Respiratory Flashcards
1
Q
What is the biggest cause of COPD?
A
Smoking
2
Q
What three cells are involved in the pathophysiology of COPD?
A
1) Neutrophils
2) CD8 T cells
3) Macrophages
3
Q
What are the effects of COPD on the airways?
A
1) Peripheral airway damage
2) Lung destruction
3) Fibrosis
4) Squamous metaplasia
4
Q
What are the main symptoms of COPD?
A
1) Cough
2) Shortness of breath
3) Weight loss
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
6
Q
What is the main test used to diagnose COPD?
A
Spirometry
7
Q
What findings will be found from spirometry with COPD?
A
1) Obstructive
2) FEV1/FVC ratio <0.7
3) Reduced FEV1
8
Q
What is the main form of treatment COPD?
A
Smoking cessation
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
10
Q
What is the oxygen saturation target for COPD in exacerbations?
A
88-92%
11
Q
What is done for the management of COPD exacerbations?
A
1) Oxygen
2) Bronchodilators
3) Systemic corticosteroids
4) Antibiotics
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
13
Q
What happens to the airways in asthma?
A
The smooth muscle undergoes excessive contraction with hypertrophy and proliferation - narrowing airways
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
15
Q
What is the spirometry finding of asthma?
A
1) Reduced FEV1
2) Reduced FEV1/FVC ratio
16
Q
What are the diagnostic findings of the peak flow test?
A
1) Reduced
2) >20% variability in 3/5 days
17
Q
What are the two main classes of treatment for asthma?
A
1) Bronchodilators
2) Anti-inflammatory drugs
18
Q
What is the most common type of Hypersensitivity pneumonitis?
A
Farmer’s lung
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
20
Q
State 4 symptoms of Hypersensitivity pneumonitis
A
1) Malaise
2) Dyspnoea
3) Cough
4) Weight loss
21
Q
State 2 signs of hypersensitivity pneumonitis?
A
1) Auscultation - inspiratory squeaks
2) Bilateral crackles
22
Q
What is the treatment of hypersensitivity pneumonitis?
A
1) Avoid exposure
2) Prednisolone for persisting symptoms
23
Q
What would be seen on a HRCT of bronchiectasis?
A
1) Air trapping
2) Nodules
3) Honeycomb shape
4) Reticulation change
24
Q
What happens to the airways in bronchiectasis?
A
They are abnormal and permanently dilated
25
State causes of bronchiectasis
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
26
What are the characteristics of bronchiectasis?
1) Neutrophil infiltration
2) Recurrent infections
3) Damage to the airways
27
List common symptoms of bronchiectasis
1) Cough
2) Sputum
3) Breathlessness
4) Infection
5) Pleuritic chest pain
28
List the four main treatments of bronchiectasis
1) Airway clearance
2) Nebulized hypertonic saline
3) Anti-inflammatories
4) Infection treatment
29
What class of antibiotics should be avoided in bronchiectasis?
Quinolones
30
What is defective in Cystic Fibrosis?
CFTR protein
31
On what chromosome is the CFTR protein gene?
Chromosome 7
32
Is Cystic fibrosis autosomal dominant or recessive?
Recessive
33
What is the most common mutation in cystic fibrosis?
F508 delta
34
What are the four consequences of cystic fibrosis to the lungs?
1) Dehydrated airway
2) Mucus stasis
3) Airway inflammation
4) Recurrent infection
35
What is the carrier rate for cystic fibrosis?
1 in 25
36
What affects can cystic fibrosis have on the GI system?
1) Lead to low BMI - failure to thrive
2) Liver disease and cirrhosis
3) Increased risk of gastrointestinal malignancy
37
Name four other effects CF can have on the body thats not GI or Resp related
1) Diabetes
2) Male infertility
3) Osteoporosis
4) Arthropathy - inflammation of the joints
38
How is CF usually picked up?
Newborn screening
39
What are the 4 main treatments for CF?
1) Airway clearance
2) Nebulized therapy
3) Anti-inflammatory tretament
4) Infection treatment
40
What is sarcoidosis?
Condition in which granulomas form in organs - particularly the lungs
41
What is a granuloma made up of?
