Resp Flashcards
1
Q
IL4 vs IL5 ?
A
il4 - release IgE which stimulate mast cells to release histamine, luekotrienes
il5 - eosinophils = toxic proteins released
2
Q
sever copd criteria?
A
GOLD classfication
FEV1 <30%
ratio < 0.7
also MRC dysnopnea scale is used!
3
Q
BRONCHITIS dx?
A
chronic cough with sputum for at least 3 months in 2 consecutive years
4
Q
FVC in COPD?
FEV1
fev1:fvc ratio
TLC
A
fvc lowered
fev1 lowered more than fvc
ratio low
tlc higher due to trapped air
5
Q
signs of COPD?
A
fast shallow breathing
barrel chest
drum like sound on percussion
cyanosis
tar color on fingers
downward dysplacement of liver
6
Q
severe gold classification copd ?
A
30% - 50% FEV1
ratio < 0.7
7
Q
complications of COPD?
A
pulomonary hypertension
pneumothorax
resp failure
COR PULMONALE
8
Q
resp failure type 1 vs type 2 ?
A
normal pCO2 low O2
type 1
raised pCO2 low O2
type 2
9
Q
spirometry in asthma?
A
normal usually
as it varies day to day
10
Q
types of asthma?
A
allergic (70%) - IgE mediated - hygiene hypothesis
non allergic (30%) - smoking
11
Q
samters triad
A
nasal polyps
asthma
aspirin sensivity
12
Q
does pharmacological tx improve copd life time?
A
doesn’t improve lung functions just symptom relief
13
Q
sputum of asthma what could be shown?
A
lexton charcot crystals
cushmans spirals
14
Q
life threatening asthma criteria?
A
PEF < 33%
MODERATE 50 - 75 %
15
Q
bronchodilator effect on asthma vs copd?
A
asthma reversible effect - >12% FEV1
COPD irreversible - <12% FEV1
16
Q
ddx copd
A
pneumonia
PE
hf
PNEUMOTHORAX
17
Q
tx for copd algortyhm?
A
chronic algorithim +16
1st line SABA
2. SABA + ICS - check complience and techniques
3. SABA + ICS + LTRA
4. SABA + ICS + LABA +/- LTRA
5. INCREASE ICS DOSE
18
Q
FENO asthma?
A
fractional exhaled nitric oxide (FeNO) test measures the level of NO in the exhaled breath and provides an indication of eosinophilic inflammation in the lungs.
19
Q
dx of asthma?
A
increased FENO
FEV1/ FVC < 0.7
FEV1 reversible with bronchodilator ]
20
Q
LTRA stand for?
A
leukotrene receptor antagonist
muscarin inhibitor - prevents contriction
LAMA is also muscarinic antagonist
21
Q
ICS example?
A
clenil modulite
22
Q
LABA example?
A
salmeterol
23
Q
MAB medication?
A
resiluzamab - monoclonal antibody treatment
Natalizumab - MS tx
24
Q
- nib what type of medication?
A
kinase inhibitor nintedanib - tx for idiopathic pulmonary fibrosis
25
main advantage of nebulisers?
* THEIR MAIN ADVANTAGE IS THAT NO COORDINATION IS REQUIRED BY THE USER, AND HIGH DOSES OF DRUG CAN BE DELIVERED TO THE AIRWAYS.
26
when to use corticosteroids in COPD?
last resort
COPD patients are usually resistant!
* COPD: MOST PATIENTS ARE RESISTANT TO ICS. RESPONSIVE PATIENTS ARE THOUGHT TO HAVE CONCOMITANT ASTHMA WHICH MAY EXPLAIN THE ELEMENT OF SENSITIVITY TO ICS.
27
ICS and beta agonists ?
benefit eachother!
GLUCOCORTICOIDS INCREASE THE TRANSCRIPTION OF THE B2-RECEPTOR GENE, RESULTING IN
INCREASED EXPRESSION OF CELL SURFACE RECEPTORS = ICS HELP BETA AGONISTS TO WORK
28
tx for bronchoiectasis ? what has limited effect?
