Brainscape's Knowledge GenomeTM

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


See full index

phase 2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what two pathologies make up COPD?

A

emphysema

bronchitis

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

what is emphysema?

A

loss of elastic recoil in the alveoli

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

what is chronic bronchitis in COPD?

A

mucus

fibrosis/thickening of airways = impaired flow of air

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

is COPD restrictive or obstructive?

A

obstructive

lung volume is fine but nt able to blow air in/out

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

in chronic COPD what provides the inspiratory drive?

A

hypoxia

CO2 is permanently high as not able to blow it off, so body becomes desensitised

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

5 signs/symptoms that indicate COPD?

A 
dyspnoea
cough 
wheeze 
odema secondary to heart failure 
tachypnoea 
chest 'tightness'
weight loss 
recurrent infections
exacerbations and better periods
barrel chest 
pursed lip breathing, bent over
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

3 symptoms of chronic disease that are generally NOT seen in COPD?

A

clubbing
haemoptysis
chest pain

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

in COPD what does spirometry show?

A

FVC fairly normal
FEV1 is low, less than 80% of expected
FEV1/FVC ratio less than 0.7
poor response to bronchodilators eg salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what might a chest x ray show in COPD?

A

only see severe disease
enlarged lungs
bullae (air pockets)
flattened diaphragm

excludes cancer and infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what part of the lung is most affected in alpha 1 antitrypsin deficiency?

A

the bottom
panacinar
use a CT or CXR to see this

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

what is TCLO and what does it tell you?

A

transfer factor for carbon monoxide
low in COPD
high in asthma

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

what is first line for COPD?

A

smoking cessation
short acting b2 agonist eg salbutamol
or short acting anti muscarinic eg ipratropium bromide
vaccinations

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

what is second line for COPD?

A

long acting b2 agonist + long acting antimuscarinic

eg oladaterol/tiotropium combo

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

what is third line for COPD, or 2nd line for COPD with asthmatic features?

A

inhaled corticosteroid (eg beclomethasone) + LABA (eg salmeterol)

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

when is ipratropium bromide contraindicated?

A

closed angle glaucoma

urinary retention eg BPH

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

side effects of ipratropium bromide / antimuscarinics?

A 
arrythmia
dizziness 
blurred vision
glaucoma 
G| upset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

side effects of salbutamol?

A

tachycardia, arrythmia

hypokalaemia esp in diabetes

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

an example of a long acting beta 2 agonist?

A

salmeterol

oladaterol

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

what drugs interact syngerstically with steroids?

A

beta agonists
steroids = increased expr of beta2receptor
beta agonist = increased expression of steroid receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

as well as relax smooth muscle, what else do beta 2 agonists do?

A

reduce histamine release

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

what is pirfenidone?

A

antifibrotic

for advanced resp conditions

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

what is theophylline?

A

phosphodiesterase inhibitor
bronchodilation
reduces reactivity to histamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is carbocysteine?

A

mucolytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

type 1 vs type 2 resp failure?

A

type 1 = low O2

type 2 = low O2 high CO2, resp acidosis

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

how can you tell if a respiratory acidosis is chronic?

A

the bicarbonate will be raised, kidneys trying to compensate, but this can’t happen immediately so you only see it in chronic

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

5 triggers for asthma?

A 
infection
exercise
cold air 
dust
damp
pollen
emotion
tobacco
beta blockers
aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what kind of hypersensitivity reaction is asthma?

A

type 3 / type 1

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

what cells/molecules are involved in asthma?

A

cytokines = IgE and mast cells
mast cells release histamine, prostaglandins, leukotrienes
and attract eosinophils

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

what happens in the late response of asthma?

A

immune mediators damage the epithelium

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

why is airflow reduced in asthma?

A

bronchoconstriction & mucus

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

is asthma reversible?

