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Medicine Year 2 5 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

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

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

What is bronchiectasis?

A

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

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3
Q

Give 3 organisms that can cause bronchiectasis

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

Give 4 causes of bronchiectasis

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

Give 3 symptoms of bronchiectasis

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

Give 3 signs of bronchiectasis

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

Give 3 complications of bronchiectasis

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

What does a CXR show in bronchiectasis?

A
  • ) Cystic shadows

- ) Thickened bronchial walls (tramline and ring shadows)

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9
Q

What does a spirometry show in bronchiectasis?

A

Obstructive pattern

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10
Q

What is the management of bronchiectasis?

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

What is cystic fibrosis?

A

Life-threatening autosomal recessive condition

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12
Q

What mutations occur in CF?

A

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

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13
Q

What does the defect lead to in CF?

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

What is someone with CF predisposed to? (2)

A
  • ) Chronic pulmonary infections

- ) Bronchiectasis

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15
Q

What changes in the mucus in people with CF?

A

More viscous

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16
Q

Give 2 presenting features of neonates with CF

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

Give 4 respiratory symptoms of CF

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

Give 3 GI symptoms of CF

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

Give 3 other symptoms of CF

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

Give 2 signs of CF

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

How do we test for CF? (2)

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

What does a CXR show in CF?

A

Hyperinflation, bronchiectasis

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23
Q

What does an abdominal US show in CF?

