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Phase 2a Medicine - Riona > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Give 4 parts of the natural immune defence in the respiratory tract

A
  • ) Commensal flora
  • ) Swallowing
  • ) Mucociliary escalator
  • ) Cough reflex and sneezing
  • ) Innate and adaptive immunity
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2
Q

What is bronchiectasis?

A

The chronic inflammation of the bronchi and bronchioles leading to the permanent dilatation and thinning of these airways

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3
Q

Give 3 organisms that can cause bronchiectasis

A
  • ) H. influenzae
  • ) Strep. pneumoniae
  • ) Staph. aureus
  • ) Pseudomonas aeruginosa
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4
Q

Give 4 causes of bronchiectasis

A
  • ) CF
  • ) Young’s syndrome
  • ) Post infection - measles, pertussis, bronchiolitis, pneumonia, TB, HIV
  • ) Bronchial obstruction
  • ) Allergic bronchopulmonary aspergillosis
  • ) UC
  • ) Idiopathic
  • ) RA
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5
Q

Give 3 symptoms of bronchiectasis

A
  • ) Persistant cough
  • ) Copious purulent sputum
  • ) Intermitent haemoptysis
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6
Q

Give 3 signs of bronchiectasis

A
  • ) Finger clubbing
  • ) Coarse inspiratory crepitations
  • ) Wheeze
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7
Q

Give 3 complications of bronchiectasis

A
  • ) Pneumonia
  • ) Pleural effusion
  • ) Pneumothorax
  • ) Haemoptysis
  • ) Cerebral abscess
  • ) Amyloidosis
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8
Q

What does a CXR show in bronchiectasis?

A
  • ) Cystic shadows

- ) Thickened bronchial walls (tramline and ring shadows)

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9
Q

What does a spirometry show in bronchiectasis?

A

Obstructive pattern

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10
Q

What is the management of bronchiectasis?

A
  • ) Airway clearance techniques
  • ) Mucolytics
  • ) Antibiotics
  • ) Bronchodilators
  • ) Corticosteroids
  • ) Possible surgery
  • ) Flu vaccinations
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11
Q

What is cystic fibrosis?

A

Life-threatening autosomal recessive condition

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12
Q

What mutations occur in CF?

A

Mutations in the CF transmembrane conductance regulator (CFTR) gene on chromosome 7

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13
Q

What does the defect lead to in CF?

A
  • ) Cl- channel defect
  • ) Defective chloride secretion
  • ) Increased sodium absorption
  • ) Across airway epithelium
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14
Q

What is someone with CF predisposed to? (2)

A
  • ) Chronic pulmonary infections

- ) Bronchiectasis

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15
Q

What changes in the mucus in people with CF?

A

More viscous

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16
Q

Give 2 presenting features of neonates with CF

A
  • ) Failure to thrive
  • ) Meconium ileus
  • ) Rectal prolapse
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17
Q

Give 4 respiratory symptoms of CF

A
  • ) Cough
  • ) Wheeze
  • ) Recurrent infections
  • ) Bronchiectasis
  • ) Pneumothorax
  • ) Haemoptysis
  • ) Respiratory failure
  • ) Cor pulmonale
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18
Q

Give 3 GI symptoms of CF

A
  • ) Pancreatic insufficiency (DM, steatorrhoea)
  • ) Distal intestinal obstruction syndrome
  • ) Gallstones
  • ) Cirrhosis
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19
Q

Give 3 other symptoms of CF

A
  • ) Male infertility
  • ) Osteoporosis
  • ) Arthritis
  • ) Vasculitis
  • ) Nasal polyps
  • ) Sinusitis
  • ) Hypertrophic pulmonary osteoarthropathy
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20
Q

Give 2 signs of CF

A
  • ) Cyanosis
  • ) Finger clubbing
  • ) Bilateral coarse crackles
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21
Q

How do we test for CF? (2)

A
  • ) Sweat test
  • ) Genetics
  • ) Faecal elastase
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22
Q

What does a CXR show in CF?

A

Hyperinflation, bronchiectasis

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23
Q

What does an abdominal US show in CF?

A

Fatty liver, cirrhosis, chronic pancreatitis

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24
Q

What type of defect is there when spirometry is done in CF?

A

Obstructive

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25
Q

What are we looking for in the heel prick test in infants for CF?

A

Immunoreactive trysinogen

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26
Q

What is the treatment for CF?

A
  • ) Physiotherapy (postural drainage, airway clearance)
  • ) Antibiotics for acute/prophylactic
  • ) Mucolytics
  • ) Bronchodilators
  • ) Treat DM, malabsorption, liver function
  • ) Bone screening, fertility and genetic counselling
  • ) Oxygen, diuretics, ventilation
  • ) Heart/lung transplantation
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27
Q

What is COPD?

A

A common progressive disorder characterised by airway obstruction with little or no reversibility

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28
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

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29
Q

What is the FEV1 in COPD?

A

<80% predicted

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30
Q

What is the FEV1/FVC in COPD?

A

<0.7

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31
Q

What 2 conditions does COPD include?

A

Chronic bronchitis and emphysema

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32
Q

What is chronic bronchitis defined clinically as?

A

Cough, sputum production on most days for 3 months of 2 successive years

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33
Q

What is emphysema defined histologically as?

A

Enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls

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34
Q

Give 4 factors that characterise COPD

A
  • ) >35
  • ) Smoking/pollution
  • ) Chronic dyspnoea
  • ) Sputum production
  • ) Minimal diurnal/day to day FEV1 variation
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35
Q

Give 3 features of a ‘pink puffer’ in COPD

A
  • ) Increased alveolar ventilation
  • ) Near normal PaO2
  • ) Normal/low PaCO2
  • ) Breathless
  • ) Not cyanosed
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36
Q

Give 3 features of ‘blue bloaters’ in COPD

A
  • ) Decreased alveolar ventilation
  • ) Low PaO2
  • ) High PaCO2
  • ) Cyanosed
  • ) Not breathless
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37
Q

What may pink puffers progress to?