A

initially, yes
over time inflammatory reactions mean the basement membrane becomes thicker and fibrosed, = permanently reduced diameter, then it is not reversible

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

what does an asthma attack look like?

A 
trigger
worsening SOB 
tachynoea 
using accessory muscles 
tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the wheeze like in asthma?

A

polyphonic
bilateral
widespread
episodic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what does spirometry show in asthma?

A

FVC fairly normal
FEV1 is low, less than 80% of expected
FEV1/FVC ratio less than 0.7
improves with bronchodilators eg salbutamol
- 12% increase in FEV1, 200ml increase in vol
worsens with histamine/metacholine challenge, which causes hyperreactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is FENO, how is it used?

A

fractional exhaled nitrogen oxide
more than 40 is pos
can be used in investigation of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is first line for asthma?

A

SABA eg salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is second line for asthma?

A

inhaled corticosteroid eg beclamethosone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are some third line options for asthma?

A
  1. montelukast
  2. laba eg salmeterol (need to be taking saba too)

theophylline
lama
more steroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is montelukast?

A

a leukotriene antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is a problem with theophylline?

A

it has a very narrow TI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

NICE treatment for severe asthma attack in hospital?

A

salbutamol (nebulised)
ipratropium bromide nebulised
oral predisolone or IV hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

in asthma exacerbation what is the ABG like?

A

initially low pCO2, as trying to get enough oxygen in - alkalosis
normal co2 means pt is getting tired of compensatory breathing, this is a bad sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are the two most common kinds of non small cell lung cancer?

A 
squamous cell (central)
adenocarcinoma (peripheral) - from mucus secreting cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what cells is small cell lung cancer from?

A 
kulchitsky cells 
(neuroendocrine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

which is generally worse, small cell or non small cell lung cancer?

A

small cell, as it tends to cause paraneoplastic syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

5 clinical presentations of lung cancer?

A 
SOB
cough
haemoptysis
clubbing 
recurrent infection 
lymphadenopathy - supraclavicular 
fever, weight loss, night sweats, lethargy
pleuritic chest pain 
wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the wheeze like in lung cancer?

A

fixed monophonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

a recurrent laryngeal nerve palsy could be caused by a ______ tumour and would result in __________

A

lung

hoarse voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

a phrenic nerve palsy caused by a lung tumour would cause ______ weakness and this would manifest as _______

A

diagphragm

SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is pembertons sign?

A

bilateral arm elevation = facial oedema

shows the vena cava is being occluded by a lump in the neck, eg enlarged thyroid or lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is Horners syndrome?

A

unilateral ptosis, anhydrosis, myosis

caused by pancoast tumour in the apex of the lung pressing on the sympathetic ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is lambert-eaton myasthenic syndrome?

A

the body produces antibodies against small cell cancer
the antibodies also attack voltage gated calcium channels
proximal weakness, diplopia, ptosis, dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what hormone does squamous cell lung cancer commonly release and what is the effect of this?

A

PTH
hypercalcaemia
osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

two molecules that small cell lung cancer commonly releases that cause paraneoplastic syndromes?

A 
ADH = SIADH = hyponatraemia 
AcTH = cushings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what is an important cause of limbic encephalitis?

A

small cell lung cancer releases antibodies to the limbic system
= memory loss, hallucinations and seizures
anti Hu antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

3 features of lung cancer seen on a chest x ray?

A

hilar enlargement
circular peripheral opacity
unilateral pleural effusion
lung collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

how might you obtain a biopsy in lung cancer?

A

percutaneous

or with an ultrasound guide bronchoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

how can you scan the body to look for cancer?

A

PET-CT

higher uptake of glucose tracer where there is more cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

treatment for non small cell lung cancer?

A

surgery can often be curative

adjuvant or palliative chemo/radio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

treatment for small cell lung cancer?

A

generally not curative

platinum based chemo + radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

5 risk factors for pulmonary embolism?

