high flow oxygen 2) short acting beta agonist (2 puffs up to 2 minutes up to 10puffs - assess/repeat every 20-30 mins) or salbutamol via nebs 2.5-5mg 3) corticosteroids - oral 1mg/kg/day for 3-5days or IV if life threatening 4) Short acting masculinisation agonist 5) magnesium sulphate if poor response to treatment

Answer 39

Inflammation of trachea, larynx and +- bronchi Barking cough, hoarseness, stridor

Answer 40

1: inspiratory stridor 2: inspirator stridor + passive expiratory stridor 3: inspirator stridor + passive expiratory stridor + pulses paradoxis 4: cyanosis, impending apnoea, apathy, marked retractions

Answer 41

Grade 1: steroids Grade 2: steroids + adrenal nebs Grade 3: steroids + adrenal nebs - no improvement in 1hr = intubate Grade 4: steroids + adrenal nebs + intubate

Answer 42

10micrograms/kg undiluted IMI (max 500micrograms)

Answer 43

Runny nose, postnatal drip, itching nose, palate, ears, eyes, headache, fatigue, drowsiness, malaise, earache

Answer 44

Nasal crease, allergic salute, hypertrophied turbinates, thin watery nasal secretions Dennie Morgan lines, lacrimation, allergic shines, swelling of palpebral conjunctivae. Tonsillar hypertrophic, high arched palate, overbite

Answer 45

Skin prick test Immunicap (specific IgE) CT/MRI (acute or chronic)

Answer 46

It is conducted to determine whether the patient is cyanosis due to respiratory disease or due to poor vascular circulation 1) measure arterial saturation while patient breathes on room air 2) measure arterial saturation after 10mins of 100% oxygen If arterial partial pressure oxygen increases, then it is lung pathology. If there is no improvement = circulation pathology (usually right to left shunt, avoiding lungs)