A

Type 1 respiratory failure

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38
Q

What may blue bloaters progress to?

A

Cor pulmonale

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39
Q

Give 3 symptoms of COPD

A
  • ) Cough
  • ) Sputum
  • ) Dyspnoea
  • ) Wheeze
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40
Q

Give 4 signs of COPD

A
  • ) Tachypnoea
  • ) Use of accessory muscles of respiration
  • ) Hyperinflation
  • ) Decreased cricosternal distance
  • ) Decreased expansion
  • ) Resonant/hyperresonant percussion note
  • ) Quiet breath sounds
  • ) Wheeze
  • ) Cyanosis
  • ) Cor pulmonale
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41
Q

Give 3 complications of COPD

A
  • ) Acute exacerbations
  • ) Infection
  • ) Polycythaemia
  • ) Respiratory failure
  • ) Cor pulmonale
  • ) Pneumothorax
  • ) Lung carcinoma
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42
Q

What does a CXR show in COPD?

A
  • ) Hyperinflation
  • ) Flat hemidiaphragms
  • ) Large central pulmonary arteries
  • ) Decreased peripheral vascular markings
  • ) Bullae
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43
Q

What does a CT show in COPD?

A
  • ) Bronchial wall thickening
  • ) Scarring
  • ) Air space enlargement
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44
Q

What does an ECG show in COPD?

A

Right atrial and ventricular hypertrophy (cor pulmonale)

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45
Q

What does an ABG show in COPD?

A

Decreased PaO2 +/- hypercapnia

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46
Q

What are the options for treatment of COPD? (4)

A

1) SAMA (ipratroprium) or SABA (salbutamol)
2) LAMA (tiotropium) or LABA (formoterol)
3) Combination LABA with corticosteroids (budenoside) or tiotropium
4) LAMA (tiotropium) and inhaled steroid and LABA

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47
Q

Give lifestyle advice for COPD

A
  • ) Smoking cessation
  • ) Exercise, diet
  • ) Lose weight
  • ) Vaccinations
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48
Q

When do we give oxygen in COPD?

A

PaO2 <7.4kPa

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49
Q

What is alpha 1 antitrypsin deficiency? (A1AT deficiency)

A

An inherited disorder affecting lung (emphysema) and liver (cirrhosis and HCC)

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50
Q

What is A1AT?

A

A glycoprotein, part of a family of serine protease inhibitors made in the liver that control inflammatory cascades

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51
Q

What does lung A1AT do?

A

Protect against tissue damage from neutrophil elastase

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52
Q

In who is the effect of an A1AT deficiency exacerbated?

A

Smokers

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53
Q

What disease can A1AT deficiency cause early onset of?

A

COPD

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54
Q

What does a pulmonary embolism usually arise from? (PE)

A

Venous thrombosis in the pelvis or legs

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55
Q

Where do clots travel from/to in PE?

A

Through veins, R heart, pulmonary circulation

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56
Q

Give 3 rare causes of a PE

A
  • ) RV thrombus (post-MI)
  • ) Septic emboli
  • ) Fat
  • ) Air
  • ) Amniotic fluid
  • ) Neoplastic cells
  • ) Parasites
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57
Q

Give 3 risk factors for a PE

A
  • ) Recent surgery
  • ) Thrombophilia
  • ) Leg fracture
  • ) Prolonged immobility
  • ) Malignancy
  • ) Pregnancy/postpartum
  • ) CCP, HRT
  • ) Previous PE
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58
Q

Give 4 symptoms of a PE

A
  • ) Acute breathlessness
  • ) Pleuritic chest pain
  • ) Haemoptysis
  • ) Dizziness
  • ) Syncope
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59
Q

Give 4 signs of a PE

A
  • ) Pyrexia
  • ) Cyanosis
  • ) Tachypnoea
  • ) Tachycardia
  • ) Hypotension
  • ) Raised JVP
  • ) Pleural rub
  • ) Pleural effusion
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60
Q

What does a negative D dimer test show in PE?

A

Excludes it

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61
Q

What may CXR show in a PE?

A
  • ) Oligaemia of affected segment
  • ) Dilated pulmonary artery
  • ) Linear atelectasis
  • ) Small pleural effusion
  • ) Wedge-shaped opacities/cavitation
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62
Q

What may a ECG show in a PE?

A
  • ) Tachycardia
  • ) RBBB
  • ) RV strain (inverted T in V1-V4)
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63
Q

What criteria do we use for assessing the clinical probability of a PE?

A

Wells

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64
Q

What is the treatment of PE?

A
  • ) LMWH
  • ) DOAC/warfarin
  • ) VC filter
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65
Q

When do we stop heparin in the treatment of a PE?

A

INR 2-3

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66
Q

What does DOAC stand for?

A

Direct oral anticoagulant

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67
Q

Give 2 methods of prevention of a PE

A
  • ) Heparin to immobile patients
  • ) Stop pill/HRT pre-op
  • ) Compression stockings
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68
Q

What do we investigate for in a patient with an unprovoked PE?

A

Malignancy

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69
Q

What is a pneumothorax?

