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Phase2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Give three bacteria which can colonise the nares.

A
  • Staphylococcus epidermidis
  • Corynebacteria
  • Staphylococcus aureus
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2
Q

Give four potentially dangerous pathogens which can colonise the pharynx.

A
  • Strep pneumoniae
  • Haemophilus influenzae
  • Strep pyogenes
  • Neisseria
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3
Q

Give four defences that the respiratory tract has against pathogens.

A
  • Commensal flora
  • Swallowing
  • Mucociliary escalator
  • Cough/sneeze reflex
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4
Q

Give four conditions which may cause immune dysfunction of the lung.

A
  • Primary immunodeficiency
  • Complement deficiencies
  • HIV
  • Immunosuppressant therapy
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5
Q

Give four reasons why someone’s ability to swallow may be impaired, putting them at a higher risk of respiratory infection.

A
  • Stroke
  • Motor neurone disease
  • Tumour
  • Surgery
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6
Q

Give four intrinsic causes of altered lung physiology, putting the patient at increased risk of infection.

A
  • Cystic fibrosis
  • Bronchiectasis
  • Emphysema
  • Interstitial lung disease
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7
Q

Give four extrinsic causes of altered lung physiology, putting the patient at increased risk of infection.

A
  • Spinal disease
  • Weakness
  • Obesity
  • Surgery
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8
Q

What is the normal alveolar-arterial gradient?

A

<2kPa

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9
Q

Give three causes of a raised Alveolar-arterial gradient.

A
  • V/Q mismatch
  • Diffusion limitation
  • Right to left cardiac shunt
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10
Q

Give two causes of a low PAO2.

A
  • Hypoventilation

- Reduced FiO2 (or Patm)

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11
Q

What physiological response occurs to alveolar hypoxia?

A

Pulmonary vasoconstriction

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12
Q

In ambient hypoxia, what lung condition can result from widespread pulmonary vasoconstriction?

A

Pulmonary oedema

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13
Q

Where does gas exchange begin in the respiratory system?

A

Respiratory bronchioles

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14
Q

What breaks a breath hold?

A

Raised CO2 in the CSF (detected by central chemoreceptors)

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15
Q

What do peripheral chemoreceptors usually respond to?

A

Large changes in PaO2.

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16
Q

Give five functions of the lung.

A
  • Gas exchange
  • Acid-base balance
  • Defence
  • Hormones
  • Heat exchange
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17
Q

Give five ways that the lung provides defence against pathogens.

A
  • Mucosal barrier
  • Mast cells
  • Macrophages
  • Mucociliary clearance
  • Cough reflex
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18
Q

What is FEV1?

A

The forced expiratory volume in 1 second.

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19
Q

Describe the FEV1 and FVC in obstructive lung disease.

A

FEV1 low
FVC normal
Low FEV1:FVC ratio

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20
Q

Describe the FEV1 and FVC in restrictive airways disease.

A

Low FEV1
Low FVC
FEV1:FVC normal

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21
Q

A disease of the airways typically causes a _____________ (obstructive/restrictive) disease.

A

Obstructive

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22
Q

A disease of the lung parenchyma typically causes a _____________ (obstructive/restrictive) disease.

A

Restrictive

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23
Q

A disease of the chest wall/pleura typically causes a _____________ (obstructive/restrictive) disease.

A

Restrictive

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24
Q

What is TLCO?

A

Transfer factor (also known as diffusing capacity)

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25
Q

Give two causes of a low TLCO.

A
  • Thickening of alveolar-capillary membrane

- Reduced lung volumes

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26
Q

Give two causes of a raised TLCO.

A
  • Increased capillary blood volume

- Pulmonary haemorrhage

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27
Q

Give two causes of increased pulmonary capillary volume, which may lead to an increased TLCO.

A
  • Polycythaemia

- Left to right cardiac shunt

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28
Q

Is lung cancer more common in males or females?

A

Males

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29
Q

What proportion of all cancer deaths does lung cancer account for?

A

One third

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30
Q

What is the five year survival rate in lung cancer?

A

<5-10%

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31
Q

Give three general risk factors for lung cancer.

A
  • Cigarettes
  • Occupational
  • Lung fibrosis
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32
Q

Give six occupational risk factors for lung cancer.

A
  • Asbestos
  • Radon
  • Nickel
  • Chromate
  • Arsenic
  • Uranium
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33
Q

What are the symptoms of lung cancer?

A
  • Cough
  • Recurrent chest infections
  • Haemoptysis
  • Increasing shortness of breath
  • General malaise
  • Weight loss
  • Chest pain
  • Hoarseness
  • Loss of voice
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34
Q

Give four general signs of lung cancer.

A
  • Cachexia
  • Anaemia
  • Clubbing
  • Supraclavicular or axillary nodes
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35
Q

Give three potential chest signs that may appear in lung cancer.

A
  • Consolidation
  • Collapse
  • Pleural effusion
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36
Q

What percentage of patients have paraneoplastic changes in lung cancer?

A

3-10%

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37
Q

Give nine paraneoplastic changes that may occur in lung cancer.

A
  • Secretion of PTH
  • SIADH
  • Secretion of ACTH and other hormones
  • Hypertrophic pulmonary osteo-arthropathy (HPOA)
  • Myasthenic syndrome (Lambert-Eaton)
  • Finger clubbing
  • Migratory thrombophlebitis
  • Non-infective endocarditis (Libman Sacks)
  • DIC
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38
Q

Describe the stage of lung cancer on presentation.

A

Most present with late stage

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39
Q

Is primary or metastatic lung cancer more common?

A

Metastatic

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40
Q

What is the most common classification of lung cancer?

A

Carcinoma (90%)

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41
Q

Give six general types of lung tumour.

A
  • Carcinoma
  • Bronchial gland neoplasm
  • Pleural neoplasia
  • Soft tissue sarcoma/benign tumour
  • Lymphoma
  • Hamartoma
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42
Q

Briefly describe the pathology of how lung cancer develops.

A
  • Precursor cell changes lead to dysplasia, which leads to cancer
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43
Q

Give three samples that can be collected in lung cancer.

A
  • Sputum
  • Bronchoalveolar lavage (BAL)
  • Pleural fluid
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44
Q

Give six investigations to carry out in lung cancer.

A
  • Fluid sample collection (cytology/histology)
  • Biopsy
  • Lobectomy/wedge/pneumonectomy
  • CXR
  • Bronchoscopy
  • Lung function tests
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45
Q

Give five types of primary lung carcinoma.

A
  • Squamous cell carcinoma
  • Adenocarcinoma (bronchioloalveolar adenocarcinoma)
  • Large (non-small) cell undifferentiated carcinoma
  • Small cell carcinoma
  • Carcinoid tumour
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46
Q

Primary lung carcinomas can be broadly divided into what two groups?

A
  • Small cell lung carcinoma (SCLC)

- Non-small cell lung carcinoma (NSCLC)

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47
Q

What grade is a small cell lung carcinoma?

A

High grade

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48
Q

What is the major risk factor for small cell lung carcinoma?

A

Cigarette smoking

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49
Q

What stage is the cancer usually at on presentation in small cell lung carcinoma?

A

Has usually spread by presentation

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50
Q

What is the standard treatment for small cell lung carcinoma?

A

Chemotherapy

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51
Q

What grade are non-small cell lung carcinomas usually?

A

Variable grade

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52
Q

What is a major risk factor for non-small cell lung carcinomas?

A

Cigarette smoking

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53
Q

Describe the stage at presentation of non-small cell lung carcinoma.

A

May have metastasised

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54
Q

Compare the rate of growth of small cell and non-small cell lung carcinomas.

A

Small cell carcinomas are faster

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55
Q

What is the usual treatment for non-small cell lung carcinomas?

A

Chemotherapy may be offered, but surgery and radiotherapy are the mainstay of treatment.
Can also use new drugs blocking specific tumour cell receptors.

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56
Q

What age group do carcinoid tumours of the lung more commonly occur in?

A

Younger people

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57
Q

Is smoking a major risk factor for carcinoid lung tumours?

A

No

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58
Q

Describe the prognosis for carcinoid lung tumours.

A

All are malignant, but they are less aggressive.

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59
Q

Give two types of lung lymphoma.

A
  • Hodgkin’s lymphoma

- Non-Hodgkin’s lymphoma/BALTOMA

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60
Q

What is a BALTOMA?

A

Bronchus associated lymphoid tissue lymphoma

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61
Q

Give an example of a sarcoma which occurs in the lung.

A

Epitheloid haemangio-endothelioma

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62
Q

What does PL1/PL2 indicate when staging lung tumours?

A

Pleural involvement

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63
Q

What does M0 mean when staging lung tumours?

A

No metastases

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64
Q

What does M1a mean when staging lung tumours?

A

Contralateral lung, or pleural/pericardial effusion/nodule

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65
Q

What does M1b mean when staging lung tumours?

A

Distant spread outside chest

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66
Q

Give three examples of non-malignant lung nodules.

A
  • TB and other infections
  • Lymph nodes
  • Benign neoplasia (eg. Hamartoma)
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67
Q

What is a hamartoma?

A

Disorganised benign tumour of various tissue types.

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68
Q

Give three types of pleural neoplasia.

A
  • Metastatic disease
  • Pleural fibroma
  • Malignant mesothelioma
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69
Q

Describe a pleural fibroma.

A
  • Solitary fibrous tumour

- Most are benign

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70
Q

What patient demographic are malignant mesotheliomas more common in?

A

Males >60yrs

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71
Q

What is a major risk factor for malignant mesothelioma?

A

Asbestos exposure

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72
Q

What is the average survival time in a malignant mesothelioma?

A

8-12months

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73
Q

Describe the treatment for malignant mesothelioma.

A

Limited benefit from surgery, chemotherapy, radiotherapy

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74
Q

Describe the microscopic appearance of a malignant mesothelioma.

A

Many different microscopic appearances

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75
Q

Give six consequences of asbestos exposure.

A
  • Plaques
  • Persistent pleural effusion
  • Pleural fibrosis
  • Lung cancer
  • Asbestosis (diffuse interstitial fibrosis)
  • Mesothelioma
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76
Q

Give ten differential diagnoses of a lung nodule.

A
  • Primary or metastatic malignancy
  • Abscesses
  • Granuloma
  • Carcinoid tumour
  • Pulmonary hamartoma
  • Arterio-venous malformation
  • Encysted effusion (fluid, blood, pus)
  • Cyst
  • Foreign body
  • Skin tumour
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77
Q

What are ‘interstitial lung diseases’?

A

A general term for diseases resulting in an increased amount of connective tissue between the alveolar spaces in the lungs.

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78
Q

In lung fibrosis, do patients have trouble breathing in or out?

A

In

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79
Q

Are interstitial lung diseases generally obstructive or restrictive?

A

Restrictive

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80
Q

Give three general consequences of interstitial lung diseases.

A
  • Increased stiffness
  • Decreased compliance
  • Loss of alveolar surface
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81
Q

Describe the Tco expected in interstitial lung diseases.

A

Reduced

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82
Q

Describe the VC expected in interstitial lung diseases.

A

Reduced

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83
Q

Describe the FEV1 expected in interstitial lung diseases.

A

Reduced

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84
Q

Describe the FEV1/FVC ratio expected in interstitial lung diseases.

A

Normal

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85
Q

Describe the peak expiratory flow rate expected in interstitial lung diseases.

A

Normal

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86
Q

Give four general clinical features of interstitial lung diseases.

A
  • Dyspnoea on exertion
  • Non-productive paroxysmal cough
  • Abnormal breath sounds
  • Abnormal CXR
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87
Q

Give five examples of acute interstitial lung diseases.

A
  • Adult respiratory distress syndrome
  • Drug and toxin reactions
  • Gastric aspiration
  • Radiation pneumonitis
  • Diffuse intrapulmonary haemorrhage
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88
Q

Give five causes of adult respiratory distress syndrome.

A
  • Shock
  • Trauma (direct pulmonary or multisystem)
  • Infections
  • Gas inhalation
  • Narcotic abuse
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89
Q

Briefly describe the pathology in adult respiratory distress syndrome.

A
  • Polymorphs release enzymes and activate complement
  • Increased capillary permeability leads to pulmonary oedema
  • Diffuse alveolar damage with hyaline membranes
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90
Q

What is the fatality rate in adult respiratory distress syndrome?

A

50%

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91
Q

What are the clinical features of adult respiratory distress syndrome?

A
  • Cyanosis
  • Tachypnoea
  • Dyspnoea
  • Tachycardia
  • Pulmonary oedema
  • Arterial hypoxaemia
  • Peripheral vasodilation
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92
Q

What would a CXR show in adult respiratory distress syndrome?

