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Phase 2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the biggest cause of COPD?

A

Smoking

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2
Q

What three cells are involved in the pathophysiology of COPD?

A

1) Neutrophils
2) CD8 T cells
3) Macrophages

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3
Q

What are the effects of COPD on the airways?

A

1) Peripheral airway damage
2) Lung destruction
3) Fibrosis
4) Squamous metaplasia

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4
Q

What are the main symptoms of COPD?

A

1) Cough
2) Shortness of breath
3) Weight loss

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5
Q

What are 5 of the signs of COPD?

A

1) Hyperextension/barrel chest
2) Cyanosis
3) Cor pulmonale
4) Wheeze
5) Raised respiratory weight

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6
Q

What is the main test used to diagnose COPD?

A

Spirometry

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7
Q

What findings will be found from spirometry with COPD?

A

1) Obstructive
2) FEV1/FVC ratio <0.7
3) Reduced FEV1

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8
Q

What is the main form of treatment COPD?

A

Smoking cessation

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9
Q

What pharmacological treatments are there for COPD? Name 5 types

A

1) Beta-2-agonists
2) Anticholinergics
3) Methylxanthines
4) Inhaled corticosteroids
5) Phosphodiesterase-4 inhibitors

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10
Q

What is the oxygen saturation target for COPD in exacerbations?

A

88-92%

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11
Q

What is done for the management of COPD exacerbations?

A

1) Oxygen
2) Bronchodilators
3) Systemic corticosteroids
4) Antibiotics

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12
Q

Name 4 factors that increase the risk of asthma

A

1) Family history
2) Another atopic condition
3) Exposure to smoke as a child
4) Premature birth or low birth weight

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13
Q

What happens to the airways in asthma?

A

The smooth muscle undergoes excessive contraction with hypertrophy and proliferation - narrowing airways

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14
Q

Asthma has two main types - Eosinophilic and non-eosinophilic. What are the catagorises of non-eosinophilic asthma?

A

1) Non-smoking
2) Smoking-related
3) Obesity-related

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15
Q

What is the spirometry finding of asthma?

A

1) Reduced FEV1

2) Reduced FEV1/FVC ratio

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16
Q

What are the diagnostic findings of the peak flow test?

A

1) Reduced

2) >20% variability in 3/5 days

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17
Q

What are the two main classes of treatment for asthma?

A

1) Bronchodilators

2) Anti-inflammatory drugs

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18
Q

What is the most common type of Hypersensitivity pneumonitis?

A

Farmer’s lung

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19
Q

Outline the pathology of hypersensitivity pneumonitis

A

1) Allergic response - cellular immunity and deposition of immune complexes
2) Immune complexes attract and activate - alveolar and interstitial macrophages leading to fibrosis

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20
Q

State 4 symptoms of Hypersensitivity pneumonitis

A

1) Malaise
2) Dyspnoea
3) Cough
4) Weight loss

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21
Q

State 2 signs of hypersensitivity pneumonitis?

A

1) Auscultation - inspiratory squeaks

2) Bilateral crackles

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22
Q

What is the treatment of hypersensitivity pneumonitis?

A

1) Avoid exposure

2) Prednisolone for persisting symptoms

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23
Q

What would be seen on a HRCT of bronchiectasis?

A

1) Air trapping
2) Nodules
3) Honeycomb shape
4) Reticulation change

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24
Q

What happens to the airways in bronchiectasis?

A

They are abnormal and permanently dilated

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25
Q

State causes of bronchiectasis

A

1) Congenital
2) Mechanical obstruction - foreign body or tumour
3) Post-infective damage
4) Granuloma
5) Idiopathic pulmonary fibrosis
6) Immune response
7) Immune deficiency
8) Mucocillary clearance defects

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26
Q

What are the characteristics of bronchiectasis?

A

1) Neutrophil infiltration
2) Recurrent infections
3) Damage to the airways

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27
Q

List common symptoms of bronchiectasis

A

1) Cough
2) Sputum
3) Breathlessness
4) Infection
5) Pleuritic chest pain

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28
Q

List the four main treatments of bronchiectasis

A

1) Airway clearance
2) Nebulized hypertonic saline
3) Anti-inflammatories
4) Infection treatment

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29
Q

What class of antibiotics should be avoided in bronchiectasis?

A

Quinolones

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30
Q

What is defective in Cystic Fibrosis?

A

CFTR protein

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31
Q

On what chromosome is the CFTR protein gene?

A

Chromosome 7

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32
Q

Is Cystic fibrosis autosomal dominant or recessive?

A

Recessive

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33
Q

What is the most common mutation in cystic fibrosis?

A

F508 delta

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34
Q

What are the four consequences of cystic fibrosis to the lungs?

A

1) Dehydrated airway
2) Mucus stasis
3) Airway inflammation
4) Recurrent infection

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35
Q

What is the carrier rate for cystic fibrosis?

A

1 in 25

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36
Q

What affects can cystic fibrosis have on the GI system?

A

1) Lead to low BMI - failure to thrive
2) Liver disease and cirrhosis
3) Increased risk of gastrointestinal malignancy

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37
Q

Name four other effects CF can have on the body thats not GI or Resp related

A

1) Diabetes
2) Male infertility
3) Osteoporosis
4) Arthropathy - inflammation of the joints

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38
Q

How is CF usually picked up?

A

Newborn screening

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39
Q

What are the 4 main treatments for CF?

A

1) Airway clearance
2) Nebulized therapy
3) Anti-inflammatory tretament
4) Infection treatment

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40
Q

What is sarcoidosis?

A

Condition in which granulomas form in organs - particularly the lungs

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41
Q

What is a granuloma made up of?

A

1) Necrosing centre
2) Epithelioid cells
3) Langhan’s giant cells
4) Lymphocytes
5) Fibrotic tissue

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42
Q

What is idiopathic disease?

A

A condition in which repetitive damage to the alveoli leads to excessive fibroblast formation and increased extracellular matrix

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43
Q

Where are 3 common sites for extrapulmonary manifestations of sarcoidosis?

A

1) Eyes
2) Skin
3) Lymph nodes

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44
Q

What are the constitutional symptoms of sarcoidosis?

A

1) General fatigue
2) Weight loss
3) Fever

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45
Q

What is the treatment for Idiopathic pulmonary fibrosis?

A

1) Serial lung function tests
2) Treatment of GORD
3) Supportive

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46
Q

What is the treatment for sarcoidosis?

A

1) Most go into spontaneous remission
2) Prednisolone
3) Immunosuppressants
4) Lung transplant

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47
Q

How does Rheumatoid arthritis affect the lungs?

A

1) Rheumatoid nodules
2) Pulmonary fibrosis
3) Obliterative bronchitis
4) Cricoarytenoid involvement

48
Q

What side effects does methotrexate have on the lungs?

A

Causes pneumonitis, fibrosis and infections

49
Q

What side effects does NSAIDs have on the lungs?

A

Pneumonitis and bronchospasm

50
Q

What side effect can corticosteroids have on the lungs?

A

Lead to greater risk of infection

51
Q

What is pulmonary hypertension defined as?

A

mPAP of >25mmHg

52
Q

What are the classes (not conditions) of pulmonary hypertension?

A

1) Idiopathic
2) Inherited
3) Associated with other conditions

53
Q

What conditions can lead to Pulmonary hypertension?

A

1) Portal hypertension
2) Left heart failure
3) Congenital heart defect
4) HIV

54
Q

What are the symptoms of hypertension?

A

1) Dyspnoea
2) Fatigue
3) Weakness
4) Angina
5) Syncope
6) Abdominal distension

55
Q

What could be seen on a chest X-ray in pulmonary hypertension?

A

1) Enlarged pulmonary arteries

2) Pruning of peripheral arteries

56
Q

What is the key part of management of pulmonary hypertension?

A

Remaining active

57
Q

What types of medication are given in pulmonary hypertension?

A

1) Oral anticoagulation
2) Diuretics
3) Digitoxin

58
Q

What two types of fluid can cause pleural effusions?

A

1) Transudates

2) Exudates

59
Q

What is a transudate?

A

Extravascular fluid with low protein content and low nucleated cells

60
Q

What is an exudate?

A

A mass of cells and fluid taht has seeped out of vessels or an organ especially in inflammation

61
Q

What is the cut off for protein content and LDH for transudates?

A

<30g/L protein

<200IU/L LDH

62
Q

What is the cut off for protein content and LDH for exudate?

A

> 30g/L protein

>200UI/L LDH

63
Q

What type of pleural effusion does heart failure cause?

A

Transudative

64
Q

What type of pleural effusion does malignancy cause?

A

Exudative

65
Q

What type of pleural effusion does inflammation cause?

A

Exudative

66
Q

What type of pleural effusion does liver cirrhosis cause?

A

Transudative

67
Q

What type of of pleural effusion does hypoalbuminaemia cause?

A

Transudative

68
Q

What type of pleural effusion does pulmonary embolism cause?

A

Exudative

69
Q

What type of pleural effusion does trauma cause?

A

Exudative

70
Q

What are the symptoms of pleural effusion?

A

1) Chest pain
2) Dry cough
3) Fever
4) Difficulty breathing

71
Q

What is the Light’s Criteria?

A

Criteria to diagnose exudate

72
Q

What is the serum protein criteria for exudate in the Light’s criteria?

A

> 0.5

73
Q

What is the pleural LDH criteria for exudatuive in the Light’s criteria?

A

> 0.6

74
Q

What is the treatment for pleural effusion?

A

1) Management of underlying condition

2) Aspiration

75
Q

What is a pneumothorax?

A

Air in the pleural space

76
Q

What is a tension pneumothorax?

A

Where air is sucked into the pleural spac eon inspiration but not let out of expiration leading to further deflation, mediastinum shift and decreased venous return

77
Q

Pneumothorax’s are more common in females - true or false?

A

False - ratio of males to females = 6:1

78
Q

What is the clinical presentation of someone with a pneumothorax?

A

1) Unilateral pleuritic pain
2) Progressive breathlessness
3) Pallor
4) Tachycardia

79
Q

What are the two main signs of pneumothorax on an X-ray?

A

1) Air in the pleural space

2) Deviated trachea

80
Q

What is the treatment for a pneumothorax?

A

Drainage

81
Q

What is the main cause of lung cancers?

A

Smoking

82
Q

What 2 more common causes of lung cancer are there other than smoking?

A

1) Asbestos

2) Radon gas

83
Q

What two catagories can lung cancers be split into?

A

1) Non-small cell lung cancer

2) Small cell lung cancer

84
Q

What is the most common lung cancer cell type?

A

Non-small cell lung cancer (NSCLC)

85
Q

What are the common sites of metastasis from primary lung cancer?

A

1) Lymph glands
2) Bone
3) Brain
4) Liver
5) Adrenal glands

86
Q

What cancers commonly spread to the lungs?

A

1) Breast
2) Colorectal
3) Prostate
4) Kidney
5) Melanoma
6) Thyroid
7) Lymphoma

87
Q

How common is lung cancer in men compared to others?

A

2nd most common

88
Q

How common is lung cancer in women compared to others?

A

3rd most common

89
Q

In terms of deaths, where does lung cancer come compared to other cancers?

A

it is the biggest killer for both men and women

90
Q

What are the key symptoms of local lung disease?

A

1) Persistant cough
2) Breathlessness
3) Haemoptysis
4) Chest pain

91
Q

What are the symptoms of metastatic lung disease?

A

1) Bone pain
2) Headache
3) Seizures
4) Hepatic pain
5) Abdominal pain

92
Q

What are the diagnostic tests for lung cancer?