A

An abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall

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70
Q

Give 5 causes of a pneumothorax

A
  • ) Spontaneous often due to rupture of subpleural bulla
  • ) Asthma
  • ) COPD
  • ) TB, pneumonia
  • ) Lung abscess
  • ) Carcinoma
  • ) CF, lung fibrosis
  • ) Sarcoidosis
  • ) Connective tissue disorders
  • ) Trauma
  • ) Iatrogenic
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71
Q

Give 3 symptoms of a pneumothorax

A
  • ) May be asymptomatic
  • ) Sudden onset dyspnoea
  • ) Sudden onset pleuritic chest pain
  • ) Suden deterioration (asthma, COPD)
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72
Q

Give 3 signs of a pneumothorax

A
  • ) Reduced expansion
  • ) Hyper-resonance to percussion
  • ) Diminished breath sounds on affected side
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73
Q

Which side will the trachea be deviated in a tension pneumothorax?

A

Away

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74
Q

What is the test for a pneumothorax?

A

CXR

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75
Q

How do we treat a pneumothorax?

A

Aspiratie, possible chest drain

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76
Q

What is a pleural effusion?

A

Fluid in the pleural space

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77
Q

What can pleural effusions be divided by?

A

Their protein concentration

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78
Q

What is a transudate? (pleural effusion)

A

Low protein concentration, <25g/L

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79
Q

What is an exudate? (pleural effusion)

A

High protein concentration, >35g/L

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80
Q

What is a haemothorax?

A

Blood in the pleural space

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81
Q

What is an empyema?

A

Pus in the pleural space

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82
Q

What is a chylothorax?

A

Chyle (lymph with fat) in the pleural space

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83
Q

What is a haemopneumothorax?

A

Blood and air in the pleural space

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84
Q

Give 3 causes for a transudate pleural effusion

A
  • ) Increased venous pressure (HF, constrictive pericarditis, fluid overload)
  • ) Hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption)
  • ) Hypothyroidism
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85
Q

Give 3 causes for an exudate pleural effusion

A

Increased leakiness of pleural capillaries secondary to:

  • ) Infection (pneumonia, TB)
  • ) Inflammation (RA, pulmonary infarction, SLE)
  • ) Malignancy (bronchogenic carcinoma, malignant mets, lymphoma etc)
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86
Q

Give 2 symptoms of a pleural effusion

A

Can be asymptomatic

  • ) Pleuritic chest pain
  • ) Dyspnoea
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87
Q

Give 4 signs of a pleural effusion

A

-) Decreased expansion
-) Stony dull percussion note
-) Diminished breath sounds
^^ All on affected side
-) Tactile vocal remits decreased
-) Vocal resonance decreased
-) Possible bronchial breathing
-) Possible tracheal deviation away
-) Possible signs of associated disease

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88
Q

What does a CXR show in pleural effusions? (2)

A
  • ) Blunt costophrenic angles (small)

- ) Water-dense shadows with concave upper borders (large)

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89
Q

What does a completely flat horizontal upper border imply on a CXR?

A

Pneumothorax and pleural effusion

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90
Q

What do we do to find out if the pleural effusion is transudate/exudate?

A

Diagnostic aspiration

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91
Q

What is the treatment of a pleural effusion?

A
  • ) Drainage if symptomatic
  • ) Pleurodesis with talc
  • ) Possible surgery
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92
Q

What is sarcoidosis?

A

A multisystem granulomatous disorder of unknown cause

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93
Q

What is sarcoidosis associated with genetically?

A

HLA-DRB1 and DQB1 alleles

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94
Q

What gender does sarcoidosis occur more commonly in?

A

Women

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95
Q

What ethnicity does sarcoidosis affect more frequently and more severely?

A

Afro-Caribbeans

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96
Q

Give 3 things sarcoidosis presents with

A
  • ) Fever
  • ) Erythema nodosum
  • ) Polyarthralgia
  • ) Bilateral hilar lymphodenopathy
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97
Q

Give 3 pulmonary symptoms of sarcoidosis

A
  • ) Dry cough
  • ) Progressive dyspnoea
  • ) Decreased exercise tolerance
  • ) Chest pain
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98
Q

Give 5 non-pulmonary signs of sarcoidosis

A

-) Lymphadenopathy
-) Hepato/splenomegaly
-) Kerato/conjunctivitis sicca
-) Bell’s palsy
-) Lacrimal and parotid gland enlargement
-) Neuropathy
-) Meningitis
-) Cardiomyopathy
-) Space occupying lesions
-) Arrhythmias
-) Hypercalcaemia/calciuria
-) Renal stones
-) Pituitary dysfunction
ETC

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99
Q

What is increased in the blood in sarcoidosis?

A
  • ) ESR
  • ) LFT
  • ) Serum ACE (60%)
  • ) Calcium
  • ) Igs
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100
Q

What is decreased in the blood in sarcoidosis?

A

Lymphopenia, decreased lymphocytes

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101
Q

What are the 5 stages seen on a CXR in sarcoidosis?

A

0) Normal
1) BHL
2) BHL and peripheral pulmonary infiltrates
3) Peripheral pulmonary infiltrates alone
4) Progressive pulmonary fibrosis, bulla formation (honeycombing), pleural involvement

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102
Q

What does BHL stand for?

A

Bilateral hilar lymphodenopathy

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103
Q

What may an ECG show in sarcoidosis?

A

Arrhythmias or BBB

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104
Q

What may lung function tests show in sarcoidosis?

A

Normal/reduced lung volumes, impaired gas transfer, restrictive ventilatory defect

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105
Q

What test is diagnostic in sarcoidosis, and what does it show?

A

Tissue biopsy, non-caveating granulomata

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106
Q

What does a bronchoalveolar lavage show in sarcoidosis?

A

Increased lymphocytes, increased neutrophils, pulmonary fibrosis

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107
Q

What is the treatment for patients with BHL in sarcoidosis?

A

Nothing

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108
Q

What is the treatment for acute sarcoidosis?

