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Pathology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

give some non-respiratory causes of chronic breathlessness

A

anaemia and heart disease

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2
Q

what will the pH be in chronic acidosis or alkalosis?

A

normal, there has been compensation

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3
Q

what will the HCo3 be in acute respiratory acidosis

A

normal

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4
Q

what 3 things change in the lungs in asthma

A

bronchoconstriction
inflammation
airway remodelling: supepithelial fibrosis, increased muscle tone and gland enlargement.
This is mediated by cysteinyl leukotrines, histamine and cytokines

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5
Q

how do glucocorticoids reduce inflammation?

A

inhibit phospholipase2, so phospholipid cannot become arachidonic acid which then forms prostaglandins (COX) and leukotrines (5-LO)

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6
Q

what are montelukast and zafirlukiast

A

cysteinyl-1 receptor antagonists

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7
Q

give some examples of long acting beta agonists

A

fomoterol

salmeterol

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8
Q

what do ipratropium and tiotropium do?

A

muscarinic antagonists so they block the activation of smooth muscle

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9
Q

what steroids are used for asthma

A

prednisolone
beclomethasone
budenoside

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10
Q

what causes type I respiratory failure?

A

airflow obstruction so asthma, sleep apnoea, V/Q mismatch (this could be caused by pulmonary HTN, NO, RL shunt or dead space from PE or pulmonary oedema)

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11
Q

what causes type II respiratory failure

A

co2 being trapped in the lungs causing an eqm (alveolar hypoventilation) so COPD, no respiratory drive (heroin OD), obesity, chest wall deformity, NMJ disorders, muscle weakness

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12
Q

what would you use continuous positive airway pressure (CPAP) for?

A

pulmonary oedema or obstructive sleep apnoea

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13
Q

what would you use bi-level positive airways pressure for?

A

type II respiratory failure because it improves alveolar ventilation, more so than CPAP

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14
Q

what is ANCA associated vasculitis?

A

anti neutrophil cytoplasmic antibody associated vasculitis

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15
Q

what is the respiratory burst?

A

where macrophages use NADPH oxidase to create superoxide 02- and H2O2. radicals to kill microorganisms

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16
Q

what does PCP look like on CT and how is it treated?

A

diffuse peri-hilar ground glass

co-trimoxazole

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17
Q

what causes the characteristic owl’s eye appearance on biopsy?

A

CMV

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18
Q

what disease of the pleura will malignancy, infection, PE, inflammation, asbestos or trauma cause?

A

exudative pleural effusion (my ex ate a lot of meat)

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19
Q

what distinguishes between exudate and transudate?

A

Light’s criteria after throracocentesis

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20
Q

how are influenza A split up

A

into which haemagglutinin and neuradimase antigens they have

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21
Q

what may influenza complicate into

A

bacterial pneumonia

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22
Q

what is an asthma attack?

A

an exacerbation in which there is more bronchoconstriction, inflammation and mucus production

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23
Q

how much improvement are you looking for with reversibility testing to diagnose asthma (b agonist 4-8 or ics 2w)

A

15%

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24
Q

what does a respiratory rate of over 25 indicate

A

severe asthma attack

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25
Q

give some features of COPD

A

breathlessness, wheezing, weight loss, cyanosis, hyperexpansion, high output cardiac failure

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26
Q

what would the MRC dyspnoea scoring system give someone who had SOB on hills?

A

2

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27
Q

define COPD exacerbation

A

an acute worsening of symptoms that exceeds day to day variation and needs a change in medication. The more a patient has, the faster their lung function will decline.

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28
Q

which pathogen is likely cause pleuritic chest pain in pneumonia

A

Streptococcus pneumoniae

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29
Q

what should all pneumonia patients be tested for

A

hep B, hep C and HIV

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30
Q

what does CURB65 stand for?