A 
immobility eg flight
recent surgery
pregnancy
oestrogens 
malignancy
polycythaemia 
thrombophilia eg antiphospholipid syndrome 
inflam conditions eg SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

5 clinical manifestations of pulmonary embolism?

A 
hypoxia -- cyanosis
SOB
haemoptysis
tachycardiaa
tachypnoea
pleuritic chest pain
hypotension
pyrexial
right parasternal heave 
syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

investigations in ?PE?

A

CXR to exclude pneumothorax, pneumonia
well’s score - is PE likely?
- yes – do a CTPA
- no – do a d dimer – if d dimer raised – do a CTPA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

if you want to do a CTPA for PE but it is contraindicated what can you do instead?
when would CTPA be contraindicated?

A

ventilation-perfusion scan - shows good ventilation poor perfusion
CTPA contraind if allergy to contrast or severe kidney failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what would ABG show in PE?

A

low oxygen - as blood cannot get to the alveoli to pick up the oxygen
resp alkalosis - as co2 is being blown off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

management of PE? - 5

A 
supportive - admission, analgaesia, oxygen 
enoxaparin 
alteplase - if PE is large 
surgical embelectomy
vena cava filter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

in pregnant patients at a high risk of PE, what is the best prophylaxis?/

A

heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

where does lung cancer commonly metastasise to?

A 
brain
bone
liver
adrenals
lymph
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

where does secondary lung cancer usually come from?

A 
breast
prostate
colon
bladder
neuroblastoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

who is TB most common in?

A

people moving from outside of UK esp s asia, subsaharan africa
immunocomp
alcoholic
homeless, ivdu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is TB’s waxy capsule made of?

A

mycolic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

how does latent TB arise?

A

the immune system forms a granuloma around the bacteria

but the granuloma does not succeed in killing it and instead actually seals off the bacteria and protects it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is it called when latent TB reactivates?

A

secondary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is milliary TB?

A

Disseminated infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what is a ‘cold abscess’?

A 
TB forms a colony in the lymph
this is often what allows it to spread
painless lump in lymph 
usually in the neck
no surrounding inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

how does TB usually spread between people?

A

through inhaled drops oof infected saliva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

5 presentations of pulmonary TB?

A 
fatigue, night sweats, weight loss, fever
cold abscess
cough/haemoptysis 
dyspnoea
clubbing
crackles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

how does the mantoux test work?

A

inject tuberculin
if there is more than 5mm induration of skin after 72 hours it is pos
the person has had TB and the imune system has generated a response against the ag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what alternative to mantoux test checks for immune response to TB?

A

IGRA - interferon gamma release assay
looks to interferon alpha in response to tb antigen
(quantiferon is an igra test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

tb on a chest x ray:

  • 3 features of primary TB?
  • 2 features of reactivated TB?
A 
GHON COMPLEX 
Primary: pleural effusion
patchy consolidation 
lymphadenopathy 
dense homogenous opacity

secondary: nodular consolidations
cavitations at the top of the lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what are TB on culture?

A

acid fast bacilli

red on ziehl-neilson stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what is the usual management of TB and what are some side effects?

A

R - rifampicin - red tears/urine, cyp induction - 6 months
I - isoniazid - lupus, peripheral neuropathy - 6 months
P - pyrazinamide - gout, hepatitis - 2 months
E - ethambutol - eye probs eg colour blind - 2 months

steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

is TB a notifiable disease?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is the most common cause of community acquired pneumonia?

A

strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what is the second most common cause of community acquired pneumonia?

A

haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

pseudomonas causes pneumonia in who?

A

cystic fibrosis

bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what syndrome can legionella pneumophilia cause, alongside pneumonia?

A

SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what extra-respiratory syndromes does mycoplasma pneumoniae present with?

A 
erythema multiformae (target rash)
neuro symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

in exams a bird owner with a cough and infection is usually infected with

A

chlamydia psittaci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what is ‘lung consolidation’?

