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Phase 2a - Jemima > Respiration > Flashcards

Respiration Flashcards

1
Q

What is COPD

A

progressively worsening and irreversible airflow limitation

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2
Q

what are types of COPD

A

chronic bronchitis
emphysema
A1AT deficiency

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3
Q

what are risk factors for COPD

A

cigarettes
air pollution
genetics - A1AT deficiency
older males

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4
Q

what organisms cause infective exacerbations in COPD

A

H.influenza
S.pneumonae

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5
Q

what is the pathophysiology of chronic bronchitis

A

Hypertrophy and hyperplasia of mucous glands
chronic inflammation cells infiltrate bronchi and bronchioles causing luminal narrowing
there is mucus hypersecretion, ciliary dysfunction and narrowed lumen, increasing infection risk and air trapping.
BLUE BLOATER

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6
Q

what are symptoms for chronic bronchitis

A

cough for 3 + months, over 2 + years with sputum

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7
Q

what is emphysema

A

destruction of elastin layer in alveolar ducts/sacs and respiratory bronchioles
- reduced elastin causes air trapping distal to blockage (large air sacs = BULLAE)

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8
Q

what are different kinds of emphysema

A

centriacinar emphysema (resp. bronchioles only)
Panacinar emphysema (resp. bronchioles, alveolar and alveolar sacs)
Distal acinar
Irregular

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9
Q

who is likely to get centriacinar emphysema

A

smokers

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10
Q

who is likely to get panacinar emphysema

A

A1AT deficiency

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11
Q

what is A1AT deficiency

A

an autosomal codominant interited condition

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12
Q

what is the pathophysiology of A1AT deficiency

A

there is a reduced A1 antitrypsin leading to an increase in neutrophil elastase which causes damage to the elastin layer in the lungs, leading to panacinar emphysema as well as liver issues

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13
Q

what is the normal function of A1 antitrypsin

A

it degrades neutrophil elastase thus protecting excess damage to elastin layer especially in the lungs

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14
Q

when do you suspect A1AT deficiency

A

in younger/middle aged men with COPD symptoms but no smoking history

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15
Q

what are symptoms of COPD

A

typically in an older patient
chronic cough
purulent sputum - increased infection risk
extensive smoking history
constant dyspnoea

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16
Q

what is a blue bloater cough

A

chronic purulent cough, dyspnoea, cyanosis and obesity

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17
Q

what conditions do you get blue bloater

A

chronic bronchitis

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18
Q

what is pink puffer in COPD

A

minimal cough with pursed lip breathing, cachectic, barrel chest and hyperresonant percussion

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19
Q

what conditions do you see pink puffer in

A

emphysema

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20
Q

what is the dyspnoea grading scale

A

MRC 1-5
1 - strenuous exercise
5 - cant do daily activities without shortness of breath such as changing clothes

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21
Q

what are the main pathogens in acute COPD exacerbations

A

S. pneumo
H. influenzae

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22
Q

how do you diagnose COPD

A

Pulmonary function test
Fractional expired nitrogen
FEV1:FVC <0.7
Obstruction on PFT spirometry
DLCO
genetic testing
ABG/ECG/CXR

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23
Q

Is COPD bronchodilator reversible

A

no

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24
Q

In COPD what change occurs to FEV1

A

FEV1 decreases in COPD

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25
Q

what lung condition is reversible with bronchodilators

A

asthma

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26
Q

What impact does asthma have on FEV1

A

Decrease in FEV1

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27
Q

what is DLCO

A

it is the diffusing capacity of CO across the lung

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28
Q

what happens to the DLCO in COPD

A

it is low

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29
Q

What happens to the DLCO in asthma

A

it is normal

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30
Q

what is a complication of COPD

A

Cor polmonale and increased infection risk

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31
Q

how do you treat COPD

A

SMOKING CESSATION
Vaccine
1. SAB2A (Salbuterol)
2. SAB2A + LAB2A (salmeterol) and LAMA3 (tiotropium)
3. SAB2A, LAB2A, LAM3A, ICS
consider long term oxygen if very severe

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32
Q

what is an acute COPD exacerbation

A

O2 target is 88-92% saturation
excess o2 increases deadspace and therefore the V/Q ratio will become mismatched and increased CO2 retention

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33
Q

how do you treat an acute COPD exacerbation

A

Nebulised salbutamol and ipratropium bromide
ICS
antibiotics

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34
Q

what is asthma

A

it is a chronic reversible airway disease characterised by reversible airway obstruction, airway hyperresponsiveness and inflamed bronchioles

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35
Q

what are types of asthma

A

Allergic - 70%
Non allergic - 30%

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36
Q

What is allergic asthma

A

it is IgE mediated anis due to an environmental trigger
Genetics should be considered here and the hygiene hypothesis

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37
Q

What are environmental triggers of asthma

A

Pollen
Smoke
Dust
Mold
Antigens

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38
Q

what is Non allergic asthma

A

this is non IgE mediated it is intrinsic
may present later in life and is harder to treat

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39
Q

what are triggers for asthma

A

Infection
Allergens
Cold weather
exercise
drugs

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40
Q

what is the hygiene hypothesis

A

when you grow up with high level of hygiene it causes you to have an increased susceptibility to asthma infection

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41
Q

what is the atopic triad

A

atopic rhinitis
asthma
eczema

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42
Q

what is samters triad

A

nasal polyps
asthma
aspirin sensitivity

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43
Q

what is the pathophysiology of asthma

A
  1. Over expressed TH2 cells in airways are exposed to a trigger
  2. TH2 cytokine release (IL3, 4, 5, 13) and leads to IgE production and eosinophil recruitment
  3. Mast cell degranulation and release of toxic proteins leads to bronchial constriction and mucus hypersecretion
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44
Q

what happens overtime in asthma

A

there is chronic remodelling which leads to bronchial scarring, recued lumen size and increased mucus

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45
Q

what are symptoms of asthma

A

wheeze
cough - typically dry
chest tightness
shortness of breath
episodic symptoms when exposed to triggers

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46
Q

what are asthmatic episodes classed as

A

moderate
severe
life threatening

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47
Q

what is PEF in a moderate asthma episode

A

50-75%

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48
Q

what is PEF in a severe asthma episode

A

35-50%

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49
Q

what is PEF in a life threatening asthma episode

A

lower than 33%

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50
Q

how do you diagnose asthma

A

spirometry
increased FeNO
FEV1: FVC <0.7

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51
Q

what is the treatment for chronic asthma

A
  1. SAB2A
  2. SAB2A + ICS
  3. SAB2A + ICS + LTRA
  4. SAB2A + ICS + LAB2A +- LTRA
  5. increase ICS dose
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52
Q

what does
SABA
LABA
SAMA
LAMA
stand for - asthma medications

A
  1. SABA is salbutamol
  2. LABA is Salmeterol (long acting bronchodilator)
  3. SAMA is Ipratropium bromide (short acting muscarinic antagonist)
  4. LAMA is Tiotropium bromide
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53
Q