* ANTIBIOTICS TREAT INFECTIVE ELEMENTS OF BRONCHIECTASIS, PHYSICAL THERAPY CLEARS AIRWAYS. SURGERY AND TRANSPLANTATION FOR SEVERE DISEASE
* STRATEGIES AIM TO REDUCE SYMPTOMS RATHER THAN UNDERLYING CAUSE OF DISEASE
* MUCOLYTICS TREAT HYpERSECRETION
* B2AGONISTS MOST USEFUL IN COPD/ASTHMA/BRONCHIECTASIS OVERLAP SYNDROMES
* ANTICHOLINERGICS HAVE LIMITED EFFECT * ICS HAVE LIMITED EFFECT
29
what is the interstitium ?
area between alveolus and blood vessel
30
interstitial lung disease examples?
idiopathic pulmonary fibrosis, interstitial pneumonia and hypersensitivity pneumonitis
31
pathophysiology of ipf?
IPF IS AN EPITHELIAL-DRIVEN DISEASE WHEREBY AN ABERRANTLY ACTIVATED LUNG EPITHELIUM PRODUCES MEDIATORS OF FIBROBLAST MIGRATION, PROLIFERATION AND DIFFERENTIATION INTO ACTIVE MYOFIBROBLASTS.
THESE MYOFIBROBLASTS SECRETE EXAGGERATED AMOUNTS OF EXTRACELLULAR MATRIX (ECM) THAT SUBSEQUENTLY REMODEL THE LUNG ARCHITECTURE.
too much collagen = honeycomb formation!
32
DRUGS THAT slow progression if IPF?
PIRFENIDONE AND NINTEDANIB
surgery is often best option
33
how to distinuigish mestholioma from other tumours?
high production of calretinin
34
role of plueral cavity?
lubrication for expansion and contraction of lungs
35
how is fluid removed from pluera?
lymphatic drainage
36
lymphatic plueral effusion?
chylothorax
thoracic duct distrupted
- damage from surgery
- tumour in mediasteinum
lymphatic fluid accumulicates in plueral space
37
symptoms of plueral effusion?
SOB lying down
pain on inhalation
asymptomatic if small
38
dx of plueral effusion?
dullness of percussionn
decrased breath sounds
decreased tactile fremitus - vibration when talking
cxr - blurring of costophrenic angle when standing
lying down - layering effect
39
transudative fluid/ exudative fluid vs lymphatic fluid from plueral effusion drainage?
transudative - clear
exudative - cloudy
lympathtic - milky
40
common location of adenocarcinoma?
peripheral lung within mucus secreting glandular epithlium
41
most common cause of secondary hypertrophic osteoartheropathy? signs of this ?
adenocarcinoma
triad
clubbing
athritis
bone sweelinnng
'onion skin' appearance
42
common cause of hypertrophic pulmonary osteoartheropathy?
squamous cell non small cell carcinoma
43
where does squamous cell carcinoma arise from and located?
risk factor - smoking
central lung from lung epihtlium
44
sign of sqaumous cell carcinoma?
PTHrP may secrete hypercalcemia
hyperparathyroidism
45
signs of bronchial carcinoma? (small cell and NCC)
Cachexia
Finger Clubbing
Hypertrophic pulmonary osteoarthropathy
Anaemia
Horner's syndrome (if the tumour is apical)
Examination of the chest: consolidation (pneumonia); collapse (absent breath sounds, ipsilateral tracheal deviation); pleural effusion (Stony dull percussion, decreased vocal resonance and breath sounds)
Enlargement of supraclavicular and axillary lymph nodes
46
Haemoptysis
COUGHING up blood
symptom of bronchial cancer
47
LEMS associated with what lung condition?
Small cell Carcinoma
48
carcinoma most like to metasize?
adenocarcinoma
49
where does small cell carcinoma arise from?
Arise from endocrine cells (Kulchitsky cells). These are APUD cells, and as a result, these tumours will secrete many poly-peptides mainly ACTH
50
specific endocrine presentation of SCC?
Addison's and Cushing's disease, SIADH
51
signs of metasizes?
horse voice - right laryngeal nerve
pemberston sign - mediastinal mass - raised arms = red face
horners syndrome
partial ptosis (drooping or falling of upper eyelid), miosis (constricted pupil), and facial anhidrosis (loss of sweating)
52
ix for lung carcinoma?