A

Bilateral pulmonary infiltrates

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93
Q

Give two cytotoxic drugs that can cause an acute interstitial lung disease.

A
  • Busulphan

- Bleomycin

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94
Q

How does paraquat (a potent herbicide) cause an acute interstitial lung disease?

A
  • Releases hydrogen peroxide and superoxide free radical

- Remains in high concentrations in the lungs after ingestion

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95
Q

Give two potential consequences of radiation pneumonitis.

A
  • Respiratory distress syndrome

- Progressive pulmonary fibrosis

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96
Q

Give five examples of chronic interstitial lung diseases.

A
  • Fibrosing alveolitis
  • Pneumoconioses
  • Sarciodosis
  • Diffuse malignancies
  • Rheumatoid diseases
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97
Q

What is another name for fibrosing alveolitis?

A

Idiopathic pulmonary fibrosis

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98
Q

Give two pathological processes that occur in idiopathic pulmonary fibrosis.

A
  • Inflammatory cell infiltrate

- Pulmonary fibrosis

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99
Q

Describe the macroscopic appearance of the lungs in idiopathic pulmonary fibrosis.

A
  • Abnormally large irregular spaces separated by thick fibrous septa
  • End stage fibrosis = honeycomb lung
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100
Q

Which areas of the lung are predominantly affected by idiopathic pulmonary fibrosis?

A

Subpleural regions

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101
Q

What pattern will the pulmonary function tests show in idiopathic pulmonary fibrosis?

A

Restrictive

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102
Q

Give the symptoms of idiopathic pulmonary fibrosis.

A
  • Dry cough
  • Exertional dyspnoea
  • Malaise
  • Weight loss
  • Arthralgia
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103
Q

Give three signs of idiopathic pulmonary fibrosis.

A
  • Cyanosis
  • Finger clubbing
  • Fine end-inspiratory crepitations
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104
Q

What would be ABG show in idiopathic pulmonary fibrosis?

A

Low PaO2

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105
Q

What would be CRP be in idiopathic pulmonary fibrosis?

A

High

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106
Q

What would the immunoglobulin levels be in idiopathic pulmonary fibrosis?

A

High

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107
Q

What would the CXR show in idiopathic pulmonary fibrosis?

A
  • Reduced lung volume

- Honeycomb lung

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108
Q

Give three potential complications in idiopathic pulmonary fibrosis.

A
  • Cor pulmonale
  • Respiratory failure
  • Increased risk of lung cancer
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109
Q

What is the 5 year survival rate in idiopathic pulmonary fibrosis?

A

50%

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110
Q

What is pneumoconiosis?

A

Lung disease caused by inhaled dust (can be organic or inorganic).

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111
Q

Give four different types of reaction that can occur in pneumoconiosis.

A
  • Inert
  • Fibrous
  • Allergic
  • Neoplastic
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112
Q

Give an example of an inert reaction to pneumoconiosis.

A

Coal worker’s pneumoconiosis

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113
Q

Give three examples of fibrous reactions to pneumoconiosis.

A
  • Progressive massive fibrosis
  • Asbestosis
  • Silicosis
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114
Q

Give an example of an allergic reaction to pneumoconiosis.

A

Extrinsic allergic alveolitis

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115
Q

Give two examples of neoplastic reactions to pneumoconiosis.

A
  • Mesothelioma

- Lung cancer

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116
Q

Describe the pathology in coal worker’s pneumoconiosis.

A
  • Coal ingested by alveolar macrophages (dust cells)

- Macrophages aggregate around bronchioles

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117
Q

What is anthracosis?

A

Presence of coal dust pigment in the lung

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118
Q

Describe macular coal worker’s pneumoconiosis.

A

Aggregates of dust laden macrophages with no significant scarring.

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119
Q

Describe nodular coal worker’s pneumoconiosis.

A

Nodules >10mm in a background of extensive macular CWP, with no significant scarring.

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120
Q

Give three consequences that can result from coal worker’s pneumoconiosis.

A
  • Progressive massive fibrosis
  • Emphysema
  • Honeycomb lung and/or cor pulmonale
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121
Q

Where are silicates found?

A

Stone and sand

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122
Q

Briefly describe the pathology of silicosis.

A
  • Silicates are toxic to macrophages
  • Macrophages die and release proteolytic enzymes
  • This leads to tissue destruction and fibrosis
  • Nodules formed after many years of exposure
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123
Q

Give a disease that has a higher incidence in people with silicosis.

A

TB

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124
Q

What is asbestos?

A

An inconsumable silicate

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125
Q

What type of hypersensitivity reaction is extrinsic allergic alveolitis?

A

Type 3

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126
Q

Describe the basic pathology in extrinsic allergic alveolitis.

A
  • Hypersensitivity leads to bronchiolitis

- Later leads to chronic inflammation and granulomas

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127
Q

Give the possible outcomes of extrinsic allergic alveolitis.

A
  • Resolution

- Fibrosis

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128
Q

What is sarcoidosis?

A

Deposits of immune complexes resulting in a granulomatous disease mainly affecting the lungs and lymph nodes.

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129
Q

What type of hypersensitivity reaction is sarcoidosis?

A

Type IV

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130
Q

Give four symptoms of sarcoidosis.

A
  • Dry cough
  • Progressive dyspnoea
  • Decreased exercise tolerance
  • Chest pain
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131
Q

Describe Kveim test.

A
  • Subcutaneous injection of sterile homogenised sarcoid tissue
  • Induces granulomas in patients with sarcoidosis
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132
Q

What investigation should be used to assess sarcoidosis?

A

CXR

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133
Q

Give a potential treatment for sarcoidosis?

A

Corticosteroids

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134
Q

Give three potential affects of Rheumatoid disease on the lungs.

A
  • Diffuse fibrosis
  • Rheumatoid nodules
  • Caplan’s syndrome
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135
Q

What is Caplan’s syndrome?

A

Rheumatoid arthritis + pneumoconiosis

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136
Q

What will the pleura show in rheumatoid disease affecting the lungs?

A

Fibrosis and lymphocytic aggregates

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137
Q

Give two diffuse malignancies that may cause a chronic interstitial lung disease.

A
  • Lymphangitis

- Bronchioloalveolar carcinoma

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138
Q

Describe lymphangitis and how it affects the lungs.

A

Tumour spreads through lung and obstructs lymphatics

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139
Q

How does brochioloalveolar carcinoma cause an interstitial lung disease?

A

Spreads on the surface of the lung to cause local scarring.

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140
Q

Is asthma an obstructive or restrictive disease?

A

Obstructive

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141
Q

Give seven pathological mechanisms that occur in asthma.

A
  • Increased irritability of the bronchi causing spasm
  • Bronchial obstruction with distal overinflation or atelectasis (lung collapse)
  • Overdistended lungs
  • Enlarged bronchial mucous glands with excess secretions (mucous plugs in bronchi)
  • Bronchial inflammation
  • Bronchial wall smooth muscle hypertrophy
  • Thickening of bronchial basement membrane
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142
Q

Give three types of extrinsic asthma.

A
  • Atopic
  • Occupational
  • Allergic bronchopulmonary aspergillosis
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143
Q

Briefly describe the pathology in extrinsic asthma.

A

Environmental agents lead to IgE cross linking and mast cell degranulation.

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144
Q

What type of reaction occurs in extrinsic asthma?

A

IgE/type 1 hypersensitivity

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145
Q

What type of reaction occurs in occupational asthma?

A

Type 3 hypersensitivity

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146
Q

Give seven causes of intrinsic asthma.

A
  • Aspirin
  • Cold
  • Infection
  • Stress
  • Exercise
  • SO2
  • Pollutants
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147
Q

Give two other conditions which are associated with intrinsic asthma.

A
  • Recurrent chest infections

- Chronic bronchitis

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148
Q

Give three other things associated with aspirin-induced asthma.

A
  • Recurrent rhinitis
  • Nasal polyps
  • Skin urticaria
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149
Q

What organism causes allergic bronchopulmonary aspergillosis?

A

Aspergillus fumigatus

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150
Q

What type of reaction occurs in allergic bronchopulmonary aspergillosis?

A

Type I and type III hypersensitivity reaction

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151
Q

Give the two categories that eosinophilic asthma can be divided into.

A
  • Atopic

- Non-atopic

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152
Q

Give three causes of atopic asthma.

A
  • Fungal allergy
  • Common aeroallergens
  • Occupation/pets/exposures
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153
Q

Give three types of non-eosinophilic asthma.

A
  • Non-smoking, non-eosinophilic
  • Smoking-associated
  • Obesity-related
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154
Q

What are the symptoms of asthma?

A
  • Cough
  • Shortness of breath
  • Episodic wheezing
  • Chest tightness
  • Secretions
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155
Q

Give two hallmark clinical features of asthma.

A
  • Diurnal variation

- Reversibility

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156
Q

Is asthma typically worse in the morning or evening?

A

Morning

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157
Q

What is type 1 brittle asthma?

A

Chronic severe (bad all the time)

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158
Q

What is type 2 brittle asthma?

A

Sudden dips

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159
Q

Give three features of the wheeze commonly heard in asthma.

A
  • Polyphonic
  • Expiratory
  • Widespread
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160
Q

Give two features you WOULDN’T expect to find on a clinical examination in a patient with asthma.

A
  • Crackles

- Sputum

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161
Q

Give six factors with may provoke asthma.

A
  • Allergens
  • Infections
  • Menstrual cycle
  • Exercise
  • Cold air
  • Laughter/emotion
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162
Q

Give three simple tests to carry out in asthma.

A
  • Blood count (eosinophils)
  • Tests for atopy and allergy (Skin prick and IgE)
  • CXR
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163
Q

Give four findings on pulmonary function tests in asthma.

A
  • Airways obstruction
  • Reduced FEV1
  • Reduced FEV1/FVC ratio
  • Reduction in PEFR (diurnal variation)
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164
Q

How can challenge agents be used to assess asthma?

A

There is increased responsiveness to challenge agents (eg. Mannitol, methacholine)

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165
Q

How can reversibility testing help to diagnose asthma?

A
  • 12% increase in FEV1 (with increase in 200ml in volume) after bronchodilator is positive
  • 400ml+ increase makes asthma highly likely
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166
Q

How can an exhaled NO test be used to assess asthma?

A
  • NO given off by inflamed lungs
  • Marker of eosinophilic inflammation
  • This is non-specific
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167
Q

Give a factor that may suppress NO production by the lungs in asthma.

A

Smoking

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168
Q

Give two factors that may increase NO production by the lungs in asthma.

A
  • Viral infections

- Rhinitis

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169
Q

What two factors should be considered when assessing the severity and control of asthma?

A
  • Day to day control

- Exacerbation

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170
Q

What three criteria, named RCP3, are used to assess day to day control of asthma?

A
  • Recent nocturnal waking?
  • Usual asthma symptoms in day?
  • Interference with ADLs?
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171
Q

What four things are taken into account when assessing the severity of asthma using exacerbations?

A
  • A and E attendances
  • GP
  • Admissions
  • ITU
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172
Q

What are the three elements of Samter’s triad?

A
  • Bronchial asthma
  • Nasal polyps
  • Aspirin intolerance
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173
Q

Compare the age of onset in asthma and COPD.

A

ASTHMA
- Usually earlier onset

COPD
- Usually onset later in life

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174
Q

Compare the association with smoking in asthma and COPD.

A

ASTHMA
- Not associated with smoking

COPD
- Usually seen in smokers

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175
Q

Compare the disease progression in asthma and COPD.

A

ASTHMA
- Relatively stable disease

COPD
- Progressive and worsens over time

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176
Q

Compare the diurnal variation in asthma and COPD.

A

ASTHMA
- Diurnal variation

COPD
- Less diurnal variation

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177
Q

Compare the day-to-day variation in asthma and COPD.

A

ASTHMA
- Day to day variation

COPD
- Less day to day variation

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178
Q

Compare the seasonal changes in asthma and COPD.

A

ASTHMA
- Not really seasonal

COPD
- Worse in winter

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179
Q

Compare the sputum production in asthma and COPD.

A

ASTHMA
- Less sputum production

COPD
- Sputum production

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180
Q

What is ACOS?

A

Asthma COPD overlap syndrome

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181
Q

Give five risk factors for asthma death.

A
  • > 3 classes of treatment
  • Recent admission/frequent attender
  • Previous near-fatal disease
  • Brittle disease
  • Psychosocial factors
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182
Q

Give four general methods of treating asthma.

A
  • Avoidance of triggers
  • Bronchodilators
  • Anti-inflammatory drugs
  • New biological drugs
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183
Q

How do bronchodilators work to treat asthma?