A

Fatty liver, cirrhosis, chronic pancreatitis

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24
Q

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

A

Obstructive

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25
What are we looking for in the heel prick test in infants for CF?
Immunoreactive trysinogen
26
What is the treatment for CF?
- ) Physiotherapy (postural drainage, airway clearance) - ) Antibiotics for acute/prophylactic - ) Mucolytics - ) Bronchodilators - ) Treat DM, malabsorption, liver function - ) Bone screening, fertility and genetic counselling - ) Oxygen, diuretics, ventilation - ) Heart/lung transplantation
27
What is COPD?
A common progressive disorder characterised by airway obstruction with little or no reversibility
28
What does COPD stand for?
Chronic obstructive pulmonary disease
29
What is the FEV1 in COPD?
<80% predicted
30
What is the FEV1/FVC in COPD?
<0.7
31
What 2 conditions does COPD include?
Chronic bronchitis and emphysema
32
What is chronic bronchitis defined clinically as?
Cough, sputum production on most days for 3 months of 2 successive years
33
What is emphysema defined histologically as?
Enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls
34
Give 4 factors that characterise COPD
- ) >35 - ) Smoking/pollution - ) Chronic dyspnoea - ) Sputum production - ) Minimal diurnal/day to day FEV1 variation
35
Give 3 features of a 'pink puffer' in COPD
- ) Increased alveolar ventilation - ) Near normal PaO2 - ) Normal/low PaCO2 - ) Breathless - ) Not cyanosed
36
Give 3 features of 'blue bloaters' in COPD
- ) Decreased alveolar ventilation - ) Low PaO2 - ) High PaCO2 - ) Cyanosed - ) Not breathless
37
What may pink puffers progress to?
Type 1 respiratory failure
38
What may blue bloaters progress to?
Cor pulmonale
39
Give 3 symptoms of COPD
- ) Cough - ) Sputum - ) Dyspnoea - ) Wheeze
40
Give 4 signs of COPD
- ) Tachypnoea - ) Use of accessory muscles of respiration - ) Hyperinflation - ) Decreased cricosternal distance - ) Decreased expansion - ) Resonant/hyperresonant percussion note - ) Quiet breath sounds - ) Wheeze - ) Cyanosis - ) Cor pulmonale
41
Give 3 complications of COPD
- ) Acute exacerbations - ) Infection - ) Polycythaemia - ) Respiratory failure - ) Cor pulmonale - ) Pneumothorax - ) Lung carcinoma
42
What does a CXR show in COPD?
- ) Hyperinflation - ) Flat hemidiaphragms - ) Large central pulmonary arteries - ) Decreased peripheral vascular markings - ) Bullae
43
What does a CT show in COPD?
- ) Bronchial wall thickening - ) Scarring - ) Air space enlargement
44
What does an ECG show in COPD?
Right atrial and ventricular hypertrophy (cor pulmonale)
45
What does an ABG show in COPD?
Decreased PaO2 +/- hypercapnia
46
What are the options for treatment of COPD? (4)
1) SAMA (ipratroprium) or SABA (salbutamol) 2) LAMA (tiotropium) or LABA (formoterol) 3) Combination LABA with corticosteroids (budenoside) or tiotropium 4) LAMA (tiotropium) and inhaled steroid and LABA
47
Give lifestyle advice for COPD
- ) Smoking cessation - ) Exercise, diet - ) Lose weight - ) Vaccinations
48
When do we give oxygen in COPD?
PaO2 <7.4kPa
49
What is alpha 1 antitrypsin deficiency? (A1AT deficiency)
An inherited disorder affecting lung (emphysema) and liver (cirrhosis and HCC)
50
What is A1AT?
A glycoprotein, part of a family of serine protease inhibitors made in the liver that control inflammatory cascades
51
What does lung A1AT do?
Protect against tissue damage from neutrophil elastase
52
In who is the effect of an A1AT deficiency exacerbated?
Smokers
53
What disease can A1AT deficiency cause early onset of?
COPD
54
What does a pulmonary embolism usually arise from? (PE)
Venous thrombosis in the pelvis or legs
55
Where do clots travel from/to in PE?
Through veins, R heart, pulmonary circulation
56
Give 3 rare causes of a PE
- ) RV thrombus (post-MI) - ) Septic emboli - ) Fat - ) Air - ) Amniotic fluid - ) Neoplastic cells - ) Parasites
57
Give 3 risk factors for a PE
- ) Recent surgery - ) Thrombophilia - ) Leg fracture - ) Prolonged immobility - ) Malignancy - ) Pregnancy/postpartum - ) CCP, HRT - ) Previous PE