A

lung is full o stuff (water, mucus) not air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what is aspiration pneumonia caused by?

A

foreign material in the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

‘q fever’ is most often seen in farmers, what is it caused by?

A

coxiella burnetti

93
Q

5 symptoms of pneumonia?

A 
SOB 
productive cough 
haemoptysis 
pleuritic chest pain 
delirium
sepsis - fever tachycardia tachypnoea hypotension etc
94
Q

5 signs of pneumonia?

A 
fever, tachycardia, tachypnoea
hypotension
bronchial/harsh breath sounds equally loud on inspiration/expiration
dullness to percuss
crackles
95
Q

what system is used to consider how risky a patients pneumonia will be? what does it consider? what score warrants admission?

A 
CURB-65 
C - confusion
U - uraemia
R - resp rate high
B - bp less than 90/ or /60
over 65

consider admit if score of 2 or more
3 or more – intensive care

96
Q

3 antibiotics commonly used in pneumonia?

A

co amoxiclav

amoxicillin
doxycycline
clarithromycin - -mycin = macrolide. usually co amoxiclav + -mycin for hosp treatment
ceftriaxone

97
Q

what antibiotic works against MRSA?

A

Vancomycin

98
Q

what is an empyma?

A

infected pulmonary effusion

99
Q

3 complications of pneumonia?

A 
ARDS
sepsis
lung abscess
pleural effusion
empyma
death
100
Q

where is the division between the upper and lower respiratory tract?

A

vocal chords

101
Q

5 parts of the upper resp tract (that might get infected!)

A 
nasal passages 
sinuses
pharynx 
larynx, above vocal cords 
tonsils 
eustachian tube
102
Q

is tonsilitis usually caused by a bacteria or virus?

A

virus

103
Q

3 features that suggest a tonsilitis is bacterial, not viral?

A

fever
tonsillar exudate
no cough
tender anterior cervical lymph nodes

104
Q

some microbiology of strep pyogenes?

A

lancefield group a
beta haemolytic
catalase neg

105
Q

presentation of tonsilitis?

A 
usually associated with pharyngitis 
red inflamed sore tonsils
sore throat
pain on swallowing 
fever
malaise
headache
106
Q

first line drug for bacterial tonsilitis?

A

penicillin V

107
Q

what is otitis media?

A

inflammation of the ‘middle ear’

commonly infection of the eustachian tube following urt inf

108
Q

4 bacteria that cause most upper resp tract infections?

A

strep pneumoniae
h influenzae
moraxella catarrhalis
staph aureus

109
Q

5 presenting signs/symptoms of otitis media?

A 
ear pain  
hearing loss 
loss of balance
inflamed/perforated tympanic membrane
middle ear effusion
otorrhea (discharge)
110
Q

1st and 2nd line treatments for otitis media and sinusitis?

A

1 - amoxicillin

2 - co amoxiclav

111
Q

what could you use instead of penicillin/amoxicillin if pt is allergic to penicillin?

A

clarithromycin

112
Q

is sinusitis usually bacterial or viral?

A

viral

eg rhinovirus

113
Q

presentation of sinusitis? 4

A 
purulent rhinorrhoea 
face pain
headache
fever
voice changes 
change in smell/taste
cough
114
Q

differences between copd and asthma?

A

copd: non reversible, interval symptoms

115
Q

emphysema vs bronchitis presentation?

A

emphysema = pink puffer - pursed lips, bent over, skinny,

blue bloater = reactive pulmonary vasoconstriction, overweight, productive cough, hypertension

116
Q

what is the most common interstitial lung disease?

A

idiopathic pulmonary fibrosis

117
Q

what kind of spirometry does silicosis and aspestosis have?

A

restrictive

118
Q

presentation of silicosis and asbestosis?

A

dry cough
dyspnoea

generally quiet, not crackly chest

119
Q

what systems are affected by granulomatosis with polyangiitis?

