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Phase 2a flashcards (Alec's) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What causes type 1 respiratory failure?

A

Lung fails to fill properly

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2
Q

What are the blood gas values for T1 respiratory failure?

A
  • O2 = low
  • CO2 = low/ normal
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3
Q

What mechanisms/ conditions can cause type 1 respiratory failures (3)?

A
  • Low ambient O2 (e.g. high altitude)
  • V/Q mismatch (e.g. PE)
  • Diffusion problem (e.g. pneumonia, ARDS)
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4
Q

How is type 1 respiratory failure often treated?

A

Oxygen alone

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5
Q

What is type 2 respiratory failure?

A

Lung fails to remove CO2 properly

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6
Q

What are the blood gas values for T2 respiratory failure?

A
  • O2 = low
  • CO2 = high
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7
Q

What mechanisms/ conditions can cause type 2 respiratory failure (2)?

A
  • Airway resistance (e.g. COPD, asthma)
  • Decrease in gas exchange area (e.g. chronic bronchitis)
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8
Q

How is type 2 respiratory failure often treated?

A

BiPAP (bi +ve airway pressure) + oxygen

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9
Q

What is COPD?

A

Lung tissue damage causing an obstruction to airflow through the lungs, making them more difficult to ventilate

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10
Q

What are the two types of COPD?

A
  • Emphysema
  • Chronic bronchitis
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11
Q

What are some risk factors/ causes of COPD?

A
  • Smoking
  • Air pollution
  • Alpha 1 antitrypsin deficiency (A1AT)
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12
Q

What mechanisms cause chronic bronchitis?

A
  • Hypertrophy/plasia mucous glands –> hypersecretion of mucous
  • Chronic inflammatory cells (in bronchi/oles) –> luminal narrowing
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13
Q

What defines chronic bronchitis?

A

Chronic productive cough for 3 months or more per year for 2 years

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14
Q

What is the mechanism in which emphysema causes respiratory failure?

A

Destruction of elastin in respiratory bronchiole + alveolar walls –> walls collapse and trap air distal to blockage

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15
Q

What is a large air sac that can form in the lungs as a result of emphysema called?

A

Bullae

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16
Q

What are the three main types of emphysema?

A
  • Centriacinar emphysema (resp bronchioles ONLY)
  • Panacinar (resp bronchioles, alveoli sac BOTH)
  • Distal acinar (alveoli sac ONLY)
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17
Q

How is A1AT deficiency inherited?

A

Autosomal co-dominance

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18
Q

How does A1AT deficiency cause pathology?

A

Alpha 1 antitrypsin degrades elastase in neutrophils (elastase degrades elastin), therefore A1AT deficiency = more elastin degradation

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19
Q

What are the signs/ symptoms of COPD (4)?

A
  • Chronic cough
  • Shortness of breath
  • Recurrent resp infections
  • Lots of mucous production
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20
Q

What are 2 presentations, one typical of emphysema one typical of chronic bronchitis?

A
  • Chronic bronchitis = blue bloater
  • Emphysema = pink puffer
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21
Q

What scale can be used to measure the level of dyspnoea in those with COPD?

A

MRC dyspnoea scale:
* 1 = breathless with strenuous exercise …
* … 5 = can’t even leave the house

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22
Q

What is not usually present in COPD (in terms of symptoms)?

A

Haemoptysis

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23
Q

What investigations are done for COPD (5)?

A
  • Pulmonary function test spirometry
  • DLCO test
  • High expired NO = lung damage
  • Genetic testing
  • ECG, ABG, Xray
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24
Q

What would spirometry results show in COPD?

A

FEV1:FVC < 0.7 (= obstructive respiratory failure)

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25
Q

How is COPD and asthma differentiated between?

A

Give bronchodilator, if FEV1 increases by more than 12% then diagnosis is likely asthma

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26
Q

What is DLCO test?

A

Diffuse capacity of CO across the lung

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27
Q

How is COPD treated medically?

A
  • 1st line = SAB2A (short acting beta 2 agonist) or SAM3A
  • 2nd line = add LAB2A and LAM3A
  • 3rd line = inhaled corticosteroids
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28
Q

What can be given to people with very severe COPD?

A

Long term oxygen therapy

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29
Q

What is given to patients with COPD to prevent infection?

A

Influenza + pneumococcal vaccine

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30
Q

What is a complication of COPD?

A

Acute inflammation of lungs associated with infection

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31
Q

What can an acute exacerbation of COPD lead to?

A

High CO2 levels due to V/Q mismatch –> respiratory acidosis

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32
Q

What is an example of a SABA inhaler?

A

Salbutamol (albuterol)

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33
Q

Give an example of a SAMA inhaler?