1st line cxr + ct
dx- brocnhiscopy + biopsy
MRI TNM staging
53
horners syndrome caused by?
pancoast tumour
tumour in lung apex that metasizes
ptosis
lack of sweat
myosis
54
tx for NSCC?
early - surgical removal
metasize - chemo +/-
MAB therpy
- cetuximab
55
bronchiectasis is caused by?
Severe pneumonia
– TB
– Whooping cough
– Obstruction
– Fibrosis – traction brochiectasis
– Ciliary dysfunction
– Immunosuppression
56
dx of bronchiectasis ? gold standard?
CXR
HRCT gold standard - dilated thicken bronchi - signet ring sign
spirometry - FEV1/FVC <0.7
SPUTUM culture -h inf, s pneumonae
57
sbx for h influenxa and Streptococcus pneumoniae
?
amoxicillin
58
plueral fluid from malignancy?
high LDH
high protein
exudate plueral effusion
59
most common location for lung metasize?
BRAIN!
60
symptoms of bronchiectasis ?
Productive cough
* Green mucoid sputum
* Large volumes
* Postural element
* Worse in infections
– Haemoptysis
– Hallitosis
61
signs for bronchiectasis ?
Clubbing
– Crackles
– Hyperexpanded chest
– Purulent sputum
– Signs of cor pulmonale
62
cp of CF in neonates ?
meconium ileus
stool too thick to pass through bowel
63
cp of CF?
thick mucus
bronchiectisis
reccurant upper resp infection
pancreatic insuffiency
bowel obstruction
64
dx for CF
salty sweat - na+ / cl - > 60 mmol/l in children
fecal elastase low!
genetic testing f508 mutation
65
tx for CF?
no cure
management - physiotherapy
antimucolytics
bronchodilator
pancreatic enzyme replacements
66
common infection in cf?
s. aureus - Flucloxacillin
h influenza - amoxicillin, cephalosporin, azithromycin, doxycycline, and fluoroquinolone.
Pseudomonas aeruginosa - tobramycin
Bacteria
67
pneumothorax?
air in plueral cavity
68
oneuothroax on x ray ?
pushing heart to left
black area
69
pocket of air within lung tissue?
cyst
70
infected fluid in pleurl cavity ?
empyema
71
collapsed lung?
atelectasis
72
COPD severity assesment ?
FEV1 % predicted
< 30% severe
73
Acute asthma severity is initially assessed by
CLINICAL EXAMINATION
74
critically ill asthma patients tx ?
IV b2 agonists
magnesium sulphate
adrenaline
ICS
aminophylline
75
haemoptysis in copd?
no UNLESS CANCER OR INFECTION
pulomonary embolism is also a cause
76
how long for tx for idiopathic PE?
6 moths at least
77
defining feature in Primary Ciliary Dyskinesia
Impaired mucociliary clearance
78
HCO3 in type 2 resp failure
acute - normal
chronic - high
79
example of type 2 resp failure?
emphysema
nueromuculsar disease
80
type 1 resp failure example?
pneumonia
pulmonary embolism
asthma
COPD exacerbation
81
resp acidosis
pco2 high
po2 low
ph low
hco3 normal
82
What is the usual cause of bronchiolitis in infants?
rsv
83
Which, nearly always, reduces TLCO?
alveolar haemorrhage increases it
pulomnary fibrosis reduces TLCO
84
Which condition is most likely to have a normal transfer factor (TLCO)?
asthma
85
otitis media ?
inflammation of middle ear
86
tx for otitis media?
ibuprofen and paracetmol
amoxicillin - strep
87
features of acute otitis media?
Causes deep seated pain, impaired hearing with systemic illness and fever.
The onset is usually rapid with a feeling of aural fullness followed by discharge when the tympanic membrane perforates with relief of pain.
Tympanic membrane shows injection of blood vessels and then diffuse erythema.
88
dx of sarcoidosis?
CXR staging 1-4 bilateral hilar adenopathy
raised calcium
89
GS ix for sarcoidosis?
histology
bronchoscopy
biopsy of erythmos nodosa
NON CASEATING GRANULOMAS WITH EPITHLOID CELLS
90
When to stART COPD patients on LABA and ICS?