A 
ELK
ENT  - conjunctivitis, ear infections (ent involvement separates it from goodpastures)
Lung  - cough/dyspnoea/wheeze 
Kidney - haematuria
general malaise, fever etc
120
Q

what investigation for staging lung cancer?

A

CT chest, liver, adrenals

121
Q

on CXR what is the difference between the consolidation inn tb and pneumonia?

A

TB - in the middle

pneumonia - at the bottom

122
Q

what are the most common causes of hosp acquired pneumonia?

A

aerobic gram neg bacilli eg
pseudomonas
klebsiella
e coli

123
Q

first line imaging for ?lung cancer or ?TB?

A

chest x ray

124
Q

in a non smoker what lung cancer is most common??

A

adenocarcinoma

125
Q

What is the most common form of pulmonary fibrosis?

A

idiopathic

126
Q

5 aetiologies of pulmonary fibrosis?

A 
idiopathic
ra/sle/annkylosing spondylitis/other connective tissue diseases
vasculitis eg goodpastures 
aspergillus/TB infection 
drugs eg amiodarone, methotrexate 
aspiration
sarcoidosis
127
Q

presentation of pulmonary fibrosis?

A

dry cough
SOB
fine bilateral crackles when you listen to chest

wheeze
haemoptysis 
chest pain
clubbing 
cor pulmonale
128
Q

what kind of spirometry is seen in pulmonary fibrosis?

A

restrictive - so reduced fvc

because fibrosis prevents the lung from expanding

129
Q

what investigation for pulmonary fibrosis?

A

chest CT is best but can do x ray if not available

ground glass appearance - irregular peripheral opacities

130
Q

how is DCLO affected in pulmonary fibrosis?

A

reduced

as gas exchange is impaired

131
Q

2 drugs for pulmonary fibrosis?

A

pirfenidone/nintendinab - anti fibrotic

132
Q

what is the epidemiology of sarcoidosis?

A

female
black and scandinavian
young adults/60+

133
Q

what is the pathophysiology of sarcoidosis?

& what type of hypersensitivity?

A

type 4 hypersensitivity
unknown antigen
granuloma
pulmonary fibrosis and nodules

134
Q

what cells make up the granulomas in sarcoidosis?

A

macrophage in the center

t cells on the edges

135
Q

what is the most common location for the granulomas in sarcoidosis?

A

the hilar lymph node, where the bronchi meets the lung

136
Q

symptoms of pulmonary sarcoidosis?

A

cough
gradual onset progressive dyspnoea
mediastinal lymphadenopathy

137
Q

5 extrapulmonary effects of sarcoidosis?

A 
systemic - fever, weight loss, fatigue 
skin - erythema nodosum, lupus pernio 
joints - polyarthralgia
eye - uveitis, conjunctivitis 
heart - bundle branch block
hypercalcaema 
liver - nodules, cirrhosis, cholestasis
nervous system - diabetes insipidus, bells palsy
138
Q

treatment for sarcoidosis?

A

generally resolves spontaneously
1st line = prednisolone
2nd line = methotrexate/azathiopurine

139
Q

blood tests in sarcoidosis? - 3

A

raised serum ACE
raised serum calcium
raised serum soluble il2 receptor

140
Q

what is gold standard investigation for sarcoidosis and what will you see?

A

ultrasound guided biopsy of mediastinal lymph nodes

non caseating granuloma with epitheloid cells

141
Q

on a chest x ray in sarcoidosis what would you see?

A

hilar lymphadenopathy

bilateral lung exudate

142
Q

what is lofgrens syndrome and what condition is it most commonly associated with?

A

sarcoidosis

triad of bilateral hilar lymphadenopathy, polyarthritis and erythema nodosum

143
Q

what is bronchiectasis?

A

widening of the bronchioles and build up of mucus

144
Q

5 aetiologies of bronchiectasis?