A

Ipratropium

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34
Q

Give an example of a LABA + LAMA combined inhaler?

A

Anoro

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35
Q

Give an example of a LABA?

A

Salmeterol

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36
Q

Give an example of a LAMA?

A

Tiotropium

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37
Q

Give an example of a LABA + LAMA + ICS combination inhaler?

A

Trimbow (brand name don’t need to know this actually)

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38
Q

How is an acute exacerbation of COPD treated?

A

Nebulised salbutamol + ipratropium
O2 saturation target = 88-92%
With ICS

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39
Q

What is asthma?

A

Chronic, but reversible obstruction/ constriction of the airways

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40
Q

What are the two types of asthma and their prevalence?

A
  • Allergic (70%)
  • Non-allergic (30%)
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41
Q

What are some common triggers for allergic asthma (3)?

A
  • Pollen
  • Dust
  • Mould
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42
Q

When do allergic and non allergic asthma tend to present?

A
  • Allergic = earlier in life
  • Non-allergic = later in life
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43
Q

What has been associated with/ is thought may cause allergic and non-allergic asthma?

A
  • Allergic = hygiene hypothesis, genetics
  • Non-allergic = smoking
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44
Q

What are some general triggers for asthma (4)?

A
  • Infection (esp. viral)
  • Cold weather
  • Exercise
  • Drugs (Bb, aspirin)
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45
Q

What is the atopic triad?

A
  • Asthma
  • Atopic rhinitis (hay fever)
  • Eczema
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46
Q

What 3 conditions/ symptoms have been associated in another triad linked to asthma?

A

Samters triad:
* Nasal polyps
* Asthma
* Aspirin sensitivity

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47
Q

What is the pathophysiology/ mechanism which causes bronchoconstriction/ inflammation in asthma?

A
  1. Over-expression of T-helper 2 cells exposed to tigger
  2. Cytokines release (esp IL 4,5)
  3. IL4 –> IgE release –> mast cell degranulation –> histamine + leukotrienes
  4. IL5 –> Eosinophil recruitment –> leukotrienes
  5. Bronchial constriction + mucous hypersecretion
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48
Q

What happens to the airways when asthma repeatedly occurs?

A

Chronic remodelling
* Decreased lumen size (scarring)
* Increased mucous production

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49
Q

What are the symptoms of asthma?

A

Bilateral episodic wheeze/ cough worse at night

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50
Q

How is asthma investigated (2)?

A
  • Mucous microscopy
  • Spirometry
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51
Q

What can be seen in asthma mucous sample (2)?

A
  • Curschmann spirals - spiral shaped mucous plugs (from gland ducts)
  • Charcot-leyton crystals - proteins from eosinophils
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52
Q

What can be used to determine the severity of an asthma episode?

A

Peak expiratory flow (PEF)
can be moderate, severe, life threatening, fatal

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53
Q

How can spirometry be used to diagnose asthma?

A
  • FEV1:FVC < 0.7
    and
  • Bronchodilator reversible > 12% FEV1 increase
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54
Q

The presence of what in the expired air can indicate inflammation?

A

High proportion NO

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55
Q

How is asthma treated?

A
  1. SABA
    • ICS
    • LTRA
    • LABA
  5. Increase ICS
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56
Q

What is important to check the patient is doing correctly when treating asthma?

A

Inhaler technique + compliance

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57
Q

What is LTRA?

A

Leukotrene receptor antagonist

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58
Q

Give an example of a LTRA inhaler?

A

Montelukast

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59
Q

How is an exacerbation of asthma treated?

A
  1. O2
  2. SABA nebulised
  3. ICS (hydrocortisone)
  4. IV MgSO4 (bronchodilator)
  5. IV theophylline (bronchodilator)
  6. Escalate
    **OSHITME
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60
Q

What can also be given to people with an exacerbation of asthma?

A
  • BIPAP
  • Antibiotics (if infection)
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61
Q

What are the 3 classes of lung cancer?

A
  • Mesothelioma
  • Small cell lung cancer
  • Non-small cell lung cancer
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62
Q

What are 4 types of non-small cell lung cancer?

A
  • Adenocarcinoma = most common
  • Squamous
  • Carcinoid
  • Large cell
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63
Q

What is the main risk factor for mesothelioma?

A

Asbestos exposure

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64
Q

Who is most commonly affected by mesotheliomas?

A

Males (40-70)

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65
Q

What are the general signs/ symptoms of mesothelioma (3)?

A
  • Weight loss
  • Night sweats/ pain
  • TATT
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66
Q

What are the lung signs/ symptoms of mesothelioma (5)?

