Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS 2 > resp > Flashcards

resp Flashcards

1
Q

features of asthma?

A 
wheeze
±dry cough
atopy/allergen sensitisation
reversible airway obstructiom
airway inflammation - eosinophils , type 2 lymphocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pathogenesis of asthma?

A

bronchial epithelium exposed allergen eg mild → inflammation → SM hypertrophy , ↑ ECM → airway remodelling

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

immune response ion asthma?

A

antigen presented to MHC II on APC → Th0 bind → Th2 → IL 4, 13, 5 → VCAM1 expression, ↑mast cells, IGE synthesis, mucin secretion, eosinophilic airway inflammation

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

how is allergic sensitaization tested for in asthma?

A

blood tests for specific IgE antibodies to allergens of interest
total IgE not sufficient

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

tests for eosinophilia?

A

blood eosinophil ≥300
sputum eosiniphil ≥2.5%
exhaled nitric oxide

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

what is FeNO used for?

A

asthma diagnosis
steroid responsiveness prediction
corticosteroid adherence

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

objective tests for asthma?

A

airway obstructi9on on spirometry - FEV1/FVC <0.7
reversible airway obstruction - bronchodilator , ≥12%
exhaled NO , ≥35 child, ≥40 adult

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

asthma management?

A
  1. ↓ inflammation - inhaled corticosteroids , leukotriene receptor antagonists
  2. acute relief - beta 2 agonists, anticholinergics (smooth muscle relaxation)
  3. severe asthma - anti-IgE antibody , anti-IL5 antibody / anti-IL5 receptor antibody
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how do corticosteroids work?

A 
↓ xcytokines 
↓ eosinophils
↓ macrophages , dendritic cells 
↓ leak from endothelial cells 
↑ b2 receptors in SM
↓mucus secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

most important of asthma management?

A

adherence to ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

why do children with asthma often have prolonged illnesses?

A

↓ IFN a, B y → reduced antiviral responses

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

how does anti-IgE antibody therapy work?

A

binds to circulating IgE → cannot activate mast cells cells and basophils → stop allergic cascade
reduces IgE production over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

anti-IgE antibody?

A

omalizumab

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

indicati9ons for omalizumab?

A

severe persistent IgE asthma ≥6yrs old
4 or more oral corticosteroids in past year
documented compliance
serum IgE 30-1500

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

anti-IL5 antibody?

A

mepolizumab

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

function of IL5?

A

regulates growth recruitment activation and survival of eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

mepolizumab indications?

A

severe eosinophilic asthma
blood eosinophils ≥300
4+ exacerbations requiring oral corticosteroids in past year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

risk factors for lung cancer?

A

75-90
M≥F
lower SES
smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

non smoking causes of cancer?

A 
asbestos 
radon
indoor cooking fumes
chronic lung diseases eg copd, fibrosis 
immunodeficiency 
familial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4 types of lung cancer?

A

adenocarcinoma - peripheral, mucous tissue
squamous cell carcinoma - central, bronchial epithelium
large cell cancer
small cell cancer - pulmonary neuroendocrine cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lung cancer oncogenes?

A

EGFR tyrosine kinase - adenocarcinoma, women, asian, never smoekrs
ALK tyrosine kinase & cROS1 receptor tyrosine kinase - NSCLC , young patients, never smokers
BRAF 1 - NSCLC, smokers !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

symptoms of lung cancer?

A 
wt loss
cough
breathlessness
fatigue 
chest pain
haemoptysis 
or asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

features of advanced / metastatic lung cancer?

A 
bone fain 
seizures , focal weakness 
clubbing
hypercalacemia 
hyponatraime 
cushings 
horners syndrome
pembertons sign (obstructed SVC)
cachexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

imaging options for lung cancer?

A

chest XR
CT abdo chest for staging
PET scan for occult metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

methods of biopsy for lung cancer>

A

central tumours - bronchoscopy
staging - endo-bronchial US and trasnbrocnhial needle aspiration of mediating lymph nodes
peripheral - CT guided lung biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what’s used to determine patient fitness in lung cancer>

A 
WHO performance status 
0 -asymptomatic 
1 - symptomatic but ambulatory
2 - symptomatic ≤50% day in bed
3- symptomatic ≥50% day in bed
4 - bedbound
5- death

radical treatment for 0-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

surgical management for lung cancer?

A

early stage disease standard care
lobectomy + lymphadenectomy
sublunar resection if stage 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

radical radiotherapy for lung cancer?

A

alt to surgery for early stage especially if comorbidity

stereotactic ablative body radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

systemic treatments for lung cancer?