What needs to be given in asthma exacerbations

A

O2
ICS (inhaled corticosteroids - Hydrocortisone)
IV MgSO4 (bronchodilation)
IV theophylline
PLUS
BIPAP/CPAP and antibiotics if an infection is present

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54
Q

what is a cancer of the pleura called

A

A mesothelioma

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55
Q

what are types of cancer of the bronchial parenchyma

A

Small cell
Non small cell

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56
Q

What are the types of non small cell lung cancer

A

Squamous cell
Adenocarcinoma
Carcinoid
Large cell

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57
Q

what is a mesothelioma

A

A malignancy of the pleura

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58
Q

What are causes of a mesothelioma

A

Asbestos

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59
Q

Who typically presents with mesothelioma

A

Males between 40-70

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60
Q

what are the symptoms of mesothelioma

A

Cancer symptoms - wt loss, TATT, night pain
Lung symptoms - SOB, persistent cough, pleuritic chest pain, hoarse voice, bone pain

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61
Q

why do you get bone pain in lung cancer (mesothelioma)

A

Sign of bone metastasis

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62
Q

why might you get horse voice with mesothelioma - lung cancer

A

as the tumour may press on nearby structures such as the recurrent laryngeal nerve causing hoarse voice

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63
Q

how do you diagnose mesothelioma

A

chest X ray and CT - imaging is first line
looks for cancer antigen CA-125
Biopsy - diagnostic

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64
Q

what is diagnostic in mesothelioma

A

performing a biopsy of the pleura

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65
Q

how do you treat mesothelioma

A

Very aggressive tumour so its normally palliative
if found early - surgery and chemo/radio therapy

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66
Q

what is a primary malignancy of lung parenchyma

A

Bronchial carcinoma

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67
Q

what are the two types of bronchial cell carcinoma

A

Small cell
Non small cell

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68
Q

what are risk factors of bronchial carcinoma

A

Smoking
Asbestos
Coal
Ionising radiation
lung disease present

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69
Q

what percentage of bronchial carcinoma is small cell lung cancer

A

15%

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70
Q

who gets small cell lung cancer

A

exclusively smokers

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71
Q

what is associated with small cell lung cancer

A

Paraneoplastic syndromes

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72
Q

what can small cell lung cancers produce

A

Ectopic ACTH - cushings
Ectopic - ADH - SIADH
Lambert eaton syndrome

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73
Q

what is the pathology of a small cell lung cancer

A

it is very fast growing with early metastasis
causing central lung lesions

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74
Q

what is a BALT lymphoma

A

a non hodgkin lymphoma originating in the bronchi

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75
Q

what percentage of non small cell cancers are squamous cell

A

25%

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76
Q

who does squamous cell lung cancer affect the most

A

mostly smokers

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77
Q

What is the pathophysiology of squamous cell lung cancer

A

it arises from lung epithelium and it affects the central lung, causes lesions with central necrosis. They may also secrete PTHrP causing hypercalcaemia

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78
Q

what is hypertrophic pulmonary osteoarthropathy

A

It is newly associated with NSCLC
it is a paraneoplastic syndrome associated with squamous cell carcinoma and causes clubbing, arthritis and pariostitis

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79
Q

what is the pathology of squamous cell lung cancer

A

It has mostly local spread with late metastasis

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80
Q

what percentage of non small cell lung cancers are adenocarcinoma

A

40%

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81
Q

who does adenocarcinoma of the lung affect

A

Commonly in those with asbestos exposure
Smokers

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82
Q

what cell type does adenocarcinoma of the lung arise from

A

Mucus secreting glandular epithelium

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83
Q

What part of the lung does adenocarcinoma affect

A

the peripheral lung

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84
Q

where are mets commonly found in adenocarcinoma of the lung

A

Bone
Brain
Adrenals
Lymph nodes
Liver

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85
Q

what is a carcinoid tumour

A

it is a neuroendocrine tumour (secretes SEROTONIN) which can appear in the lungs
symptoms only appear when liver mets are present

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86
Q

what genetic are carcinoid tumours associated with

A

MEN1 mutation and neurofibromatosis 1

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87
Q

what are general symptoms of lung cancers

A

Chest pain
cough
haemoptysis
cancer symptoms
signs of mets

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88
Q

how do you diagnose lung cancer

A

imaging - CXR CT
diagnostic - bronchoscopy and biopsy
MRI - staging, TNM

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89
Q

what is the biggest cause of secondary hypertrophic osteoarthritis

A

Adenocarcinoma

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90
Q

what is the triad seen in secondary hypertrophic osteoarthritis

A

Clubbing
arthritis
Long bone swelling

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91
Q

how do you treat small cell lung cancer

A

More aggressive
if caught early consider chemo/radiotherapy
if metastasised palliative care

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92
Q

how do you treat non small lung cancer

A

if caught early - surgical excision
if metastasised - chemo +/- radiotherapy
can also give mAb therapy such as cetuximab which is against epidermal growth factor

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93
Q

are primary or secondary lung tumours more common

A

Secondary tumours

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94
Q

Why are secondary tumours more common than primary ones

A

Lungs oxygenate 100% of the blood and therefore all the blood comes to the lungs, increasing the chance of mets risk

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95
Q

What cancers commonly metastasise to the lungs

A

Breast
Kidney
Bowel
Bladder

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96
Q

what is a pancoast tumour

A

It is a tumour in the lung apex which metastasised to the necks sympathetic plexus which causes horners syndrome

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97
Q

what is Horners syndrome

A

when there is ptosis, myosis and anhidrosis
- droopy eyelids
- contraction of pupil
- lack of sweat

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98
Q

what is a pulmonary embolism

A

It is when pulmonary artery circulation is blocked by a blood clot, usually an embolism of a DVT

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99
Q

what is a pulmonary embolism

A

It is when pulmonary artery circulation is blocked by a blood clot, usually an embolism of a DVT

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100
Q

what are risk factors for pulmonary embolism

A

Anything affecting virchows triad
immobility
post surgery
pregnancy
obesity
malignancy
Factor V leiden
antiphospholipid syndrome
smoking
hypertension
trauma
catheters

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101
Q

what is Virchows triad

A

implicates three contributing factors in the formation of thrombosis: venous stasis, vascular injury, and hypercoagulability

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102
Q

what is the pathophysiology of a pulmonary embolism

A
  1. DVT embolises and enters right heart
  2. moves to the lungs and occludes a small pulmonary vessel
  3. this causes reactive bronchoconstriction and dyspnoea
  4. embolus increases pulmonary pressure leading to hypertension
  5. hypertension leads to strain, and to cor pulmonale and right heart failure
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103
Q

what are symptoms of pulmonary embolism

A

Sudden onset shortness of breath
chest pain (pleuritic)
swollen calf (DVT)
Haemoptysis
increased jugular venous pressure
tachycardia and dyspnoea

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104
Q

what are signs of right sided heart failure

A

hypotensive
tachycardic
peripheral oedema

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105
Q

What is the wells score

A

Wells’ Criteria for Pulmonary Embolism objectifies risk of pulmonary embolism

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106
Q

what criteria are looked at in the Wells score

A

DVT
PE most likely differential diagnosis
HR less than 100
malignancy
haemoptysis