A
  • SoB
  • Cough
  • Pleuritic chest pain
  • Haemoptysis
  • Hoarse voice
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67
Q

How is mesothelioma investigated (3) - (clue = something weird)?

A
  • Xray + CT
  • CA-125 antigen (general tumour marker)
  • Biopsy = diagnostic
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68
Q

How is mesothelioma treated?

A

Mostly palliative care as VERY aggressive

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69
Q

Where do small and non-small cell lung cancers form in?

A

Parenchyma lung

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70
Q

What are some risk factors for lung cancer (not including mesotheliomas), (5)?

A
  • Asbestos
  • Smoking
  • Coal
  • Radiation
  • Other lung conditions
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71
Q

What are some symptoms of lung cancer (9)?

A
  • SoB
  • Weight loss
  • Hoarse voice
  • Haemoptysis
  • Cough
  • Chest pain
  • TATT
  • Night sweats/ pain
  • Finger clubbing
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72
Q

What usually causes finger clubbing?

A

Chronically low blood oxygen levels

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73
Q

What are two extra pulmonary manifestations of lung tumours caused by them pressing on structures?

A
  • Horners syndrome
  • Superior vena cava obstruction
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74
Q

What is horners syndrome and what causes it (3 things)?

A

Tumour pressing on sympathetic ganglion –> ptosis, miosis (pupil constriction), anhidrosis (no sweat)

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75
Q

How does a SVC obstruction present and what is this sign called?

A

Pemberton’s sign - swollen congested face

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76
Q

What percentage of lung cancers (not mesothelioma) are SCLCs?

A

15%

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77
Q

What is a paraneoplastic syndrome?

A

A syndrome that is the consequence of a tumour in the body

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78
Q

What are some paraneoplastic syndromes caused by an SCLC (3)?

A
  • SIADH
  • Cushings
  • Lambert-eaton syndrome (nmj autoimmune disorder)
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79
Q

Where do SCLCs originate from?

A

Neuroendocrine cells in lung

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80
Q

Where do squamous NSCLCs originate from?

A

Lung epithelium

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81
Q

What do squamous NSCLCs sometimes secrete?

A

PTH

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82
Q

Where do adenocarcinoma NSCLCs originate from?

A

Mucous secreting glandular epithelial cells

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83
Q

Where do carcinoid lung tumours originate from?

A

Neuroendocrine cells (like SCLC) - sometimes secrete serotonin

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84
Q

What gene mutations are carcinoid tumours associated with (2)?

A
  • MEN 1 mutation
  • Neurofibromatosis 1
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85
Q

Where do carcinoid tumours also form?

A

GIT

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86
Q

How are lung cancers investigated (3)?

A
  • CT/ xray
  • Bronchoscopy + biopsy
  • MRI (for staging - TNM)
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87
Q

How are lung cancers treated?

A
  • Surgery (for less aggressive NSCLC)
  • Chemo/radio therapy
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88
Q

What is a monoclonal antibody therapy used for lung cancers called that is anti epidermal growth factor called?

A

Cetuximab

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89
Q

What are 2 risk factors for pulmonary embolism?

A
  • Anything affecting virchows triad
  • Family history
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90
Q

How does a PE affect alveolar-arterial gradient?

A

Increases gradient as more oxygen in alveoli compared to arteries

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91
Q

How is V/Q of the lungs affected in a PE?

A

Ventilation with no perfusion = dead space
Perfusion without ventilation = shunt

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92
Q

How do the lungs respond to the VQ mismatch found in PEs?

A

Bronchoconstriction to the areas of dead space

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93
Q

What are 2 typical presentations for a PE?

A
  • Female uni student on contraception pill returns from Japan
  • Older man had surgery 6 weeks ago and hasn’t been able to move
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94
Q

What are the signs/ symptoms of a PE (7)?

A
  • Tachypnoea + dyspnoea
  • Haemoptysis
  • High JVP
  • Tachycardia
  • Evidence of DVT
  • Pleuritic chest pain
  • Cough
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95
Q

What score is used to asses the likelihood of a PE?

A

Wells score

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96
Q

How should a PE be investigated (3)?

A
  • D-dimer test
  • CT PA
  • V/Q scan (if really impaired)
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97
Q

When should each of these tests be carried out for a PE?

A
  • If wells score < 4 –> d-dimer
  • If wells score > 4 or d-dimer +ve –> CTPA or V/Q scan
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98
Q

What ECG signs are seen in those with PE (5)?

A
  • Deep S waves (lead 1)
  • Deep Q waves (lead 3)
  • Inverted T wave (lead 3)
    S1Q3T3
  • RBBB
  • Tachycardia
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99
Q

What is a massive PE?