A

oncogene-directed - metastatic NSCLC with mutation
immunotherapy - metastatic NSCLC with no mutation and PDL1 ≥50%
cytotoxic chemo - metastatic NSCLC with no mutation and PDL1 ≤50% (+immunotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

treatment for metastatic NSCLC with mutation? example?

A

oncogene directed (EGFR, ALK, ROS-1) erlotinib, crizotinib (tyrosine kinase inhibitors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

treatment for metastatic NSCLC with no mutation and PDL1 ≥50↓? example

A

immunotherapy eg pembro/atezo lizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

treatment for metastatic NSCLC with no mutation and PDL1 ≤50↓? examples?

A

cytotoxic chemo , platinum based eg carbo/cisplatin

+ immunotherapy

33
Q

palliative care for lung cancer?

A 
all with advanced stage disease
symptom contorl
psychological support
education
end of life planning
34
Q

treatment options for lung cancer if locally advanced/lymph nodes involved?

A

surgery + adjuvant chemo

radio + chemo ± immunotherapy

35
Q

symptoms of upper RTI?

A 
cough 
sneezing
runny nose
sore throat
headache
36
Q

symptoms of lower RTI?

A 
phlegm cough
muscle aches
wheezing
bretahlessness
fever 
fatigue
37
Q

symptoms of pneumonia?

A

chest pain
blue lips
sever fatigue
high fever

38
Q

commonest cause of infant mortality ≤1 yr?

A

lower RTIs esp RSV

39
Q

risk factors for pneumonia?

A 
age ≤2 / ≥65
smoking
↑↑alchohol
contact with school aged children
poverty /ovrcrowding 
ICS, PPIs, immunosuppressants 
COPD , asthma , diabetes, HIV, malignancy
40
Q

common pathogens of respiratory infection?

A 
bacterial :
strep pneumoniae
myxoplasma pneumoniae
haemophilus pneumoniae
mycobacterium tuberculosis
viral:
influenza a or b
RSV
rhinovirus
cornoviruses
human metapneumovirus
41
Q

common causes of CAP?

A 
sterp pneumoniae*
myxoplasma pneumoniae**
staph aureus
chlamydia pneumoniae**
haemophilus influenzae*
  • typical
  • *aTYPICAL
42
Q

common causes of HAP?

A 
staph aureus *
pseudomonas aeurignoas*
klebsiella species
e coli 
acinetobacter
enterobacter*

*ventialtor

43
Q

how is potential bacterial pneumonia graded?

A 
CURB-65 score 
confusion
resp rate ≥30
blood pressure ≤90 SBP / ≤60 DBP
≥65
urea≥7 if hospital
44
Q

treatments for bacterial pneumonia?

A 
oxygen
fluids
analgesia
nebuliser saline
penicillins
macrolides
45
Q

CURB-65 scores and treatments?

A

0 CAP - amoxicillin (/clarithromycin if pen allergic)
0 HAP - doxycycline PO

1-2 CAP - amoxicillin + clarithomycin

3-5 CAP - benzylpenicillin IV + clarithomycin PO (or teicoplanin)
severe HAP - tazocin IV ± gentamicin IV

46
Q

strep pneumonia characteristics?

A

gram positive
extracellular
opportunistic (takes advantage of change in environment)

47
Q

what is a pathobiont?

A

normally commensal microbe

wrong environment → pathology

48
Q

how do viral infections result in disease?

A

not pathobionts
cause cellular inflammation , mediator release, local immune memory , damage epithelium → loss of cilia , bacterial growth, poor antigen barrier, loss of chemoreceptors

49
Q

what causes severe viral disease?

A

highly pathogenic strains eg zoonotic
innate immunodefieicny - absence of prior immunity
predisposing condition
frail/elderly/pregnant

50
Q

where does H1N1 influenzaA infect?

A

URT - haemogluttinin binds a2,6 sialic acids

51
Q

where does H5N1 avian flu infect?

A

LRT - haemogluttinin binds a 2,3 sialic acids

52
Q

where does SARS CoV2 infect?

A

spike proteins bind ACE in nasal epithelium and type 2 pneumocytes

53
Q

defence mechanisms of respiratory epithelium?

A 
tight junctions 
mucous linign and cilia clearance 
anitmicrobials 
pathogen recognition receptors 
interferon pathways - up regulate anti viral proteins
54
Q

antibodies in nasal cavity?

A

IgA
epithelial cells have polyIgA receptor → export IgA to mucosal surface from plasma
homodimer very stable in protease rich environment

55
Q

antibodies in bronchi?