A 
Confusion
Urea>7mmol (but in the community, can't measure this)
Respiratory rate>30
Blood pressure<90/60
Over 65, get 1 point for each
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31
Q

at which CURB65 score should you definitely admit someone to hospital?

A

2 (moderate), 3+ is severe if they are above 4, consider admission to critical care

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32
Q

what atypical pneumonia would you suspect in a homeless person or for an HAI?

A

Klebsiella pneumoniae

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33
Q

what are some complications of pneumonia?

A

necrotising pneumonia, meningitis, bacteraemia, parapneumonic effusion, abscess

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34
Q

what may a PET scan show as cancer?

A

inflammation or infection since these areas will also metabolise more glucose

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35
Q

which cancers may lead to lung cancer?

A 
breast
colorectal
prostate
kidney
thyroid
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36
Q

what are some paraneoplastic syndromes that occur in lung cancer?

A 
PTH causing hypercalcaemia
finger clubbing
DIC
anorexia
SIADH (SCLC)
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37
Q

what respiratory diseases can asbestos cause?

A 
mesothelioma
plaques
asbestosis (pulmonary fibrosis)
asbestos effusion
bronchial carcinoma
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38
Q

list some side effects of chemotherapy

A 
alopecia
N&amp;V
peripheral neuropathy
constipation
mucositis
rash
BM suppression (anaemia, thrombocytopenia, neutropenia)
fatigue
anaphylaxis
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39
Q

what can benign effusion complicate into?

A

diffuse pleural thickening

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40
Q

What do fine inspiratory creps, a restrictive disease and finger clubbing suggest?

A

Interstitial lung disease or (rarely) bronchiectasis

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41
Q

What do high lymphocytes from BAL suggest?

A

Sarcoidosis

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42
Q

Which idiopathic interstitial lung disease is not responsive to steroids?

A

Idiopathic pulmonary fibrosis, also called cryptogenic fibrosing alveolitis

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43
Q

give the pulmonary manifestations of cystic fibrosis

A

bronchiectasis, pneumothorax, inflammation, infection. Leads to obstruction on sprirometry.

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44
Q

what 2 things do you need to diagnose CF?

A

clinical signs and evidence of CFTR (CF transmemebrane conductance regulator) malfunction this is through sweat tests, nasal potential difference or small bowel ion studies

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45
Q

give some bacteria that affect patients with CF?

A

Pseudomonas aeruginosa, Staphylococcus aureus, mycobacteria

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46
Q

what is pulmonary hypertension defined as?

A

over 25mmHg pulmonary arterial pressure when right heart catheterisation is performed

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47
Q

what are some symptoms of pulmonary hypertension?

A

dyspnoea
ankle swelling
chest pain

48
Q

list the stepwise treatments of asthma

A 
Allergen avoidance
SABA
ICS
LABA
leukotrine receptor antagonist
steroid po
49
Q

list the stepwise treatments of COPD

A

SABA
LABA/LAMA
ICS
all 4

50
Q

consolidation which looks like pneumonia on CXR, what else could it be?

A

immune mediated lung disease

51
Q

what would you add to broad spectrum antibiotics if an immunocompromised patient had pneumonia?

A

antifungals for aspergillus

52
Q

what investigations can you carry out on the pleura?

A

Biopsy: Abrahams needle, CT guided biopsy (visible masses), VATS (video assisted throascopic surgery).

53
Q

what is pleurodesis?

A

poudrage where steritalc is put between the layers of the pleura to stick them together for pneumothorax or pleural effusion

54
Q

what is croup?

A

laryngotracheobroncitis, barking cough

55
Q

define COPD

A

a disease characterised by airflow limitation which isn’t fully reversible and is usually progressive and associated with abnormal inflammatory response of the lungs to noxious stimuli.

56
Q

what is a complication of giving COPD patients inhaled corticosteroids?

A

increased risk of pneumonia

57
Q

what is a COPD exacerbation

A

1) patient complains of it

2) requires a change in medication

58
Q

what would suggest that a patient has developed a parapneumonic effusion (complicated or empyema)

A

fever doesn’t settle after ABx
pain on deep inspiration
dull on percussion
reduced air entry

59
Q

give some non-infectious causes of pneumonia

A

eosinophils, vasculitis, drugs

60
Q

give some examples of occupational lung diseases

A

asthma, COPD, EAA, lung cancer, mesothilioma, fibrosis (asbestos, silica, coal); they happen due to someone’s work alone. asthma and asbestosis are the most common

61
Q

what kind of inhaled particles are there?

A

dusts (chiselling), fumes (welding) are solid
mists (metalwork) are liquid
vapours are gases. Some are respirable-small enough to get to the alveoli.

62
Q

what is sarcoidosis

A

abnormal collections of inflammatory cells, responds to oral steroids but not ICS. It may be caused by bacteria, nanoparticles, firefighting, metalwork. It can lead to lung fibrosis, cardiac arrhythmia or nephrocalcinosis.

63
Q

how is bronchiectasis treated?

A

mucus clearance with physio+mucolytics+hypertonic saline neb
antimicrobial therapy
bronchodilators

64
Q

list the respiratory complications of CF

A

bronciectasisinfection, bronchitis, bronciectasis, fibrosis, inflammation, haemoptysis, sinusitis, pneumothroax

65
Q

how can CF affect the liver?

A

biliary cirrhosis from obstruction of bile caliculi

66
Q

what can cause pulmonary vasculitis?

A

Churg-Strauss syndrome, ANCA associated vasculitis, granulomatosis with polyangitis and microscopic polyangitis

67
Q

what happens if TB spreads to the spine

A

Pott disease=TB spondylitis which may lead to kyphosis and spinal cord compression

68
Q

what does the Bacille Calmette Guerin vaccine do?

A

It prevents TB becoming disseminated

69
Q

what happens when mycobacterium tuberculosis enters the body 95% of the time?

A

macrophages starve it, no infection

70
Q

what is the Ghon focus?

A

when tuberculosis and macrophages cause the formation of a granuloma, it progresses to complex where lymph nodes are involved

71
Q

what will you find on auscultation in a patient with PE?

A

coarse crackles and pleural rub

72
Q

what pulmonary vascular disorders can cause pulmonary hypertension

A

pulmonary thromboembolism, multiple pulmonary artery stenoses, pulmonary veno-oclusive disease or parasitic infection

73
Q

what kind of cause of pulmonary hypertension is COPD

A

capillary, COPD causes vasoconstriction due to hypoxia>HTN

74
Q

What are the symptoms of right heart failure and what do they indicate?

A

SOB, oedema, raised jugular venous pressure and ascites, they may have been caused by pulmonary hypertension

75
Q

what signs suggest pneumothorax?

A

hyper-resonant, diminished breath sounds, reduced expansion

76
Q

what should you do if you suspect tension pneumothorax?

A

very SOB, tachycardic and respiratory distress. Do not XR first but aspirate then XR then insert drain.

77
Q

what can asbestos lead to?

A 
asbestos bodies
pleural plaques (thickening and restriction)
pleural hickening
mesothilioma
astbestosis (pul fibrosis)
bronchial carcinoma
78
Q

what is mesothelioma resistant to?

A

surgery
chemotherapy
radiotherapy

79
Q

give symptoms of bronchial carcinoma

A 
cough
chest pain]haemootysis
IVC obstruction
hoarse voice
hypercalcaemia
finger clubbing
80
Q

what are some side effects of chemotherapy?

A 
bone marrow suppression leading to anaemia, neutropenia or thrombocytopenia
alopecia
N&amp;V
peripheral neuropathy
constipation
mucositis
rash
fatigue
anaphylaxis
81
Q

what is alpha 1 antitrypsin?