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107
Q

how do you diagnose pulmonary embolism

A

Well score - less than 4 PE unlikely, over 4 PE likely
D-Dimer
Gold standard CTPA
ECG
CXR

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108
Q

what is seen when testing D-dimer in a pulmonary embolism

A

if the D dimer is less than 500 then PE is unlikely if its over then PE is more likely

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109
Q

what is seen on ECG in someone with pulmonary embolism

A

S1Q3T3 - S waves deep in lead I, Q waves in lead III, T waves inverted in lead III
RBBB v1-3 - RSR pattern due to right axis deviation
sinus tachycardia

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110
Q

how do you treat pulmonary embolism if the patient is hemodynamically stable

A

Anticoagulants
1st line = DOAC: rivaroxaban, apixaban
If doacs contraindicated
1st line = low molecular weight heparin
2nd line = warfarin

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111
Q

how do you treat pulmonary embolism if the patient is haemodynamically unstable

A

Thrombolysis - alteplase
Catheter embolectomy

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112
Q

what can be given as prophylaxis in pulmonary embolism

A

compression stockings
regular walking
sc low molecular weight heparin

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113
Q

what is pneumonia

A

it is fluid exudation into the alveoli due to inflammation from infection
- typically bacterial

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114
Q

what is CAP

A

community acquired pneumonia
- appears less than 48 hours after admission

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115
Q

what are the most common causes CAP

A

S. pneumoniae
H. influenzae
Mycoplasmodium pneumoniae

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116
Q

what other bacteria can cause CAP

A

S. aureus
Legionella
Moraxella
chlamydia pneumoniae

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117
Q

what are viral causes of pneumonia

A

H. flu
CMV

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118
Q

what are fungal causes of pneumonia

A

P. Jirarechi

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119
Q

what is HAP

A

hospital acquired pneumonia
appears over 48 hours after admission

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120
Q

what bacteria cause HAP

A

P. aeruginosa
E. coli
Klebsiella
MRSA

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121
Q

how do people catch pneumonia

A

through inhalation of pathogens
aspiration

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122
Q

what are risk factors for pneumonia

A

Immunocompromised
IV drug users
pre-existing respiratory disease
Extremes of life

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123
Q

what is the pathophysiology of typical pneumonia

A

Bacteria invades and exudate forms inside the alveoli lumen
sputum on coughing

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124
Q

what is the pathophysiology of atypical pneumonia

A

The bacteria invades and exudate forms in the interstitium of the alveoli
dry cough

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125
Q

what are symptoms of pneumonia

A

Productive cough with rusty coloured sputum
Pyrexic
pleuritic chest pain
tachypnoea
dyspnoea
confusion in the elderly

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126
Q

what is seen on chest X ray in pneumonia

A

pneumonic lesions = fluid filled alveoli

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127
Q

what bacteria causes multilobular pneumonia

A

S. pneumoniae
S. aureus
legionella

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128
Q

What bacteria causes multiple abscesses in pneumonia

A

S. aureus

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129
Q

what bacteria affects the upper lobes in pneumonia

A

Klebsiella (exclude TB first)

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130
Q

how do you diagnose pneumonia

A

1st line diagnostic - chest X ray
sputum sample and culture
CURB65 for assessing severity in CAP

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131
Q

what is CURB65 when assessing CAP severity

A

Confusion
Urea nitrogen >7mmol/L
Respiratory rate > 30
Blood pressure <90/60 mmHg
65 + years old

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132
Q

how is the CURB65 score used when treating pneumonia

A

the score is out of 5
1 = Outpatient, oral antibiotics and discharge
2 = Consider short hospital stay and Abx
3 and over = hospital ICU, IV antibiotics

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133
Q

how do you treat pneumonia

A

Oxygen
antibiotics
analgesia

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134
Q

What antibiotics are used to treat CAP

A

Amoxicillin if CURB is 0-2
Co-amoxiclav and clarithromycin if CURB 3-5

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135
Q

what pneumonia causing disease is notifiable to PHE

A

Legionella

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136
Q

What medication does legionella causing pneumonia require

A

Clarithromycin is first line

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137
Q

what is aspiration pneumonia

A

It is seen in patients with a stroke, bulbar palsy and myasthenia gravis
- aspiration of gastric contents into the lungs

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138
Q

what is tuberculosis

A

a granulomatous caseating disease caused by mycobacteria

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139
Q

what are the four mycobacteria species known as the mycobacterium tuberculosis complex

A

M. tuberculosis
M. africanum
M. Microtis
M. Bavis

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140
Q

Where is M. Bavis found

A

in unpasturised milk

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141
Q

where is tuberculosis common

A

South asia - China, India and Pakistan
Subsaharan africa

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142
Q

how many people worldwide have TB

A

1.7 billion people

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143
Q

How it tuberculosis spread

A

airborne pathogen

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144
Q

what are risk factors for tuberculosis

A

country and travel associated
immunocompromised
Homeless/crowded housing
IV drug users
smoking and alcohol
increased age

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145
Q

what are the features of MTC (mycobacterium tuberculosis complex)

A

Non motile and non spore forming
Mycotic acid capsule - acid fast staining
resistant to phagolysosome killing
slow growing (15-20hr)

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146
Q

what is the pathophysiology of tuberculosis

A
  1. TB phagocytosed but isnt killed and forms a granuloma
  2. T cells are recruited and the central region of the granuloma undergoes caseating necrosis
  3. have primary Ghon focus formation in the upper parts of the lung
  4. Ghon focus spreads to lymph nodes close by
  5. this forms a ghon complex
  6. if infection spreads systemically its known as Miliary TB
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147
Q

What is TB known as if it spreads systemically

A

Miliary TB

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148
Q

In most how does TB survive

A

it survives within the granulomas and is known as latent TB

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149
Q

what causes latent TB to reactivate

A

in immunosuppressed patients it may reactivate

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150
Q

what are symptoms of TB

A

Characteristic = night sweats and weight loss
pyrexia
chest pain
if extrapulmonary can have meningitis fever, skin changes, TB pericarditis symptoms and joint pain

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151
Q

how do you diagnose TB

A

Mantoux skin test - latent or active
Sputum cultures - acid fast test
Biopsy
Chest X ray

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152
Q

how do you treat Tuberculosis

A

RI2PE6
Rifampicin - 2 months
Isoniazid - 2 months
Pyrimidine - 6 months
Erythromycin - 6 months

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153
Q

what is a side effect of rifampicin

A

Bloody/red urine and tears

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154
Q

What is a side effect of Isoniazid

A

peripheral neuropathy - tingling hands and feet

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155
Q

What is a side effects of pyrimidine

A

Hepatitis

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156
Q

what is a side effect of ethambutol

A

optic neuritis - eye problems

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157
Q

what are types of interstitial lung diseases

A

Granulomatous - sarcoidosis
Inhalational - hypersensitivity pneumonitis
Idiopathic pneumonias - pulmonary fibrosis
Conn tissue - scleroderma
Drug induced - Amiodarone
Other - goodpastures, vasculitis