A 
young syndrome 
cf
infection eg tb, pneumonia, hiv, pertussis 
bronchial obstruction eg tumour 
rheumatoid arthritis/uc 
alpha 1 antitrypsin deficiency
copd
145
Q

why is there increased risk of infection in bronchiectasis?

A

because the cilia are damaged so cannot clear the mucus+infection as easily

146
Q

is bronchiectasis an obstructive or restrictive disease?

A

obstructive, the main problem is that mucus obstructs the airways

147
Q

why is there pulmonary hypertension in bronchiectasis?

A

in response to hypoxia the pulmonary vessels constrict in an attempt to divert flow to somewhere with better airflow

148
Q

5 clinical presentations of bronchiectasis?

A 
persistent productive cough
purulous sputum which is foul smelling and dark green (usually has been sat around in the lung for a long time before it can be coughed up)
intermittent haemoptysis
SOB
clubbing
wheeze 
coarse inspiratory crepitations 
prone to respiratory infections
149
Q

what does the chest x ray show in bronchiectasis?

A

cystic shadows

dilated and thickened bronchi and bronchioles

150
Q

how to manage the mucus in bronchiectasis?

A

mucolytic eg carbocysteine

flutter valve for mucus drainage

151
Q

what population is at greatest risk of cystic fibrosis?

A

caucasian

152
Q

what is the mutation in cf and what is the effect of it?

A

mutation in CFTR protein
= lack of cl- into mucus secretions
= thick and sticky mucus

153
Q

5 clinical presentations of CF?

A 
Failure to thrive 
cough - haemoptysis/thick sputum 
wheeze 
recurrent resp inf 
bronchiectasis 
pancreatic insufficiency = steatorrhoea and diabetes 
gall stones, cholestasis
male infertility
nasal polyps
cyanosis
clubbing 
bilateral coarse crackles
154
Q

what is the test for CF in newborns? how does it work?

A

Guthrie
detects raised trypsinogen
trypsinogen raised in response to pancreatic damage

155
Q

what is the gold standard CF test?

A

sweat test
inject pilocarpine to stimulate sweat production
salty sweat = cf, sweat glands are opposite so cl- cannot be absorbed from the sweat

156
Q

two methods of genetic testing for CF during pregnancy?

A

amniocentesis

chorionic villus sampling

157
Q

management for CF?

A

chest physio
antibiotics - acute or prophylactic
mucolytics eg dornase alpha
bronchodilators eg salbutamol
fat soluble vitamin supplement
ursodeoxycholic acid to improve bile flow
ivacaftor or lunacaftor depending on mutation

158
Q

what is a pleural effusion?

A

fluid in the pleural cavity

159
Q

exudative vs transudative effusion?

A 
transudative = low protein, less than 3
exudative = high protein, more than 3
160
Q

3 aetiology of transudative pleural effusion?

A

transudative is caused by movement of fluid eg

congestive heart failure
low albumin
hypothyroid
peritoneal dialysis

161
Q

3 aetiologies of exudative pleural effusion?

A

exudative caused by inflammation, which means both fluid and proteins can move

lung cancer
pneumonia
tb
RA
SLE and other autoimmune 
pulmonary embolism
162
Q

clinical presentation of pleural effusion?

A 
SOB
cough
pleuritic chest pain
stony dull to percussion
reduced chest expansion
superior raspy breathing 
tracheal and mediastinal deviation, if severe
163
Q

investigation for pleural effusion?

A

chest drain/pleural effusion, test the fluid for culture, protein/LDH, appearance, cell count

chest xray

164
Q

what does the chest x ray in pleural effusion show?

A

blunting of the costophrenic angle
fluid in the lung fissures
meniscus at the bottom
tracheal and mediastinal deviation

165
Q

management of pulmonary effusion?

A

antibiotics
diuretics
pleural aspiration or chest drain
small may spontaneously resolve

166
Q

2 complications of pulmonary effusion?

