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Phase 2a LM > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How many respiratory deaths are due to workplace exposures

A

12,000

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2
Q

What are the causes of occupational lung disorders

A

Historical exposures, current exposures, future exposures

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3
Q

Give 4 examples of historical exposures

A

Vapour, gases, dust, fumes

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4
Q

What are the 2 types of occupational asthma

A

Asthma induced by sensitisation (allergy) at work - 90%

Asthma induced by massive accidental irritant exposure - 10%

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5
Q

Give examples of common occupational asthma inducers

A

Isocyanates, flour, cleaning products, wood dusts, enzymes

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6
Q

What is the % of adult onset asthma that is due to occupation

A

9-15%

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7
Q

Describe the acute phase of extrinsic allergic alveolitis

A

Alveoli are infiltrated with acute inflammatory cells

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8
Q

Describe the chronic stage of extrinsic allergic alveolitis

A

Granuloma formation and obliterative bronchiolitis occur

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9
Q

Give some causes of extrinsic allergic alveolitis

A 
Bird/pigeon fancier's lung (proteins in the droppings)
Fish meal and rodent handlers
Farmer's and mushroom's lung (MOs)
Vegetation (coffee and wood)
Chemicals (insecticide, isocyanates)
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10
Q

Name 5 things that fall under asbestos-related lung disease

A
  1. Pleural plaques
  2. Diffuse pleural lining
  3. Asbestosis
  4. Lung cancer
  5. Mesothelioma
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11
Q

Briefly describe asbestosis

A

Pulmonary fibrosis that can occur with or without plaques. There is no effective treatment

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12
Q

Briefly describe mesothelioma

A

Rapidly progressive and usually incurable pleural cancer- the lung is encased by tumour

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13
Q

What is an acute obstruction caused by

A

Tumour or foreign body

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14
Q

What does an acute obstruction cause

A

Distal lung collapse (atelectasis) or over expansion (valve effect)

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15
Q

What can extrinsic asthma be caused by

A

Atopic (IgE/ type 1 sensitivity)

Occupational (type 3 sensitivity)

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16
Q

What can intrinsic asthma be caused by

A

Aspirin, cold, infection, stress, exercise, pollutants

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17
Q

Describe the pathogenesis of asthma

A

Bronchial obstruction with distal overinflation or collapse
Mucus can plug the bronchi
Bronchial inflammation

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18
Q

Name 3 diseases that are examples of chronic obstruction

A

Chronic bronchitis and/or emphysema
Asthma
Bronchiectasis

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19
Q

What is needed to diagnose chronic bronchitis

A

Cough and sputum for 3 months in 2 consecutive years

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20
Q

Who does chronic bronchitis typically affect

A

Affects middle aged heavy smokers

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21
Q

What can chronic bronchitis lead to

A

Hypercapnia
Hypoxia
Cyanosis (BLUE BLOATERS)
Right sided heart failure

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22
Q

What is the pathology behind emphysema

A

Enlargement of the alveolar air spaces with destruction of elastin in the walls

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23
Q

What are some causes of emphysema

A

Smoking predominantly, alpha-1-antitrypsin deficients, coal dust exposure, cadmium toxicity

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24
Q

What are the signs of emphysema

A

Reduced PaCO2
Normal PaO2
This is due to hyperventilation to maintain oxygen
PINK PUFFERS

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25
Q

What is bronchiectasis

A

The permanent dilation of bronchi and bronchioles

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26
Q

What are the common symptoms of bronchiectasis

A

Chronic cough with expectoration of large quantities of foul smelling sputum, flecked with blood sometimes

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27
Q

Name 2 common complications of bronchiectasis

A 
Pneumonia
Fungal colonisation 
Emphysema
Septicaemia 
Meningitis 
Amyloid formation
Metastatic abscesses
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28
Q

What is the pathology of interstitial lung diseases

A

Increased amount of lung tissue, alveolar-capillary wall is the site of the lesion

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29
Q

What are the signs of an interstitial lung disease

A

Reduced Tco
Reduced VC
Reduced FEV1
Relatively normal FEV1/FVC ratio and PEFR

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30
Q

What is the site of the lesion in interstitial lung diseases

A

Alveolar-capillary wall

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31
Q

Name an acute interstitial lung disease

A

Adult respiratory distress syndrome (ARDS)