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158
Q

what is the most common interstitial lung disease

A

pulmonary fibrosis

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159
Q

what demographic is pulmonary fibrosis most commonly seen in

A

Older men (60+) who smoke

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160
Q

What are risk factors for developing pulmonary fibrosis

A

smoking
occupational - dust
drugs - methotrexate
viruses - EBV, CMV

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161
Q

what drug can cause pulmonary fibrosis

A

methotrexate

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162
Q

what viruses can cause pulmonary fibrosis

A

EBV and CMV

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163
Q

what is the pathology of pulmonary fibrosis

A

progressive scarring of the lungs eventually leads to a type 1 respiratory failure

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164
Q

what are symptoms of pulmonary fibrosis

A

Exertional dyspnoea
dry unproductive cough

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165
Q

how do you diagnose pulmonary fibrosis

A

spirometry = restriction
FV1:FVC is over 0.7
FVC is low (less than 0.8)
Gold standard = High resolution CT

166
Q

what is seen on chest CT in someone with pulmonary fibrosis

A

Ground glass lungs
traction bronchiectasis

167
Q

how do you treat pulmonary fibrosis

A

smoking cessation and vaccines
Pirfenidone
Nintendanib
Surgery - lung transplant

168
Q

what is pneumoconiosis

A

it is an occupationally acquired form of interstitial lung disease

169
Q

what are the two types of pneumoconiosis

A

Silicosis
Asbestosis

170
Q

what is silicosis

A

this is inhalation of silicon dioxide causing eggshell calcification and hilar lymph nodes

171
Q

What is asbestosis

A

This is the inhalation of asbestos which affects the pleura and can cause mesothelioma

172
Q

what is sarcoidosis

A

this is an idiopathic granulomatous disease

173
Q

what demographic is sarcoidosis most common in

A

women
20-40yrs
Afro-Caribbean

174
Q

what are the symptoms of sarcoidosis

A

Fever
fatigue
dry cough
dyspnoea
eye lesions
lupus pemio

175
Q

what is Lefgrens syndrome

A

it is a subset of sarcoidosis

176
Q

what triad is seen in Lefgrens syndrome

A

Bilateral hilar infiltration
Erythema nodosum
Acute polyarthritis

177
Q

how do you diagnose sarcoidosis

A

chest X ray - staging 1-4
Diagnostic - biopsy
bloods -increased serum calcium and ACE

178
Q

what is seen on a chest X ray in sarcoidosis

A

Bilateral Hilar adenopathy
pulmonary infiltrate

179
Q

what is seen on biopsy in sarcoidosis

A

Non caseating granulomas

180
Q

how do you treat sarcoidosis

A

Early stages = Self resolving
Symptomatic = Corticosteroids

181
Q

what is hypersensitivity pneumonitis

A

it is a T3 hypersensitivity: immune Ab-Ag deposition at the lung tissues and causes immune hyperresponsiveness

182
Q

what are risk factors for hypersensitivity pneumonitis

A

occupation - farmer
bird keeping

183
Q

what are types of hypersensitivity pneumonitis

A

Farmer’s lung - mouldy hay (MC)
pigeon fanciers lung - anon protein in bird poo
malt workers lung
cheeseworkers lung
humidifier fever

184
Q

how do you treat hypersensitivity pneumonitis

A

remove the allergen

185
Q

what is goodpastrues syndrome

A

it is a T2 autoimmune hypersensitivity response

186
Q

what is the pathology of Goodpastrues syndrome

A

There are autoantibodies (AntiGBM) which attack the lungs and kidneys leading to lung fibrosis and glomerulonephritis

187
Q

how do you diagnose Goodpastures disease

A

lung and kidney biopsy
serology - anti GBM positive

188
Q

what is seen on the lung and kidney biopsy in Goodpastures syndrome

A

damage and Ig deposition

189
Q

how do you treat goodpastures syndrome

A

Supportive
corticosteroids
plasma exchange - get rid of Anti-GBM

190
Q

what is Wegners granulomatosis

A

it is a granulomatosis vasculitis affecting small and medium vessels typically causing BNT, lung and kidney symptoms

191
Q

what is Wegners granulomatosis associated with

A

c-ANCA associated vasculitis

192
Q

what are symptoms of Wegners granulomatosis

A

Saddle shapes nose
Ear infection
diffuse alveolar haemorrhage
haemoptysis
granulonephtitis
haematuria

193
Q

how do you diagnose Wegners granulomatosis

A

ANCA positive

194
Q

how do you treat Wegners granulomatosis

A

Corticosteroids
immunosuppression - rituximab

195
Q

what is bronchiectasis

A

it is the permanent dilation of the bronchioles
and excessive mucus within them

196
Q

what are the symptoms of bronchiectasis

A

productive cough with lots of sputum and dyspnoea

197
Q

what are risk factors for developing bronchiectasis

A

MC - post infection
HIV
Cystic fibrosis
ABPA

198
Q

what is the pathology of bronchiectasis

A

there is irreversible dilation, loss of cilia and mucus hypersecretion which increases risk of infection as there is a reduction in mucociliary clearance

199
Q

how do you diagnose Bronchiectasis

A

Imaging - chest X ray
Gold - HRCT
spirometry - obstructive FEV1:FVC <0.7
sputum culture

200
Q

what is seen on HRCT in bronchiectasis

A

Dilated thickened bronchi
cysts at the end of bronchi

201
Q

what organisms may be found in the lungs in Bronchiectasis

A

H. Influenzae
S. Pneumoniae
P. Aeruginosa

202
Q

how do you treat bronchiectasis

A

non curative
conservative = chest physio and stop smoking
Bronchodilators
antibiotics if infection is present

203
Q

what is cystic fibrosis

A

an autosomal recessive mutation on chromosome 7 in the gene that encodes the CFTR protein

204
Q

what are risk factors for cystic fibrosis

A

family history
caucasians

205
Q

what is the pathology behind cystic fibrosis

A

There is a defective CFTR gene which prevents CL-, Na+ and H2O secretion making mucus secretions thicker with more sodium and chloride retention

206
Q

what is the normal function of the CFTR protein

A

secretion of Cl- actively and Na+ passively (+H2O) into ductal secretions making them thin and watery

207
Q

what affect does CFTR gene mutation have on the lungs

A

there is impaired mucociliary clearance as the mucus is extra thick which causes an increase in stagnation and increased infection risk
it causes difficulty breathing and increases risk of bronchiectasis

208
Q

what are the respiratory symptoms of cystic fibrosis

A

Thick and sticky sputum cough
recurrent infection
bronchoiectasis

209
Q

what are neonate symptoms in cystic fibrosis

A

Meconium ileus - earliest stool is too thick to pass through bowel and causes an obstruction
failure to thrive

210
Q

what are GIT symptoms of cystic fibrosis

A

thick secretions
pancreatic insufficiency
bowel obstruction

211
Q

what may males with cystic fibrosis experience

A

atrophy of the vas deferens and epididymis

212
Q

how do you diagnose cystic fibrosis

A

sweat test - high sodium and chloride
Fecal elastase - negative in CF
family history
genetic testing

213
Q

how do you treat cystic fibrosis

A

non curative
conservative - chest physio and stop smoking
drugs - antimucolytics, bronchodilators, pancreatic enzyme replacement, fast soluble vitamin supplements

214
Q

what are common infections in CF patients

A

S. aureus
H. influenzae
P. Aeruginosa
(same as in bronchiectasis)

215
Q

what is pleural effusion

A

when there is excess fluid accumulation between the visceral and parietal pleural layers

216
Q

what are the two types of pleural effusion

A

Transudative
Exudative

217
Q

what is transudative pleural effusion

A

it is when there is low protein (<25g/L)

218
Q

what causes transudative pleural effusion

A

an increase in hydrostatic pressure or reduced oncotic pressure - transparent fluid
- congestive heart failure
- liver cirrhosis
- nephrotic syndrome

219
Q

what is exudative pleural effusion

A

when there is high protein (>35 g/L)

220
Q

what causes exudative pleural effusion

A

inflammation causing a high vascular permeability - cloudy
- cancer
- TB
-pneumonia

221
Q

what are symptoms of pleural effusion

A

Generic dyspnoea
pleuritic chest pain
cough
decreased breathy sounds
dull percussion on ipsilateral side

222
Q

what is lights criteria used for

A

In pleural effusion when the excess fluid protein is between 25-35g/L

223
Q

what would be hyperresonant on lung percussion

A

pneumothorax

224
Q

How do you diagnose pleural effusion

A

Chest X-ray
Thoracocentesis - sample of pleural fluid

225
Q

what is seen on a chest X ray in pleural effusion

A

decreased costophrenic angles
excess fluid appears white
tracheal indentation may be present

226
Q

what is pleural fluid tested for in pleural effusion

A

pH
lactate
White cell count
microscopy
transudate or exudate

227
Q

how do you treat pleural effusion

A

chest drain
if recurrent then pleurodesis

228
Q

what is pleurodesis

A

surgical joining of the pleural layers

229
Q

what is a pneumothorax

A

it is excess air accumulation in the pleural space causing ipsilateral collapse

230
Q

who typically presents with pneumothorax

A

tall thin males
connective tissue disorders such as marfans
smokers

231
Q

what are the two types of pneumothorax

A

primary - spontaneous
secondary - trauma/pathology

232
Q

what is the pathology of pneumothorax

A

the pleural space is normally a vacuum
a breach in the pleura causes an abnormal space between the pleura and the airways introducing air into the pleural space = pneumothorax

233
Q

what are symptoms of a pneumothorax

A

shortness of breath
one sided sharp pleuritic pain
decreased breathing sounds
hyperresonant percussion unilaterally

234
Q

how do you diagnose a pneumothorax

A

Chest X ray - excess air appears black and there is tracheal deviation to the otherside
CT is more sensitive to small pneumothoraxes

235
Q

how do you treat a pneumothorax

A

small = self healing
larger = needle decompression (suck air out) or a chest drain
Surgical if recurrent = pleurodosis

236
Q

what is a simple pneumothorax

A

it is a non medical emergency when there is little tracheal deviation and air can flow in and out of the valve between the alveoli and the pleura
- doesnt/unlikely to worsen with every breath

237
Q

what is a tension pneumothorax

A

medical emergency with contralateral tracheal deviation.
there is a one way valve between the alveoli and pleura where air can flow in but not out meaning it worsens with every breath

238
Q

how do you treat a tension pneumothorax

A

insert a large bore cannula into the second intercostal space at the midclavicular line
needle decompress and then chest drain

239
Q

what is cor pulmonale

A

it is right circulation (pulmonary hypertension) changes which directly causes right heart failure

240
Q

what is pulmonary hypertension

A

a resting pulse pressure of over 25mmHg, measured with right heart catheterisation

241
Q

what are causes of pulmonary hypertension

A

pre-capillary
capillary and lung
post capillary
chronic hypoxemia

242
Q

what are pre capillary causes of pulmonary hypertension

A

pulmonary emboli
primary pulmonary hypertension

243
Q

what are capillary and lung causes of pulmonary hypertension

A

COPD
asthma

244
Q

what are post capillary causes of pulmonary hypertension

A

LV failure

245
Q

what are chronic hypoxemia causes of pulmonary hypertension

A

COPD
altitude

246
Q

what is the pathophysiology of pulmonary hypertension

A
  1. due to pulmonary hypertension there is reactive pulmonary vasoconstriction
  2. this increases pulmonary vascular resistance and pressure increasing endothelial damage
  3. this causes right ventricular hypertension and failure
247
Q

what are the symptoms of pulmonary hypertension

A

usually on exertional dyspnoea and fatigue
then RHF signs
- increased jugular venous pressure
- peripheral oedema
- V waves prominent on JVP
- Louder S2 than normal

248
Q

how do you diagnose pulmonary hypertension

A

Chest X ray
ECG
ECHO - right ventricular hypertension
GS = right heart catheter to measure pressure

249
Q

what is seen on a chest X ray in pulmonary hypertension

A

signs of right ventricular hypertension - enlarged proximal pula

250
Q

what is seen on an ECG in pulmonary hypertension

A

RA dilation - peaked P waved of over 2.5mm

251
Q

how do you treat pulmonary hypertension

A

phosphodiesterase S inhibitor (sildenafil)
CCB (amlodipine)
Endothelin 1 antagonist/prostaglandin analogue
diuretics for oedema

252
Q

what is pharyngitis

A

inflamed pharynx plus of minus exudate

253
Q

what are viral causes of pharyngitis

A

EBV
Adenovirus

254
Q

what are bacterial causes of pharyngitis

A

Group A beta haemolytic strep - S. pyogenes

255
Q

what are symptoms of pharyngitis

A

sore throat
fever
Viral - cough and nasal congestion
Bacterial - Exudate

256
Q

what is important to rule out if someone has bacterial pharyngitis

A

Rheumatic fever

257
Q

what is rheumatic fever

A

a systemic inflammatory disease typically 2-4 weeks post group A strep infection

258
Q

how would you treat bacterial pharyngitis

A

amoxicillin

259
Q

what is sinusitis

A

it is inflamed mucosa of the nasal cavity and nasal sinuses

260
Q

what are causes of sinusitis

A

it is mostly viral (less then 10 days non purulent discharge)
Sometimes bacterial (over 10 days, purulent)

261
Q

what are causes of bacterial sinusitis

A

S. pneumo
H. influenzae

262
Q

how do you treat bacterial sinusitis

A

Amoxicillin

263
Q

what is Otitis media

A

it is an inflamed middle ear, typically in children

264
Q

what can cause otitis media

A

bacterial - streptococcus
Viral

265
Q

how do you diagnose otitis media

A

an otoscopy shows inflamed erythematous tympanic membrane

266
Q

what can sinusitis and otitis media be linked to

A

meningitis contagious spread - direct

267
Q

what is epiglottitis

A

it is inflammation of the epiglottis - mostly in children

268
Q

what is the most common cause of epiglottitis

A

H. influenzae

269
Q

What are symptoms of epiglottitis

A

tripoding - leant forward, mouth open and tongue out to maximise air in
sore throat
shortness of breath

270
Q

how do you diagnose epiglottitis

A

laryngoscopy is gold standard
lateral radiograph - thumb print sign

271
Q

what is whooping cough

A

a chronic cough caused by bordella pertussis mainly seen in children

272
Q

what type of bacterial is Bordella pertussis

A

a gram negative bacillus

273
Q

what virulence factors does bordella have to increase infection risk

A
  1. Haemagglutinin and fibroae adhere to the URT
  2. Adenylate cyclase toxin inhibits phagocyte chemotaxis
  3. Pertussis toxin inhibits alveolar macrophages
274
Q

what is croup/laryngobronchitis

A

an occasional complication of an upper respiratory tract infection particularly from parainfluenza and measles in children

275
Q

what are the symptoms of croup/laryngobronchitis

A

hoarse voice
barking cough
stridor - high pitched wheeze when inhaling

276
Q

how do you treat Croup/Laryngobronchitis

A

single dose of dexamethosone

277
Q

what are risk factors for asthma

A

History of atopy
Low birth weight
Not breastfed
Exposure to allergens

278
Q

what investigations are done for asthma

A

FEV1 - reduced
FCV - normal
FEV1/FVC is less than 0.7
FeNO3 - adults over 40pbb and children over 35

279
Q

what can be used for acute asthma management

A
  1. oxygen
  2. salbutamol nebulisers
  3. ipratropium bromide nebulisers
  4. hydrocortisone IV or oral prednisolone
  5. IV magnesium sulphate
  6. Aminophylline or IV salbutamol
280
Q

in asthma what if pCO2 is normal

A

this is a bad sign as it means that the patient is tiring

281
Q

what is type 1 respiratory failure

A

It is caused by fibrosis where the lung fails to fill properly
Low PaO2 and PaCO2 is normal or low

282
Q

how do you treat type 1 respiratory failure

A

Continuous positive airway pressure

283
Q

What is type 2 respiratory failure

A

caused by obstruction where the lung fails to remove CO2 properly
PaO2 is low and PaCO2 is high

284
Q

what diseases show type 2 respiratory failure

A

COPD
Asthma

285
Q

how do you treat type 2 respiratory failure

A

Bi positive airway pressure

286
Q

what is seen on chest X ray in patients with COPD

A

hyperinflation
Bullae - fluid filled sac or region
flat hemidiaphragm
Exclude malignancy!

287
Q

when should you consider long term oxygen in COPD

A

when the FEV1 is less than 30% predicted
cyanosis
polycythaemia
peripheral oedema
raised JVP
O2 less than or equal to 92% on room air

288
Q

how do you manage a primary pneumothorax

A

if its less than 2cm then discharge
aspiration
chest drain

289
Q

how do you manage a secondary pneumothorax

A
  1. <1cm: O2 and admit
  2. 1-2cm: aspirate
  3. > 2cm: chest drain
290
Q

how do you manage cystic fibrosis

A

Chest physio and postural drainage
high calorie, high fat diet
minimise contact with other infective patients
pancreatinc supplementation

291
Q

what are causes of bronchiectasis

A

Post infection
CF
lung cancer

292
Q

how do you manage bronchiectasis

A

Physical training
postural drainage
Prophylactic antibiotics
Surgery (localised disease)

293
Q

what organism causes pneumonia in immunocompromised patients

A

Pneumocystis Jiroveci

294
Q

what organisms can cause atypical pneumonia

A

Legionella pneumophila
mycoplasma pneumoniae
chlamydia psittaci
chlamydiopilia pneumoniae
coxiella burnetii

295
Q

what pneumonia signs are heard on auscultation

A

Decreased air entry
wheezing
course crackles
bronchial breath sounds
increased vocal resonance

296
Q

what would be seen on a chest X ray of someone with pneumonia

A

Localised or widespread consolidation, effusion, abscess and empyema

297
Q

what would be seen on FBC on someone with pneumonia

A

Increased white cell count
increased urea
increased CRP

298
Q

what is the definition of pharyngitis

A

Acute pharyngitis is characterised by the rapid onset of a sore throat and inflammation of the pharynx (with or without exudate)

299
Q

what are common viral causes of pharyngitis

A

Rhinovirus
RSV
Adenovirus
Enterovirus
Influenza A and B
Parainfluenza
EBV
CMV

300
Q

what are symptoms of pharyngitis

A

Sore throat - difficulty swallowing
Fever
Headache
Joint pain or muscle ache
Skin rashes
Swollen lymph nodes in the neck

301
Q

what are viral specific symptoms of pharyngitis

A

runny nose
blocked nose
sneezing
cough

302
Q

what are bacterial specific symptoms of pharyngitis

A

Fever
pharyngeal exudate
cervical lymphadenopathy
absence of cough and runny nose

303
Q

what investigations are done for pharyngitis

A

Assess the likelihood of Strep A infection
Rapid antigen detection test

304
Q

what is the treatment for viral pharyngitis

A

Normally self resolving
supportive care

305
Q

what is the treatment for bacterial causing pharyngitis

A

Phenoxymethylpenicillin (or clarithromycin if penicillin allergic)

306
Q

what is the aetiology of sinusitis

A

common infectious agents are
- streptococcus pneumoniae
- Haemophilus influenzae
- Rhinovirus

307
Q

what is double sickening in sinusitis

A

when someone has a viral infection which progresses to a secondary bacterial infection

308
Q

what are risk factors for sinusitis

A

Nasal pathology - septal deviation or nasal polyps
Recent local infection - dental extraction
Swimming or diving
Smoking

309
Q

how does viral sinusitis present

A

symptoms usually last less than 10 days
- clear nasal discharge
- fever
- sore throat

310
Q

How does bacterial sinusitis present

A

symptoms are over 10 days
- purulent nasal discharge
- nasal obstruction
- dental or facial pain
- headache

311
Q

how do you treat sinusitis

A

symptom management with analgesia and intranasal decongestants
Nice - Internasal corticosteroids if symptoms last longer than 10 days
Abx not required but can be given in severe presentations - phenoxymethylpenicillin

312
Q

what type of lung cancer has worse prognosis

A

Small cell lung cancer

313
Q

what type of lung cancer is more common

A

Non small cell lung cancer - 80-85% of all cases

314
Q

what is the epidemiology of lung cancer

A

it is the third most common cancer in the UK behind breast and prostate

315
Q

what is the most common cancer cell type in non smokers

A

adenocarcinoma

316
Q

what lung cancer is most strongly associated with cigarette smoking

A

Squamous cell carcinoma

317
Q

what is more common, primary or secondary lung cancer

A

Secondary

318
Q

what are the most common sites for lung cancer metastasis

A

Liver
Bone
Adrenal glands
Brain

319
Q

what paraneoplastic changes can occur in lung cancer

A

increased PTH - hyperparathyroidism
Increased ADH - SIADH
increased ACTH - cushings syndrome

320
Q

what are extrapulmonary manifestations of lung cancer

A

Recurrent laryngeal nerve palsy - hoarse voice
Superior vena cava obstruction - facial swelling, distended veins in neck and chest, Pembertons sign
Horners syndrome - ptosis, miosis, anhidrosis

321
Q

what are symptoms of metastatic disease

A

Bone pain
Headache
Seizures
Neuro deficit
Abdominal pain

322
Q

what is diagnostic for lung cancer

A

Percutaneous or bronchoscopic biopsy and histology

323
Q

what is seen on a chest X ray in someone with lung cancer

A

Opacified lesion
Hilar enlargement
Pleural effusion (usually unilateral)
collapse

324
Q

what type of pleural effusion is due to systemic causes

A

Transudative

325
Q

what are causes for transudative pleural effusion

A

Congestive heart failure
Fluid overload
Hypoalbuminemia (cirrhosis, nephrotic syndrome)

326
Q

what are causes for exudative pleural effusion

A

lung cancer
Pneumonia
TB
RA

327
Q

what is seen if there is a large plural effusion

A

can have tracheal deviation away from the effusion

328
Q

what are different treatment options for pleural effusion

A

dependent on the cause
fluid overload or congestive HF - diuretic
Infective - antibiotics
large effusions need aspiration or drainage

329
Q

what are symptoms of pulmonary embolism

A

Acute onset shortness of breath
cough +/- hemoptysis
Pleuritic chest pain

330
Q

What are signs of pulmonary embolism

A

DVT - unilateral leg swelling and tenderness
Hypoxia
tachycardia
increased respiratory rate
low grade fever
haemodynamic instability causing hypotension

331
Q

what are the things looked at by the wells score

A

clinical signs and symptoms of DVT - 3 points
Alternative diagnosis less likely than PE - 3
Bed for 3+ days or major surgery - 1 point
Heart rater over 100bpm - 1.5 points
Immobilisation for over 3 weeks - 1.5
previous DVT -PE - 1.5 points
Haemoptysis - 1 point
Active cancer - 1 point

332
Q

if someone is haemodynamically unstable how do you treat a pulmonary embolism

A

IV thrombolysis
Catheter - direct thrombolysis
Embolectomy - surgery

333
Q

what do you give someone with suspected PE if their investigations are delayed

A

Start on interim therapeutic anticoagulation

334
Q

What do you do if anticoagulation reoccurs or if treatment is unsuccessful

A

put in an IVC filter - An IVC filter is a small metal device that traps large clot fragments and prevents them from traveling through the vena cava vein to the heart and lungs

335
Q

what is the pathophysiology of COPD

A

There is chronic inflammation affecting the central and peripheral airways, lunch parenchyma and the alveoli
there is repeated injury and repair leading to structural and physiological changes
narrowing and remodeling of airways, increased goblet cells, enlargement of mucus secreting glands, alveolar loss and pulmonary hypertension

336
Q

How is breathlessness categorised according to the medial research council

A

0 = no breathlessness except with hard exercise
1 = SOB when hurrying or walking up hill
2 = walks slower than people same age or stops for breath when walking the same pace
3 = Stops for breath when walking after 100m
4 = too breathless to leave the house

337
Q

What are differentials for COPD

A

Asthma
Congestive heart failure
Bronchiectasis
TB
Bronchiolitis
Upper airway dysfunction
Chronic sinusitis/postnasal drip
GORD
CEi induced cough
Lung cancer

338
Q

what are possible complications of COPD

A

Cor pulmonale
Lung cancer
Recurrent pneumonia
Depression
Pneumothorax
Respiratory failure
Anaemia
Polycythaemia

339
Q

what is the definition of chronic bronchitis

A

bronchitis over 3 months a year for over 2 years

340
Q

what is bronchitis

A

it is inflammation of the bronchi

341
Q

what does chronic bronchitis lead to

A

leads to narrowing of the airways due to tissue swelling and excess mucus production

342
Q

what is the pathophysiology of chronic bronchitis

A

Enlargement of the mucus secreting glands
Increased in number of goblet cells
After inflammation there is fibrosis leading to thickening of wall and reduced lumen size and a decreased FEV1

343
Q

what are the main immune cells involved in chronic bronchitis

A

Neutrophils
CD8 T cells

344
Q

what are features of acute bronchitis

A

Cough - chesty
Often productive - clear, yellow or green
lasts 2 weeks
Fever

345
Q

how is acute bronchitis managed

A

it is self limiting

346
Q

what is the pathophysiology of emphysema

A

Loss of elasticity of the alveoli
Inflammation and scarring reduces size of lumen
Mucus hypersecretion reduces size of lumen

347
Q

what are differential diagnosis for asthma

A

CF
Chronic rhinosinusitis
Trachemolacia
Vascular ring
Foreign body aspiration
Vocal cord dysfunction
Alpha-1-antitrypsin deficiency
COPD
Bronchiectasis
PE
Congestive Heart Failure
Common Variable Immunodeficiency

348
Q

what are complications of asthma

A

Airway remodelling

349
Q

what lung cancer commonly invades the mediastinal lymph nodes and the pleura

A

adenocarcinoma

350
Q

what lung cancer is well differentiated and matastisises early

A

Large cell carcinomas of the lung

351
Q

what lung cancer arises from endocrine cells (Kulchintsky cells)

A

Small cell carcinoma of the lung

352
Q

what are complications of pulmonary embolism

A

Pulmonary infarction
Cardiac arrest/death
Chronic thromboemolic pulmonary hypertension
Recurrent venous thromboembolic event

353
Q

what are differential diagnosis for TB

A

COVID-19
Community-acquired pneumonia
Lung cancer
Non-tuberculosis mycobacterium
Fungal infection
Sarcoidosis

354
Q

what are risk factors for pneumonia

A

Strep pneumonia infection (allows viral infection with influenza or parainfluenza)
Hospitalisation
Cigarette smoking
Alcohol exces
Bronchiectasis
Bronchial obstruction
Immunosuppression
IV drug use
Dysphagia

355
Q

what are complications of pneumonia

A

Respiratory failure
Hypotension
Pleural effusion
Empyema
Lobar collapse
Thromboembolism
Pneumothorax
Lung abscess
Septicaemia
ARDS

356
Q

what are causes of Otitis media

A

Virus
Step. Pneumoniae
Strep. Aureus
H. Influenzae

357
Q

what is the clinical presentation of epiglottitis

A

Acute onset fever
sore throat
respiratory distress
tachycardia
hypotension

358
Q

what is the clinical presentation of otitis media

A

Fever discharge
ear ache

359
Q

what is the clinical presentation of sunisutis

A

non resolving
biphasic cold pattern
pain
purulent discharge
anosmia

360
Q

what are the clinical presentations of pharyngitis

A

Inflammation
exudate
fever
tender cervical lymph nodes

361
Q

how id epiglottitis managed

A

Abs - amoxicillin, ampicillin, erythromycin

362
Q

how is otitis media managed

A

Penicillins
macrolides

363
Q

how is sinusitis managed

A

Amoxicillin

364
Q

what are complications of pharyngitis

A

Scarlet fever
rheumatic fever
post strep glomerulonephritis

365
Q

what are complications of pulmonary fibrosis

A

Pulmonary hypertension
Lung cancer
GORD
Pulmonary infection
Pneumothorax
PE
DVT
ACS