A

Systolic BP < 90mmHg

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100
Q

How is a haemodynamically stable PE treated (2)?

A
  • DOACs = 1st line (rivaroxiban, apixaban); (LMWH if contraindicated)
  • Warfarin = 2nd line
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101
Q

How is a haemodynamically unstable PE treated (2)?

A
  • Thrombolysis (alteplase)
  • Catheter embolectomy
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102
Q

What is pneumonia?

A

Inflammation and fluid exudation into lung parenchyma, due to infection

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103
Q

How is pneumonia classified in terms of where it develops (2)?

A
  • Community acquired pneumonia
  • Hospital acquired pneumonia
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104
Q

What defines hospital acquired pneumonia?

A

Developed > 48 hours after hospital admission

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105
Q

What are the two most common bacterial causes of pneumonia?

A
  • S. pneumoniae (most common)
  • H. influenzae
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106
Q

What is atypical pneumonia?

A

Pneumonia that cannot be cultured in the normal way or detected using gram staining

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107
Q

Give 2 examples of atypical pneumonia?

A
  • Mycoplasma pneumoniae
  • Legionella pneumoniae
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108
Q

How are atypical pneumonias usually treated?

A

Clarithomycin (as penicillin resistant)

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109
Q

Where is legionella pneumoniae frequently associated with?

110
Q

What viruses commonly cause pneumonia (2)?

A
  • Influenza A virus
  • CMV
111
Q

What fungi sometimes causes pneumonia?

A

P. jiroveci (pneumocystis pneumonia)

112
Q

What is fungal pneumonia often suggestive of?

113
Q

Which bacteria are more common in HAP (4)?

A
  • P. aeruginosa
  • E. coli
  • Klebsiella
  • MRSA
114
Q

What are two ways pneumonia is commonly developed?

A
  • Inhaling pathogen
  • Aspiration pneumonia
115
Q

What are risk factors for pneumonia (4)?

A
  • IVDU (staph aureus)
  • Very old/ young
  • Pre existing lung disease
  • Immunocompromised
116
Q

What is the difference in presentation between atypical and typical pneumonia?

A
  • Atypical = unproductive cough (exudate forms in interstitium)
  • Typical = productive cough (exudate forms in alveoli)
117
Q

What are the signs/ symptoms of pneumonia (8)?

A
  • Pyrexia
  • Productive cough
  • Pleuritic chest pain
  • Tachypnoea
  • Tachycardia + hypotension
  • Hypoxia
  • Haemoptysis
  • Crackling lungs on auscultation
118
Q

How is pneumonia investigated (2)?

A
  • Xray chest
  • Sputum culture
119
Q

What is seen on an Xray positive for pneumonia?

A

Consolidation (fluid filled alveoli highlight air filled bronchi)

120
Q

How is the severity of pneumonia assessed?

A

CURB 65 score

121
Q

What is assessed in CURB-65?

A
  • Confusion
  • Urea > 7
  • Respiratory rate > 30
  • Blood pressure (<90 systolic or <60 diastolic)
  • 65 years <
    1 point for each
122
Q

How does CURB-65 score guide management?

A
  • 0/1 = outpatient treatment (3% mortality)
  • 2 = hospital admission (3-15% mortality)
  • 3+ = ICU admission (15% + mortality)
123
Q

How is pneumonia treated?

A
  • Maintain O2 sats (94-98%)
  • Antibiotics
  • Analgesia
  • Fluids
124
Q

What antibiotics are used for CURB-65 score 1/0 patients?

A

Amoxicillin

125
Q

What antibiotics are used for CURB-65 score 2+ patients?

A

Amoxicillin + clarithomycin

126
Q

Which bacteria are the exceptions to these antibiotic treatments?

A

Atypical pneumonia = clarithomycin strait away

127
Q

What is tuberculosis?

A

Caseating granulomatous disease, caused by mycobacterium

128
Q

Give an example of a non TB causing mycobacterium?

129
Q

What are the two most common mycobacterium causing TB?

A
  • Mycobacterium tuberculosis
  • Mycobacterium bovis
130
Q

Where is TB more prevalent in the world (2)?

A
  • South asia
  • Sub-saharan africa
131
Q

How many people have TB globally?

A

About 2 million (mostly latent)

132
Q

How is TB spread?

133
Q

What are some risk factors for TB (4)?

A
  • Travel/ migrant
  • Immunocompromised
  • Crowded living space
  • Older age
134
Q

What is the waxy capsule found around TB mycobacterium made of?

A

Mycolic acid

135
Q

What is TB resistant to in the immune system?