A

Bed rest, NSAIDs

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109
Q

Give 4 indications for corticosteroids in sarcoidosis treatment

A
  • ) Parenchymal lung disease
  • ) Uveitis
  • ) Hypercalcaemia
  • ) Neuro/cardiac involvement
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110
Q

What corticosteroid do we give in sarcoidosis?

A

Prenisolone

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111
Q

What do we give in severe sarcoidosis?

A
  • ) IV methyprednisolone or immunosuppressants
  • ) Anti-TNF therapy
  • ) Lung transplant
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112
Q

What is extrinsic allergic alveolitis? (EAA)

A

Inhalation of antigens provokes a hypersensitivity reaction in sensitised individuals

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113
Q

Give 2 examples of allergens in EAA

A

Fungal spores, avian proteins

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114
Q

What occurs in the acute phase of EAA?

A

Alveoli infiltrated with acute inflammatory cells

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115
Q

What occurs in the chronic phase of EAA?

A

Granuloma formation and obliterative bronchiolitis

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116
Q

Give 3 causes of EAA

A
  • ) Bird/pigeon-fancier’s lung
  • ) Farmer’s/mushroom workers lung
  • ) Malt worker’s lung
  • ) Bagassosis/sugar worker’s lung
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117
Q

Give 3 symptoms of EAA 4-6 hours post-exposure

A
  • ) Fever
  • ) Rigors
  • ) Myalgia
  • ) Dry cough
  • ) Dyspnoea
  • ) Fine bibasal crackles
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118
Q

Give 3 chronic symptoms of EAA

A
  • ) Finger clubbing
  • ) Increasing dyspnoea
  • ) Weight loss
  • ) Exertional dyspnoea
  • ) T1 respiratory failure
  • ) Cor pulmonale
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119
Q

What does a CXR show in acute EAA?

A
  • ) Upper zone mottling/consolidation

- ) Hilar lymphadenopathy (rare)

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120
Q

What does a CXR show in chronic EAA?

A
  • ) Upper zone fibrosis

- ) Honeycomb lung

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121
Q

What is found in the blood in both chronic and acute EAA?

A

Serum antibodies

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122
Q

What do lung function tests show in acute EAA?

A

Reversible restrictive defect

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123
Q

What do lung function tests show in chronic EAA?

A

Restrictive defect

124
Q

What does a bronchoalveolar lavage show in EAA?

A

Increased lymphocytes and mast cells

125
Q

How do we treat acute EAA? (3)

A
  • ) Remove allergen
  • ) Give O2
  • ) Prednisolone
126
Q

How do we treat chronic EAA? (2)

A
  • ) Avoid allergen/facemask

- ) Long term steroids

127
Q

What type of hypersensitivity reaction is EAA?

A

Type 1, allergic

128
Q

What are the 4 types of hypersensitivity reaction?

A 
ACID
Type 1 - Allergic
Type 2 - Cytotoxic
Type 3 - Immune complex
Type 4 - Delayed T cell
129
Q

Give an example of each of the hypersensitivity reactions (4)

A

Type 1 - Bee stings, latex, asthma
Type 2 - Goodpasture’s
Type 3 - SLE
Type 4 - Transplant

130
Q

What is a mesothelioma?

A

Tumour of mesothelial cells that usually only occurs in the pleura

131
Q

What are mesotheliomas associated with?

A

Occupational exposure to asbestos

132
Q

Give 4 symptoms of a mesothelioma

A
  • ) Finger clubbing
  • ) Chest pain
  • ) Dyspnoea
  • ) Weight loss
  • ) Recurrent pleural effusions
133
Q

Give 3 signs of a mesothelioma metastasis

A
  • ) Lymphadenopathy
  • ) Hepatomegaly
  • ) Bone pain/tenderness
  • ) Abdominal pain/obstruction
134
Q

What does a CT/CXR show in a mesothelioma?

A

Pleural thickening/effusion

135
Q

What is the pleural fluid like in a mesothelioma?

136
Q

What is the treatment for a mesothelioma?

A
  • ) Pemetrexed and cisplatin chemotherapy
  • ) Possible surgery
  • ) Possible pleurodesis and indwelling intra-pleural drain
137
Q

What is asbestosis caused by?

A

Inhalation of asbestos fibres

138
Q

What is the degree of exposure to asbestos related to?

A

Degree of pulmonary fibrosis

139
Q

Give 3 clinical features of asbestosis

A
  • ) Progressive dyspnoea
  • ) Clubbing
  • ) Find end-inspiratory crackles
  • ) Pleural plaques
140
Q

What does asbestosis give an increased risk of?

A

Bronchial adenocarcinoma and mesothelioma

141
Q

What is the management of asbestosis?

A

Symptomatic

142
Q

What is silicosis caused by?

A

Inhalation of silica particles (very fibrogenic)

143
Q

Give 2 jobs that may be associated with silica exposure

A
  • ) Metal mining
  • ) Stone quarrying
  • ) Sandblasting
  • ) Pottery/ceramic manufacture
144
Q

Give a clinical feature of silicosis

A
  • ) Progressive dyspnoea

- ) Increased incidence of TB

145
Q

What does a CXR show in silicosis?

A
  • ) Diffuse miliary/nodular pattern in upper and mid-zones

- ) Egg shell calcification of hilar nodes

146
Q

What does spirometry show in silicosis?

A

Restrictive

147
Q

What is the treatment of silicosis?

A

Symptomatic

148
Q

What is coal worker’s pneumoconiosis? (CWP)

A

A common dust disease in countries with underground coal mines

149
Q

What is CWP caused by?

A

Inhalation of coal dust particles over 10-20 years

150
Q

What causes fibrosis in CWP?