58
Give 4 symptoms of a PE
- ) Acute breathlessness - ) Pleuritic chest pain - ) Haemoptysis - ) Dizziness - ) Syncope
59
Give 4 signs of a PE
- ) Pyrexia - ) Cyanosis - ) Tachypnoea - ) Tachycardia - ) Hypotension - ) Raised JVP - ) Pleural rub - ) Pleural effusion
60
What does a negative D dimer test show in PE?
Excludes it
61
What may CXR show in a PE?
- ) Oligaemia of affected segment - ) Dilated pulmonary artery - ) Linear atelectasis - ) Small pleural effusion - ) Wedge-shaped opacities/cavitation
62
What may a ECG show in a PE?
- ) Tachycardia - ) RBBB - ) RV strain (inverted T in V1-V4)
63
What criteria do we use for assessing the clinical probability of a PE?
Wells
64
What is the treatment of PE?
- ) LMWH - ) DOAC/warfarin - ) VC filter
65
When do we stop heparin in the treatment of a PE?
INR 2-3
66
What does DOAC stand for?
Direct oral anticoagulant
67
Give 2 methods of prevention of a PE
- ) Heparin to immobile patients - ) Stop pill/HRT pre-op - ) Compression stockings
68
What do we investigate for in a patient with an unprovoked PE?
Malignancy
69
What is a pneumothorax?
An abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall
70
Give 5 causes of a pneumothorax
- ) Spontaneous often due to rupture of subpleural bulla - ) Asthma - ) COPD - ) TB, pneumonia - ) Lung abscess - ) Carcinoma - ) CF, lung fibrosis - ) Sarcoidosis - ) Connective tissue disorders - ) Trauma - ) Iatrogenic
71
Give 3 symptoms of a pneumothorax
- ) May be asymptomatic - ) Sudden onset dyspnoea - ) Sudden onset pleuritic chest pain - ) Suden deterioration (asthma, COPD)
72
Give 3 signs of a pneumothorax
- ) Reduced expansion - ) Hyper-resonance to percussion - ) Diminished breath sounds on affected side
73
Which side will the trachea be deviated in a tension pneumothorax?
Away
74
What is the test for a pneumothorax?
CXR
75
How do we treat a pneumothorax?
Aspiratie, possible chest drain
76
What is a pleural effusion?
Fluid in the pleural space
77
What can pleural effusions be divided by?
Their protein concentration
78
What is a transudate? (pleural effusion)
Low protein concentration, <25g/L
79
What is an exudate? (pleural effusion)
High protein concentration, >35g/L
80
What is a haemothorax?
Blood in the pleural space
81
What is an empyema?
Pus in the pleural space
82
What is a chylothorax?
Chyle (lymph with fat) in the pleural space
83
What is a haemopneumothorax?
Blood and air in the pleural space
84
Give 3 causes for a transudate pleural effusion
- ) Increased venous pressure (HF, constrictive pericarditis, fluid overload) - ) Hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption) - ) Hypothyroidism
85
Give 3 causes for an exudate pleural effusion
Increased leakiness of pleural capillaries secondary to: - ) Infection (pneumonia, TB) - ) Inflammation (RA, pulmonary infarction, SLE) - ) Malignancy (bronchogenic carcinoma, malignant mets, lymphoma etc)
86
Give 2 symptoms of a pleural effusion
Can be asymptomatic - ) Pleuritic chest pain - ) Dyspnoea
87
Give 4 signs of a pleural effusion
-) Decreased expansion -) Stony dull percussion note -) Diminished breath sounds ^^ All on affected side -) Tactile vocal remits decreased -) Vocal resonance decreased -) Possible bronchial breathing -) Possible tracheal deviation away -) Possible signs of associated disease
88
What does a CXR show in pleural effusions? (2)
- ) Blunt costophrenic angles (small) | - ) Water-dense shadows with concave upper borders (large)
89
What does a completely flat horizontal upper border imply on a CXR?
Pneumothorax and pleural effusion
90
What do we do to find out if the pleural effusion is transudate/exudate?
Diagnostic aspiration
91
What is the treatment of a pleural effusion?
- ) Drainage if symptomatic - ) Pleurodesis with talc - ) Possible surgery
92
What is sarcoidosis?
A multisystem granulomatous disorder of unknown cause
93
What is sarcoidosis associated with genetically?
HLA-DRB1 and DQB1 alleles
94
What gender does sarcoidosis occur more commonly in?
Women
95