A

Phagolysosome (enzymes in lysosomes) killing

136
Q

What is the pathophysiology/ mechanism of TB infection?

A
  1. TB phagocytosed, but resists killing –> granuloma forms
  2. T cells recruited, central part of granuloma undergoes caseating necrosis –> primary ghon focus
  3. TB spreads to nearby lymph nodes –> ghon complex
  4. TB systemic spread = miliary TB
137
Q

Where in the lungs does TB typically affect and why?

A

Upper lobes as TB is aerobic and there is higher perfusion in upper lobes

138
Q

What is the difference between symptomatic and latent TB?

A

Latent = asymptomatic

139
Q

What are the signs/ symptoms of TB (5)?

A
  • Fever + night sweats
  • Cough
  • Weight loss
  • Chest pain
  • Lymphadenopathy
140
Q

How is TB investigated (4)?

A
  • Mantoux skin test
  • Sputum culture
  • Chest X-ray
  • Biopsy
141
Q

What would sputum analysis show for TB (2)?

A
  • Acid fast bacilli
  • Ziehl Neelson = bright red
142
Q

How does the Mantoux skin test work?

A

Tuberculin injected into skin, if lump (induration) certain size = positive result

143
Q

How is active TB treated?

A
  • Rifampicin (6 months)
  • Isoniazid (6 months)
  • Pyrazinamide (2 months)
  • Ethambutol (2 months)
    RIPE
144
Q

How is latent TB sometimes treated?

A

R+I (from ripe) for 3 months

145
Q

What is a side effect of rifampicin?

A

Discolouration of urine (orange/ yellow)
riff am piss ing

146
Q

What is a side effect of isoniazid?

A

Peripheral neuropathy

147
Q

What is a side effect of pyrazinamide?

A

Gout (hyperuricaemia)

148
Q

What is a side effect of ethambutol?

A

Eye problems (colour blindness)

149
Q

What are all RIPE drugs associated with?

A

Hepatotoxicity

150
Q

What is pulmonary fibrosis?

A

Replacement of normal elastic lung tissue with scar tissue that does not function properly

151
Q

What are the different types of pulmonary fibrosis (3)?

A
  • Idiopathic
  • Drug induced
  • Secondary (to another condition)
152
Q

Which drugs can induce pulmonary fibrosis (3)?

A
  • Amiodarone
  • Methotrixate
  • Nitrofurantoin
153
Q

What conditions can cause pulmonary fibrosis (3)?

A
  • SLE
  • RA
  • A1AD
154
Q

What is the most common interstitial lung disease?

A

Idiopathic pulmonary fibrosis

155
Q

What are risk factors for idiopathic pulmonary fibrosis (4)?

A
  • Smoking
  • Older age
  • Occupation (e.g. dust)
  • Viruses (e.g. EBV, CMV)
156
Q

What type of respiratory failure does pulmonary fibrosis cause?

A

Type 1 (problem with filling lungs, not gas exchange)

157
Q

What are the signs/ symptoms of pulmonary fibrosis (3)?

A
  • Slow onset dyspnoea
  • Dry cough
  • Finger clubbing
158
Q

How is pulmonary fibrosis investigated (2)?

A
  • Spirometry
  • CT chest
159
Q

What would spirometry results be for someone with pulmonary fibrosis (2)?

A
  • FEV1 : FVC > 0.7 (= normal)
  • But FVC < 0.8 predicted
160
Q

What type of lung disease does pulmonary fibrosis represent?

A

Restrictive

161
Q

What does a CT for pulmonary fibrosis show (2)?

A
  • Ground glass lung (white streaks of fibrous tissue)
  • Traction brochiectasis
162
Q

What medication is used to treat pulmonary fibrosis (2)?

A
  • Pirfenidone
  • Nintedanib
163
Q

What else can be done to treat pulmonary fibrosis?

A

Lung transplant

164
Q

What term is used to describe interstitial lung disease caused by the inhalation of dust?

A

Pneumoconiosis

165
Q

What 3 inhaled materials cause pneumoconiosis the most?

A
  • Silicosis (crystalline silica)
  • Asbestosis (asbestos)
  • Coal miners lung (coal) - coaliosis if you will…
166
Q

What findings can sometimes be found on X-ray of silicosis and coal miners lung?

A

Egg shell calcification

167
Q

What is sarcoidosis?

A

Idiopathic granulomatous disease that tends to affect the lungs

168
Q

What are 3 risk factors for sarcoidosis?

A
  • Bimodal distribution (younger adulthood, 60+)
  • Female
  • Black
169
Q

How are the lungs affected by sarcoidosis - what does it cause in the lungs (3)?