A

Macrophages ingest coal dust particles, die, release enzymes

151
Q

What is the main clinical feature of CWP?

A

Asymptomatic, coexisting chronic bronchitis is common

152
Q

What does a CXR show in CWP?

A

Many round opacities, especially in upper zone

153
Q

What is the treatment of CWP?

A

Avoid exposure, treat co-existing chronic bronchitis

154
Q

What is progressive massive fibrosis caused by? (PMF)

A

Progression of CWP

155
Q

Give 2 clinical features of PMF

A
  • ) Progressive dyspnoea
  • ) Fibrosis
  • ) Cor pulmonale
156
Q

What does a CXR show in PMF?

A

Usually bilateral upper-mid zone fibrotic masses, develop from periphery towards hilum

157
Q

What is the treatment for PMF?

A

Avoid exposure

158
Q

What is Caplan’s syndrome?

A

The association between RA, pneumoconiosis and pulmonary rheumatoid nodules

159
Q

What is cor pulmonale?

A

Right heart failure caused by chronic pulmonary arterial hypertension

160
Q

Give 3 causes of cor pulmonale

A
  • ) Chronic lung disease (COPD, bronchiectasis, pulmonary fibrosis)
  • ) Pulmonary vascular disorders (pulmonary emboli, vasculitis, sick cell, primary pulmonary HTN)
  • ) Neuromuscular and skeletal diseases (MG, poliomyelitis, MND, scoliosis)
161
Q

Give 2 symptoms of cor pulmonale

A
  • ) Dyspnoea
  • ) Fatigue
  • ) Syncope
162
Q

Give 4 signs of cor pulmonale

A
  • ) Cyanosis
  • ) Tachycarida
  • ) Raised JVP with prominent a and v waves
  • ) RV heave
  • ) Loud P2
  • ) Pansystolic murmur
  • ) Hepatomegaly
  • ) Oedema
163
Q

What is increased in a FBC in cor pulmonale? (2)

A

Hb and haematocrit

164
Q

What does an ABG show in cor pulmonale?

A

Hypoxia +/- hypercapnia

165
Q

What does a CXR show in cor pulmonale? (2)

A
  • ) Enlarged RA and RV

- ) Prominent pulmonary arteries

166
Q

What does an ECG show in cor pulmonale? (3)

A
  • ) P pulmonale
  • ) Right axis deviation
  • ) RV hypertrophy/strain
167
Q

What is the management of cor pulmonale?

A
  • ) Treat underlying cause
  • ) Treat respiratory failure (oxygen)
  • ) Treat cardiac failure (diuretics, furosemide)
  • ) Possible venesection (haematocrit >55%)
  • ) Possible heart-lung transplantation
168
Q

What is Goodpasture’s disease?

A

A pulmonary-renal syndrome

169
Q

What does Goodpasture’s include?

A

Acute glomeruloneprihtis and lung symptoms

170
Q

What are the lung symptoms in Goodpasture’s?

A

Haemoptysis/diffuse pulmonary haemorrhage

171
Q

What is Goodpasture’s caused by?

A

Antiglomerular basement membrane antibodies binding to kidney’s basement membrane and alveolar membrane

172
Q

What does a CXR show in Goodpasture’s?

A

Infiltrates due to pulmonary haemorrhage, often in lower zones

173
Q

What does a kidney biopsy show in Goodpasture’s?

A

Crescentic glomerulonephritis

174
Q

How do we treat Goodpasture’s?

A
  • ) Treat shock
  • ) Immunosuppressants
  • ) Plasmapheresis
175
Q

What is the second most common cancer in the UK?

A

Carcinoma of the bronchus

176
Q

Give 3 risk factors for lung tumours

A
  • ) CIGARETTE SMOKING
  • ) Passive smoking
  • ) Asbestos
  • ) Chromium
  • ) Arsenic
  • ) Iron oxides
  • ) Radiation
177
Q

What is the most important clinical/histological division between lung tumours?

A

Small cell (SCLC) and non-small cell (NSCLC)

178
Q

Give 3 NSCLCs

A
  • ) Squamous
  • ) Adenocarcinoma
  • ) Large cell
  • ) Adenocarcinoma in situ
179
Q

What do SCLCs arise from?

A

Endocrine cells (Kulchitsky cells)

180
Q

Give 4 symptoms of lung tumours

A
  • ) Cough
  • ) Haemoptysis
  • ) Dyspnoea
  • ) Chest pain
  • ) Recurrent/slowly resolving pneumonia
  • ) Lethargy, anorexia, weight loss
181
Q

Give 3 signs of lung tumours

A
  • ) Cachexia
  • ) Anaemia
  • ) Clubbing
  • ) Hypertrophic pulmonary osteoarthropathy, wrist pain
  • ) Supraclavicular/axillary nodes
  • ) Consolidation, collapse, pleural effusion
182
Q

Give 3 signs of lung tumour metastases

A
  • ) Bone tenderness
  • ) Hepatmegaly
  • ) Confusion, fits, focal CNS signs, cerebellar syndrome
  • ) Proximal myopathy, peripheral neuropathy
183
Q

Give 3 local complications of lung tumours

A
  • ) Recurrent laryngeal nerve palsy
  • ) Phrenic nerve palsy
  • ) SVC obstruction
  • ) Horner’s syndrome (Pancoast’s tumour)
  • ) Rib erosion
  • ) Pericarditis
  • ) AF
184
Q

Give 3 metastatic locations for lung tumours

A
  • ) Brain
  • ) Bone
  • ) Liver
  • ) Adrenals
185
Q

What causes a horse voice?

A

Recurrent laryngeal nerve compression

186
Q

What does a CXR show in lung tumours?