1) Necrosing centre
2) Epithelioid cells
3) Langhan's giant cells
4) Lymphocytes
5) Fibrotic tissue
42
What is idiopathic disease?
A condition in which repetitive damage to the alveoli leads to excessive fibroblast formation and increased extracellular matrix
43
Where are 3 common sites for extrapulmonary manifestations of sarcoidosis?
1) Eyes
2) Skin
3) Lymph nodes
44
What are the constitutional symptoms of sarcoidosis?
1) General fatigue
2) Weight loss
3) Fever
45
What is the treatment for Idiopathic pulmonary fibrosis?
1) Serial lung function tests
2) Treatment of GORD
3) Supportive
46
What is the treatment for sarcoidosis?
1) Most go into spontaneous remission
2) Prednisolone
3) Immunosuppressants
4) Lung transplant
47
How does Rheumatoid arthritis affect the lungs?
1) Rheumatoid nodules
2) Pulmonary fibrosis
3) Obliterative bronchitis
4) Cricoarytenoid involvement
48
What side effects does methotrexate have on the lungs?
Causes pneumonitis, fibrosis and infections
49
What side effects does NSAIDs have on the lungs?
Pneumonitis and bronchospasm
50
What side effect can corticosteroids have on the lungs?
Lead to greater risk of infection
51
What is pulmonary hypertension defined as?
mPAP of >25mmHg
52
What are the classes (not conditions) of pulmonary hypertension?
1) Idiopathic
2) Inherited
3) Associated with other conditions
53
What conditions can lead to Pulmonary hypertension?
1) Portal hypertension
2) Left heart failure
3) Congenital heart defect
4) HIV
54
What are the symptoms of hypertension?
1) Dyspnoea
2) Fatigue
3) Weakness
4) Angina
5) Syncope
6) Abdominal distension
55
What could be seen on a chest X-ray in pulmonary hypertension?
1) Enlarged pulmonary arteries
| 2) Pruning of peripheral arteries
56
What is the key part of management of pulmonary hypertension?
Remaining active
57
What types of medication are given in pulmonary hypertension?
1) Oral anticoagulation
2) Diuretics
3) Digitoxin
58
What two types of fluid can cause pleural effusions?
1) Transudates
| 2) Exudates
59
What is a transudate?
Extravascular fluid with low protein content and low nucleated cells
60
What is an exudate?
A mass of cells and fluid taht has seeped out of vessels or an organ especially in inflammation
61
What is the cut off for protein content and LDH for transudates?
<30g/L protein
| <200IU/L LDH
62
What is the cut off for protein content and LDH for exudate?
>30g/L protein
| >200UI/L LDH
63
What type of pleural effusion does heart failure cause?
Transudative
64
What type of pleural effusion does malignancy cause?
Exudative
65
What type of pleural effusion does inflammation cause?
Exudative
66
What type of pleural effusion does liver cirrhosis cause?
Transudative
67
What type of of pleural effusion does hypoalbuminaemia cause?
Transudative
68
What type of pleural effusion does pulmonary embolism cause?
Exudative
69
What type of pleural effusion does trauma cause?
Exudative
70
What are the symptoms of pleural effusion?
1) Chest pain
2) Dry cough
3) Fever
4) Difficulty breathing
71
What is the Light's Criteria?
Criteria to diagnose exudate
72
What is the serum protein criteria for exudate in the Light's criteria?
>0.5
73
What is the pleural LDH criteria for exudatuive in the Light's criteria?
>0.6
74
What is the treatment for pleural effusion?
1) Management of underlying condition
| 2) Aspiration
75
What is a pneumothorax?
Air in the pleural space
76
What is a tension pneumothorax?
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
Pneumothorax's are more common in females - true or false?
False - ratio of males to females = 6:1
78
What is the clinical presentation of someone with a pneumothorax?
1) Unilateral pleuritic pain
2) Progressive breathlessness
3) Pallor
4) Tachycardia
79
What are the two main signs of pneumothorax on an X-ray?
1) Air in the pleural space
| 2) Deviated trachea
80
What is the treatment for a pneumothorax?
Drainage
81
What is the main cause of lung cancers?
Smoking
82
What 2 more common causes of lung cancer are there other than smoking?
1) Asbestos
| 2) Radon gas
83
What two catagories can lung cancers be split into?