A
  • Mediastinal lymphadenopathy
  • Pulmonary fibrosis
  • Pulmonary nodules
170
Q

What are the signs/ symptoms of sarcoidosis (6)?

A
  • Fever
  • Weight loss
  • Dry cough
  • Dyspnoea
  • Uveitis
  • Skin lesions (erythema nodosum, lupus pernio - purple lumps)
171
Q

What is lofgren’s syndrome?

A

Presentation of sarcoidosis characterised by:
* Erythema nodosum
* Bilateral hilar lymphadenopathy
* Polyarthritis

172
Q

How is sarcoidosis investigated (3)?

A
  • Bloods
  • Xray/ CT/ (MRI fro CNS involvement)
  • Biopsy
173
Q

What blood results are suggestive of sarcoidosis (2)?

A
  • High ACE
  • Hypercalcaemia
174
Q

What would a chest Xray show in sarcoidosis?

A
  • Bilateral hilar lympadenopathy
  • Pulmonary infiltrates
175
Q

What is a pulmonary infiltrate?

A

Substance denser than air, seen on Xray

176
Q

What would a sarcoidosis biopsy show?

A

Non-caseating granuloma

177
Q

How is sarcoidosis treated (3)?

A

Often self resolving, if more severe…
* Coricosteroids
* DMARDs
* lung transplant

178
Q

What is hypersensitivity pneumitis?

A

Inflammation of the lung due to exposure to an allergen

179
Q

What type of hypersensitivity is hypersensitivity pneumitis?

A

Type 3 (antigen antibody complex deposition)

180
Q

What are some common causes of hypersensitivity pneumitis (4)?

A
  • Pidgeon fanciers lung!!! - bird droppings
  • Farmers lung - mouldy hay
  • Mushroom workers lung
  • Cheese workers lung
181
Q

How is hypersensitivity pneumitis diagnosed?

A

Bronchoalveolar lavage - raised lymphocytes + mast cells

182
Q

How is hypersensitivity pneumitis treated?

A

Steroids (prednisolone)

183
Q

What type hypersensitivity is goodpasture’s syndrome?

A

Type 2 hypersensitivity

184
Q

What is the pathophysiology/ mechanism of Goodpastures syndrome?

A
  1. Anti - glomerular basement membrane (anti-GBM) antibody production
  2. Attack basement membrane in the lungs + kidneys –> pulmonary fibrosis + glomerulonephritis
185
Q

How is Goodpasture’s syndrome investigated (2)?

A
  • Lung + kidney biopsy = Ig deposition
  • Serology = anti-GBM antibodies
186
Q

How is Goodpasture’s syndrome treated (3)?

A
  • Steroids + DMARDs
  • Plasmapheresis + plasma exchange
187
Q

What is Wegeners vasculitis (granulomatosis with polyangitis)?

A

Autoimmune medium/ small vessel vasculitis

188
Q

What antibodies are associated with granulomatosis with polyangitis?

189
Q

What are the symptoms of granulomatosis with polyangitis (3)?

A
  • ENT = saddle shape nose + ear infection
  • Lungs = haemoptysis
  • Kidneys = glomerulonephritis (haematuria)
    ELK
190
Q

How is granulomatosis with polyangitis diagnosed?

A

c-ANCA +ve antibodies

191
Q

How is granulomatosis with polyangitis treated (2)?

A
  • Corticosteroids
  • DMARDs
192
Q

What is bronchiectasis?

A

Permanent bronchial dilation due to irreversible damage to the bronchial wall

193
Q

What are some risk factors/ causes of bronchiectasis (2)?

A
  • Post infection
  • Pulmonary disease (e.g. CF, COPD)
194
Q

What are the symptoms of bronchiectasis (3)?

A
  • Productive cough
  • Dyspnoea
  • Haemoptysis
195
Q

What is the pathophysiology of bronchiectasis?

A
  1. Infection –> dilation of bronchi + loss of cilia + mucous hyper secretion
  2. Factors prevent bronchodilator from reversing –> irreversible bronchodilation
196
Q

Which lobes are usually affected by bronchiectasis?

A

Lower (maybe as this is where infection is more likely)

197
Q

How is bronchiectasis investigated (4)?

A
  • Xray - exclude other stuff
  • High resolution CT
  • Spirometry
  • Sputum culture
198
Q

What would CT show in bronchiectasis?

A

Dilated thickened bronchi (signet ring sign

199
Q

What is a typical spirometry result for bronchiectasis?

A

Obstructive (FEV1:FVC < 0.7)

200
Q

How is bronchiectasis treated?

A

Bronchodilators (+ antibiotics if infection)

201
Q

How is cystic fibrosis inherited?