A

Relieve symptoms

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184
Q

How do anti-inflammatory drugs work to treat asthma?

A

Prevent exacerbations

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185
Q

Give four categories of bronchodilators which are used in asthma.

A
  • Beta agonists
  • Leukotriene receptor antagonists
  • Theophyllines
  • Long acting beta agonists
  • Anticholinergics
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186
Q

Give a beta agonist used to treat asthma.

A

Salbutamol

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187
Q

Give two leukotriene receptor antagonists used to treat asthma.

A
  • Montelukast

- Zafirlukast

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188
Q

Give a theophylline used to treat asthma.

A

Aminophylline

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189
Q

Give two long acting beta agonists used to treat asthma.

A
  • Salmeterol

- Formoterol

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190
Q

Give two anticholinergics used to treat asthma.

A
  • Ipratropium

- Tiotropium

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191
Q

What class of anti-inflammatory drugs are used to treat asthma?

A

Steroids

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192
Q

Give an example of a steroid used to treat asthma.

A

Beclometasone

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193
Q

Give two examples (and how they work) of new biological drugs used to treat asthma.

A
  • Omalizumab (Anti-IgE)

- Mepolizumab (Anti-IL5)

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194
Q

Give the three first steps (in order) in managing acute asthma.

A
  • High flow oxygen
  • Emergency beta agonists (nebuliser)
  • Brief history/examination
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195
Q

Describe the PEFR, RR, pulse, and speech in moderate acute asthma.

A
  • PEFR = >50%
  • RR <25
  • Pulse <110
  • Normal speech
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196
Q

Describe the PEFR, RR, pulse, and speech in severe acute asthma.
How many criteria need to be present?

A
  • PEFR 33%-50%
  • RR >25
  • Pulse >110
  • Inability to complete sentences

*Only one has to be present

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197
Q

Describe the PEFR, O2 sats/PaO2, and PaCO2 in life-threatening acute asthma.

A
  • PEFR <33%
  • O2 <92%
  • PaO2 <8kPa
  • Normal PaCO2
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198
Q

What would you expect the PaCO2 to be in acute asthma?

A

Low due to hyperventilation.

*If normal or high this is a bad sign

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199
Q

Give seven indications, other than vital signs, of life-threatening acute asthma.

A
  • Altered consciousness level
  • Exhaustion
  • Arrhythmia
  • Hypotension
  • Silent chest
  • Poor effort
  • Cyanosis
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200
Q

Give two organs that are affected in Goodpasture’s syndrome.

A
  • Lungs

- Kidney

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201
Q

What is the clinical presentation of Goodpasture’s syndrome in the kidney?

A

Acute glomerulonephritis

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202
Q

Give two effects of Goodpasture’s syndrome on the lung?

A
  • Haemoptysis

- Diffuse pulmonary haemorrhage

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203
Q

What would be seen on a CXR in Goodpasture’s syndrome?

A

Infiltrates due to pulmonary haemorrhage (often in lower zones)

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204
Q

What would be seen on a kidney biopsy in Goodpasture’s syndrome?

A

Crescentic glomerulonephritis

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205
Q

How is Goodpasture’s syndrome treated?

A
  • Vigorous immunosuppression

- Plasmapheresis

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206
Q

What is the cut off for pulmonary hypertension at rest?

A

> 25mmHg

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207
Q

What is the cut off for pulmonary hypertension during exercise?

A

> 30mmHg

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208
Q

Describe primary pulmonary hypertension.

A

Rare, occurs in the absence of chronic lung or heart disease.

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209
Q

Describe secondary pulmonary hypertension.

A

Quite common, develops as a complication of lung or heart disease.

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210
Q

Give five causes of primary pulmonary hypertension.

A
  • Idiopathic
  • Drugs
  • HIV
  • Collagen vascular disease
  • Congenital systemic-to-pulmonary shunts
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211
Q

Give four common causes of secondary pulmonary hypertension.

A
  • COPD
  • Interstitial lung disease
  • Left ventricular failure
  • Chronic pulmonary thromboemboli
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212
Q

Describe the clinical presentation of primary pulmonary hypertension.

A
  • Exertional dyspnoea
  • Fatigue
  • Dizziness
  • Syncope
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213
Q

Describe the clinical presentation of secondary pulmonary hypertension.

A
  • Worsening of symptoms of pre-existing condition

- Increasing breathlessness

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214
Q

What is the five year survival rate in primary pulmonary hypertension?

A

25-50%

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215
Q

Describe the prognosis in secondary pulmonary hypertension.

A

Generally implies significant underlying cardiac or lung disease with poor prognosis.

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216
Q

Give two investigations to carry out in pulmonary hypertension.

A
  • Echocardiogram

- Right heart catheterisation

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217
Q

What is cystic fibrosis?

A

An inherited disorder caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

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218
Q

Describe the inheritance pattern in cystic fibrosis.

A

Autosomal recessive

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219
Q

What is allelic heterogeneity, in terms of cystic fibrosis?

A

Many different mutations in the same gene can cause the disease.

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220
Q

What does the CFTR gene code for?

A

A chloride channel

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221
Q

Describe the pathology of cystic fibrosis.

A

Lack of normal CFTR causes defective electrolyte transfer across epithelial cell membranes, resulting in thick mucous secretions.

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222
Q

What is the most common form of presentation of cystic fibrosis?

A

Pulmonary disease

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223
Q

At what stage in cystic fibrosis does liver disease develop?

A

Late

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224
Q

Describe a neonatal presentation of cystic fibrosis.

A
  • Failure to thrive
  • Meconium ileus (bowel obstruction)
  • Rectal prolapse
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225
Q

Describe how a child/young adult might present with cystic fibrosis.

A
  • Cough
  • Wheeze
  • Recurrent infections
  • Bronchiectasis
  • Pneumothorax
  • Haemoptysis
  • Respiratory failure
  • Cor pulmonale
  • Pancreatic insufficiency
  • Distal intestinal obstruction syndrome
  • Gallstones
  • Cirrhosis
  • Male infertility
  • Osteoporosis
  • Arthritis
  • Vasculitis
  • Nasal polyps
  • Sinusitis
  • Hypertrophic pulmonary osteoarthropathy (HPOA)
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226
Q

Give three signs of cystic fibrosis.

A
  • Cyanosis
  • Finger clubbing
  • Bilateral course crackles
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227
Q

What organisms commonly cause respiratory infections in cystic fibrosis patients?

A
  • Initially, infection is caused by common bacteria which colonise the lungs
  • Eventually Pseudomonas aeruginosa becomes the dominant organism
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228
Q

Give two macroscopic changes that may occur in cystic fibrosis.

A
  • Widespread bronchiectasis

- Liver may be fatty/cirrhotic

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229
Q

Give four microscopic changes that may be seen in cystic fibrosis.

A
  • Lungs contain thick mucous
  • Acute inflammation may be seen if there is active infection in the lungs
  • Periportal fibrosis in liver, may lead to cirrhosis
  • Thickened bile in intrahepatic bile ducts
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230
Q

Give three diagnostic tests for cystic fibrosis.

A
  • Sweat test
  • Genetics
  • Faecal elastase
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231
Q

What sweat test results would suggest cystic fibrosis?

A
  • Sodium and chloride >60mmol/L

- Chloride usually greater than sodium

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232
Q

How can the faecal elastase test be used to assess cystic fibrosis?

A

Screening test for exocrine pancreatic dysfunction (low measurement suggests insufficiency)

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233
Q

What blood tests would it be useful to carry out in cystic fibrosis?

A
  • FBC
  • U and E
  • LFT
  • Clotting
  • Vitamins A/D/E
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234
Q

How could the presence of an infection be detected in cystic fibrosis?

A

Cough swab or sputum culture

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235
Q

How can diabetes be picked up in cystic fibrosis patients?

A

Annual glucose tolerance test

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236
Q

Give two potential features of a CXR in cystic fibrosis.

A
  • Hyperinflation

- Bronchiectasis

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237
Q

Give three potential USS findings in cystic fibrosis.

A
  • Fatty liver
  • Cirrhosis
  • Chronic pancreatitis
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238
Q

What pattern might the spirometry results show in cystic fibrosis?

A

Obstructive

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239
Q

As well as faecal elastase, what other faecal test might be useful in cystic fibrosis?

A

Faecal fat analysis

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240
Q

Give four management principles for the chest in cystic fibrosis.

A
  • Physiotherapy
  • Antibiotics for acute infections and prophylactically
  • Mucolytics
  • Bronchodilators
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241
Q

Give four management principles for the GI system in cystic fibrosis.

A
  • Pancreatic enzyme replacement
  • Fat soluble vitamin supplements (A, D, E, K)
  • Ursodeoxycholic acid for impaired liver function
  • Cirrhosis may require liver transplant
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242
Q

Give four management principles for advanced lung disease in cystic fibrosis.

A
  • Oxygen
  • Diuretics (for Cor pulmonale)
  • Non-invasive ventilation
  • Lung or heart/lung transplant
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243
Q

What is the average life expectancy for a patient with cystic fibrosis?

A

35yrs

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244
Q

What is the most common cause of death in cystic fibrosis?

A

Pulmonary disease

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245
Q

What is a pleural effusion?

A

An accumulation of excess fluid within the pleural space.

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246
Q

What is the protein content of a transudate pleural effusion?

A

<25g/L

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247
Q

What is the protein content of an exudate pleural effusion?

A

> 35g/L

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248
Q

What is a haemothorax?

A

Blood in the pleural space

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249
Q

What is an empyema?

A

Pus in the pleural space

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250
Q

What is a chylothorax?

A

Chyle (lymph with fat) in the pleural space

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251
Q

What is the term for blood and air in the pleural space?

A

Haemopneumothorax

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252
Q

Give four general causes/mechanisms of transudate pleural effusion.

A
  • Increased venous pressure
  • Hypoproteinaemia
  • Hypothyroidism
  • Meigs’ syndrome
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253
Q

Give three causes of transudate pleural effusion due to increased venous pressure.

A
  • Left ventricular failure
  • Constrictive pericarditis
  • Fluid overload
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254
Q

Give three causes of transudate pleural effusion due to hypoproteinaemia.

A
  • Cirrhosis
  • Nephrotic syndrome
  • Malabsorption
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255
Q

Describe the mechanism which causes an exudate pleural effusion.

A

Increased leakiness of pleural capillaries.

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256
Q

Give six causes of exudate pleural effusion.

A
  • Pneumonia
  • TB
  • Pulmonary infarction
  • Pulmonary embolism
  • Malignancy
  • Multisystem autoimmune diseases (SLE, RA)
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257
Q

What are the symptoms of a small pulmonary effusion.

A

May be asymptomatic

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258
Q

Give two symptoms of a large pleural effusion.

A
  • Breathlessness

- Pleuritic chest pain

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259
Q

Give seven signs of a pleural effusion.

A
  • Decreased expansion
  • Stony dull percussion note
  • Diminished breath sounds
  • Decreased vocal resonance
  • Bronchial breathing above effusion
  • Tracheal deviation (away from effusion) if large effusion
  • Signs of underlying disease
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260
Q

Give three signs of a pleural effusion that may be seen on a CXR.

A
  • Blunting of costophrenic angles
  • Water-dense shadows with concave upper borders
  • Completely flat horizontal upper borders implies that there is also a pneumothorax
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261
Q

When is an ultrasound useful in pleural effusion?

A

To identify presence of pleural fluid and to guide aspiration.

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262
Q

Give four tests that can be carried out on a diagnostic pleural aspiration.

A
  • Clinical chemistry
  • Bacteriology
  • Cytology
  • Immunology
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263
Q

Give four management options for a pleural effusion.

A
  • Treat underlying cause
  • Drainage
  • Pleurodesis
  • Surgery
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264
Q

When is drainage of a pleural effusion carried out?

A
  • If symptomatic

- Not in TB

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265
Q

How fast should the fluid be removed when draining a pleural effusion?

A

Slowly

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266
Q

What is pleurodesis?

A

Adhesion of the pleural layers (obliterating the pleural space).

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267
Q

Give three substances that can be used for Pleurodesis.

A
  • Tetracycline
  • Bleomycin
  • Talc
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268
Q

What is the prognosis for a parapeumonic/pulmonary embolus effusion?

A

Usually resolve upon treatment

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269
Q

What is the prognosis for a pleural effusion due to left ventricular failure?

A

Usually implies advanced disease and poor prognosis.

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270
Q

Describe the prognosis in a pleural effusion due to malignancy.

A

Due to metastatic disease so has very poor prognosis.

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271
Q

Give two causes of a turbid, yellow pleural effusion.

A
  • Empyema

- Parapneumonic effusion

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272
Q

Give three causes of a haemorrhagic pleural effusion.

A
  • Trauma
  • Malignancy
  • Pulmonary infarction
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273
Q

Give two causes of a pleural effusion with increased neutrophils.

A
  • Parapneumonic effusion

- Pulmonary embolism

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274
Q

Give five causes of a pleural effusion with increased lymphocytes.

A
  • Malignancy
  • TB
  • Rheumatoid arthritis
  • Lupus
  • Sarcoidosis
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275
Q

Give a cause of pleural effusion with many mesothelial cells.

A

Pulmonary infarction

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276
Q

Give a cause of a pleural effusion containing abnormal mesothelial cells.

A

Mesothelioma

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277
Q

Give a cause of a pleural effusion containing multinucleated giant cells.

A

Rheumatoid arthritis

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278
Q

Give a cause of pleural effusion which contains lupus erythematosus cells.

A

Lupus

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279
Q

Give five causes of a pleural effusion with glucose <3.3mmol/L.

A
  • Empyema
  • Malignancy
  • TB
  • Rheumatoid arthritis
  • SLE
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280
Q

Give five causes of a pleural effusion with pH <7.2.

A
  • Empyema
  • Malignancy
  • TB
  • Rheumatoid arthritis
  • SLE
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281
Q

Give five causes of a pleural effusion with raised LDH.

A
  • Empyema
  • Malignancy
  • TB
  • Rheumatoid arthritis
  • SLE
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282
Q

Give four causes of a pleural effusion with raised amylase.

A
  • Pancreatitis
  • Carcinoma
  • Bacterial pneumonia
  • Oesophageal rupture
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283
Q

Give four causes of a pleural effusion with low complement levels.

A
  • Rheumatoid arthritis
  • SLE
  • Malignancy
  • Infection
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284
Q

Give two pulmonary diseases in which Pseudomonas aeruginosa is a likely cause of infection.

A
  • Cystic fibrosis

- Bronchiectasis

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285
Q

What is the term for when Streptococcus pneumoniae gets into the blood?

A

Invasive pneumococcal pneumona

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286
Q

Describe the shape of Haemophilus.

A

Coccobacilli (short rod)

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287
Q

What are the X, V, and XV disks sometimes used on agar plates?

A

Growth factors - can see which ones the organism needs to grow.

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288
Q

Give an alternative stain to the Zeil Neelsen stain that can be used to identify Mycobacteria.

A

Auramine-phenol stain

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289
Q

Give two cultures on which Mycobacteria can be cultured.

A
  • Lowenstein Jensen slope

- Mycobacterial growth indicator tube (MGIT)

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290
Q

Give two ways that a sputum sample can be obtained from a patient with a non-productive cough.

A
  • Bronchoalveolar lavage

- Induced sputum sample (physiotherapy + nebuliser)

291
Q

Give two organisms that cause tuberculosis.

A
  • Mycobacterium tuberculosis

- Mycobacterium bovis

292
Q

Give a stain that can identify Mycobacteria.

A

Ziehl-Neelsen stain

293
Q

Give another name for Mycobacteria.

A

Acid fast bacilli

294
Q

What is the most common infectious disease worldwide?

A

TB

295
Q

Where in the world is TB more prevalent?

A

Africa and third world countries

296
Q

Give three groups of people who have higher rates of TB in the UK.

A
  • Black African
  • Indian
  • Pakistani
297
Q

Give six risk factors for tuberculosis.

A
  • Born in high prevalence area
  • IV drug users
  • Homeless
  • Alcoholic
  • Prisons
  • HIV
298
Q

How is TB spread?

A

Aerosol spread

Spitting/sneezing

299
Q

What does ‘smear positive’ mean in relation to TB?

A

Bacteria can be identified in the sputum.

300
Q

If a patient is smear positive for TB, what are the chances that household contacts will also be infected?

A

27-50%

301
Q

What type of TB is caused by Mycobacterium bovis?

A

Bovine TB

302
Q

How can bovine TB be caught, and who is at increased risk?

A
  • Caught from unpasteurised milk

- Butchers/abattoir workers are at increased risk

303
Q

Once Mycobacterium tuberculosis has entered a person, what is the most common consequence?

A

Person mounts an effective immune response that encapsulates and contains the organism forever.

304
Q

What percentage of people infected with Mycobacterium tuberculosis develop clinically evident primary pulmonary disease?

A

2-5%

305
Q

What is the disease called when latent TB reactives at a later date?

A

Post primary disease

306
Q

Give five risk factors for developing active TB once infected.

A
  • Elderly
  • Malnourished
  • Diabetic
  • Immunosuppressed
  • Alcoholic
307
Q

Which area of the lung do the bacteria settle in in TB and why?

A

Lung apex, because there is more air and less blood supply/immune cells.

308
Q

What forms when Mycobacteria tuberculosis settle in the lung apex?

A

Caseating granuloma

309
Q

Describe the pathology of primary pulmonary TB.

A
  • Bacilli and macrophages coalesce in apex of lung to form caseating granuloma
  • Bacilli taken in lymphatics to lymph nodes
  • As granuloma grows middle becomes necrotic and full of pus, and a cavity is produced
  • Cavity full of TB bacilli, which are expelled when the patient coughs
310
Q

What is the caseating granuloma called in primary pulmonary TB?

A

Primary (Ghon) focus

311
Q

What is the primary focus (the caseating granuloma) + involvement of the mediastinal lymph nodes called in primary pulmonary TB?

A

Primary (Ghon) complex

312
Q

Give the systemic features of TB.

A
  • Weight loss
  • Low grade fever
  • Anorexia
  • Night sweats
  • Malaise
313
Q

Give four symptoms of pulmonary TB.

A
  • Cough >3weeks
  • Chest pain
  • Breathlessness
  • Haemoptysis
314
Q

Give four pathological consequences of TB.

A
  • Consolidation
  • Collapse
  • Pleural effusion
  • Pericardial effusion
315
Q

How does a pleural effusion occur in TB?

A

Rupture of the primary focus into the pleural space.

316
Q

How is a pleural effusion treated in TB?

A

Does not need draining

317
Q

How does a pericardial effusion occur in TB?

A

Rupture of a lymph node through the pericardium.

318
Q

Give seven types of non-pulmonary TB.

A
  • Miliary TB
  • Pleural TB
  • Lymph node TB
  • Bone and joint TB
  • Abdominal TB
  • Genitourinary TB
  • CNS TB
319
Q

Describe miliary TB.

A

Disseminated infection, forming many small granulomas.

320
Q

What is the second most common form of TB, after pulmonary?

A

Lymph node TB

321
Q

Give two presentations of bone and joint TB.

A
  • Pain/swelling of joint

- Potts disease in spinal cord

322
Q

Give three features of abdominal TB.

A
  • Ascites
  • Abdominal lymph nodes
  • Ileal malabsorption
323
Q

Give four features of genitourinary TB.

A
  • Epididymitis
  • Frequency
  • Dysuria
  • Haematuria
324
Q

Give three features of CNS TB.

A
  • Meningitis
  • CN palsy
  • Tuberculoma
325
Q

Give seven potential non-specific findings in tests that may show up in TB.

A
  • Normochromic normocytic anaemia
  • Thrombocytosis
  • Raised ESR/CRP
  • Hypoalbuminaemia
  • Hypergammaglobulinaemia
  • Hypercalcaemia
  • Sterile pyuria
326
Q

Give three techniques/tests that can definitively diagnose TB.

A
  • Microscopy
  • PCR
  • Culture
327
Q

Give five samples that can be taken which can help to diagnose TB.

A
  • Sputum
  • Urine
  • CSF
  • Pleural fluid
  • Biopsy (lymph nodes, peritoneum, bone, brain, etc)
328
Q

How many sputum samples must be taken to diagnose TB?

A

3

329
Q

Give two possible methods of diagnosing latent TB.

A
  • Tuberculin skin test ‘mantoux’

- Interferon gamma release assays (IGRAs)

330
Q

Briefly describe the tuberculin skin test.

A
  • Protein derived from organism injected intradermally
  • Stimulates type 4 hypersensitivity reaction
  • Positivity determined by size of reaction that is produced

*Measures immune response, not actual bacteria

331
Q

Give two cases where a false negative tuberculin skin test would be produced.

A
  • Immunosuppressed

- Miliary TB

332
Q

Give an example of when a false positive tuberculin skin test would be produced.

A

BCG vaccine

333
Q

Briefly describe the interferon gamma release assay to test for latent TB.

A
  • Take patient’s blood and mix with antigen specific to M.tuberculosis
  • Measure IFN-y released by cells in patient’s blood
334
Q

Give a major differential diagnosis for TB.

A

Cancer

335
Q

What is the general principle of the treatment of active TB?

A

Treat with at least 4 drugs for at least 6 months.

336
Q

What four drugs are used to treat TB?

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
337
Q

How long is Rifampicin given in TB?

A

6 months (12 months if CNS)

338
Q

Describe the mechanism of action of Rifampicin.

A

Blocks protein synthesis

339
Q

Give three side effects of Rifampicin.

A
  • Red urine
  • Hepatitis
  • Drug interactions (oral contraceptive)
340
Q

How long is Isoniazid given for in active TB?

A

6 months (12 months if CNS)

341
Q

Describe the mechanism of action of Isoniazid.

A

Blocks cell wall synthesis

342
Q

Give two side effects of Isoniazid.

A
  • Hepatitis

- Neuropathy

343
Q

How long is pyrazinamide given for in active TB?

A

First 2 months of treatment

344
Q

Describe the mechanism of action of pyrazinamide.

A

Bacteriocidal initially, less effective later

345
Q

Give three side effects of pyrazinamide.

A
  • Hepatitis
  • Arthralgia/gout
  • Rash
346
Q

How long is Ethambutol given for in active TB?

A

First 2 months

347
Q

Describe the mechanism of action of Ethambutol.

A

Blocks cell wall synthesis

348
Q

Give a side effect of Ethambutol.

A

Optic neuritis

349
Q

Why is treatment given for so long in TB?

A

Treatment allows early killing of active bacteria, and when dormant bacteria reactivate months down the line there is opportunity for those to be killed too.

350
Q

Which is the drug which is most common for single-agent resistance TB in the UK?

A

Isoniazid

351
Q

Which two drugs are responsible for most cases of multi-drug resistant TB?

A

Rifampicin and Isoniazid

352
Q

Give four risk factors for having multi-drug resistant TB.

A
  • Previous treatment
  • High risk area
  • Contact of resistant TB
  • Poor response to therapy
353
Q

Give five consequences of drug resistant TB.

A
  • More difficult to treat
  • Side effects
  • IV/IM treatment
  • > 20months treatment
  • Increased relapse rate
354
Q

Give four groups of people at risk of latent TB.

A
  • Contacts
  • New entrants
  • Health care workers
  • Immunocompromised
355
Q

What is the treatment for latent TB?

A

6 months Isoniazid

OR

3 months Rifampicin + Isoniazid

356
Q

Give three prevention strategies for TB.

A
  • Active case finding
  • Detection and treatment of latent TB
  • Vaccination
357
Q

Who routinely gets a vaccination against TB?

A

Neonates in high risk groups

358
Q

What vaccine is used for TB?

A

BCG

359
Q

Define ‘pneumonia’.

A

Inflammation of the lung parenchyma

360
Q

Give 11 organisms which can cause community-acquired pneumonia.
Which is most common?

A
  • Streptococcus pneumoniae (most common)
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Chlamydophila psittaci
  • Haemophilus influenzae
  • Legionella pneumophilia
  • Coxiella burnetti
  • Staphylococcus aureus
  • Gram negative bacilli
  • Influenza A virus
  • Respiratory syncytial virus
361
Q

Give the four atypical pneumonia pathogens.

A
  • Mycoplasma pneumoniae
  • Chlamydophila pneumonia/psittaci
  • Legionella pneumophilia
  • Coxiella burnetti
362
Q

What organisms are a common cause of hospital-acquired pneumonia?

A

Gram negative bacteria (Eg. Klebsiella, Escherichia, Pseudomonas)

363
Q

Give three causes of pneumonia that may occur in immunocompromised patients.

A
  • Viral
  • Mycobacteria
  • Pneumocystis
364
Q

Describe pneumonia caused by Mycoplasma.

A

Usually a milder illness in young adults, but may have extrapulmonary features.

365
Q

Describe the pneumonia caused by legionella.

A

Severe illness with respiratory failure.

366
Q

Where can Legionella be caught?

A

Warm water (water cooling towers, showers, air conditioning, travel)

367
Q

How is Chlamydophila psittaci caught?

A

Contact with sick birds

368
Q

Give another name for Coxiella burnetti pneumonia.

