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