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Respiratory 3 Flashcards

1
Q

when is ipratropium bromide contraindicated?

A

closed angle glaucoma

urinary retention eg BPH

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2
Q

side effects of ipratropium bromide / antimuscarinics?

A 
arrythmia
dizziness 
blurred vision
glaucoma 
G| upset
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3
Q

side effects of salbutamol?

A

tachycardia, arrythmia

hypokalaemia esp in diabetes

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4
Q

an example of a long acting beta 2 agonist?

A

salmeterol

oladaterol

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5
Q

what drugs interact syngerstically with steroids?

A

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

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6
Q

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

A

reduce histamine release

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7
Q

what is pirfenidone?

A

antifibrotic

for advanced resp conditions

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8
Q

what is theophylline?

A

phosphodiesterase inhibitor
bronchodilation
reduces reactivity to histamine

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9
Q

what is carbocysteine?

A

mucolytic

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10
Q

type 1 vs type 2 resp failure?

A

type 1 = low O2

type 2 = low O2 high CO2, resp acidosis

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11
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

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12
Q

5 triggers for asthma?

A 
infection
exercise
cold air 
dust
damp
pollen
emotion
tobacco
beta blockers
aspirin
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13
Q

what kind of hypersensitivity reaction is asthma?

A

type 3 / type 1

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14
Q

what cells/molecules are involved in asthma?

A

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

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15
Q

what happens in the late response of asthma?

A

immune mediators damage the epithelium

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16
Q

why is airflow reduced in asthma?

A

bronchoconstriction & mucus

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17
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

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18
Q

what does an asthma attack look like?

A 
trigger
worsening SOB 
tachynoea 
using accessory muscles 
tachycardia
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19
Q

what is the wheeze like in asthma?

A

polyphonic
bilateral
widespread
episodic

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20
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

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21
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

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22
Q

what is first line for asthma?

A

SABA eg salbutamol

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23
Q

what is second line for asthma?

A

inhaled corticosteroid eg beclamethosone

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24
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

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25
Q

what is montelukast?

A

a leukotriene antagonist

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26
Q

what is a problem with theophylline?

A

it has a very narrow TI

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27
Q

NICE treatment for severe asthma attack in hospital?

A

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

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28
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

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29
Q

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

A 
squamous cell (central)
adenocarcinoma (peripheral) - from mucus secreting cells
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30
Q

what cells is small cell lung cancer from?

A 
kulchitsky cells 
(neuroendocrine)
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31
Q

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

A

small cell, as it tends to cause paraneoplastic syndromes

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32
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
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33
Q

what is the wheeze like in lung cancer?

A

fixed monophonic

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34
Q

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

A

lung

hoarse voice

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35
Q

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

A

diagphragm

SOB

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36
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

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37
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

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38
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

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39
Q

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

A

PTH
hypercalcaemia
osteomalacia

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40
Q

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

A 
ADH = SIADH = hyponatraemia 
AcTH = cushings
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41
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

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42
Q

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

A

hilar enlargement
circular peripheral opacity
unilateral pleural effusion
lung collapse

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43
Q

how might you obtain a biopsy in lung cancer?

A

percutaneous

or with an ultrasound guide bronchoscopy

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44
Q

how can you scan the body to look for cancer?

A

PET-CT

higher uptake of glucose tracer where there is more cancer

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45
Q

treatment for non small cell lung cancer?

A

surgery can often be curative

adjuvant or palliative chemo/radio

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46
Q

treatment for small cell lung cancer?

A

generally not curative

platinum based chemo + radiotherapy

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47
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
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48
Q

5 clinical manifestations of pulmonary embolism?

A 
hypoxia -- cyanosis
SOB
haemoptysis
tachycardiaa
tachypnoea
pleuritic chest pain
hypotension
pyrexial
right parasternal heave 
syncope
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49
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

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50
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

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51
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

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52
Q

management of PE? - 5

A 
supportive - admission, analgaesia, oxygen 
enoxaparin 
alteplase - if PE is large 
surgical embelectomy
vena cava filter
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53
Q

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

A

heparin

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54
Q

where does lung cancer commonly metastasise to?

A 
brain
bone
liver
adrenals
lymph
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55
Q

where does secondary lung cancer usually come from?

A 
breast
prostate
colon
bladder
neuroblastoma
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56
Q

who is TB most common in?

A

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

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57
Q

what is TB’s waxy capsule made of?