A

Q fever

369
Q

How is Coxiella burnetti caught?

A

Exposure to partuent animals (sheep)

370
Q

Give eight risk factors for pneumonia.

A
  • Extremities of age (infants and elderly)
  • COPD and certain other chronic lung diseases
  • Immunocompromised
  • Nursing home residents
  • Impaired swallow
  • Diabetes
  • Congestive heart disease
  • Alcoholics and IV drug abusers
371
Q

Briefly describe the pathology of bacterial pneumonia.

A
  • Bacteria enter normally sterile distal airway and overwhelm resident host defence
  • Alveolar spaces filled with inflammatory infiltrate rich in neutrophils
372
Q

Describe the resolution phase of bacterial pneumonia.

A
  • Bacteria cleared

- Inflammatory cells removed by apoptosis

373
Q

What are the symptoms of pneumonia?

A
  • Fever
  • Rigors
  • Sweats
  • Productive cough
  • Malaise
  • Anorexia
  • Dyspnoea
  • Haemoptysis
  • Pleuritic pain
374
Q

Describe the typical appearance of sputum produced in S.pneumoniae infection.

A

Rusty

375
Q

Give the signs of pneumonia.

A
  • Pyrexia
  • Cyanosis
  • Confusion
  • Tachypnoea
  • Tachycardia
  • Hypotension
  • Signs of consolidation
  • Pleural rub
376
Q

Give five signs of pulmonary consolidation.

A
  • Diminished expansion
  • Dull percussion
  • Increased vocal resonance
  • Bronchial breathing
  • Crackles +/- wheeze
377
Q

Which two systems might show extrapulmonary features of Legionella pneumonia?

A
  • Neurological

- Gastrointestinal

378
Q

Give an extrapulmonary feature of Mycoplasma pneumonia.

A

Rash

379
Q

Give five investigations to carry out in suspected pneumonia.

A
  • CXR
  • Assess oxygenation and BP
  • Blood tests and cultures
  • Sputum
  • Pleural fluid aspiration
380
Q

Give three features that may be seen on a chest X ray in pneumonia.

A
  • Lobar/multilobar infiltrates
  • Cavitation
  • Pleural effusion
381
Q

How is the severity of pneumonia assessed?

A

CURB-65

382
Q

What are the components of CURB-65?

A
  • Confusion
  • Urea >7mmol/L
  • Respiratory rate >30/min
  • BP <90 systolic
  • > 65yrs
383
Q

What does a CURB-65 score of 0-1 mean?

A

Mild = home treatment possible

384
Q

What does a CURB-65 score of 2 mean?

A

Hospital therapy

385
Q

What does a CURB-65 score of 3+ mean?

A

Severe pneumonia (consider ITU)

386
Q

What severity score is used in the community for pneumonia?

A

CRB-65

387
Q

Give four management principles of pneumonia.

A
  • Antibiotics
  • Oxygen
  • IV fluids
  • Analgesia
388
Q

What empirical antibiotics are used for mild pneumonia (and for penicillin allergy)?

A

Amoxicillin

Penicillin allergy = clarithromycin or doxycycline

389
Q

What empirical antibiotics are given in moderate pneumonia?

A

Amoxicillin + Clarithromycin

390
Q

What empirical antibiotics are given in severe pneumonia (and for penicillin allergy)?

A

IV co-amoxiclav + clarithromycin

PENICILLIN ALLERGY = Cefuroxime + clarithromycin

391
Q

What antibiotics are effective against S.pneumoniae pneumonia?

A
  • Amoxicillin
  • Cefuroxime/cefotaxime if penicillin allergy

Can also use clarithromycin or ciprofloxacin

392
Q

What antibiotics can be used for H.influenzae pneumonia?

A
  • Co-amoxiclav
  • Doxycycline
  • NOT Macrolides
393
Q

Give two antibiotics that can be used for S.aureus pneumonia.

A
  • Flucloxacillin

- Cefuroxime

394
Q

Give two antibiotics that can be used for MRSA pneumonia.

A
  • Vancomycin

- Linezolid

395
Q

Give two antibiotics that can be used for klebsiella pneumonia.

A
  • Co-amoxiclav

- Cephalosporins

396
Q

What antibiotic should be in the regimen for Legionella pneumonia?

A

Ciprofloxacin

397
Q

Give two antibiotics that can be used to treat necrotising pneumonia.

A
  • IV linezolid

- IV clindamycin

398
Q

What antibiotics can be given for Pseudomonas pneumonia?

A
  • IV ceftazidime or piperacillin-tazobactam

+

Gentamicin/tobramycin or ciprofloxacin

399
Q

Give three antibiotics that can be used to treat atypical pneumonia pathogens.

A
  • Erythromycin/clarithromycin
  • Ciprofloxacin
  • Doxycycline
400
Q

Give nine potential complications of pneumonia.

A
  • Respiratory failure
  • Septicaemia
  • Pleural effusion
  • Empyema
  • Lung abscess
  • Brain abscess
  • Pericarditis
  • Myocarditis
  • Cholestatic jaundice
401
Q

Give five markers on thoracocentesis of a parapneumonic effusion that suggests empyema.

A
  • pH<7.2
  • Glucose <3.3mmol/L
  • LDH >1000
  • Positive gram stain or culture
  • Pus or thick fluid
402
Q

Give three choices of antibiotics for an empyema secondary to pneumonia.

A
  • Co-amoxiclav
  • Piperacillin-tazobactam
  • Meropenam
403
Q

Give three groups of people in whom lung abscesses are more common in pneumonia.

A
  • Aspiration
  • Alcoholics
  • Poor dentition
404
Q

Give four organisms that can cause lung abscesses in pneumonia.

A
  • Streptococcus milleri
  • Anaerobes
  • Klebsiella pneumonia
  • Other gram-negative bacteria
405
Q

Define hospital acquired pneumonia.

A

Pneumonia acquired at least 48hrs after hospital admission.

406
Q

Give three risk factors for hospital-acquired pneumonia.

A
  • Elderly
  • Ventilator
  • Post-operative
407
Q

Give five features suggestive of hospital-acquired pneumonia.

A
  • New fever
  • Purulent secretions
  • New radiological infiltrates
  • New leukocytosis/CRP increase
  • Increased O2 requirements
408
Q

Give four organisms which can cause late-onset hospital-acquired pneumonia.

A
  • Staph.aureus (including MRSA)
  • Pseudomonas aeruginosa
  • Acinetobacter baumanii
  • Klebsiella pneumoniae
409
Q

Give three empirical antibiotics that can be used in hospital-acquired pneumonia.

A
  • Piperacillin-tazobactam
  • Meropenam
  • Ceftazadime
410
Q

Give six causes of pneumonia in immunocompromised patients.

A
  • Pseudomonas aeruginosa
  • Pneumocystis pneumonia
  • Mould (Aspergillus)
  • Cytomegalovirus
  • Adenovirus
  • Respiratory syncytial virus
411
Q

Give five non-infectious causes of chronic pneumonia.

A
  • Malignancy
  • Vasculitis
  • Chronic interstitial pneumonia
  • Drugs
  • Eosinophils
412
Q

Give six common respiratory viruses.

A
  • Rhinoviruses
  • Influenza A virus
  • Coronaviruses
  • Adenoviruses
  • Parainfluenza viruses
  • Respiratory syncytial viruses
413
Q

Give six complications of a respiratory virus.

A
  • Sinusitis
  • Pharyngitis
  • Otitis media
  • Bronchitis
  • Rarely pneumonia
  • May lead to bacterial super-infection
414
Q

What is the proper scientific name for Tamiflu?

A

Oseltamiver

415
Q

When is tamiflu indicated?

A

If influenza A or B virus is circulating and he patient is in an ‘at risk’ group

416
Q

How does Tamiflu work?

A

Neuraminidase inhibitor (stops virus from budding out of host cell).

417
Q

Describe the presentation of pharyngitis.

A
  • Sore throat
  • Tender glands in neck
  • Fever
  • Tender cervical lymph nodes
  • Tonsil enlargement
418
Q

Is pharyngitis usually bacterial or viral?

A

Viral

419
Q

What are the two most common viral causes of pharyngitis?

And two less common ones

A
  • Rhinovirus
  • Adenovirus

(- Epstein Barr virus)
(- acute HIV infection)

420
Q

Give six bacterial causes of pharyngitis.

A
  • Streptococcus pyogenes
  • Other Streptococci
  • Mycoplasma pneumoniae
  • Neisseria gonorrhoea (and other STIs)
  • Fusobacterium necrophorum
  • Corynebacterium diphtheria
421
Q

Give three complications of Strep.pyogenes pharyngitis.

A
  • Scarlet fever
  • Post-streptococcal glomerulonephritis
  • Rheumatic fever
422
Q

Give five features of rheumatic fever.

A
  • Carditis
  • Arthritis
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules
423
Q

What is the treatment for bacterial pharyngitis?

A

Amoxicillin

424
Q

What is the treatment for Corynebacterium diphtheriae pharyngitis?

A

Anti-toxin and erythromycin

425
Q

Give the four Centor criteria which favour a bacterial causes of a sore throat over a viral cause.

A
  • Tonsillar exudate
  • Tender anterior cervical adenopathy
  • Fever over 38
  • Absence of cough
426
Q

Describe the presentation of sinusitis.

A
  • Fever
  • Facial pain
  • Purulent nasal discharge
  • May have pain in ears and teeth
427
Q

Is sinusitis usually bacterial or viral?

A

Viral

428
Q

Give four bacterial causes of sinusitis.

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Streptococci
429
Q

Give four features of sinusitis that make a bacterial cause more likely.

A
  • Unilateral pain
  • Purulent discharge
  • Fever >10days
  • Acute presentation with complications
430
Q

Give three complications of sinusitis.

A
  • Brain abscess
  • Sinus vein thrombosis
  • Orbital cellulitis
431
Q

Describe the clinical presentation of epiglottitis.

A
  • Sore throat
  • Pain on swallowing (odynophagia)
  • Fever
  • Inspiratory stridor
432
Q

What is the most common causative organism of epiglottitis?

A

Haemophilus influenzae

433
Q

What is the standard treatment for epiglottitis?

A

Amoxicillin (but 20% produce beta-lactamase, so use doxycycline or co-amoxiclav)

434
Q

Which antibiotics is Haemophilus influenzae not susceptible to?

A

Macrolides

435
Q

How long is the incubation phase for whooping cough?

A

7-10days

436
Q

What are the two phases of whooping cough and how long do they last for?

A 
Catarrhal phase (1-2weeks)
Paroxysmal phase (1-6weeks)
437
Q

What are the symptoms in the catarrhal phase of whooping cough?

A
  • Rhinorrhoea
  • Conjunctivitis
  • Low-grade fever
  • Lymphocytosis
438
Q

What are the symptoms in the paroxysmal phase of whooping cough?

A
  • Coughing spasms
  • Inspiratory ‘whoop’
  • Post-ptussive vomiting
  • Cough >14days
439
Q

What is the causative organism of whooping cough?

A

Bordatella pertussis

440
Q

Give four diagnostic techniques that can be used in whooping cough.

A
  • Culture
  • PCR
  • ELISA
  • IgG
441
Q

Give three complications of whooping cough.

A
  • Pneumonia
  • Encephalopathy
  • Subconjunctival haemorrhage
442
Q

What antibiotics are used to treat whooping cough?

A

Clarithromycin

443
Q

What is another name for croup?

A

Acute laryngo-tracheobronchitis

444
Q

What age group gets croup?

A

Children

445
Q

What is the most common cause of croup?

A

Parainfluenza viruses

446
Q

Give 2 less common causes of croup.

A
  • Respiratory syncytial virus

- Influenza A

447
Q

Describe the presentation of croup.

A
  • Barking cough
  • Fever
  • Cyanosis
  • Tachypnoea
  • Inspiratory stridor
448
Q

What are the two most common causes of the common cold?

A
  • Rhinoviruses

- Coronaviruses

449
Q

What are the two most common viral causes of a sore throat?

A
  • Adenoviruses

- Epstein-Barr virus

450
Q

What is the most common cause of influenza?

A

Influenza A and B

451
Q

What is the most common viral cause of acute bronchitis?

A

Adenoviruses

452
Q

What are three common viral causes of chronic bronchitis?

A
  • Respiratory syncytial virus
  • Rhinoviruses
  • Parainfluenza viruses
453
Q

What are two common viral causes of bronchiolitis?

A
  • Respiratory syncytial virus

- Adenoviruses

454
Q

Define influenza.

A

Acute respiratory illness caused by an infection with influenza viruses.

455
Q

What family are the influenza viruses part of?