What ethnicity does sarcoidosis affect more frequently and more severely?
Afro-Caribbeans
96
Give 3 things sarcoidosis presents with
- ) Fever - ) Erythema nodosum - ) Polyarthralgia - ) Bilateral hilar lymphodenopathy
97
Give 3 pulmonary symptoms of sarcoidosis
- ) Dry cough - ) Progressive dyspnoea - ) Decreased exercise tolerance - ) Chest pain
98
Give 5 non-pulmonary signs of sarcoidosis
-) Lymphadenopathy -) Hepato/splenomegaly -) Kerato/conjunctivitis sicca -) Bell's palsy -) Lacrimal and parotid gland enlargement -) Neuropathy -) Meningitis -) Cardiomyopathy -) Space occupying lesions -) Arrhythmias -) Hypercalcaemia/calciuria -) Renal stones -) Pituitary dysfunction ETC
99
What is increased in the blood in sarcoidosis?
- ) ESR - ) LFT - ) Serum ACE (60%) - ) Calcium - ) Igs
100
What is decreased in the blood in sarcoidosis?
Lymphopenia, decreased lymphocytes
101
What are the 5 stages seen on a CXR in sarcoidosis?
0) Normal 1) BHL 2) BHL and peripheral pulmonary infiltrates 3) Peripheral pulmonary infiltrates alone 4) Progressive pulmonary fibrosis, bulla formation (honeycombing), pleural involvement
102
What does BHL stand for?
Bilateral hilar lymphodenopathy
103
What may an ECG show in sarcoidosis?
Arrhythmias or BBB
104
What may lung function tests show in sarcoidosis?
Normal/reduced lung volumes, impaired gas transfer, restrictive ventilatory defect
105
What test is diagnostic in sarcoidosis, and what does it show?
Tissue biopsy, non-caveating granulomata
106
What does a bronchoalveolar lavage show in sarcoidosis?
Increased lymphocytes, increased neutrophils, pulmonary fibrosis
107
What is the treatment for patients with BHL in sarcoidosis?
Nothing
108
What is the treatment for acute sarcoidosis?
Bed rest, NSAIDs
109
Give 4 indications for corticosteroids in sarcoidosis treatment
- ) Parenchymal lung disease - ) Uveitis - ) Hypercalcaemia - ) Neuro/cardiac involvement
110
What corticosteroid do we give in sarcoidosis?
Prenisolone
111
What do we give in severe sarcoidosis?
- ) IV methyprednisolone or immunosuppressants - ) Anti-TNF therapy - ) Lung transplant
112
What is extrinsic allergic alveolitis? (EAA)
Inhalation of antigens provokes a hypersensitivity reaction in sensitised individuals
113
Give 2 examples of allergens in EAA
Fungal spores, avian proteins
114
What occurs in the acute phase of EAA?
Alveoli infiltrated with acute inflammatory cells
115
What occurs in the chronic phase of EAA?
Granuloma formation and obliterative bronchiolitis
116
Give 3 causes of EAA
- ) Bird/pigeon-fancier's lung - ) Farmer's/mushroom workers lung - ) Malt worker's lung - ) Bagassosis/sugar worker's lung
117
Give 3 symptoms of EAA 4-6 hours post-exposure
- ) Fever - ) Rigors - ) Myalgia - ) Dry cough - ) Dyspnoea - ) Fine bibasal crackles
118
Give 3 chronic symptoms of EAA
- ) Finger clubbing - ) Increasing dyspnoea - ) Weight loss - ) Exertional dyspnoea - ) T1 respiratory failure - ) Cor pulmonale
119
What does a CXR show in acute EAA?
- ) Upper zone mottling/consolidation | - ) Hilar lymphadenopathy (rare)
120
What does a CXR show in chronic EAA?
- ) Upper zone fibrosis | - ) Honeycomb lung
121
What is found in the blood in both chronic and acute EAA?
Serum antibodies
122
What do lung function tests show in acute EAA?
Reversible restrictive defect
123
What do lung function tests show in chronic EAA?
Restrictive defect
124
What does a bronchoalveolar lavage show in EAA?
Increased lymphocytes and mast cells
125
How do we treat acute EAA? (3)
- ) Remove allergen - ) Give O2 - ) Prednisolone
126
How do we treat chronic EAA? (2)
- ) Avoid allergen/facemask | - ) Long term steroids
127
What type of hypersensitivity reaction is EAA?
Type 1, allergic
128
What are the 4 types of hypersensitivity reaction?
``` ACID Type 1 - Allergic Type 2 - Cytotoxic Type 3 - Immune complex Type 4 - Delayed T cell ```
129
Give an example of each of the hypersensitivity reactions (4)
Type 1 - Bee stings, latex, asthma Type 2 - Goodpasture's Type 3 - SLE Type 4 - Transplant
130
What is a mesothelioma?
Tumour of mesothelial cells that usually only occurs in the pleura
131