A

mycolic acid

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58
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

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59
Q

what is it called when latent TB reactivates?

A

secondary TB

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60
Q

what is milliary TB?

A

Disseminated infection

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61
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
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62
Q

how does TB usually spread between people?

A

through inhaled drops oof infected saliva

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63
Q

5 presentations of pulmonary TB?

A 
fatigue, night sweats, weight loss, fever
cold abscess
cough/haemoptysis 
dyspnoea
clubbing
crackles
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64
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

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65
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)

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66
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

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67
Q

what are TB on culture?

A

acid fast bacilli

red on ziehl-neilson stain

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68
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

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69
Q

is TB a notifiable disease?

A

yes

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70
Q

what is the most common cause of community acquired pneumonia?

A

strep pneumoniae

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71
Q

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

A

haemophilus influenzae

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72
Q

pseudomonas causes pneumonia in who?

A

cystic fibrosis

bronchiectasis

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73
Q

what syndrome can legionella pneumophilia cause, alongside pneumonia?

A

SIADH

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74
Q

what extra-respiratory syndromes does mycoplasma pneumoniae present with?

A 
erythema multiformae (target rash)
neuro symptoms
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75
Q

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

A

chlamydia psittaci

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76
Q

what is ‘lung consolidation’?

A

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

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77
Q

what is aspiration pneumonia caused by?

A

foreign material in the lungs

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78
Q

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

A

coxiella burnetti

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79
Q

5 symptoms of pneumonia?

A 
SOB 
productive cough 
haemoptysis 
pleuritic chest pain 
delirium
sepsis - fever tachycardia tachypnoea hypotension etc
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80
Q

5 signs of pneumonia?

A 
fever, tachycardia, tachypnoea
hypotension
bronchial/harsh breath sounds equally loud on inspiration/expiration
dullness to percuss
crackles
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81
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

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82
Q

3 antibiotics commonly used in pneumonia?

A

co amoxiclav

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

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83
Q

what antibiotic works against MRSA?

A

Vancomycin

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84
Q

what is an empyma?

A

infected pulmonary effusion

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85
Q

3 complications of pneumonia?

A 
ARDS
sepsis
lung abscess
pleural effusion
empyma
death
86
Q

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

A

vocal chords

87
Q

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

A 
nasal passages 
sinuses
pharynx 
larynx, above vocal cords 
tonsils 
eustachian tube
88
Q

is tonsilitis usually caused by a bacteria or virus?

A

virus

89
Q

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

A

fever
tonsillar exudate
no cough
tender anterior cervical lymph nodes

90
Q

some microbiology of strep pyogenes?

A

lancefield group a
beta haemolytic
catalase neg

91
Q

presentation of tonsilitis?

A 
usually associated with pharyngitis 
red inflamed sore tonsils
sore throat
pain on swallowing 
fever
malaise
headache
92
Q

first line drug for bacterial tonsilitis?

A

penicillin V

93
Q

what is otitis media?

A

inflammation of the ‘middle ear’

commonly infection of the eustachian tube following urt inf

94
Q

4 bacteria that cause most upper resp tract infections?

A

strep pneumoniae
h influenzae
moraxella catarrhalis
staph aureus

95
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)
96
Q

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

A

1 - amoxicillin

2 - co amoxiclav

97
Q

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

A

clarithromycin

98
Q

is sinusitis usually bacterial or viral?

A

viral

eg rhinovirus

99
Q

presentation of sinusitis? 4

A 
purulent rhinorrhoea 
face pain
headache
fever
voice changes 
change in smell/taste
cough
100
Q

what is the most common interstitial lung disease?

A

idiopathic pulmonary fibrosis

101
Q

what kind of spirometry does silicosis and aspestosis have?

A

restrictive

102
Q

presentation of silicosis and asbestosis?

A

dry cough
dyspnoea

generally quiet, not crackly chest

103
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
104
Q

what investigation for staging lung cancer?

A

CT chest, liver, adrenals

105
Q

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

A

TB - in the middle

pneumonia - at the bottom

106
Q

what are the most common causes of hosp acquired pneumonia?

A

aerobic gram neg bacilli eg
pseudomonas
klebsiella
e coli

107
Q

first line imaging for ?lung cancer or ?TB?

A

chest x ray

108
Q

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

A

adenocarcinoma

109
Q

What is the most common form of pulmonary fibrosis?