A

Orthomyxoviridae (bird viruses)

456
Q

Give the three genera of the influenza virus.

A
  • Influenza A
  • Influenza B
  • Influenza C
457
Q

What are the four key antigenic sites on the influenza virus?

A
  • Haemagglutinin
  • Neuraminidase
  • M2 ion channel
  • Ribonucleoprotein
458
Q

Which influenza viruses cause disease in humans?

A

Influenza A and Influenza B

459
Q

Describe the influenza viral genome structure.

A

8 single-stranded RNA segments

460
Q

How does the influenza virus change its genome so much?

A

Gene re-assortment can occur in infections, and gene swapping can occur during co-infection with human and avian flu virus in human and pigs.

461
Q

Describe antigenic drift and its consequences.

A
  • Minor antigenic variation

- Causes seasonal epidemics

462
Q

What is an epidemic?

A

More cases in one area

463
Q

Describe antigenic shift and its consequences.

A
  • Gene reassortment and major antigenic variation

- Associated with pandemics

464
Q

What is a pandemic?

A

An epidemic which crosses international borders

465
Q

What haemagglutinin and neuraminidase subtypes of the influenza A virus are humans infected by?

A

H1/H2/H3

N1/N2

466
Q

Describe the disease caused by the Influenza A virus.

A

Severe and extensive outbreaks and pandemics

467
Q

Describe the outbreaks associated with the influenza B virus.

A

Tends to cause sporadic, less severe outbreaks (schools, care homes, garrisons)

468
Q

What age group is Influenza B more commonly seen in?

A

Children

469
Q

Describe the disease that is caused by the Influenza C virus.

A
  • Relatively minor disease

- Mild symptoms or asymptomatic

470
Q

How is influenza transmitted?

A

Mainly via aerosols (coughs/sneezes)

- Also possible via hand-to-hand contact, other personal contact, or fomites

471
Q

Describe what causes seasonal flu.

A

Each year the virus undergoes antigenic drift

472
Q

What causes pandemic flu?

A

Virus mutates markedly (antigenic shift)

473
Q

Give three risks which may lead to a flu pandemic.

A
  • More travel
  • More people
  • Intensive farming (more animal contacts with people, factory farming ‘breeds’ viruses)
474
Q

Give four consequences of a flu pandemic.

A
  • High morbidity
  • Excess mortality
  • Social disruption
  • Economic disruption
475
Q

Who is more likely to be killed in a flu pandemic and why?

A

Young people - older people may be more immune

476
Q

What are the symptoms of flu?

A
  • Upper and/or lower respiratory tract symptoms
  • Fever
  • Headache
  • Myalgia
  • Weakness
477
Q

Give a complication of flu.

A

Bacterial pneumonia

478
Q

Give six risk factors for mortality in the flu.

A
  • Chronic cardiac and pulmonary diseases
  • Meningitis (synergistic effects between flu and meningitis)
  • Old age
  • Chronic metabolic diseases
  • Chronic renal disease
  • Immunosuppressed
479
Q

Give four principles of supportive care in flu.

A
  • Oxygenation
  • Hydration/nutrition
  • Maintain homeostasis
  • Prevent/treat secondary infections
480
Q

Give two coronaviruses.

A
  • SARS coronavirus

- MERS coronavirus

481
Q

What is SARS?

A

Severe acute respiratory syndrome

482
Q

What is MERS?

A

Middle Eastern Respiratory Syndrome

483
Q

What is bronchiolitis?

A

Airways obstruction due to inflammation of the bronchioles and mucus production.

484
Q

What is the most common causative organism of bronchiolitis?

A

Respiratory syncytial virus (RSV)

485
Q

What age group does bronchiolitis affect?

A

Babies and small children

486
Q

Define bronchitis.

A

Self-limited inflammation of the epithelium of the bronchi due to upper airway infection.

487
Q

Is bronchitis usually bacterial or viral?

A

Viral

488
Q

Give three potential (but rare) causes of bronchitis.

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Bordatella pertussis
489
Q

Give three symptoms of bronchitis.

A
  • Cough (may be productive or non-productive)
  • SOB
  • Wheeze
490
Q

Where is focal consolidation found in bronchitis?

A

No signs of focal consolidation are found

491
Q

What are the systemic features that usually occur in bronchitis?

A

Fever/systemic features are unusual

492
Q

Describe the CXR in bronchitis.

A

Normal

493
Q

What is the treatment for bronchitis?

A

Usually none, especially if viral

494
Q

Define bronchiectasis.

A

An abnormal permanent dilation of the bronchi accompanied by inflammation in their walls and in adjacent lung parenchyma.

495
Q

In which countries is bronchiectasis more common?

A

Less developed countries

496
Q

In general, what causes bronchiectasis?

A

Chronic inflammation of bronchi and bronchioles.

497
Q

Give eleven causes of chronic inflammation that can lead to bronchiectasis.

A
  • Idiopathic
  • Obstruction (tumour, foreign body)
  • Cystic fibrosis
  • Young’s syndrome
  • Primary ciliary dyskinesia
  • Kartagener’s syndrome
  • Post-infection
  • Allergic bronchopulmonary aspergillosis
  • Hypogammaglobulinaemia
  • Rheumatoid arthritis
  • Ulcerative colitis
498
Q

Give two infections that can lead to bronchiectasis.

A
  • Whooping cough

- TB

499
Q

Give five organisms that colonise the respiratory tract and can cause infections in bronchiectasis.

A
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Moraxella catarrhalis
  • Pseudomonas aeruginosa
500
Q

Briefly describe the pathogenesis of bronchiectasis.

A
  • Recurrent inflammation weakens bronchial walls
  • Scarring in adjacent lung parenchyma places traction on weakened bronchi
  • Bronchi permanently dilate
501
Q

What are the symptoms of bronchiectasis?

A
  • Persistent productive cough

- Haemoptysis

502
Q

Give three signs of bronchiectasis.

A
  • Finger clubbing
  • Course inspiratory crepitations
  • Wheeze
503
Q

Give five investigations to carry out in bronchiectasis.

A
  • Sputum culture
  • CXR
  • High resolution CT (HRCT) chest
  • Spirometry
  • Bronchoscopy
504
Q

Give two CXR findings in bronchiectasis.

A
  • Cystic shadows

- Thickened bronchial walls

505
Q

Why would a high resolution CT chest be carried out in bronchiectasis?

A

Assess extent and distribution of disease

506
Q

What pattern would be seen on spirometry in bronchiectasis?

A

Obstructive

507
Q

Give three reasons why bronchoscopy is carried out in bronchiectasis.

A
  • Locate site of haemoptysis
  • Exclude obstruction
  • Obtain samples for culture
508
Q

Give two microscopic findings in bronchiectasis.

A
  • Visibly dilated airways

- Airways filled with macropurulent material

509
Q

Give three microscopic findings in bronchiectasis.

A
  • Chronic inflammation in bronchial walls
  • Lymphoid aggregates
  • Adjacent alveoli may show acute and organising pneumonia
510
Q

Give five management options for bronchiectasis.

A
  • Postural drainage/chest physiotherapy
  • Antibiotics
  • Bronchodilators
  • Corticosteroids (for allergic bronchopulmonary aspergillosis)
  • Surgery
511
Q

Give two indications for surgery in bronchiectasis.

A
  • Localised disease

- Severe haemoptysis

512
Q

Give eight potential complications of bronchiectasis.

A
  • Pulmonary hypertension
  • Right ventricular failure
  • AA (serum amyloid A) amyloidosis
  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Cerebral abscess
  • Haemoptysis
513
Q

What is a pneumothorax?

A

Presence of air in the pleural space.

514
Q

Are pneumothoraces more common in men or women?

A

Men

515
Q

Give some causes of pneumothorax.

A
  • Spontaneous
  • COPD
  • Asthma
  • Pneumonia
  • Tuberculosis
  • Cystic fibrosis
  • Sarcoidosis
  • Lung carcinoma
  • Idiopathic pulmonary fibrosis
  • Trauma (penetrating chest wound, rib fractures)
  • Iatrogenic (subclavian vein cannulation, lung biopsy)
516
Q

Describe when spontaneous pneumothorax is typically seen.

A

Typically seen in thin tall young men, due to rupture of small apical delicate blebs of lung tissue which result from stretching of the lung.

517
Q

Describe the pathology of a pneumothorax.

A
  • Air leaks out of damaged lung into pleural space until pressures equalise
  • Lung collapses to a variable degree
518
Q

Describe a tension pneumothorax.

A
  • Tissues near lung defect act as a one way valve
  • Pressure/volume builds up in pleural space
  • Displacement of mediastinal structures, causing cardiorespiratory arrest
519
Q

What are the symptoms of a pneumothorax?

A
  • Sudden onset unilateral pleuritic chest pain
  • Dyspnoea
  • Worsening of symptoms in pre-existing lung condition
520
Q

What are the signs of a pneumothorax?

A
  • Reduced expansion
  • Hyper-resonance to percussion
  • Diminished breath sounds
  • Trachea deviated away from affected side in tension pneumothorax
521
Q

What investigation should be carried out in a pneumothorax, and when shouldn’t it be done?

A

CXR

*Don’t do it suspected tension pneumothorax as it delays treatment

522
Q

Give two findings on CXR in pneumothorax.

A
  • Air present in pleural space

- Varying amounts of lung collapse

523
Q

Give two management options for a pneumothorax.

A
  • Aspiration

- Chest drain

524
Q

Give four indications for surgery in a pneumothorax.

A
  • Bilateral pneumothoraces
  • Lung fails to expand after intercostal drain insertion
  • 2 or more previous pneumothoraces on same side
  • History of pneumothorax on opposite side
525
Q

What proportion of patients with a spontaneous pneumothorax suffer recurrent episodes?

A

1/3

526
Q

Give two things that can cause acute airways obstruction.

A
  • Tumour

- Foreign body

527
Q

Give two things that acute airways obstruction can cause in the lungs.

A
  • Distal collapse (atelectasis)

- Over-expansion (valve effect)

528
Q

What do the pulmonary function tests usually show in acute airways obstruction?

A

They are usually normal

529
Q

Give two potential complications of acute airways obstruction.

A
  • Infective pneumonia

- Bronchiectasis

530
Q

Give two types of chronic airways obstruction.

A
  • COPD

- Asthma

531
Q

Define COPD.

A

A chronic lung condition characterised by breathlessness due to poorly reversible and progressive airflow obstruction.

532
Q

What three specific conditions does COPD entail?

A
  • Chronic bronchitis
  • Bronchiolitis
  • Emphysema
533
Q

Define emphysema.

A

Enlarged airspaces distal to terminal bronchioles, with destruction of alveolar walls.

534
Q

Define chronic bronchitis.

A

Prolonged cough and sputum production (most days for 3 months of 2 successive years).

535
Q

Give three groups of people in whom COPD is more common.

A
  • Middle-aged/elderly
  • Smokers
  • Males
536
Q

What is the most common cause of COPD?

A

Smoking

537
Q

What is a common cause of COPD in younger individuals?

A

A1-antitrypsin deficiency

538
Q

Briefly describe the pathology of emphysema.

A
  • Imbalance of proteases and antiproteases causes destruction of lung parenchyma with dilation of terminal air spaces and air trapping
  • Enlargement of alveolar airspaces and destruction of elastin in walls
539
Q

Describe the pathology in chronic bronchitis/bronchiolitis.

A
  • Inflammation and scarring of small bronchioles
  • Mucus gland hyperplasia and chronic inflammation (effects of smoke) causes productive cough
  • Irritation and inflammation lead to squamous metaplasia
540
Q

Give five bacteria which cause recurrent low grade bronchial infections in COPD.

A
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Moraxella catarrhalis
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
541
Q

Give six viruses that cause infections in COPD.

A
  • Respiratory syncytial virus
  • Adenovirus
  • Rhinovirus
  • Coronavirus
  • Influenza
  • Parainfluenza
542
Q

Give five characteristics of COPD.

A
  • Airflow obstruction
  • Usually progressive
  • Not fully reversible
  • Doesn’t change markedly over several months
  • Predominantly caused by smoking
543
Q

What are the symptoms of COPD?

A
  • Cough
  • Sputum
  • Dyspnoea
  • Wheeze
544
Q

What are the signs of COPD?

A
  • Tachypnoea
  • Use of accessory muscles of respiration
  • Hyperinflation
  • Decreased cricosternal distance
  • Decreased lung expansion
  • Resonant or hyperresonant percussion note
  • Quiet breath sounds
  • Wheeze
  • Cyanosis
  • Cor pulmonale
  • Weight loss
545
Q

Describe pink puffers.

