resp Flashcards
what is type 1 hypersensitivity mediated by?
IgE
give 3 examples of type 1 hypersensitivity
allergy
anaphylaxis
atopy
what is type 2 hypersensitivity mediated by?
IgM or IgG
give 3 examples of type 2 hypersensitivity?
haemolytic disease of the newborn
autoimmune haemolytic anaemia
goodpastures syndrome
what is type 3 hypersensitivity mediated by?
antigen - antibody immune complexes
what is type 4 hypersensitivity mediated by?
T cells
give 3 examples of type 3 hypersensitivity
serum sickness
SLE
post streptococcal glomerulonephritis
what is the timeframe for a type 4 hypersensitivity reaction?
delayed reaction (24-72 hrs)
give 1 example of a type 4 hypersensitivity reaction
contact dermatitis
what are interstitial lung diseases?
conditions that cause inflammation and fibrosis of the lung parenchyma
how do interstitial lung diseases present?
SOB
dry cough
fatigue
what are the typical examination findings of idiopathic pulmonary fibrosis?
basal fine end inspiratory crackles
finger clubbing
what is the characteristic CT finding of interstitial lung disease?
ground glass appearance
what is the spirometry pattern in interstitial lung disease?
restrictive
FEV1 and FVC equally reduced
what is hypersensitivity pneumonitis?
type 3 and 4 allergic reactions to environmental allergens that cause an immune response leading to inflammation and damage to the lung tissue
what is asthma?
a chronic inflammatory airway disease leading to variable airway obstruction
what are the typical symptoms of asthma?
SOB
chest tightness
dry cough
wheeze
which 2 drug classes can worsen asthma?
beta blockers
NSAIDs
what is the spirometry picture seen in asthma?
obstructive
FEV1:FVC ratio <70%
what are the 2 initial investigations for asthma?
spirometry w/ bronchodilator reversibility
fractional exhaled nitric oxide
explain the stepwise approach for treating asthma?
- SABA
- add low dose inhaled corticosteroid
- add LABA or trial of leyukotrine receptor antagonists (LTRA)
- inhaled corticosteroid increased to medium dose or trial LTRA
- inhaled corticosteroid dose increased to high
what is the spirometry picture seen in COPD?
obstructive
what is the inheritance pattern of cystic fibrosis?
autosomal recessive
what are the centor criteria?
presence of tonsillar exudate
lymphadenopathy
fever
absence of cough
what should be considered if a pt has recurrent pneumothoraces?
video assisted thoracoscopic surgery to allow for pleurodesis
what is the management of idiopathic pulmonary fibrosis?
antifibrotics e.g. ninedanib or pirfenidone
what is bronchiectasis?
a chronic respiratory disease characterised by permanent bronchial dilation due to irreversible damage to the bronchial wall
why do bronchiectasis pts get recurrent infections?
because dilated bronchi are predisposed to persistent microbial colonisation
what is the most common cause of bronchiectasis?
post infectious
what is the gold standard diagnostic investigation for bronchiectasis?
high resolution CT chest
what is the most common cause of bronchiolitis?
RSV
what is the definition of pneumonia?
acute inflammation of the lung parenchyma
what is the most common cause of community acquired pneumonia?
streptococcus pneumonia
what is the definition of hospital acquired pneumonia?
lower respiratory tract infection acquired after 48hrs of hospital admission
how does pneumonia caused by mycoplasma pneumoniae present?
slow onset history over days - weeks
persistent dry and hacking cough
what are the criteria for CURB65 for pneumonia?
C - confusion
U - urea >7mmol
R - resp rate >30
B - <90 systolic or <60 diastolic
65 - >65 y/o
what is the first line treatment for low risk community acquired pneumonia?
amoxicillin 500mg - 1g 3x daily
what are the alternative antibiotics used in the treatment for low risk community acquired pneumonia?
doxycycline
clarithromycin
what is the first line treatment for moderate risk community acquired pneumonia?
combination of amoxicillin and clarithromycin
what is the first line treatment for high risk community acquired pneumonia?
combination of coamoxicalv and clarithromycin
what is a pneumothorax?
air in the pleural space
what is the difference between a primary and secondary pneumothorax?
a primary pneumothorax is in a pt w/ no known respiratory disease
a secondary pneumothorax is in a pt w/ known respiratory disease
explain the management of a tension pneumothorax
emergency decompression - large bore cannula second intercostal space mid clavicular line
chest drain insertion immediately after decompression
how does a pneumothorax present?
ipsilateral chest pain and dyspnoea
what are the 2 classifications of lung cancer?
non-small cell carcinoma
small cell carcinoma
what is the most common type of lung cancer?
non small cell carcinoma
what are the 3 types of non small cell carcinoma?
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
which lung cancer is most common in non smokers?
adenocarcinomas
what is the management of non small cell lung cancer?
surgery in the early disease
chemotherapy +/- targeted therapy in advanced disease
what is needed for the definitive diagnosis of PE?
CTPA
what wells score means PE is likely?
> 4
what is the management if a PE is likely (wells score >4)?
CTPA immediately
what is the management if a PE is unlikely (wells score <4)?
d dimer
if d dimer +ve then CTPA
if d dimer -ve then PE unlikely
what is the management of a PE if there is haemodynamic instability?
IV tissue plasminogen activator (e.g. alteplase)
what is the management of a PE if there is no haemodynamic instability?
anticoagulation
frist line: DOAC (apixaban or rivaroxaban)
what is used for anticoagulation in a pregnant woman who has had a PE and why?
low molecular weight heparin
because DOACs and warfarin are contraindicated
what is sarcoidosis?
a chronic granulomatous disorder
what are the extra pulmonary manifestations of sarcoidosis?
erythema nodosum
lymphadenopathy
lupus perino
what are the pt demographics that sarcoidosis is more common in?
women
20-40 y/o
black ethnic origin
what is erythema nodosum?
nodules of inflamed subcutaneous fat on the shins
what is lupus perino?
raised purple lesions on the cheeks and nose
specific to sarcoidosis
what are the blood test findings of sarcoidosis?
raised angiotensin converting enzyme (ACE)
raised calcium
what is the first line treatment for sarcoidosis when treatment is required?
oral steroids for 6 - 24 months
if a sputum culture grows acid fast bacilli which stain red w/ zeihl neelsen staining what is the likely causative organism and diagnosis?
causative organism: mycobacterium tuberculosis
diagnosis: TB