366
Q

what is the pathology of idiopathic pulmonary fibrosis

A

Pro-inflammatory response is triggered
Influx of immune cells
Dysregulation of normal tissue repair process
Fibroblastic and myofibroblastic activity persists
there is alveolar destruction, infiltration into interstitial space and architectural distortion of lung parenchyma

367
Q

what is the clinical presentation of idiopathic pulmonary fibrosis

A

Dyspnoea
Cough
Crackles
Weight loss
Fatigue
Malaise
Clubbing

368
Q

what parts of the body does sarcoidosis commonly affect

A

Lung, skin and eyes

369
Q

what is the pathophysiology of sarcoidosis

A

There is non caseating granuloma formation with multi nucleated giant cells in the centre
CD4 lymphocytes are spread throughout with CD8 around periphery
CD4 and cytokines promote and maintain the granulomas

370
Q

what are differential diagnosis for sarcoidosis

A

TB
Histoplasmosis
Non small cell lung cancer
Lymphoma
Berylliosis
Hypersensitive pneumonitis

371
Q

what is bronchiectasis normally a consequence of

A

Recurrent and or severe infections secondary to an underlying condition

372
Q

what are causes of bronchiectasis

A

Post - infectious
Immunodeficiency
Genetic
Aspiration/inhalation injury
Inflammatory bowel disease
COPD and asthma
Idiopathic

373
Q

what is the clinical presentation of bronchiectasis

A

Cough
Sputum production
Crackles, high-pitched
inspiration and rhonchi
Dyspnoea
Fever
Fatigue
Haemoptysis
Rhinosinusitis
Weight loss
Wheezing

374
Q

what are differential diagnosis for bronchiectasis

A

COPD
asthma
pneumonia
chronic sinusitis

375
Q

what are complications of bronchiectasis

A

Massive haemoptysis
respiratory failure
cor pulmonale
ischaemic stroke

376
Q

why does CF lead to pancreas dysfunction

A

thick sticky secretions leads to blockage of the exocrine ducts
early activation of pancreatic enzymes
eventual autodigestion of the exocrine pancreas

377
Q

how does CF affect the intestine

A

bulky stool can lead to intestinal blockage

378
Q

what is differential diagnosis for cystic fibrosis

A

primary ciliary dyskinesia
primary immunodeficiency
Asthma
GORD
chronic aspiration
failure to thrive
coeliac disease
protein losing enteropathy

379
Q

what inhaler is used in asthma

A

short acting inhaler - salbutamol

380
Q

what are risk factors of pleural effusion

A

congestive heart failure
pneumonia
malignancy

381
Q

what are differential diagnosis for pleural effusion

A

Pleural thickening
pulmonary collapse and consolidation
elevated hemidiaphragm
pleural tumours/extrapleural fat
covid -19

382
Q

what are complications of pleural effusion

A

Atelectasis or lobar collapse
re-expansion pulmonary oedema
pleural fibrosis
pseudochylothorax
trapped lung

383
Q

what are causes of pneumothorax

A

chest injury
lung disease
ruptured air blisters
mechanical ventilation

384
Q

what are risk factors for pneumothorax

A

smoking
genetics
lung disease
mechanical ventilation
previous pneumothorax

385
Q

what are differential diagnosis for pneumothorax

A

Asthma
COPD
PE
Myocardial ischaemia
Pleural effusion
Bronchopleural fistula
Fibrosing lung disease
Oesophageal perforation
Giant bullae

386
Q

what are possible complications for a pneumothorax

A

Re-expansion pulmonary oedema

387
Q

what are group 1 causes of pulmonary hypertension

A

primary pulmonary hypertension or connective tissue disease

388
Q

what are group 2 causes of pulmonary hypertension

A

left heart failure

389
Q

what are group 3 causes for pulmonary hypertension

A

chronic lung disease

390
Q

what are group 4 causes of pulmonary hypertension

A

pulmonary vascular disease - embolism

391
Q

what are group 5 causes of pulmonary hypertension

A

miscellaneous causes
- sarcoidosis
- glycogen storage disease
- haematological disorders

392
Q

what are complications of pulmonary hypertension

A

respiratory failure
heart failure
arrhythmias

393
Q

what are risk factors for hypersensitivity pneumonitis

A

smoking
viral infection
exposure to antigens
nitrofurantoin, methotrexate, roxithromycin, rituximab
herbal supplements

394
Q

what are signs and symptoms of hypersensitivity pneumonitis

A

Dysponea
Cough (+- productive)
Fevers/chills
Malaise
Weight loss/anorexia
Bibasilar rales
Diffuse rales
Clubbing

395
Q

how do you diagnose hypersensitivity pneumonitis

A

Immune response to causative antigen
FBC
CXR - fibrosis
Pulmonary function test

396
Q

what is the treatment for hypersensitivity pneumonitis

A

avoidance of causative antigen
corticosteroid - prednisolone

397
Q

what is coal worker pneumoconiosis

A

accumulation of dust in the lungs and the reaction of the tissue to it being there

398
Q

what type of asbestos is most fibrogenic

A

blue - crocidolite

399
Q

what is the pathophysiology of silicosis

A

silica is particularly toxic to alveolar macrophages and initiates fibrogenesis

400
Q

what is the pathophysiology of asbestosis

A

it has distinct cellular infiltrate and extracellular matrix deposition distal to the terminal bronchiole

401
Q

what is the clinical presentation of progressive massive fibrosis

A

black sputum
effort dyspnoea
fibrosis
emphysema

402
Q

what is the clinical manifestation of silicosis

A

progressive dyspnoea

403
Q

what is the clinical manifestation of asbestosis

A

dyspnoea
finger clubbing
bilateral basal end inspiratory crackles
pleural plaques

404
Q

what is the pathophysiology of goodpastures disease

A

autoimmunity directed against the alpha-3 chain of type IV collagen

405
Q

what are risk factors for goodpastures disease

A

HLA DRB1 or DR4

406
Q

what are symptoms of Goodpastures disease

A

Reduced urine output
Haemoptysis
Oedema
Male sex
20-30; 60-70yo
SOB
Cough
Fever
Nausea
Crackles on lung examination

407
Q

what are complications of Goodpastures disease

A

Pulmonary haemorrhage
CKD

408
Q

what is the classic triad seen with Granulomatosis with polyangiitis (Wegeners granulomatosis)

A

upper and lower respiratory tract involvement
pauci-immune glomerulonephritis

409
Q

What is the pathophysiology of granulomatosis with polyangiitis?

A

Granulomatous inflammation and vasculitis are the histopathological hallmarks of the disease

Necrotising inflammation is typical

410
Q

What are the risk factors for granulomatosis with polyangiitis?

A

Genetic predisposition
Infection
Environmental exposures - Silica and other occupational exposures have been proposed as triggers

411
Q

why do you get bone pain in lung cancer (mesothelioma)

A

Sign of bone metastasis

412
Q

why do you get bone pain in lung cancer (mesothelioma)

A

Sign of bone metastasis

Phase 2a - Jemima (11 decks)

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