A

protease inhibitor, it protects elastin so a deficiency leads to COPD

82
Q

what infections are CF patients prone to?

A

H influenzae

Strep pneumoniae-same as most common pneumonia causes.

83
Q

what is the vital capacity?

A

tidal volume+inspiratory reserve volume+expiratory reserve volume, the most someone can breathe in and out

84
Q

what is the functional residual volume?

A

the residual volume and the expiratory reserve

85
Q

give some antibiotics used for hospital acquired pneumonias?

A

piperacillin

tazobactam

86
Q

what is a baltoma?

A

bronchus associaed tissue lymphoma, it is a B cell lymphoma-responds to chemo

87
Q

define chronic bronchitis

A

excessive sputum production most days for 3 months of 2 successive years

88
Q

what do theophylline and aminophylline do?

A

bronchodilate though not very effective

89
Q

what causes exudate pleural effusion?

A

malignancy
infection
inflammation (local causes)

90
Q

what is ARDS

A

acute respiratory distress syndrome which is acute lung injury with diffuse alveolar damage

91
Q

give some causes of ARDS

A 
direct trauma
burns
sepsis
pancreatitis
hypovolaemia shock
multiple blood transfusions
92
Q

what conditions is spontaneous pneumothorax associated with?

A

Ehlers Danlos

Marfans

93
Q

give signs of a tension pneumothorax

A

distended neck veins
shock
hyperresonant percusssion
cyanosis

94
Q

when would you used unfractioned heparin rather than LMWH for PE?

A

if the patient has renal failure, bleeding risk or is haemodynamically unstable

95
Q

which cells are involved in the inflammation in COPD

A

CD8
macrophages
neutrophils

96
Q

acute management of asthma

A 
O SHIT ME
oxygen
salbutamol neb
hydrocortisone
ipratopium
theophylline
97
Q

what type of disease will motor neurone disease cause?

A

restrictive

98
Q

inhaled corticosteroid examples

A

beclamethasone

budenoside

99
Q

what may happen to the blood count in a pink puffer?

A

polycythaemia

100
Q

how are asthmatic coughs different to COPD

A

COPD usually productive, asthma usually dry

101
Q

what can cause bronchiectasis?

A 
COPD
GORD
TB
pertussis
ciliary dysfunction
102
Q

what may CF cause in the GI tract?

A

chronic pancreatitis

malabsorption

103
Q

most common cause of atypical pneumonia?

A

mycoplasma pneumoniae

104
Q

what is Mycobacterium tuberculosis ingested by in the lungs

A

lymphocytes and Langerhan’s cells, become epithelioid histiocytes

105
Q

how is tuberculosis diagnosed?

A

3 sputum samples

106
Q

what gives ELK symptoms?

A

ENT, lung, kidney-Granulomatous with polyangitis

107
Q

what pulmonary diseases can methotrexate cause?

A

interstitial lung diseases

108
Q

what kind of response does EAA cause

A

hypersenstivity type III

109
Q

what lung carcinoma is not really linked to smoking

A

adenocarcinoma

110
Q

what lung carcinoma is most common in smokers

A

squamous cell

111
Q

most common lung carcinomas in order?

A

squamous cell
SCLC
adenocarcinoma
large cell

112
Q

symptoms of pulmonary embolism?

A

sudden onset dyspnoea
unexplained cough
pleuritic chest pain
haemoptysis because blood is blocked so it’s at high pressure elsewhere

113
Q

what kind of chest pain may a patient with pneumonia experience?

A

pleuritic chest pain

114
Q

pulmonary embolism treatment

A

heparin then warfarin

115
Q

causes of transudate effusion?

A

cardiac failure
vena cava obstruction
decreased albumin

116
Q

causes of exudate effusion?

A

malignancy

bacterial infection

117
Q

what must be checked in a patient with GB syndrome?

A

respiratory testing-peak flow or spirometry every 4 hours

Pathology (21 decks)

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