A
  • ) Peripheral nodule
  • ) Hilar enlargement
  • ) Consolidation
  • ) Lung collapse
  • ) Pleural effusion
  • ) Bony secondaries
187
Q

What do we use to stage a lung tumour?

188
Q

What do we use a bronchoscopy for in lung tumours?

A

Histology and assessing operability

189
Q

What is the treatment for a NSCLC?

A
  • ) Lobectomy
  • ) Radical radiotherapy
  • ) Chemo and radio
  • ) Cetuximab (monoclonal antibody)
190
Q

What is the treatment for a SCLC?

A
  • ) Consider surgery
  • ) Chemo and radio
  • ) Palliation with radio
  • ) SVC stent and radio
  • ) Endobronchial therapy
  • ) Pleural drainage/pleurodesis
  • ) Drugs (analgesia, steroids, anti-emetics, bronchodilators, antidepressants)
191
Q

What is interstitial lung disease? (ILD)

A

A number of conditions that primarily affect the parenchyma in a diffuse manner

192
Q

What is ILD characterised by?

A

Chronic inflammation and/or progressive interstitial fibrosis

193
Q

Give 2 signs/symptoms of ILD

A
  • ) Dyspnoea on exertion
  • ) Non-productive paroxysmal cough
  • ) Abnormal breath sounds
194
Q

What does a spirometry shew in ILD?

A

Restrictive

195
Q

What are the pathological features of ILD?

A
  • ) Fibrosis and remodelling of the interstitium

- ) Hyperplasia of type II epithelial cells or type II pneumocytes

196
Q

What are the 3 categories of ILD?

A
  • ) Those with a known cause
  • ) Those associated with systemic disorders
  • ) Idiopathic
197
Q

Give 4 causes of ILD

A
  • ) Asbestosis etc
  • ) Drugs
  • ) Hypersensitivity reactions
  • ) Infections
  • ) GORD
  • ) Sarcoidosis
  • ) RA
  • ) SLE and other connective tissue diseases
  • ) UC
  • ) Idiopathic pulmonary fibrosis
198
Q

What is idiopathic pulmonary fibrosis? (IPF)

A

A type of idiopathic interstitial pneumonia

199
Q

What is the pathogenesis of IPF?

A

Inflammatory cell infiltrate and pulmonary fibrosis of unknown cause

200
Q

Give 3 symptoms of IPF

A
  • ) Dry cough
  • ) Exertional dyspnoea
  • ) Malaise
  • ) Weight loss
  • ) Arthralgia
201
Q

Give 3 signs of IPF

A
  • ) Finger clubbing
  • ) Cyanosis
  • ) Fine end-inspiratory crepitations
202
Q

Give 2 complications of IPF

A

Respiratory failure, increased risk of lung cancer

203
Q

What does an ABG show in IPF?

A

Decreased PaO2, high PaCO2 if severe

204
Q

What 4 things may be increased/positive in the blood in IPF?

A
  • ) CRP
  • ) Igs
  • ) ANA (30%)
  • ) RF (10%)
205
Q

What does a CT/CXR show in IPF?

A
  • ) Decreased lung volume
  • ) Bilateral lower zone reticula-nodular shadows
  • ) Honeycomb lung (advanced)
206
Q

What does spirometry show in IPF?

A

Restrictive

207
Q

What are the usual histological changes in IPF referred to as?

A

Usual interstitial pneumonia

208
Q

What is the treatment for IPF?

A
  • ) Supportive care (O2, analgesia, palliative)

- ) Possible lung transplantation

209
Q

What is asthma characterised by?

A

Recurrent episodes of dyspnoea, cough and wheeze caused by reversible obstruction

210
Q

What are the 3 factors that contribute to airway narrowing in asthma?

A
  • ) Bronchial muscle contraction
  • ) Mucosal swelling/inflammation
  • ) Increased mucus
211
Q

What is mucosal swelling/inflammation caused by in asthma?

A

Mast cell and basophil degranulation resulting in the release of inflammatory mediators

212
Q

Give 3 symptoms of asthma

A
  • ) Intermittent dyspnoea
  • ) Wheeze
  • ) Cough (often nocturnal)
  • ) Sputum
213
Q

Give 4 precipitants of asthma

A
  • ) Cold air
  • ) Exercise
  • ) Emotion
  • ) Allergens (house dust mite, pollen, fur)
  • ) Infection
  • ) Smoking/passive smoking
  • ) Pollution
  • ) NSAIDs, beta blockers
214
Q

What is diurnal variation?

A

Symptoms or peak flow may vary over the day

215
Q

When is peak flow worst in asthma?

216
Q

What may also be present in asthma due to it being an atopic disease?

A

Eczema, hay fever

217
Q

Give 3 signs of asthma

A
  • ) Tachypnoea
  • ) Audible wheeze
  • ) Hyperinflated chest
  • ) Hyper-resonant percussion note
  • ) Decreased air entry
  • ) Widespread, polyphonic wheeze
218
Q

What marks a near fatal attack of asthma?

A

Increased PaCO2

219
Q

What marks a severe asthma attack?

A

Inability to complete sentences

220
Q

What marks a life-threatening asthma attach?

A

Silent chest, confusion, exhaustion, cyanosis, bradycardia

221
Q

What is an exacerbation?

A

An acute event characterised by a worsening of the patient’s symptoms that is beyond normal day to day variations

222
Q

How do we diagnose asthma?

A

≥15% improvement in FEV1 following beta-2-agonists or steroid trial

223
Q

What does PEF monitoring show in asthma?

A

Diurnal variation of >20% on ≥3d a week for 2 weeks

224
Q

Why do we do a CXR in an acute attack of asthma?