A

empyema

trapped lung

167
Q

in exams what is a common epidemiology/type of patient for pneumothorax?

A

a tall young male with sudden onset shortness of breath while playing sport

168
Q

what conditions is spontaneous pneumothorax more likely in?

A

marfans
rheumatoid arthritis
etc

169
Q

some causes of iatrogenic pneumothorax?

A

central line insertion
mechanical ventillation
lung biopsy

170
Q

presentation of pneumothorax?

A 
sudden onset SOB / pain / cough
cyanosis
tachycardia
tachypnoea 
reduced breath sounds 
hyper resonance 
pleuritic chest pain
171
Q

first line investigation for pneumothorax?

A

erect chest x ray - see a visible rim with no lung markings

172
Q

gold standard investigation for pneumothorax?

A

ct thorax

allows you to see smaller pneumothorax and measure them more effectively than a cxr

173
Q

when would a pneumothorax not need management?

A

less than 2cm with no SOB

174
Q

management of pneumothorax? 3

A

high flow oxygen
insert a chest drain at 5th intercostal space on the mid axillary line
aspiration

175
Q

what can you do for recurrent pneumothorax?

A

surgery to remove the pleura or stick the visceral and parietal layers together

176
Q

where is the air in pneumothorax?

A

in the pleural space (between visceral and parietal pleura)

177
Q

what is a tension pneumothorax caused by?

A

trauma

one way valve

178
Q

clinical presentation of tension pneumothorax?

A 
decreased air entry
unequal lung expansion
tachycardia
hypotension
trachial deviation
hyperresonance
179
Q

management of tension pneumothorax?

A

large bore canula
2nd intercostal space
mid clavicular line

180
Q

at what pressure is pulmonary hypertension diagnosed?

A

25mmHg

181
Q

what are the 5 groups of aetiology of pulmonary hypertension?

A
  1. primary - eg SLE
  2. left sided heart failure - eg MI, systemic hypertension
  3. chronic lung disease - eg COPD - reactive vasoconstriction
  4. pulmonary vascular disease eg PE
  5. miscellaneous eg sarcoidosis, vasculitis
182
Q

what is the effect on the lungs of hypertension?

A

thickening of alveolar and capillary membranes

= reduced gas exchange

183
Q

what is cor pulmonale?

A 
increased pressure in the lung vessels
backs up into right ventricle
= rv hypertrophy 
= backpressure into veins 
= systemic oedema
184
Q

clinical presentation of pulmonary hypertension?

A 
SOB worse when flat / on excercise - orthopnoea 
syncope 
tachycardia
raised jvp
hepatomegaly
peripheral oedema 
chest pain
heart murmur
185
Q

what does an ECG show in pulmonary hypertension?

A

large R waves on the right V1-V3
large S waves on left V4-V6
right axis deviation
right bundle branch block

186
Q

a blood test that would show heart pathology in pulmonary hypertension?

A

NT - pro - BNP

187
Q

3 drugs for primary pulmonary hypertension?

A

IV prostanoid eg epoprostenol
endothelin receptor antagonist eg macitenan
pde-5 inhibitor eg sildenafil

188
Q

3 complications of pulmonary hypertension?

A

resp failure
heart failure
arrythmia

189
Q

how many points do you need on the well’s score for pe to be likely?

A

if wells is more than 4 PE could be likely

190
Q

gold standard test for pulmonary hypertension?

A

right heart catheterisation

this is a way of measuring the pulmonary BP

191
Q

Bird fanciers lung, farmers lung and malt workers lung are all examples of

A

hypersensitivity pneumonitis

192
Q

what type of hypersensitivity reaction is hypersensitivity pneumonitis?

A

type 3

over time – type 4

193
Q

what happens to the lung in hypersensitivity pneumonitis?

A

fibrosis – impaired gas exchange, loss of elasticity

non caseating granulomas

194
Q

what part of the lung is most affected in hypersensitivity pneumonitis?