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32
Q

Give some causes of adult respiratory distress syndrome

A 
Drug and toxin reactions
gastric aspiration
radiation pneumonitis
diffuse intrapulmonary haemorrhage
shock
trauma
infections
gas inhalation
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33
Q

Name some chronic interstitial lung diseases

A 
Fibrosis alveolitis
Pneumoconioses
Sarcoidosis
Rheumatoid diseases
Diffuse malignancies
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34
Q

What is pneumoconiosis

A

Lung disease caused by inhaled dust

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35
Q

Describe the pathogenesis of coal workers’ pneumoconiosis

A

The coal is ingested by alveolar macrophages
They aggregate around bronchioles
Can cause trivial discolouring, or nodules, or emphysema

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36
Q

What is silicosis

A

Inhalation is silicates (inorganic minerals abundant in stone and sand)

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37
Q

What happens if you have silicosis

A

Tissue destruction and fibrosis, after years of exposure nodules form

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38
Q

Define incidence

A

The rate at which new cases occur in a population during a specific time period

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39
Q

Define prevalence

A

The proportion of a population that have the disease at a point in time

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40
Q

Define mortality

A

The incidence of death from a disease

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41
Q

In COPD what happens to the FEV1/FVC ratio

A

It’s less than 70% or 0.7 of the predicted value

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42
Q

What is the estimation of prevalence of COPD in the UK

A

3.7 million

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43
Q

Which study confirmed that there was COPD mortality in smokers

A

Doll and Bradford-Hill study (1951-2001)

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44
Q

What are the reasons for the geographical variation of COPD seen across the UK

A

Socio-economic differences
Socio-economic deprivation
Historic industry
Passive smoking

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45
Q

What is the incidence of lung cancer in the UK

A

Nearly 40,000 new cases per year

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46
Q

Is lung cancer a disease of the young or elderly

A

Elderly

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47
Q

What is the most common cancer to cause death

A

Lung cancer

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48
Q

How many adults in the UK smoke

A

9.5 million

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49
Q

What % of COPD and lung cancers are preventable

A

90%

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50
Q

Briefly define palliative care

A

Improves the Q of L of patients and families with life-threatening illnesses, pain and symptom relief, support from diagnosis to the end of life and bereavement

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51
Q

Describe some aspects of palliative care

A

Holistic/ humanistic
Individualised
Patient and carer
Multidisciplinary approach

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52
Q

What are 4 difficulties with COPD regarding palliative care

A
  1. Unpredictable illness trajectory
  2. Difficulties with prognostication
  3. Poor patient understanding
  4. Limited access to specialised palliative care
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53
Q

What is the % of lung cancer patients that receive palliative care

A

30%

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54
Q

What is the % of COPD patients that receive palliative care

A

0%

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55
Q

What % of people die within 2 years of an exacerbation of COPD

A

50%

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56
Q

Nomenclature:

….mab

A

Monoclonal antibodies

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57
Q

Nomenclature

…sone

A

Corticosteroid

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58
Q

Nomenclature

…terol

A

Bronchodilators

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59
Q

Nomenclature

…lone

A

Corticosteroid

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60
Q

Nomenclature

…nib

A

Kinase inhibitor

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61
Q

What are the 4 delivery systems for inhaled drugs

A
  1. Pressurised metered-dose inhalers (PMDI)
  2. Spacer devices
  3. Dry powder inhalers (DPI)
  4. Nebulisers
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62
Q

Give some advantages of inhaled drugs

A

Lungs are robust
Medicines can act directly on lung or enter systemic circ
Very rapid absorption
Lungs are naturally permeable to peptides
Large s a
Fewer metabolising enzymes than blood/liver
Non invasive port of entry into systemic system
Potentially fewer side effect

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63
Q

What two classes of drugs are used to reduce bronchoconstriction

A

Adrenergic - beta 2 adrenoreceptor agonists

Anti-cholinergic - muscarinic antagonists

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64
Q

Name a SABA

A

Salbutamol

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65
Q

Name a LABA

A

Salmetrol or formoterol

66
Q

What is the class of drugs used to treat inflammation of the lungs

A

Glucocorticoids (corticosteroids)

67
Q

What is the most effective anti-inflammatory for asthma

A

Glucocorticoids

68
Q

How do inhaled corticosteroids reduce inflammation

A

Reduce no of infl cells in airways
Suppress the production of chemotactic mediators
Reduce adhesion molecule expression
Suppress infl gene expression in airway epithelial cells

69
Q

What are the long term side effects of inhaled corticosteroids

A

Loss of bone density
Adrenal suppression
Cataracts, glaucoma

70
Q

What percentage of bronchial tumours are malignant

A

95%

71
Q

What are the two classifications of malignant bronchial tumours

A

Non small cell lung cancer (NSCLC)

Small cell lung cancer

72
Q

What are the causes of lung cancer

A 
Smoking
Asbestos
Radon
Coal and tar
Chromium
73
Q

What are the main symptoms someone with lung cancer has

A 
Cough
Haemoptysis
Dyspnoea 
Chest pain
Hoarseness
Recurrent pneumonia 
Anorexia/weight loss
74
Q

Where does lung cancer typically spread to

A 
Lymph nodes
Bone
Brain
Liver
Adrenal glands
75
Q

What are some of the symptoms of metastatic disease originating from lung cancer

A 
Bone pain 
Headache
Seizures
Neurological deficit
Abdo pain
Hepatomegaly
76
Q

What are 3 symptoms of paraneoplastic syndrome

A

Hypercalcaemia
Hyponatraemia (SIADH)
Finger clubbing

77
Q

What is the incidence of lung cancer

A

Nearly 40,000 new cases per year

78
Q

What are some of the signs of lung cancer

A 
Cachexia
Anaemia
Clubbing
Consolidation/ collapse of lung 
Pleural effusion
79
Q

Why are respiratory tract infections so common

A

No thick skin barrier
No room for immune cells/response
Large s a for gas exchange means lots of room for pathogens
No acid

80
Q

What protection is there against respiratory tract infections

A 
Commensal flora 
Swallowing - reflex, epiglottis 
Mucociliary escalator 
Cough reflex and sneezing 
Immunity
81
Q

What are the common viruses that cause pharyngitis

A

Rhinovirus and adenovirus

82
Q

What do: tonsillar exudate, tender anterior cervical adenopathy, fever over 38 degrees and absence of cough all indicate

A

Bacterial infection (not virus)

83
Q

What is the incidence of pneumonia

A

350 per 100,000 per year

84
Q

What is the mortality of pneumonia

A

1% in community
10% in hospital
30% in ITU

85
Q

Who is most at risk of getting pneumonia

A 
Infants and elderly 
COPD and other chronic lung diseases
Immunocompromised
Nursing home
Diabetes
86
Q

What is heard when you listen to the chest of someone with pneumonia

A

Crackles

87
Q

Why does the chest crackle with pneumonia

A

The alveoli are trying to open but the mucous/fluid doesn’t allow it to do so properly

88
Q

What does the percussion sound like in someone with pneumonia

A

Dull

89
Q

What are the common symptoms of pneumonia

A 
Fever
Cough
Sputum --> rusty brown = S. pneumoniae 
SOB
Pleuritic chest pain
90
Q

What are some of the abnormal vital signs someone with pneumonia has

A 
Increased HR and RR
Decreased BP and air entry
Fever
Dehydration 
Dull percussion
91
Q

What aids a diagnosis of pneumonia in a full blood count

A

Increased White blood cell numbers

92
Q

What are the main treatments of pneumonia

A

Co Amoxiclav 625 mg TDS PO

Clarithromyocin 500 mg BD PO

93
Q

What can pneumonia lead to

A

Sepsis

94
Q

What score is used to assess the severity of Community Acquired Pneumonia (and sepsis)

A

CURB65

95
Q

What does the CURB65 score stand for

A 
Confusion 
Urea >7 mmol/L
Respiratory rate >30/min
BP systolic <90 or diastolic <60
Age >65
96
Q

Briefly describe the pathogenesis of pneumonia

A

Bacteria ‘translocate’ to the alveoli
Alveolar macrophages engulf however immune system becomes ‘overwhelmed’
Cytokines and chemokines start inflammatory response
Neutrophils and exudate fill the alveolar air space - difficult to exchange gases

97
Q

What are the investigations done if pneumonia is suspected

A 
CXR
FBC 
U+E (renal = severity)
LFT (liver = complications)
CRP (inflammation)
Pulse oximetry (severity)
98
Q

What two viruses commonly cause the common cold

A

Rhinovirus and coronavirus

99
Q

What two viruses commonly cause a sore-throat

A

Adenovirus

EBV * Epstein-Barr virus

100
Q

What’s the common respiratory rate for a child <5yrs old

A

30-40

101
Q

What’s the common respiratory rate for a child <1yr old

A

40-50

102
Q

What’s the normal respiratory rate for an adult

A

<20

103
Q

What 3 things can you look for in a child who’s in respiratory distress

A

Increased respiratory rate
Grunting
Subcostal regions

104
Q

Describe influenza virus

A

Acute respiratory illness caused by infection with influenza viruses

105
Q

What are the 2 key surface antigens that influenza A is subdivided into

A

Haemagluttinin (H) 15 subtypes

Nueraminidase (N) 9 subtypes

106
Q

What are minor antigenic variations in viral genomes called

A

Antigenic drift

107
Q

What are major reassortments of a viral genome called

A

Antigenic shift

108
Q

What are some common symptoms of an influenza virus

A

URT and LRT symptoms
Fever
Headaches
Myalgia and weakness

109
Q

What is a common complication of influenza infection

A

Bacterial pneumonia

110
Q

What are the treatment options for someone with influenza infection

A 
'Supportive care':
Oxygenation
Hydration/nutrition
Maintain homeostasis 
Prevent/treat secondary infections
111
Q

What is the role of antiviral medication ‘tamiflu’

A

Reduce transmission to others e.g. In a care home

112
Q

Define outbreak

A

2 or more linked cases

113
Q

Define epidemics

A

More cases in a region/country

114
Q

Define pandemic

A

Epidemics that span international boundaries

115
Q

What is type 1 respiratory failure

A

Low oxygen levels

116
Q

What is type 2 respiratory failure

A

Low oxygen levels and increased CO2 levels

117
Q

What are the causes of type 2 respiratory failure in lungs that appear normal on a CXR

A

Sedatives
Neuromuscular disorders
Upper airway obstruction

118
Q

What are the causes of type 2 respiratory failure in lungs that look abnormal on CXR

A

COPD

Acute asthma

119
Q

What are the chronic respiratory disorders that cause type 1 respiratory failure

A

COPD
Acute asthma
Diffuse interstitial lung disorders

120
Q

What are the localised acute respiratory disorders that cause type 1 respiratory failure

A

Pneumonia

Pulmonary embolism

121
Q

What are the diffuse acute respiratory disorders that cause type 1 respiratory failure

A

ARDS (results of sepsis - killer)

Cardiogenic oedema

122
Q

What are the signs and symptoms of type 1 failure

A 
Cyanosis 
Increased respiratory rate 
Accessory muscle use
Tachycardia 
Hypotension 
Signs of underlying disease
Confusion
123
Q

Signs and symptoms of type 2 respiratory failure

A 
Dyspnoea 
Anxiety 
Orthopnoea 
Drowsiness
Frequent chest infections
Disturbed sleep 
Confusion
Warm peripheries 
Flapping tremor 
Bounding pulses 
Myoclonus jerks
124
Q

What are the treatment options for respiratory failure

A 
ABC
Treatment for underlying condition 
Oxygen therapy 
CPAP 
NIV
IPPV
125
Q

What is CPAP in respiratory failure treatment

A

Continuous positive airways pressure
Which is positive pressure applied throughout the respiratory cycle to a spontaneously breathing patient- improves ventilation and V/Q ratios

126
Q

What is NIV in respiratory failure treatment

A

Non-invasive Ventilation

Bi-phasic positive airway pressure - increases ventilation

127
Q

If the breathing tubes are involved in a respiratory disease is it obstructive or restrictive

A

Obstructive

128
Q

If the lung parenchyma is involved in a respiratory disease is it obstructive or restrictive

A

Restrictive

129
Q

If the chest wall is involved in a respiratory disease is it obstructive or restrictive

A

Restrictive

130
Q

Briefly describe spirometry

A

Fill the lungs with as much air as possible
Blow air out as fast as possible
Keep on blowing air out as long as possible

131
Q

What is the transfer coefficient test

A

A measure of the ability of oxygen to diffuse across the alveolar membrane

132
Q

Briefly describe how the transfer coefficient test works

A

Inspire a low dose of carbon monoxide, and hold the breath for 10 seconds at total lung capacity. The gas transfer is measured and is equivalent to the rate of oxygen transfer.