A

To exclude infection or pneumothorax

225
Q

What does spirometry show in asthma?

A

Obstructive defect

226
Q

What is a marker of eosinophilic inflammation?

A

Exhaled nitric oxide

227
Q

Give 3 differential diagnoses for asthma

A
  • ) Pulmonary oedema
  • ) COPD
  • ) Large airway obstruction
  • ) SVC obstruction
  • ) Pneumothorax
  • ) PE
  • ) Bronchiectasis
  • ) Obliterative bronchiolitis
228
Q

What are the treatment steps for asthma? (5)

A

1) SABA, short acting beta-2-agonist as needed (salbutamol)
2) ICS, add inhaled steroid (beclometasone)
3) LABA, Add long acting beta-2-agonist (salmeterol)
4) Consider high dose beclometasone, theophylline, beta-2-agonist tablets, oral leukotriene receptor antagonist
5) Oral prednisolone

229
Q

What do beta-2-adrenoceptor agonists do?

A

Relax bronchial smooth muscle by increasing cAMP within minutes

230
Q

What do corticosteroids do?

A

Act over days to decrease bronchial mucosal inflammation

231
Q

What can corticosteroids cause if the mouth is not rinsed after use?

A

Oral candidiasis

232
Q

What does aminophylline do?

A

It is metabolised to theophylline, and acts by inhibiting phosphodiesterase, thus decreasing bronchocontriction by increasing cAMP levels

233
Q

What is the main cause of the common cold?

A

Rhinoviruses

234
Q

What are the symptoms of a common cold?

A

Self limiting nasal discharge becoming mucopurulent over a few days

235
Q

Give a complication of the common cold

A
  • ) Otitis media

- ) Pneumonia

236
Q

What pharyngitis look like?

A
  • ) Glandularfever EBV

- ) Acute HIV

237
Q

What is the main symptom of pharyngitis?

A

Sore throat

238
Q

Give 3 causes of pharyngitis

A
  • ) Rhinovirus
  • ) Adenovirus
  • ) Group A beta haemolytic strep
  • ) Strep. pyogenes
  • ) STIs
239
Q

Give 2 associated diseases of pharyngitis

A
  • ) Scarlet fever
  • ) Poststreptococcal glomerulonephritis
  • ) Rheumatic fever
240
Q

What is the centor criteria?

A

The likelihood of a sore throat being due to a bacterial infection

241
Q

What are the centor criteria? (4)

A
  • ) Tonsillar exudate
  • ) Tender anterior cervical adenopathy
  • ) Fever over 38
  • ) Absence of cough
242
Q

What is influenza?

A

A viral respiratory infection spread via droplets

243
Q

What is influenza caused by?

A

Influenza virus

244
Q

Give 3 complications of influenza

A
  • ) Bronchitis
  • ) Pneumonia
  • ) Sinusitis
  • ) Otitis media
  • ) Encephalitis
  • ) Pericarditis
245
Q

Give 4 symptoms of influenza

A
  • ) Headache
  • ) Malaise
  • ) Low mood
  • ) Myalgia
  • ) Prostration
  • ) Nausea
  • ) Vomiting
  • ) Conjunctivitis
  • ) Photophobia
246
Q

How do we test for influenza?

A

Serology and culture from nasal swab

247
Q

What is the treatment for influenza?

A

Bed rest and paracetamol

248
Q

What can we use within 48 hours of symptoms beginning in influenza?

A

Oseltamivir (tamiflu)

249
Q

What is oseltamivir?

A

Neuraminidase inhibitor that reduces the time and severity of illnesss

250
Q

What types of influenza can we use oseltamivir with?

251
Q

Why do we use oseltamivir?

A

To reduce spread in at risk groups

252
Q

What is antigenic drift?

A

Minor variation, seasonal epidemics

253
Q

What is antigenic shift?

A

Major variation, pandemics

254
Q

What is an outbreak?

A

2 or more linked cases

255
Q

What is an epidemic?

A

More than 2 linked cases in a region/country

256
Q

What is a pandemic?

A

Epidemic that spans international boundaries

257
Q

What is pneumonia?

A

An acute lower respiratory tract illness

258
Q

What is the most common cause of community-acquired pneumonia?

A

Streptococcus pneumoniae

259
Q

What is the most common cause of hospital-acquired pneumonia?

A

Gram negative enterobacteria or staph aureus

260
Q

What is hospital-acquired pneumonia defined as?

A

> 48 hours after admission

261
Q

Give 3 circumstances with a greater risk of acquiring pneumonia through aspiration

A
  • ) Stroke
  • ) Myasthenia
  • ) Bulbar palsies
  • ) Decreased consciousness
  • ) Oesophageal disease
  • ) Poor dental hygiene
262
Q

Give 2 of the most common causative organisms in pneumonia

A
  • ) Strep. pneumoniae
  • ) H. influenzae
  • ) Staph aureus
263
Q

Give 4 symptoms of pneumonia

A
  • ) Fever, rigors, malaise, anorexia
  • ) Dyspnoea
  • ) Cough
  • ) Purulent sputum
  • ) Haemoptysis
  • ) Pleuritic pain
264
Q

Give 4 signs of pneumonia

A
  • ) Pyrexia
  • ) Cyanosis
  • ) Confusion
  • ) Tachypnoea
  • ) Tachycardia
  • ) Hypotension
  • ) Signs of consolidation
  • ) Pleural rub
265
Q

Give 2 signs of consolidation

A
  • ) Reduced expansion
  • ) Dull percussion
  • ) Increased tactile vocal fremitus/vocal resonance
  • ) Bronchial breathing
266
Q

What does a CXR show in pneumonia?

A

Lobal or multilobar infiltrates, cavitation, pleural effusion

267
Q

What tests do we do in pneumonia?