A

idiopathic

110
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
111
Q

presentation of pulmonary fibrosis?

A

dry cough
SOB
fine bilateral crackles when you listen to chest

wheeze
haemoptysis 
chest pain
clubbing 
cor pulmonale
112
Q

what kind of spirometry is seen in pulmonary fibrosis?

A

restrictive - so reduced fvc

because fibrosis prevents the lung from expanding

113
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

114
Q

how is DCLO affected in pulmonary fibrosis?

A

reduced

as gas exchange is impaired

115
Q

2 drugs for pulmonary fibrosis?

A

pirfenidone/nintendinab - anti fibrotic

116
Q

what is the epidemiology of sarcoidosis?

A

female
black and scandinavian
young adults/60+

117
Q

what is the pathophysiology of sarcoidosis?

& what type of hypersensitivity?

A

type 4 hypersensitivity
unknown antigen
granuloma
pulmonary fibrosis and nodules

118
Q

what cells make up the granulomas in sarcoidosis?

A

macrophage in the center

t cells on the edges

119
Q

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

A

the hilar lymph node, where the bronchi meets the lung

120
Q

symptoms of pulmonary sarcoidosis?

A

cough
gradual onset progressive dyspnoea
mediastinal lymphadenopathy

121
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
122
Q

treatment for sarcoidosis?

A

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

123
Q

blood tests in sarcoidosis? - 3

A

raised serum ACE
raised serum calcium
raised serum soluble il2 receptor

124
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

125
Q

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

A

hilar lymphadenopathy

bilateral lung exudate

126
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

127
Q

what is bronchiectasis?

A

widening of the bronchioles and build up of mucus

128
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
129
Q

why is there increased risk of infection in bronchiectasis?

A

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

130
Q

is bronchiectasis an obstructive or restrictive disease?

A

obstructive, the main problem is that mucus obstructs the airways

131
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

132
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
133
Q

what does the chest x ray show in bronchiectasis?

A

cystic shadows

dilated and thickened bronchi and bronchioles

134
Q

how to manage the mucus in bronchiectasis?

A

mucolytic eg carbocysteine

flutter valve for mucus drainage

135
Q

what population is at greatest risk of cystic fibrosis?

A

caucasian

136
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

137
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
138
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

139
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

140
Q

two methods of genetic testing for CF during pregnancy?

A

amniocentesis

chorionic villus sampling

141
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

142
Q

what is a pleural effusion?

A

fluid in the pleural cavity

143
Q

exudative vs transudative effusion?

A 
transudative = low protein, less than 3
exudative = high protein, more than 3
144
Q

3 aetiology of transudative pleural effusion?

A

transudative is caused by movement of fluid eg

congestive heart failure
low albumin
hypothyroid
peritoneal dialysis

145
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
146
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
147
Q

investigation for pleural effusion?

A

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

chest xray

148
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

149
Q

management of pulmonary effusion?

A

antibiotics
diuretics
pleural aspiration or chest drain
small may spontaneously resolve

150
Q

2 complications of pulmonary effusion?

A

empyema

trapped lung

151
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

152
Q

what conditions is spontaneous pneumothorax more likely in?

A

marfans
rheumatoid arthritis
etc

153
Q

some causes of iatrogenic pneumothorax?

A

central line insertion
mechanical ventillation
lung biopsy

154
Q

presentation of pneumothorax?

A 
sudden onset SOB / pain / cough
cyanosis
tachycardia
tachypnoea 
reduced breath sounds 
hyper resonance 
pleuritic chest pain
155
Q

first line investigation for pneumothorax?

A

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

156
Q

gold standard investigation for pneumothorax?

A

ct thorax

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

157
Q

when would a pneumothorax not need management?

A

less than 2cm with no SOB

158
Q

management of pneumothorax? 3

A

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

159
Q

what can you do for recurrent pneumothorax?

A

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

160
Q

where is the air in pneumothorax?

A

in the pleural space (between visceral and parietal pleura)

161
Q

what is a tension pneumothorax caused by?

A

trauma

one way valve

162
Q

clinical presentation of tension pneumothorax?

A 
decreased air entry
unequal lung expansion
tachycardia
hypotension
trachial deviation
hyperresonance
163
Q

management of tension pneumothorax?

A

large bore canula
2nd intercostal space
mid clavicular line

164
Q

at what pressure is pulmonary hypertension diagnosed?