A

Autosomal recessive

202
Q

What gene and which chromosome are mutated in CF?

A

Cystic fibrosis transmembrane conductance regulatory gene on chromosome 7

203
Q

What is the most common mutation on the cystic fibrosis transmembrane conductance regulatory gene?

A

Delta-F508 mutation

204
Q

What is the prevalence of CF?

A

1/25 carry gene (1/2500 affected - [25 X 25 X 4])

205
Q

What ethnicity is most affected by CF?

A

Caucasians

206
Q

What is the pathophysiology of CF (how does it thicken secretions)?

A

CFTR is a chlorine channel which moves chlorine into secretions –> H2O is drawn in by the Cl- –> thinner watery secretions
Mucous thicker due to lack of Cl- secretion

207
Q

What effects does thicker mucous have on the lungs (2)?

A
  • Mucociliary dysfunction = high infection risk
  • Higher risk of bronchiectasia
208
Q

What are some signs/ symptoms of CF (7)?

A
  • Chronic cough
  • Thick sputum
  • Recurrent respiratory infections
  • Abdominal pain
  • Bowel obstruction
  • Finger clubbing
  • Failure to thrive
209
Q

What is often the first sign a baby has CF?

A

Meconium ileus = thick sticky stool –> bowel obstruction

210
Q

How is CF investigated (4)?

A
  • Newborn blood spot test
  • Sweat test (gold standard)
  • Genetic testing
  • Faecal testing
211
Q

What is diagnostic of CF in sweat test?

A

Cl- >60 mmol/L

212
Q

Why is Cl- high in sweat in CF?

A

Cl- cannot be reabsorbed through channels in the skin

213
Q

What is suggestive of CF in faecal testing?

A

Low amounts of pancreatic enzymes (as blockage in duct system

214
Q

How is CF treated medically (3)?

A
  • Bronchodilators
  • Mucolytics
  • Pancreatic enzyme supplementation
215
Q

What bacteria commonly colonise CF patients (3)?

A
  • H. influenzae
  • S. aureus
  • P. aeruginosa
216
Q

What bacteria is particularly problematic for CF patients and why?

A

P. aeruginosa due to antibiotic resistance

217
Q

What should people with CF be advised to do?

A

CF patients should not have contact with each other

218
Q

What is pleural effusion?

A

Excess fluid accumulation between the visceral and parietal pleura

219
Q

What are the two types of pleural effusion?

A
  • Trasudative
  • Exudative
220
Q

What is transudative pleural effusion?

A

Movement of interstitial fluid into the pleural space (due to high hydrostatic/ low oncotic pressures)

221
Q

What is exudative pleural effusion?

A

Leaky capillaries –> high vascular permeability –> proteins leak out into pleural space –> H2O follows

222
Q

What are the defining protein contents of transudative and exudative fluid?

A
  • Transudative < 25 g/L (transparent)
  • Exudative > 35 g/L (cloudy)
    25-35 g/L = ambiguous
223
Q

What causes transudative pleural effusion (3)?

A
  • Herat failure
  • Liver cirrhosis
  • NephrOtic syndromes
224
Q

What causes exudative pleural effusions (3)?

A
  • Cancer
  • TB
  • Pneumonia
225
Q

What are the symptoms of a pleural effusion (5)?

A
  • Dyspnoea
  • Dullness when purcussed
  • Reduced breath sounds
  • Chest pain
  • Cough
226
Q

How is pulmonary effusion investigated (2)?

A
  • Chest X-ray
  • Thoracocentesis (aspiration of pleural fluid)
227
Q

What would a chest x-ray show in pleural effusion (3)?

A
  • Costophrenic angles decreased
  • White fluid visible
  • Tracheal deviation
228
Q

How is pleural effusion treated (2)?

A
  • Chest drain
  • Surgical fusion of pleura (if recurrent)
229
Q

What is an infected pleural effusion known as?

230
Q

What is a pneumothorax?

A

Excess air accumulation in the pleural space

231
Q

What are some risk factors for a pneumothorax (4)?

A
  • Tall + thin
  • Family history
  • Connective tissue disorders
  • Smoking
232
Q

What are the 3 types of pneumothorax?

A
  • Primary spontaneous (in absence of known lung disease)
  • Secondary spontaneous (in presence of lung disease)
  • Traumatic
233
Q

What life threatening condition can each type of pneumothorax develop into?

A

Tension pneumothorax

234
Q

What are the signs/ symptoms of pneumothorax (5)?

A
  • Dyspnoea
  • Pleuritis chest pain (unilateral)
  • Tachycardia/ hypotensive
  • Decreased breath sounds
  • Hyperresonant percussion
235
Q

What is the pathophysiology of a tension pneumothorax, why is it a medical emergency?