133
Q

What conditions would have a low transfer coefficient

A

Severe emphyema, fibrosing alveolitis, anaemia

134
Q

What condition leads to a high transfer coefficient

A

Pulmonary haemorrhage

135
Q

Briefly describe mycobacterium

A

Aerobic, non-motile, non-sporing and covered in waxy capsule

136
Q

Are mycobacterium rapidly or slowly deciding organisms

A

Slowly - 15-20hour generation time

137
Q

Where are the most endemic countries for TB

A

India, sub-Saharan Africa

138
Q

What was the incidence of TB in the UK in 2012

A

13.5 per 100,000 per year

139
Q

What are some risk factors for TB

A 
Born in high prevalence area
IVDU
Homelessness
Alcoholic 
Prisons
HIV positive
140
Q

What are two methods of catching TB

A

Spread in aerosol- spitting or sneezing and breathing in the bacilli
Spread enterally - drinking milk from infected cows

141
Q

What % of people don’t develop the disease once they’ve been infected

A

> 95%

142
Q

In a pulmonary infection only, where do the bacilli settle in the lungs

A

Apex

143
Q

Why do the bacilli tend to settle in the apex of the lungs

A

More oxygen (aerobic) and less blood/fewer immune cells

144
Q

What is the immune response to pulmonary TB

A

Macrophages and lymphocytes seal in, contain and kill the majority of the bacteria

145
Q

What happens to the bacilli that survive macrophage phagolysosomes

A

The macrophages travel to the draining lymph nodes and the bacilli multiply in the lymph nodes

146
Q

Briefly describe pulmonary TB (PTB)

A

The bacilli and macrophages coalesce to form a granuloma.
Mediastinal lymph nodes enlarge.
The growing granuloma forms a cavity.
The cavity can erode into the airway and bacilli can now be coughed out.

147
Q

What is the granuloma of bacilli and macrophages known as

A

Primary focus

148
Q

What is the primary focus and mediastinal lymph node enlargement known as

A

Ghon complex

149
Q

What are the systemic features of TB

A 
Weight loss
Night sweats
Low grade fever
Anorexia
Malaise
150
Q

What are the features of pulmonary TB

A

Cough
Chest pain
Breathlessness
Haemoptysis

151
Q

What may be associated with PTB

A

Pleural effusion or pericardial effusion

Consolidation/collapse

152
Q

What is haematogenous dissemination of TB

A

Bacilli spread through the bloodstream to other organs/parts of the body

153
Q

What test results are abnormal in TB (diagnosing TB)

A 
Anaemia - normochromic normocytic 
Thrombocytosis 
Raised ESR/CRP
Hypoalbuminaemia 
Hypergammaglobulinaemia 
Hypercalcaemia
Sterile pyuria
154
Q

How do you diagnose latent TB

A

Tuberculin skin test ‘Mantoux’

Interferon gamma release assays

155
Q

Briefly describe the tuberculin skin test ‘mantoux’

A

Protein derived from TB is injected into the skin, activates memory T cells if previously infected with TB, look at the size of the red infl reaction to see if memory cells activated

156
Q

Briefly describe the interferon gamma release assays test

A

Use WBC from blood sample in lab, give TB antigens and if WBC release INF-gamma then there is a prior exposure

157
Q

What are the four drugs used to treat TB

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

158
Q

What are the side effects of rifampicin

A

Red urine/secretions
Hepatitis
Drug interactions

159
Q

What are the side effects of isoniazid

A

Hepatitis

Neuropathy

160
Q

What are the side effects of pyrazinamide

A

Hepatitis
Arthralgia/ gout
Rash

161
Q

What are the side effects of ethambutol

A

Optic neuritis

Phase 2a LM (7 decks)

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