A

25mmHg

165
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
166
Q

what is the effect on the lungs of hypertension?

A

thickening of alveolar and capillary membranes

= reduced gas exchange

167
Q

what is cor pulmonale?

A 
increased pressure in the lung vessels
backs up into right ventricle
= rv hypertrophy 
= backpressure into veins 
= systemic oedema
168
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
169
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

170
Q

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

A

NT - pro - BNP

171
Q

3 drugs for primary pulmonary hypertension?

A

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

172
Q

3 complications of pulmonary hypertension?

A

resp failure
heart failure
arrythmia

173
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

174
Q

gold standard test for pulmonary hypertension?

A

right heart catheterisation

this is a way of measuring the pulmonary BP

175
Q

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

A

hypersensitivity pneumonitis

176
Q

what type of hypersensitivity reaction is hypersensitivity pneumonitis?

A

type 3

over time – type 4

177
Q

what happens to the lung in hypersensitivity pneumonitis?

A

fibrosis – impaired gas exchange, loss of elasticity

non caseating granulomas

178
Q

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

A

top

179
Q

presentation of acute hypersensitivity pneumonitis?

A

fever, rigors
cough
dyspnoea
headache

180
Q

presentation of chronic hypersensitivity pneumonitis?

A 
progressive cough
progressive dyspnoea 
fatigue
cyanosis
resp failure
weight loss 
clubbing
181
Q

what do you see on biopsy with hypersensitivity pneumonitis?

A

non caseating granuloma

182
Q

management of hypersensitivity pneumonitis?

A

steroids

remove trigger

183
Q

what do you see on imaging in hypersensitivity pneumonitis?

A

diffuse infiltrate
ground glass (fibrosis)
bronchiectasis

184
Q

what are the antibodies to in goodpastures?

A

type 4 collagen

which is in glomerular basement membranes

185
Q

presentation of goodpastures? - 5

A 
cough
SOB
haemoptysis
haematuria
proteinuria
oliguria
hypertension 
anorexia
myalgia/arthralgia
lethargy
fever
186
Q

best investigation for goodpastures, what do you see?

A

kidney biopsy
immunoflorescence - iGg associated with glomerulus
crescents
inflammation

187
Q

what is DCLO in goodpastures?

A

high

188
Q

management of goodpastures?

A

plasmaphoresis
steroids
cyclophosphamide

189
Q

what is the most common ANCA vasculitis?

A

granulomatosis with polyangiitis

190
Q

which ANCA antibody is usually associated with granulomatosis with polyangiitis?

A

cANCA

191
Q

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

A

nodules
fluffy alveolar haemorrhage
cavitating lesions
consolidation

192
Q

mesothelioma is associated with

A

asbestos!

193
Q

what is mesothelium?

A

epithelium that forms lining ie pleura, peritoneum, pericardium etc

194
Q

what molecule does mesothelioma express?

A

calretinin

195
Q

presentation of mesothelioma?

A 
history to suggest
clubbing
sob
pleuritic chest pain 
harmoptysis
fever, weight loss etc
196
Q

which part of the lung is fibrosed in mesothelioma?

A

lower

197
Q

polo mint sign on CT is associated with what condition?

A

PE

198
Q

bronchus sign on CT indicates what lung pathology?

A

bronchogenic cancer

199
Q

tree in bud sign on CT indicates what lung pathology?

A

pneumonitis, bronchiolitis

200
Q

split pleura sign on CT indicates what lung pathology?

A

exudative, malignant or infected pleural effusion

201
Q

signet ring sign on CT indicates what lung pathology?

A

bronchiectasis

202
Q

what is the most common type of lung cancer?

A

squamous

203
Q

what is the most common lung cancer in non smokers?

A

adenocarcinoma

204
Q

complications of bronchiectasis?

A

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

205
Q

what is the microbiology of h influenzae?

A

small
gram neg
cocco-bacillus

206
Q

risk factors for pneumothorax?

A

smoking
trauma
previous pneumothorax
mechanical ventilation

207
Q

how long after admission is it called hospital acquired pneumonia?

A

48hrs

208
Q

what type of hypersensitivity is goodpastures?

A

type 2

209
Q

what is gold standard for TB diagnosis?

A

sputum culture

210
Q

what is the most common cause of pneumonia in bronchiectasis?

A

h influenzae

211
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

212
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

Respiratory (9 decks)

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