1) Non-small cell lung cancer
| 2) Small cell lung cancer
84
What is the most common lung cancer cell type?
Non-small cell lung cancer (NSCLC)
85
What are the common sites of metastasis from primary lung cancer?
1) Lymph glands
2) Bone
3) Brain
4) Liver
5) Adrenal glands
86
What cancers commonly spread to the lungs?
1) Breast
2) Colorectal
3) Prostate
4) Kidney
5) Melanoma
6) Thyroid
7) Lymphoma
87
How common is lung cancer in men compared to others?
2nd most common
88
How common is lung cancer in women compared to others?
3rd most common
89
In terms of deaths, where does lung cancer come compared to other cancers?
it is the biggest killer for both men and women
90
What are the key symptoms of local lung disease?
1) Persistant cough
2) Breathlessness
3) Haemoptysis
4) Chest pain
91
What are the symptoms of metastatic lung disease?
1) Bone pain
2) Headache
3) Seizures
4) Hepatic pain
5) Abdominal pain
92
What are the diagnostic tests for lung cancer?
1) Chest X-rays
2) CT scan
3) Bronchoscopy
4) Needle biopsy
5) Surgical biopsy
93
What are the options of treatment for lung cancers?
1) Surgery
2) Chemotherapy
3) Palliative care
94
What is mesthothelioma?
A type of cancer originating from the outer lining of some of the bodies organs - usually the lungs
95
What is the main cause of mesothelioma?
Asbestos exposure
96
What are the treatment options for mesothelioma?
1) Symptom control
2) Palliative chemotherapy
3) Radical surgery
4) Palliative radiotherapy
97
What is Goodpasture's Syndrome?
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
What is the difference between the damage to the lungs and the damage to the kidneys in Goodpasture's Syndrome?
The damage to the kidneys is permanent but the damage to the lungs is usually not long lasting
99
At what ages is Goodpasture's Syndrome most common?
20-30 and over 60 years
100
What is the clinical presentation of Goodpasture's Syndrome?
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
What tests are done for Goodpasture's syndrome?
1) Blood tests - to check identify function and antibodies
2) Kidney biopsy
3) Lung biopsy
4) Chest X-ray
102
What is the treatment for Goodpasture's Syndrome?
1) Plasmapheresis
2) Immunosupression
3) High dose steroids e.g. methylprednisolone
4) Haemodialysis
5) Renal transplant
103
What is Wegner's Granulomatosis?
A condition in which the blood vessel walls become inflamed causing tissue damage and organ failure
104
Wegner's Granulomatosis is a disease of the young - true or false?
False - it can occur at any age but predominately in middle aged and elderly
105
What are the symptoms of Wegner's Granulomatosis?
!) 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
What tests are done for Wegner's Granulomatosis?
1) Blood tests - look for ANCAs
2) Biopsy
3) CT & MRI
107
What is the treatment for Wegner's Granulomatosis to induce remission?
1) Prednisolone
| 2) Cyclophosphamide
108
What is given long term for Wegner's Granulomatosis?
Milder immunosupression e.g. methotrexate
109
What is the usual cause for a pulmonary embolism?
Emboli that has broken from a DVT and gone into the lungs
110
What condition, other than DVT, can lead to pulmonary embolism?
Atrial fibrillation
111
What are the risk factors for DVT?
1) Prolonged bed rest
2) Injury/surgery
3) Birth control/HRT
4) Smoking
5) Overweight
112
What are the symptoms of pulmonary embolsim?
1) Breathlessness
2) Pleuritic chest pain
3) possible symptoms of DVT
113
What are teh signs of pulmonary embolism?
1) Tachycardia
2) Tachypnoea
3) Pleural rub
114
With symptoms of pulmonary embolism what test should be done to rule out other causes?
1) ECG
2) Chest X-ray
3) Blood gases
115
What test can be done, which is not diagnostic, but can rule out pulmonary embolism?
D-dimer
116
What is the treatment for a pulmonary embolism?
1) LMW heparin - once a day for 5-7 days
2) Then oral warfrin for 6 months
3) treatment of cause if known
117
What can be done if a patient can not be put on anticoagulants but has has surgery?
IVC filter