A

1) Chest X-rays
2) CT scan
3) Bronchoscopy
4) Needle biopsy
5) Surgical biopsy

93
Q

What are the options of treatment for lung cancers?

A

1) Surgery
2) Chemotherapy
3) Palliative care

94
Q

What is mesthothelioma?

A

A type of cancer originating from the outer lining of some of the bodies organs - usually the lungs

95
Q

What is the main cause of mesothelioma?

A

Asbestos exposure

96
Q

What are the treatment options for mesothelioma?

A

1) Symptom control
2) Palliative chemotherapy
3) Radical surgery
4) Palliative radiotherapy

97
Q

What is Goodpasture’s Syndrome?

A

It is an autoimmune disease in which the body produced anti-gomerular basement membrane antibody which also damages the lungs as well as the kidneys

98
Q

What is the difference between the damage to the lungs and the damage to the kidneys in Goodpasture’s Syndrome?

A

The damage to the kidneys is permanent but the damage to the lungs is usually not long lasting

99
Q

At what ages is Goodpasture’s Syndrome most common?

A

20-30 and over 60 years

100
Q

What is the clinical presentation of Goodpasture’s Syndrome?

A

1) Pale & tired - anaemia
2) Bloood & protein in the urine
3) Back pain
4) Frequent loo breaks
5) Swelling in the hands and feet
6) High blood pressure
7) Nausea and vomiting

101
Q

What tests are done for Goodpasture’s syndrome?

A

1) Blood tests - to check identify function and antibodies
2) Kidney biopsy
3) Lung biopsy
4) Chest X-ray

102
Q

What is the treatment for Goodpasture’s Syndrome?

A

1) Plasmapheresis
2) Immunosupression
3) High dose steroids e.g. methylprednisolone
4) Haemodialysis
5) Renal transplant

103
Q

What is Wegner’s Granulomatosis?

A

A condition in which the blood vessel walls become inflamed causing tissue damage and organ failure

104
Q

Wegner’s Granulomatosis is a disease of the young - true or false?

A

False - it can occur at any age but predominately in middle aged and elderly

105
Q

What are the symptoms of Wegner’s Granulomatosis?

A

!) Persistent unexplained fever

2) Fatigue
3) Persistent ear infections
4) Frequent sinitus
5) Recurrent nosebleeds
6) Chest pain
7) Shortness of breath
8) Blood in urine
9) Coughing up blood

106
Q

What tests are done for Wegner’s Granulomatosis?

A

1) Blood tests - look for ANCAs
2) Biopsy
3) CT & MRI

107
Q

What is the treatment for Wegner’s Granulomatosis to induce remission?

A

1) Prednisolone

2) Cyclophosphamide

108
Q

What is given long term for Wegner’s Granulomatosis?

A

Milder immunosupression e.g. methotrexate

109
Q

What is the usual cause for a pulmonary embolism?

A

Emboli that has broken from a DVT and gone into the lungs

110
Q

What condition, other than DVT, can lead to pulmonary embolism?

A

Atrial fibrillation

111
Q

What are the risk factors for DVT?

A

1) Prolonged bed rest
2) Injury/surgery
3) Birth control/HRT
4) Smoking
5) Overweight

112
Q

What are the symptoms of pulmonary embolsim?

A

1) Breathlessness
2) Pleuritic chest pain
3) possible symptoms of DVT

113
Q

What are teh signs of pulmonary embolism?

A

1) Tachycardia
2) Tachypnoea
3) Pleural rub

114
Q

With symptoms of pulmonary embolism what test should be done to rule out other causes?

A

1) ECG
2) Chest X-ray
3) Blood gases

115
Q

What test can be done, which is not diagnostic, but can rule out pulmonary embolism?

A

D-dimer

116
Q

What is the treatment for a pulmonary embolism?

A

1) LMW heparin - once a day for 5-7 days
2) Then oral warfrin for 6 months
3) treatment of cause if known

117
Q

What can be done if a patient can not be put on anticoagulants but has has surgery?

A

IVC filter

Phase 2a (2 decks)

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