A

IgG

thin walled alveoli allow transfer of plasma IgG into alveolar space

56
Q

leading cause of infant hospitilaztion?

A

respiratory syncytial virus

57
Q

RSV symptoms?

A 
nasal flaring 
chest wall retractions 
hypoxemia 
cyanosis
croupy cough
wheezing on expiration 
prolonged expiration 
rales and rhonchi 
tachypnea
apneic episodes
58
Q

risk factors for RSV in oinfants?

A

premature birth

congenital heart and lung diseases

59
Q

treatment options for SARS CoV2?

A 
oxygen
fluids
analgesia 
dexamethasone 
tocilizumab
remdesevir
paxlovid
monoclonal antibodies 
vaccines
60
Q

what is the SRDS Berlin definition?

A

within 1 week of a known clinical insult or new or worsening respiratory symptoms
bilateral opacities on imaging not explained baby collapses, effusions, nodules
oedema not explained by cardiac failure/fluid overload
oxygenation - PEEP ≥5
PaO2/FIO2:
mild 200-300
moderate 100-200
severe ≤100

61
Q

what can cause acute resp failure?

A 
infection
aspiration
primary graft dysfunction after lung Tx
trauma
pancreatitis 
sepsis
myasthenia 
Guillain-Barré syndrome
62
Q

what can cause chronic resp failure?

A 
copd
fibrosis
CF
lobectomy
muscular dystrophy
63
Q

what can cause acute on chronic resp failure?

A

infective exacerbation of COPD/CF
myasthenia crises
post operative

64
Q

what is type I resp failure? causes?

A

hypoxemic , PAO2 < 60
increased shunt fraction, alveolar flooding

collaspe
aspiration 
pulmonary oedema 
fibrosis 
pulmonary embolism 
pulmonary hypertension
65
Q

what is type II resp failure? causes?

A

hypercapnic, pacCO2 ≥ 45
decreased alveolar minute ventilation ,↑ dead space ventilation

muscle failure, airway obstruction, chest wall deformity

66
Q

what is type III resp failure? causes?

A

perioperartive resp failure
low functional residual capacity → ↑ atelectasis
hypoxaemia or hypercapnia

posture, incentive spirometry, analgesia, anaesthetic technique

67
Q

what is type IV resp failure? causes?

A

shock → poor perfusion

patients are ventilated and intubated

68
Q

causes of ARDS?

A 
pulmonary :
aspiration
trauma
inhalation burns
surgery
drugs
infection
extra pulmonary :
trauma
pancreatitis
burns
trasnfusion
sx
BM trasnplant
drugs
infection
69
Q

what responses cause acute lung injury?

A 
leucocyte activation and migration → macrophages and neutrophils 
DAMP releaae - HMGB1 , RAGE
cytokine release , IL-6,8,1B, IFN-y
cell death 
TNF signalling via TNFR-1
70
Q

management for resp failure?

A 
treat underlying cause:
bronchodilators, pulmonary vasodilators 
steroids
Abx, antivirals 
plasma exchange, ritixumab

resp support:
oxygen, nebulisers, ventilation, ECMO

multiple organ support:
CV
renal
immune therapies

71
Q

sequelae of ARDS?

A

poor gas excahnge
infection →sepsis
inflammation
systemic effects

72
Q

specific interventions for ARDS?

A

resp support
intubation and ventilation
mechanical intervention
pronation

73
Q

imaging for ARDS?

A

CT- lung recruitment

lung USS

74
Q

scoring system for ARDS?

A 
Murray score = average score of all 4:
PaO2/FiO2
CXR
PEEP
Compliance

0=normal
1-2.5 = mild
2.5-3 = severe
≥3 = ECMO

75
Q

ECMO inclusion criteria?

A

severe resp failure with non-cardiac cause , Murray score ≥ 3
pH ≤ 7.2
positive pressure ventilation is inappropriate
reversible disease process, unlikely to lead to prolonged disability

76
Q

ECMO exclusion criteria?

A

significant comorbidity
would be life dependent on ECMO
contraindicated to continuation of active support

77
Q

issues with ecmo?

A 
time to access
geographical inequity
obtaining access
clotting/bleeding
costs
78
Q

how can exercise capacity be evaluated?

A

cardiopulmonary exercise test - cycle ergometer/treadmill
six minute walk test
incremental shuttle walk test

79
Q

top 3 causative agents of resp infection?

A

human rhinovirus
influenza a/b
s pneumoniae

BRS 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions