Respiratory Flashcards
1
Q
proportion of children diagnosed with asthma in UK?
A
1/10
2
Q
Type 1 pneumocyte =?
A
Gas exhange
3
Q
Type 2 pneumocyte =?
A
Surfactant
4
Q
Type 1 respiratory failure =?
A
Low CO2
5
Q
Type 2 respiratory failure =?
A
High CO2 >6.3 hypercapnic drive
6
Q
Interstitial lung diseases examples?
A
ARDS, Fibrosisng alveolitits and sarcoidosis.
7
Q
Mesothelioma is a disease of what?
A
Pleura
8
Q
% lung tumours malignant?
A
90%
9
Q
% lung tumours due to smoking ?
A
80%
10
Q
Risk factors for Lung CA
A
Cigarettes naturally, asbestos, radon, tar, arsenic chromates.
11
Q
Primary lung tumours are….
A
Rare
12
Q
Most dangerous asbestos?
A
Blue
13
Q
High levels of asbestos causes what?
A
Pulmonary fibrosis
14
Q
% of lung cancer that are non small cell?
A
85% with 52% squamous
15
Q
All small cell carcinomas are of what origin?
A
Neuroendocrine
16
Q
small cell carcinoma accounts for what % of lung cancer?
A
15%
17
Q
Cytokeratin positive lung tumours are from where?
A
Upper GI, but also small cell and adeno
18
Q
Cytokeratin 7 -ve and 20 +ve possibly from where/
A
Colorectal
19
Q
Squamous carcinoma of lung can cause what blood abnormality?
A
Hypercal due to parathyroid peptide
20
Q
approx 90% of people with this lung cancer are smokers?
A
Squamous
21
Q
Normal bronchus lining?
A
Pseudostrat colum epi
22
Q
Irritants in smoke cause what change in the epithelium of bronchus?
A
Metaplastic change to stratified squamous
23
Q
define: One metaplastic cell undergoes irreversible genetic changes (a series of sequential somatic mutations of oncogenes & anti-oncogenes) producing the first neoplastic cell
{squamous}
A
Dysplasia
24
Q
Neoplastic cells proliferate [squamous]….
A
more successfully than metaplastic and replace these = dysplasia and carcinoma insitu
25
neoplastic cells invade basement membrane to produce ...
Invasive squamous carcinoma
26
Bronchioalveolar carcinoma also known as?
Adenomcarcinoma in situ
27
Adenocarcinoma in situ mimics what disease?
Pneumonia
28
what is a kulchitsky cell?
Neuroendocrine cell
29
Typical lung carcinoid tumours are not associated with?
Smoking
30
Atypical lung carcinoid tumours ... talk to me?
not good, necrosis, aggressive grrrr
31
Large cell lung neuroendocrine tumours associated with?
Smoking
32
Smokers account for what % of lung small cell tumours?
99%
33
Hormones such as acth present in what lung carcinomas?
Small cell
34
approx 50% of large cell carcinomas express what factor?
Thyroid transcription
35
Lambert Eaton myasthenic syndrome caused by what lung problerm?
anti-neuromuscular junction autoantibodies in small cell carcinoma
36
T1
37
T2 =
3-7cm
38
>7cm =
T3
39
New drugs used in lung cancer?
EGFR-TK imhibitor non curative but stabilises
40
Transudate pleural effusion seen in?
Your mum ... CCF
41
Malignant mesothelioma is a tumour of what?
Pleura
42
what % of mesothelioma asbestos responsible ?
>90 blue especially and brown
43
What is often seen on radiographs to indicate exposure to asbestos?
fibrous pleaural plaques
44
Are fibrous pleural plaques malignant
no
45
Definition of chronic bronchitis?
Cough and sputum 3 months in each of 2 consecutive years
46
Define emphysema?
Abnormal permanent dilation of airspace distal to terminal bronchiole destruction of airspace wall. no fibrosis
47
Classicifcation of emphysema?
centrilobular or panlobular (>80% alpha anti trypsin deficient)
48
often adult onset asthma is associated with what?
Occupation
49
restrictive lung diseases often what type?
interstitial
50
inflammation and fibrosis of lung tissue causes waht?
Increased diffusion distance restrictive disease
51
Lobes affected first in idiopathic pulmonary fibrosis?
Sub pleural lower lobes
52
Characteristic appearance of idiopathic pulmonary fibrosis on lung?
cobblestone
53
What is sarcoidosis?
Non-caseating perilymphatic pulmonary granulomas, then fibrosis
54
What size must inhaled particles be in order to reach alveoli?
55
What does silicosis do to the lungs?
Kills phagocytosing macrophages
56
Silicosis can cause reactivation of what?
TB
57
pigeon fanciers lung is what type of reaction?
Type III super pigeon antigen
58
cftr gene on which chromosome?
7
59
Normal flora of urt?
Strep viridans, neisseria, diptheroid and anerobes
60
asymptomatic pathogen carry?
Strep pneumoniae, moraxella, and strep pyogenes, haemophillus influenza
61
Rhino sinusitis aetiology?
Post viral inflammation
62
Rhinosinusitis organism is bacterial?
Strep pneumoniae, haemophillus
63
Rhinosinusitis abx if needed?
Amoxicillin
64
what should you avoid giving to people with EBV?
Ampicillin (rash and may say allergic)
65
Ebv diagnosis?
serology IgM igG
66
Diptheria causative organism?
Corynebacterium diptheriae
67
Diptheria treatment?
Erythromycin/penicillin and antitioxin severe
68
Epiglottitis what should you not do?
Touch throat, unless ET tube to hand
69
Lateral neck XRAY can diagnose what?
Epiglottitis
70
Hot potato speech?
Epiglottitis
71
Treatment of epiglottitis?
cefotaxime
72
Croup aka?
Laryngotracheobronchitis.
73
incubation of whooping cough?
1-3 weeks
74
otitis externa -acute possible organism?
Pseudomonas, s.aureus
75
What to avoid in chronic otitis externa?
gentamicin
76
Malignant otitis externa ?
lots of pus and pain often pseudomonas
77
otitis media common cause?
Most viral
78
Co-amoxiclav first line for treating what in the ear?
Mastoiditis
79
3 usual suspects
strep pneumoniae, moraxella, and haemophilus influenzae
80
pseudomonal antibiotics examples c,c,g
ciprofloxacin, ceftazadine, gentamicin
81
what is unusual about the cell wall of mycobacteria?
Unusually waxy
82
Comment on the growth of mycobacterium?
slow growing
83
What is a classic stain for mycobacteria?
Acid fast, Ziehl Neelsen
84
Important skin infection caused by mycobacterium?
M.leprae
85
one third of worlds population infected with what?
TB
86
>50% of TB is what?
Pulmonary
87
Most common sone for TB in lungs?
Midzone
88
There is often a focus of what on a chest radiographs?
Ghon focus of the hilar lymph node
89
Granuloma in TB are what?
Epitheloid cells, and giant cells
90
What type of nbecrosis in TB possibly?
Casseous
91
Risks for TB re-activation?
```
>50
Men
alcoholism
HIV
INFLIXIMAB!
Chronic disease
```
92
TB often reactivated where in lungs?
Apices, obligate aerobe
93
Miliary tb is what affects who?
Very young, old, immunocompromised
94
TB meningitis presentation?
Insidious, persoonality change, fever, focal defects, mild headache
95
TB blood test?
Interferon gamma release
96
How many specimins of sputum and when TB?
3 early morning
97
>how many oprganism per ml is smear positive in TB?
5000
98
Tb meningitis high what white cell count in CSF?
Lympho
99
2 months of tb treatment how many drugs?
4 drugs
100
4 months tb how many drugs?
2 drugs
101
Main drugs for TB?
Isoniazid, rifampicin, pyrazinamide, streptomycin(ethamutol)
102
secondline TB drug (a)
Amikacin
103
Leprosy also know as what?
Hansens disease
104
4 groups of pneumonia?
ventilator, community, hospital, aspiration
105
Predisposing factors for LRTI?
Swallowing issues, no cough reflex, ciliary defect, pulmonary oedema, smoking and congenital immunodeficiency
106
LRTI includes what?
Below larynx
107
4 viral causes of bronchitis?
coronavirus, rhinovirus, adenovirus and influenza
108
Bronchiolitis msot common in?
Kids (2-10mnths)
109
Most common cause of bronchiolitis?
RSV (75%)
110
Pneumonia affects where?
most distal airways
111
two anatomical pneumonias?
Bronchial and lobar
112
Lobar pneumonia >90% caused by what?
S.pneumoniae
113
Hospital acquired pneumonia classified if acquired when ?
>48hrs after hospital
114
organisms with hospital pneumoniae?
Enterobacteria and pseudopmonas
115
Community acquired pneumonia incidnce?
1%
116
Atypical pneumonia organism?
Mycoplasma, legionella, chlamydia and coxiella
117
Typical pneumonia organism?
strep pneumo, moraxella, haemophillus, staph, kleb
118
Classical pneumonia symptoms?
Quick onset, chest pain, fever, rigors, malaise and fatigue
119
Legionealla associated with what symptom most?
High High fever, vomiting, lfts deranged
120
Guillain barre and peripheral neuropathy = possibility what pneumonia?
Mycoplasma
121
Bird handlers pneumonia type + symptom?
Chlamydia psittaci and splenomegaly
122
score for pneumonia ? greater than what for doing stuff?
CURB65 >2