A

Air can enter the pleura, but cant leave - this effectively squashes lung!!!

236
Q

How is a pneumothorax diagnosed?

A

Chest xray

237
Q

What can be seen on a pneumothorax chest xray (2)?

A
  • Air appears black
  • Tracheal deviation
238
Q

How is a pneumothorax treated (3)?

A
  • Small = do nothing
  • Large = needle aspiration/ chest drain
  • Recurrent = pleurodesis (surgical) - stick lung to chest wall
239
Q

How is a tension pneumothorax treated?

A

Insertion of bore cannula into 2nd intercostal space at mid-clavicular line

240
Q

What is cor pulmonale (value)?

A

Mean pulmonary arterial pressure > 25 mmHg

241
Q

How is mean arterial pressure measured?

A

Right heart catheterisation with pressure probe

242
Q

How are the causes of pulmonary hypertension classified (4)?

A
  • Pre capillary - PE
  • Capillary/ lung - asthma, COPD
  • Post capillary - LV failure, mitral regurgitation
  • Chronic hypoxaemia - COPD, altitude
243
Q

How does cor pulomale cause RHS heart failure?

A

High BP –> High resistance –> RS hypertrophy –> heart failure

244
Q

What are the symptoms of right ventricular failure (4)?

A
  • Exertional dyspnoea
  • Tachycardia
  • High JVP
  • Peripheral oedema
245
Q

How is cor pulmonale diagnosed?

A
  • X-ray
  • ECG
  • Echo
  • Right heart catheter probe
246
Q

What is suggestive of cor pulmonale on X-ray and echo (2)?

A

RV hypertrophy + enlarged proximal pulmonary artery

247
Q

What ECG features are associated with cor pulmonale (4)?

A
  • P. pulmonale (peaked p waves)
  • Right axis deviation
  • ST depression + T inversion (v1-3)
  • RBBB
248
Q

How is pulmonary hypertension treated (4)?

A
  • Phosphdiesterase-5 inhibitors (sildenafil) = viagra
  • Endothelin-1 antagonists
  • CCBs (amlodipine)
  • Diuretics
249
Q

What is pharyngitis?

A

Inflammation of the parynx

250
Q

What are 2 common causes of viral pharyngitis?

A
  • EBV
  • Adenoviruses
251
Q

What are bacteria commonly causes pharyngitis?

A
  • S. pyogenes (group A beta haemolytic strep)
252
Q

What are the signs/ symptoms of pharyngitis (3)?

A
  • Sore throat
  • Fever
  • Cough
253
Q

What is important to rule out after bacterial infections causes pharyngitis?

A

Rheumatic fever

254
Q

What is sinusitis?

A

Inflammation of the lining of the sinuses + nasal cavity

255
Q

What group of pathogens most commonly cause sinusitis?

256
Q

Which 2 bacteria most commonly cause sinusitis?

A
  • S. pneumoniae
  • H. influenzae
257
Q

What is otitis media?

A

Inflammation of the middle ear

258
Q

How is otitis media diagnosed?

A

Otoscopy = inflamed erythematous tympanic membrane

259
Q

What is important to be weary of with otitis media?

A

Meningitis

260
Q

What is epiglottitis?

A

Inflammation of the epiglottis

261
Q

What is a dangerous complication of epiglottitis?

A

Obstruction of the airway

262
Q

What bacteria most commonly causes epiglottitis?

A

H. influenzae

263
Q

What are the symptoms of epiglottitis (5)?

A
  • Dyspnoea
  • Sore throat
    Tripoding (to get more air in):
  • Lean forward
  • Stick tongue out
  • Open mout wide
264
Q

What causes whooping cough?

A

Bordella pertussis (gram -ve bacteria)

265
Q

What is often heard in those with whooping cough?

A

Characteristic whoop at end of cough

266
Q

How does bordella pertussis cause disease + inflammation?

A

Produce toxins that damage epithelium + macrophages

267
Q

What is croup?

A

Larygobronchitits

268
Q

What are the symptoms of croup (4)?

A
  • Hoarse voice
  • Cough
  • Stridor
  • Sore throat
269
Q

What commonly causes croup?

A

Parainfluenza infections

270
Q

What is a treatment for severe croup?

A

Dexamethasone (single dose)

271
Q

What is used to measure the extent of dyspnoea?

A

MRC dyspnoea scale

272
Q

What are the 5 grades of dyspnoea?

A
  1. No dyspnoea
  2. When walking uphill
  3. Walks slowly
  4. With a few minutes of walking
  5. Getting dressed

Phase 2a flashcards (Alec's) (13 decks)

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