A
  • More alveolar ventilation
  • Near normal PaO2
  • Normal or low PaCO2
  • Breathless but not cyanosed
  • May progress to type 1 respiratory failure
  • More emphysema
546
Q

Describe blue bloaters.

A
  • Decreased alveolar ventilation
  • Low PaO2
  • High PaCO2
  • Cyanosed but not breathless
  • May develop Cor pulmonale
  • Rely on hypoxic drive to maintain respiratory effort
  • More bronchitis
547
Q

Give four macroscopic findings in the lungs in COPD.

A
  • Hyperinflated lungs
  • Thick mucus in airways
  • Dilated terminal airspaces
  • Bullae may be present
548
Q

Give four microscopic findings on the lungs in COPD.

A
  • Chronic inflammation and fibrosis of small bronchioles
  • Finely pigmented macrophages in respiratory bronchioles
  • Dilated terminal airspaces
  • Larger airways show mucus gland hyperplasia
549
Q

Give four investigations to perform in COPD.

A
  • CXR
  • Spirometry
  • ECG
  • ABG
550
Q

Give five potential CXR findings in COPD.

A
  • Hyperinflation
  • Flat hemidiaphragms
  • Large central pulmonary arteries
  • Decreased peripheral vascular markings
  • Bullae
551
Q

Give four findings on spirometry in COPD.

A
  • Obstructive
  • Low FEV1 (<80%)
  • Low FEV1/FVC ratio (<0.7)
  • Scalloping of flow-volume curve
552
Q

What may be seen on an ECG in COPD?

A

Right atrial and ventricular hypertrophy

553
Q

What may be seen on an ABG in COPD?

A

Decreased PaO2 +/- hypercapnia

554
Q

Give seven differential diagnoses of COPD.

A
  • Other causes of SOB
  • Heart failure
  • Pulmonary embolus
  • Pneumonia
  • Lung cancer
  • Asthma
  • Bronchiectasis
555
Q

Describe stage 1 COPD.

A

FEV1 >80% of normal (mild)

556
Q

Describe stage 2 COPD.

A

FEV1 50-79% of normal (moderate)

557
Q

Describe stage 3 COPD.

A

FEV1 30-49% of normal (severe)

558
Q

Describe stage 4 COPD.

A

FEV1 <30% of normal (very severe)

559
Q

What is stage 1 of the MRC dyspnoea scale?

A

SOB on marked exertion

560
Q

What is stage 2 of the MRC dyspnoea scale?

A

SOB on hills

561
Q

What is stage 3 of the MRC dyspnoea scale?

A

Slow or stop on flat

562
Q

What is stage 4 of the MRC dyspnoea scale?

A

Exercise tolerance 100-200 yards on flat

563
Q

What is stage 5 of the MRC dyspnoea scale?

A

Housebound/SOB on minor tasks

564
Q

Name two methods of evaluating symptom severity in COPD.

A
  • MRC dyspnoea scale

- CAT (COPD assessment test)

565
Q

What 2 criteria are needed to be ranked ‘A’ in the combined assessment of COPD?

A
  • MRC 1-2 or CAT <10

- Up to 1 exacerbation in past year, not needing hospitalisation

566
Q

What 2 criteria are needed to be ranked ‘B’ in the combined assessment of COPD?

A
  • MRC3+ or CAT>10

- Up to 1 exacerbation in last year, not needing hospitalisation

567
Q

What 2 criteria are needed to be ranked ‘C’ in the combined assessment of COPD?

A
  • MRC1-2 or CAT<10

- An exacerbation in the last year needing hospitalisation, or more than one exacerbation

568
Q

What 2 criteria are needed to be ranked ‘D’ in the combined assessment of COPD?

A
  • MRC3+ or CAT>10

- An exacerbation in the last year needing hospitalisation, or more than one exacerbation

569
Q

Give five non-pharmacological treatments for COPD.

A
  • Stop smoking
  • Exercise
  • Treat poor nutrition or obesity
  • Influenza and pneumococcal vaccination
  • Pulmonary rehabilitation/palliative care
570
Q

What treatment can be given to mild COPD?

A

Short-acting antimuscarinic or beta-2 agonist

571
Q

What treatment can be given in moderate/severe COPD?

A

Long-acting antimuscarinic/beta-2 agonist + corticosteroid

572
Q

Give four management options for advanced COPD.

A
  • Long term oxygen therapy (LTOT)
  • Ventilatory support (NIV/Bi-PAP)
  • Lung volume reduction surgery
  • Lung transplant
573
Q

What is an acute exacerbation of COPD?

A

Acute event characterised by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variation and leads to a change in medications.

574
Q

Give three common causes of exacerbations of COPD.

A
  • Viral infection
  • Bacterial infection
  • Pollutants
575
Q

Give five management steps in the treatment of acute exacerbations of COPD.

A
  • Nebulized bronchodilators (short acting beta2/antimuscarinics)
  • Controlled oxygen therapy
  • Steroids (IV hydrocortisone and oral prednisolone)
  • Antibiotics if evidence of an infection
  • Physiotherapy for sputum
576
Q

What oxygen sats should be aimed for in COPD?

A

88-92%

577
Q

Give three indications for antibiotics in acute exacerbations of COPD.

A
  • Increased dyspnoea
  • Increased sputum volume
  • Increased sputum purulence
578
Q

Give seven potential complications of COPD.

A
  • Acute exacerbations
  • Infections
  • Polycythaemia
  • Respiratory failure
  • Cor pulmonale
  • Pneumothorax
  • Lung carcinoma
579
Q

Describe how Cor pulmonale occurs in COPD.

A

Pulmonary hypertension occurs due to obliteration and vasoconstriction.

580
Q

What is the most common cause of death in COPD?

A

Combination of respiratory and cardiac failure.

581
Q

Define respiratory failure.

A

Inability of the lungs to adequately oxygenate the arterial blood supply, and/or eliminate CO2 from the venous blood supply.

582
Q

What is type 1 respiratory failure?

A

Low O2 (lung failure)

583
Q

What is type 2 respiratory failure?

A

Low O2 + high CO2 (pump failure)

584
Q

What is a low O2 defined as?

A

<8kPa

585
Q

Give six general causes of type 1 respiratory failure.

Which is the most common?

A
  • Reduced FiO2
  • V/Q mismatch (most common)
  • Increased shunt
  • Diffusion impairment
  • Airways obstruction
  • Alveolar hypoventilation
586
Q

Give three causes of diffusion impairment which may result in type 1 respiratory failure.

A
  • Emphysema
  • Interstitial lung disease
  • Drug-induced lung disease
587
Q

Describe the mechanism that usually causes type 2 respiratory failure?

A

Alveolar hypoventilation (CO2 enters the alveoli but is not removed)

588
Q

What is the normal V/Q?

A

0.8

589
Q

Describe dead space?

A

Infinate V/Q

Normal alveolus but no blood supply

590
Q

Describe shunt (when applied to the lungs).

A

V/Q = 0

Normal blood supply but no oxygen

591
Q

Give seven causes of a V/Q mismatch.

A
  • Pneumonia
  • Pulmonary oedema
  • PE
  • Asthma
  • Emphysema
  • Pulmonary fibrosis
  • Adult respiratory distress syndrome
592
Q

Give six causes of alveolar hypoventilation.

A
  • Airways obstruction
  • Airway secretions
  • Obesity/obstructive sleep apnoea
  • Chest wall abnormalities
  • Neuromuscular disorders
  • Central sleep apnoeas
593
Q

Give three neuromuscular disorders which can cause alveolar hypoventilation.

A
  • Myasthenia gravis
  • Motor neurone disease
  • Guillan-Barre syndrome
594
Q

What are the signs of type 1 respiratory failure?

A
  • Cyanosis
  • Tachypnoea
  • Accessory muscle use
  • Tachycardia
  • Signs of underlying disease
  • Confusion
595
Q

What are the signs of hypercapnia/type 2 respiratory failure?

A
  • Bounding pulse
  • Flapping tremor
  • Confusion
  • Drowsiness
  • Reduced consciousness
596
Q

What is the treatment for type 1 respiratory failure?

A
  • Oxygen
  • Treat underlying cause
  • CPAP (if unable to maintain adequate oxygenation)
597
Q

What O2 sats would be aimed for in type 1 respiratory failure?

A

94-98%

598
Q

What is the treatment for type 2 respiratory failure?

A
  • Oxygen
  • Treat underlying cause
  • NIV (if unable to maintain oxygenation or removal of CO2)
599
Q

What O2 sats are aimed for in type 2 respiratory failure and why?

A

88-92%

Respiratory drive may become insensitive to CO2 so patient relies on hypoxia to maintain respiratory drive

600
Q

If a patient comes into hospital in an emergency and they have respiratory failure, what sats do you aim for?

A

88-92% until ABG results are back

601
Q

Describe CPAP.

A

Positive pressure applied thought the respiratory cycle to increase pressure in the airways.
It prevents airway collapse and decreases work of breathing.

602
Q

Describe NIV.

A

Biphasic positive airways pressure that aids alveolar ventilation.

603
Q

In which types of respiratory failure would CPAP and NIV be used?

A 
CPAP = type 1
NIV = type 2
604
Q

What is the route of administration for the antibodies used to treat asthma?

A

Subcutaneous

605
Q

Give two diseases that bronchoconstriction is a feature of.

A
  • Asthma

- COPD

606
Q

Give four respiratory diseases that inflammation is a part of.

A
  • Pneumonia
  • Asthma
  • COPD
  • Idiopathic pulmonary fibrosis
607
Q

Give three respiratory diseases that bronchiectasis is a feature of.

A
  • Asthma
  • Cystic fibrosis
  • COPD
608
Q

Inhalers deliver drugs in what formulation?

A

Dry powder

609
Q

Give three different types of inhaler devices.

A
  • Pressurised metered-dose inhalers
  • Spacers
  • Dry powder inhaler
610
Q

Pressurised metered-dose inhalers release a spray containing what two things?

A

Drug and propellant

611
Q

How do spacers work?

A

Slow down drug particles and allow more time for evaporation of the propellant so more drug is inhaled.

612
Q

Nebulisers deliver drugs in what formulation?

A

Aerosols

613
Q

Give two advantages of nebulisers compared to inhalers.

A
  • No coordination required by the user

- Can use high doses

614
Q

Give three reasons why delivery of drugs to the conducting airways instead of the respiratory region of the lungs is not as effective.

A
  • Smaller surface area
  • Lower regional blood supply
  • High filtering capacity (mucus/cilia)
615
Q

Describe the size of the drug particles required to get a drug to the respiratory region of the lungs.

A

Particles need to be small

616
Q

Give eight advantages of inhaled medications.

A
  • Lungs are robust so can handle repeated drug exposure
  • Lungs are naturally permeable to peptides
  • Large surface area
  • Rapid absorption of small hydrophobic particles
  • Drugs can act directly on lung or enter circulation
  • 2nd fastest systemic uptake and non-invasive
  • Fewer drug metabolising enzymes (smaller doses)
  • Fewer systemic side effects
617
Q

Is it better to use a nasal or inhalational route of administration?

A

Inhalation

618
Q

What does too forceful inhalation when using an inhaler result in?

A

Deposition in upper airways instead of lungs.

619
Q

Name two new drugs that are being used in idiopathic pulmonary fibrosis.

A
  • Pirfenidone

- Nintedanib

620
Q

Give three ways that pirfenidone works in idiopathic pulmonary fibrosis.

A
  • Reduces fibroblast proliferation
  • Reduces collagen production
  • Reduces production of fibrogenic mediators
621
Q

What type of drug is nintedanib?

A

Tyrosine kinase inhibitor

622
Q

Give four receptors/pathways that nintedanib inhibits in idiopathic pulmonary fibrosis.

A
  • Vascular endothelial growth factor receptor (VEGFR)
  • Transforming growth factor beta (TGF-b)
  • Platelet derived growth factor (PDGF)
  • Fibroblast growth factor (FGF-2)
623
Q

Name two types of bronchodilators.

A
  • Beta2 agonists

- Muscarinic antagonists

624
Q

Give two actions of beta2 agonists.

A
  • Cause smooth muscle relaxation and bronchodilation

- Inhibit histamine release from lung mast cells

625
Q

Give three categories of beta2 agonist.

A
  • Short acting (SABA)
  • Long acting (LABA)
  • Ultra LABA
626
Q

What is the advantage of ultra LABA?

A

Allow once-daily dosing

627
Q

Give an example of a SABA.

A

Salbutamol

628
Q

Give two examples of LABAs.

A
  • Formoterol

- Salmeterol

629
Q

Give two examples of ultra LABAs.

A
  • Indacaterol

- Olodaterol

630
Q

Give two indications for bronchodilators, and what other drugs they are combined with.