A

top

195
Q

presentation of acute hypersensitivity pneumonitis?

A

fever, rigors
cough
dyspnoea
headache

196
Q

presentation of chronic hypersensitivity pneumonitis?

A 
progressive cough
progressive dyspnoea 
fatigue
cyanosis
resp failure
weight loss 
clubbing
197
Q

what do you see on biopsy with hypersensitivity pneumonitis?

A

non caseating granuloma

198
Q

management of hypersensitivity pneumonitis?

A

steroids

remove trigger

199
Q

what do you see on imaging in hypersensitivity pneumonitis?

A

diffuse infiltrate
ground glass (fibrosis)
bronchiectasis

200
Q

what are the antibodies to in goodpastures?

A

type 4 collagen

which is in glomerular basement membranes

201
Q

presentation of goodpastures? - 5

A 
cough
SOB
haemoptysis
haematuria
proteinuria
oliguria
hypertension 
anorexia
myalgia/arthralgia
lethargy
fever
202
Q

best investigation for goodpastures, what do you see?

A

kidney biopsy
immunoflorescence - iGg associated with glomerulus
crescents
inflammation

203
Q

what is DCLO in goodpastures?

A

high

204
Q

management of goodpastures?

A

plasmaphoresis
steroids
cyclophosphamide

205
Q

what is the most common ANCA vasculitis?

A

granulomatosis with polyangiitis

206
Q

which ANCA antibody is usually associated with granulomatosis with polyangiitis?

A

cANCA

207
Q

what do you see on chest imaging of granulomatosis with polyangiitis?

A

nodules
fluffy alveolar haemorrhage
cavitating lesions
consolidation

208
Q

mesothelioma is associated with

A

asbestos!

209
Q

what is mesothelium?

A

epithelium that forms lining ie pleura, peritoneum, pericardium etc

210
Q

what molecule does mesothelioma express?

A

calretinin

211
Q

presentation of mesothelioma?

A 
history to suggest
clubbing
sob
pleuritic chest pain 
harmoptysis
fever, weight loss etc
212
Q

which part of the lung is fibrosed in mesothelioma?

A

lower

213
Q

polo mint sign on CT is associated with what condition?

A

PE

214
Q

bronchus sign on CT indicates what lung pathology?

A

bronchogenic cancer

215
Q

tree in bud sign on CT indicates what lung pathology?

A

pneumonitis, bronchiolitis

216
Q

split pleura sign on CT indicates what lung pathology?

A

exudative, malignant or infected pleural effusion

217
Q

signet ring sign on CT indicates what lung pathology?

A

bronchiectasis

218
Q

what is the most common type of lung cancer?

A

squamous

219
Q

what is the most common lung cancer in non smokers?

A

adenocarcinoma

220
Q

complications of bronchiectasis?

A

empyema
respirator failure
repeated inf = worsening lung function
pneumothorax from repeated coughing

221
Q

what is the microbiology of h influenzae?

A

small
gram neg
cocco-bacillus

222
Q

risk factors for pneumothorax?

A

smoking
trauma
previous pneumothorax
mechanical ventilation

223
Q

how long after admission is it called hospital acquired pneumonia?

A

48hrs

224
Q

what type of hypersensitivity is goodpastures?

A

type 2

225
Q

what is gold standard for TB diagnosis?

A

sputum culture

226
Q

what is the most common cause of pneumonia in bronchiectasis?

A

h influenzae

227
Q

which sinus is most prone to infection and what are the symptoms of that?

A

maxillary, because it drains from the top
forehead and cheek tenderness
worse when leaning forward

228
Q

is cystic fibrosis restrictive or obstructive?

A

obstructive

229
Q

3 Indicators of good asthma control?

A 
no  night time symptoms 
inhaler used no more than 3x per week
no breathing difficulties, cough or wheeze on most days 
able to exercise without symptoms 
normal lung function test

phase 2a (10 decks)

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