SABA/ SAMA not working and has high eosinophils (reposivness to steroids) then start LABA and ics
91
most common cause of HIV pts pneumonia?
fungal - p. jiroveci
peumocystitis pneumonia
92
tx for pseudomonas arguenosa
anti-pseudomonal beta lactam (e.g. piperacillin-tazobactam or ceftazidime) or fluoroquinolone (e.g. ciprofloxacin) is indicated for treatment.
93
cxr of copd?
barrel chest
hyper inflation
bullae, flat hemidiaphragm, barrel chest (1 mark
for each CXR finding)
94
cp of lung cancer?
distended jugualr veins
oedma of upperperipheral limbs
breathlessness
periorbital oedma
visual distrubances
95
signs of a PE?
tachycardia
unilateral sharp pluertic chest pain
hypotension
dvt
96
when to use nasal cannulea?
non acute settings
mild hypoxia
97
when to use venturi mask?
copd
flow rate varies
not used for super low oxy sat
98
when to use non rebreather mask ?
acutely unwell pts with super low ox sat
99
cause of pulmonary oedma?
left sided heart failure
htn
infection
trauma
100
cxr of pulmonary oedma?
kerly b lines
cephalization
pleural effusion - horizontal fissure
cardiomegaly
cardiothoracic ratio increased
bat wings
101
ix of pneumothorax?
cxr:
tension pneumothorax - mediastinal shift and tracheal deviation contralaterally
dark area betwen lung and chest wall
ct: GOLDSTANDARD
102
TX OF tension kPNEUMOTHORAX?
LARGE bore cannula DRAIn in midclavicular line in 2nd intercostal space
103
cp of pneumothorax?
hypotension
tachycardia
sudden sob
sudden chest pain
Hyperresonance ipsilaterally (resonance is higher when percussed)
reduced breath sounds ipsilaterally
104
cxr and ct of pneumocystitis pneumonia?
CXR - PERI-HILAR OPACITIES on CXR & sub-pleural ‘blebs’ - chest radiographs classically demonstrate bilateral, diffuse, often perihilar, fine, reticular interstitial opacification, which may appear somewhat granular.
CT - ‘ground glass appearance’ on CT (HRCT)
105
CP of pneumocystitis pneumonia?
Dry cough, EXERTIONAL dyspnoea (often profound), fever, often insidious onset. Co-existing opportunistic infections may also be present.
106
tx for pneumocystisi pneumonia?
trimethoprime - (co-trimoxazole)
107
cold agglutinins?
triggered by the cold
cold agglutin antibodies vs RBCs - autoimmune heamolysis
triggered by pneumonia
108
Patient is a HOT TUB enthusiastic who presents with abdominal pain, diarrhea, lymphocytopenia and hyponatremia?
legionares disease
tx - flouroquinolone +/- clarithromycin.
109
complications of sever pneumonia?
sepsis
AF increased risk
emphysema
pericarditis
hypotension
110
HAP causative organisms?
S.aureus,
Klebsiella spp,
Pseudomonas aeruginosa
co amoxiclav
doxycycline
111
empyema vs abscess
An empyema is a collection of pus in a pre-existing cavity/space such as the pleural space.
Absecess e.g lung abscess is within the lung parenchyma (parenchymal necrosis).
Empyema is defined as pus in the pleural space. It typically is a complication of pneumonia. However, it can also arise from penetrating chest trauma, esophageal rupture, complication from lung surgery, or inoculation of the pleural cavity after thoracentesis or chest tube placement.
112
tx for acute asthma ?
Some - saba inhaler
Pretend - prednisolone
Its - Ipratropium bromide
Mega - magnesium sulfate
Asthma! - AMINOPHILLINE
113
common organism for pneumonia returning from spain:?
legionella pneumophillia
114
common organsim for pneumonia in HIV patients?
fungal !
Pneumocystitis jirovecii
115
causes and tx for copd exaserbation?
h. influenza (-rod)
s. pneumonia (+ coccci optochin sensitive)
AMOXICILLIN!