A
  • LABA + corticosteroids for asthma

- LABA + LAMA for COPD

631
Q

Give two actions of muscarinic antagonists.

A
  • Prevent muscle contraction and gland secretion

- Enhance neurotransmitter release

632
Q

Name a naturally-occurring anticholinergic.

A

Atropine

633
Q

Give two examples of newer synthetic derivatives of antimuscarinics that are used as bronchodilators.

A
  • Ipratropium bromide

- Tiotropium bromide

634
Q

What is the advantage of using new synthetic derivatives of anticholinergics instead to atropine?

A

Fewer side effects

635
Q

When are muscarinic antagonists used, and what are they used with?

A

Used with steroids to treat asthma and COPD.

636
Q

Give three actions of corticosteroids in lung disease.

A
  • Improve lung function and QoL in asthma
  • Reduce frequency of exacerbations
  • Can prevent irreversible airway changes
637
Q

Why may steroids not be as effective in severe asthma?

A

Severe asthmatics may become resistant.

638
Q

Give three lung diseases in which steroids are relatively ineffective.

A
  • COPD
  • Cystic fibrosis
  • Idiopathic pulmonary fibrosis
639
Q

What are steroids relatively ineffective in COPD?

A

Most patients are resistant

640
Q

Give five examples of inhaled corticosteroids used in respiratory medicine.

A
  • Beclomethasone dipropionate
  • Budesenide
  • Ciclesonide
  • Flucticasone propionate
  • Mometasone furoate
641
Q

Give four mechanisms of action of steroids in lung diseases.

A
  • Suppress production of chemotactic mediators
  • Reduce adhesion molecule expression
  • Inhibit inflammatory cell survival in the airway
  • Inhibit Nf-kB pathway
642
Q

Describe the two aspects of bronchodilator and corticosteroid synergism.

A
  • Glucocorticoids increase transcription of b2 receptor gene

- LABAs increase translocation of steroids from cytoplasm to nucleus

643
Q

What is extrinsic allergic alveolitis/hypersensitivity pneumonitis?

A

An interstitial lung disease caused by an immunologic reaction to inhaled antigens.

644
Q

Is hypersensitivity pneumonitis more common in smokers or non-smokers?

A

Non-smokers

645
Q

Give five causes of hypersensitivity pneumonitis.

A
  • Mouldy hay
  • Compost
  • Air conditioner ducts
  • Fungi
  • Bird droppings/feathers
646
Q

Give four examples of hypersensitivity pneumonitis caused by fungi.

A
  • Farmer’s lung
  • Malt worker’s lung
  • Mushroom worker’s lung
  • Sugar worker’s lung
647
Q

Give two examples of hypersensitivity pneumonitis caused by bird droppings/feathers.

A
  • Bird-fancier’s lung

- Pigeon-fancier’s lung

648
Q

Briefly describe the pathology of hypersensitivity pneumonitis.

A
  • Inhaled antigens lead to an abnormal immune reaction in the lungs
  • Involves a combination of immune complex (type 3) and cell-mediated (type 4) hypersensitivity reactions
649
Q

Describe the acute presentation of hypersensitivity pneumonitis 4-6hrs after a large exposure.

A
  • Severe breathlessness
  • Dry cough
  • Crackles (no wheeze)
  • Fever
  • Rigors
  • Myalgia
  • Resolution typically within 12-18hrs after exposure
650
Q

When does hypersensitivity pneumonitis cause chronic disease?

A

Prolonged exposure to small amounts of antigen.

651
Q

Describe the presentation of chronic hypersensitivity pneumonitis.

A
  • Breathlessness
  • Dry cough
  • Fatigue
  • Weight loss
  • Exertional dyspnoea
  • Type 1 respiratory failure
  • Cor pulmonale
652
Q

Give three microscopic appearances that may be seen in hypersensitivity pneumonitis.

A
  • Cellular chronic interstitial pneumonia
  • Peribronchiolar accentuation
  • Foci of organising pneumonia and poorly formed granulomas may also be present
653
Q

Give four investigations to carry out in hypersensitivity pneumonitis.

A
  • Bloods
  • Arterial blood gas
  • High resolution CT
  • Lung function tests
654
Q

Give three things to look for on a blood test in hypersensitivity pneumonitis.

A
  • Neutrophilia
  • Increased ESR
  • Serum precipitins
655
Q

Give three things that may be seen on a high resolution CT in hypersensitivity pneumonitis.

A
  • Middle to upper long mottling/consolidation
  • Hilar lymphadenopathy
  • May also see traction bronchiectasis and honeycomb areas
656
Q

What may the lung function tests show in hypersensitivity pneumonitis?

A
  • Reversible restrictive deficit

- Reduced TLco during acute attacks

657
Q

Describe the acute management of hypersensitivity pneumonitis.

A
  • Remove allergen
  • Give O2
  • Oral prednisolone
658
Q

Describe the management for chronic hypersensitivity pneumonitis.

A
  • Avoid allergen exposure
  • Wear facemask or positive pressure helmet
  • Long term steroids
659
Q

Give two consequences of persistent exposure in hypersensitivity pneumonitis.

A
  • Irreversible lung fibrosis

- Respiratory failure

660
Q

Define occupational lung disorders.

A

Respiratory conditions caused by inhaling a harmful substance (inhalable particles, gases, and vapours) in the workplace.

661
Q

Give an example of an immediate effect of an occupational lung disorder.

A

High dose exposure to chlorine gas leads to acute airway injury and chronic asthma.

662
Q

What is the significance of a condition having a shorter latency period on repeated exposure occupational lung disorders?

A

The patient might still be in the job so exposure may still be occurring.

663
Q

Give seven consequences of occupational lung disorders.

A
  • Unemployment
  • Loss of earnings
  • Loss of self worth
  • Chronic respiratory ill health
  • Depression
  • Breakdown of relationships
  • Compensation
664
Q

Which regulation makes prevention of occupational lung disorders a legal requirement?

A

Control of substances hazardous to health regulations 2002 (COSHH)

665
Q

Give three methods of prevention of occupational lung disorders.

A
  • Risk assessment
  • Prevent or minimise exposure to harmful substances
  • Surveillance if residual risk
666
Q

Give four ways of preventing or minimising exposure to harmful substances in the workplace.

A
  • Elimination
  • Substitution
  • Engineering controls
  • PPE
667
Q

Give four causes of occupational asthma.

A
  • Flour (bakers)
  • Wood
  • Metal working fluids
  • Isocyanate paint
668
Q

How is occupational asthma diagnosed?

A
  • Normal method of asthma diagnosis

- Difference in peak flow measurements between work and home

669
Q

Give three characteristic features of occupational asthma.

A
  • Latent period
  • Deteriorating symptoms
  • Gradual improvement (when away from work)
670
Q

Give a consequence of occupational asthma.

A

Depression

671
Q

Up until what time period (decade) were workers exposed to asbestos?

A

1980s

672
Q

Give three occupations which were very exposed to asbestos.

A
  • Electrician
  • Plumber
  • Joiner
673
Q

What are pleural plaques?

A

Layers of collagen which are often calcified

674
Q

What do pleural plaques indicate?

A

They are a harmless marker of asbestos exposure.

675
Q

What do pleural plaques lead to?

A

Not cancer

676
Q

Describe asbestosis.

A

Interstitial lung disease with a long latency

677
Q

Describe the typical working history in asbestosis.

A

Usually have a history of heavy exposure to asbestos.

678
Q

How does asbestosis usually present?

A

Progressive breathlessness

679
Q

How is asbestosis treated?

A

No effective treatment

680
Q

Describe the prognosis in asbestosis.

A

May progress slowly (without further exposure)

681
Q

Give four conditions in which haemoptysis occurs.

A
  • Pneumonia
  • Bronchiectasis
  • Lung cancer
  • Pulmonary embolism
682
Q

Does haemoptysis occur in COPD?

A

Not normally

683
Q

Why does haemoptysis occur in bronchiectasis?

A

Damage to the surrounding vasculature

684
Q

Give a condition which is defined by impaired mucociliary clearance.

A

Primary ciliary dyskinesia

685
Q

Describe the age of onset of primary ciliary dyskinesia.

A

Congenital (childhood)

686
Q

Describe the TLco in anaemia.

A

Reduced

687
Q

Describe the TLco in asthma.

A

Normal

688
Q

What is shock usually heralded by in PE?

A

Syncope

689
Q

Describe the mechanism by which lung cancer causes Horner’s syndrome.

A

Compression of the recurrent laryngeal nerve

690
Q

Give five things that are seen on an X-ray, in order of blackest to whitest.

A
  • Air
  • Fat
  • Soft tissue or fluid
  • Calcium
  • Metal
691
Q

Give four lung X ray abnormalities of increased density.

A
  • Consolidation
  • Interstitial
  • Atelectasis
  • Nodules and masses
692
Q

Give three radiographical patterns of lung consolidation.

A
  • Lobar
  • Diffuse
  • Multifocal
693
Q

Give four substances that can cause lung consolidation.

A
  • Water
  • Pus
  • Blood
  • Cells
694
Q

Give four causes of lung consolidation due to water.

A
  • Heart failure
  • ARDS
  • Hypoalbuminaemia
  • Renal failure
695
Q

Give a cause of lung consolidation due to pus.

A

Pneumonia

696
Q

Give three causes of lung consolidation due to blood.

A
  • Trauma
  • Goodpasture
  • SLE
697
Q

Give three causes of lung consolidation due to cells.

A
  • Carcinoma
  • Organising pneumonia
  • Sarcoidosis
698
Q

What modality of radiological imaging is it best to see interstitial pattern of disease?

A

High resolution CT

699
Q

Give three patterns of radiographical interstitial changes.

A
  • Reticular
  • Cystic
  • Fine nodular
700
Q

Give three causes of reticular interstitial changes on lung radiography.

A
  • Oedema
  • Interstitial pneumonia
  • Lymphangiitis
701
Q

Give three causes of fine nodular interstitial changes on lung radiography.

A
  • Sarcoidosis
  • Metastases
  • TB
702
Q

What is atelectasis?

A

Collapse of part of a lung.

703
Q

Give five causes of atelectasis.

A
  • Mucous plugging
  • Tumour
  • Foreign body
  • Pleural effusion
  • Pneumothorax
704
Q

Give two patterns of nodules/masses on lung radiology.

A
  • Solitary pulmonary nodule

- Multiple masses

705
Q

What is the most common cause of a nodule/mass on lung radiology?

A

Granuloma

706
Q

Give five causes of nodules/masses on lung radiography.

A
  • Granuloma
  • Bronchial carcinoma
  • Metastasis
  • Organising pneumonia
  • Hamartoma
707
Q

Give three radiographical lung abnormalities of decreased density.

A
  • Cavity
  • Cyst
  • Emphysema
708
Q

What does a cavity look like on Xray?

A

Lucency with a thick wall (>3mm)

709
Q

What does a cyst look like on Xray?

A

Lucency with a thin wall (<3mm)

710
Q

What does emphysema look like on an Xray?

A

Lucency without a visible wall.

711
Q

What can a lung cavity on Xray be the result of?

A

Necrosis

712
Q

Give three conditions that can cause a lung cavity on Xray.

A
  • Infection
  • Neoplasm
  • Lung infarction
713
Q

Give three things that can cause lung cysts on Xray.

A
  • Congenital
  • Bulla
  • Pneumatocele
714
Q

What is silhouette sign on lung radiography?

A

Refers to the loss of borders between thoracic structures.

715
Q

Give two criteria for silhouette sign to be seen on a radiograph.

A
  • Two objects must be in contact with each other

- They must have the same radiographic density

716
Q

What is phlegm?

A

Secretions from the respiratory tract.

717
Q

What is sputum?

A

Secretions that are obtained via the mouth (may contain phlegm and saliva)

718
Q

What is the usual cause of a loud, brassy cough?

A

Pressure on the trachea

719
Q

What is the usual cause of a hollow, ‘bovine’ cough?

A

Recurrent laryngeal nerve palsy

720
Q

What is the usual cause of a barking cough?

A

Croup

721
Q

Give two causes of dry, chronic coughing.

A
  • Acid irritation of the lungs (oesophageal reflux)

- ACEi

722
Q

Give four causes of acute SOB.

A
  • Foreign body
  • Pneumothorax
  • Pulmonary embolus
  • Acute pulmonary oedema
723
Q

Give three causes of subacute SOB.

A
  • Asthma
  • Parenchymal disease
  • Effusion
724
Q

Describe phlegm and sputum production in asthma.

A

More phlegm is produced but not more sputum because cilia are less efficient.

Phase2a (12 decks)

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