A
  • ) CXR
  • ) O2 saturation and BP
  • ) Blood
  • ) Sputum - MC&S
  • ) Pleural fluid aspiration
  • ) Bronchoscopy/BAL
  • ) Urine fo atypical organisms
  • ) ABG
268
Q

Give 3 complications of pneumonia

A
  • ) Pleural effusion
  • ) Empyema
  • ) Lung abscess
  • ) Respiratory failure
  • ) Septicaemia
  • ) Brain absces
  • ) Pericarditis
  • ) Myocarditis
  • ) Cholestatic jaundice
269
Q

What do we use to assess he severity of pneumonia?

A 
CURB-65
Confusion (AMT ≤8)
Urea >7mmol/L
Respiratory rate ≥30/min
BP <90 systolic +/or 60 diastolic
Age ≥65
270
Q

How do we treat pneumonia?

A
  • ) Antibiotics
  • ) Oxygen
  • ) IV fluids
  • ) Analgesia
271
Q

What is the empirical treatment for CAP pneumonia?

A

Amoxicillin or clarithromycin or doxycycline

272
Q

What is the empirical treatment for severe CAP pneumonia?

A

Co-amoiclav or cephalosporin

273
Q

What antibiotic do we add in CAP pneumonia treatment if staph is suspected?

A

Flucloxacillin +/- rifampicin

274
Q

What antibiotic do we add in CAP pneumonia treatment if MRSA is suspected?

A

Vancomycin

275
Q

What is tuberculosis caused by? (TB)

A

Mycobacterium tuberculosis

276
Q

What is active infection of TB?

A

Continment by the immune system is inadequate

277
Q

How does transmission of TB occur?

A

Inhalation of aerosol droplets (only pulmonary disease is communicable)

278
Q

What is latent TB?

A

Infection without disease due to persistent immune system containment

279
Q

How does the immune system contain TB?

A

Granuloma formation prevents bacterial growth and spread

280
Q

Give 2 risk factors for reactivation of latent TB

A
  • ) New infection
  • ) HIV
  • ) Organ transplantation
  • ) Immunosuppression
  • ) Silicosis
  • ) Ilicit drug use
  • ) Malnutrition
  • ) High risk settings, low socio-economic status
  • ) Haemodialysis
281
Q

Where are TB granulomata most likely to form?

A

Apex of lung

282
Q

Give 6 symptoms of TB

A
  • ) Systemic - fever, anorexia, malaise, night sweats, clubbing
  • ) Pulmonary - cough, pleurisy, haemoptysis
  • ) Tuberculous lymphadenitis - painless enlargement of cervical/supraclavicular lymph nodes
  • ) GI - colicky abdominal pain, vomiting, bowel obstruction
  • ) Spinal - local pain and bony tenderness
  • ) Miliary
  • ) CNS - meningitis, headache, confusion, seizures
  • ) GU - dysuria, frequency, loin pain, haematuria
  • ) Cardiac - pericarditis, pericardial effusion, constrictive pericarditis
  • ) Skin - lupus vulgarisms, scrofuloderma
283
Q

Where does most GI TB occur?

A

Ileocaecal

284
Q

How do we test for latent TB?

A

Mantoux test

285
Q

What does a CXR show in active pulmonary TB?

A
  • ) Fibronodular/linear opacities in upper lobe (typical)
  • ) Cavitation
  • ) Calcification
  • ) Miliary disease
  • ) Effusion
  • ) Lymphadenonopathy
286
Q

What stain do we do to detect acid fast bacilli?

A

Ziehl-Neelsen

287
Q

What is smear positive TB?

A

Can see the mycobacterium in the sputum/spit under a microscope

288
Q

Is smear positive or negative more infectious?

289
Q

What tests do we do to diagnose TB?

A
  • ) Mantoux test
  • ) CXR
  • ) Sputum smear/culture
  • ) Interferon-gamma release assays
290
Q

What do interferon gamma release assays do?

A

Diagnose exposure to TB be measuring the release of interferon-gamma from T-cells reacting to TB antigen

291
Q

What do interferon gamma release assays distinguish between?

A

BCG vaccination and TB latent infection

292
Q

What 4 drugs do we give in TB?

A 
RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
293
Q

What are the 2 phases of TB treatment?

A

Initial - 8 weeks on RIPE

Continuation - 16 weeks on RI

294
Q

Give a side effect of rifampicin

A

Red body fluids (sweat, urine, tears)

295
Q

Give a side effect of isoniazid

A

Peripheral neuropathy

296
Q

Give a side effect of pyrazinamide

297
Q

Give a side effect of ethambutol

A

Visual problems (optic neuritis)

298
Q

What do we have to warn the patients of when taking rifampicin?

A

Take additional contraception - pill excreted too quickly

299
Q

What is the transfer co-efficient?

A

A measure of the ability of oxygen to diffuse across the alveolar membrane, tested by inhaling low dose CO

300
Q

What does LABA stand for?

A

Long acting beta 2 antagonist

301
Q

What does SABA stand for?

A

Short acting beta 2 antagonist

302
Q

What does LAMA stand for?

A

Long acting muscarinic antagonist

303
Q

What does SAMA stand for?

A

Short acting muscarinic antagonist

304
Q

What is the most common organism to cause hospital acquired pneumonia?

A

Staph aureus

305
Q

What is the most common organism to cause community acquired pneumonia?

A

Strep pneumoniae

306
Q

What causes a hoarse voice?

A

Recurrent laryngeal nerve compression

307
Q

What is needed when a patient is taking rifampicin?

A

Barrier protection (pill excreted hepatically)

Phase 2a Medicine - Riona (17 decks)

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