What are mesotheliomas associated with?
Occupational exposure to asbestos
132
Give 4 symptoms of a mesothelioma
- ) Finger clubbing - ) Chest pain - ) Dyspnoea - ) Weight loss - ) Recurrent pleural effusions
133
Give 3 signs of a mesothelioma metastasis
- ) Lymphadenopathy - ) Hepatomegaly - ) Bone pain/tenderness - ) Abdominal pain/obstruction
134
What does a CT/CXR show in a mesothelioma?
Pleural thickening/effusion
135
What is the pleural fluid like in a mesothelioma?
Bloody
136
What is the treatment for a mesothelioma?
- ) Pemetrexed and cisplatin chemotherapy - ) Possible surgery - ) Possible pleurodesis and indwelling intra-pleural drain
137
What is asbestosis caused by?
Inhalation of asbestos fibres
138
What is the degree of exposure to asbestos related to?
Degree of pulmonary fibrosis
139
Give 3 clinical features of asbestosis
- ) Progressive dyspnoea - ) Clubbing - ) Find end-inspiratory crackles - ) Pleural plaques
140
What does asbestosis give an increased risk of?
Bronchial adenocarcinoma and mesothelioma
141
What is the management of asbestosis?
Symptomatic
142
What is silicosis caused by?
Inhalation of silica particles (very fibrogenic)
143
Give 2 jobs that may be associated with silica exposure
- ) Metal mining - ) Stone quarrying - ) Sandblasting - ) Pottery/ceramic manufacture
144
Give a clinical feature of silicosis
- ) Progressive dyspnoea | - ) Increased incidence of TB
145
What does a CXR show in silicosis?
- ) Diffuse miliary/nodular pattern in upper and mid-zones | - ) Egg shell calcification of hilar nodes
146
What does spirometry show in silicosis?
Restrictive
147
What is the treatment of silicosis?
Symptomatic
148
What is coal worker's pneumoconiosis? (CWP)
A common dust disease in countries with underground coal mines
149
What is CWP caused by?
Inhalation of coal dust particles over 10-20 years
150
What causes fibrosis in CWP?
Macrophages ingest coal dust particles, die, release enzymes
151
What is the main clinical feature of CWP?
Asymptomatic, coexisting chronic bronchitis is common
152
What does a CXR show in CWP?
Many round opacities, especially in upper zone
153
What is the treatment of CWP?
Avoid exposure, treat co-existing chronic bronchitis
154
What is progressive massive fibrosis caused by? (PMF)
Progression of CWP
155
Give 2 clinical features of PMF
- ) Progressive dyspnoea - ) Fibrosis - ) Cor pulmonale
156
What does a CXR show in PMF?
Usually bilateral upper-mid zone fibrotic masses, develop from periphery towards hilum
157
What is the treatment for PMF?
Avoid exposure
158
What is Caplan's syndrome?
The association between RA, pneumoconiosis and pulmonary rheumatoid nodules
159
What is cor pulmonale?
Right heart failure caused by chronic pulmonary arterial hypertension
160
Give 3 causes of cor pulmonale
- ) Chronic lung disease (COPD, bronchiectasis, pulmonary fibrosis) - ) Pulmonary vascular disorders (pulmonary emboli, vasculitis, sick cell, primary pulmonary HTN) - ) Neuromuscular and skeletal diseases (MG, poliomyelitis, MND, scoliosis)
161
Give 2 symptoms of cor pulmonale
- ) Dyspnoea - ) Fatigue - ) Syncope
162
Give 4 signs of cor pulmonale
- ) Cyanosis - ) Tachycarida - ) Raised JVP with prominent a and v waves - ) RV heave - ) Loud P2 - ) Pansystolic murmur - ) Hepatomegaly - ) Oedema
163
What is increased in a FBC in cor pulmonale? (2)
Hb and haematocrit
164
What does an ABG show in cor pulmonale?
Hypoxia +/- hypercapnia
165
What does a CXR show in cor pulmonale? (2)
- ) Enlarged RA and RV | - ) Prominent pulmonary arteries
166
What does an ECG show in cor pulmonale? (3)
- ) P pulmonale - ) Right axis deviation - ) RV hypertrophy/strain
167
What is the management of cor pulmonale?
- ) Treat underlying cause - ) Treat respiratory failure (oxygen) - ) Treat cardiac failure (diuretics, furosemide) - ) Possible venesection (haematocrit >55%) - ) Possible heart-lung transplantation
168
What is Goodpasture's disease?
A pulmonary-renal syndrome
169
What does Goodpasture's include?
Acute glomeruloneprihtis and lung symptoms
170
What are the lung symptoms in Goodpasture's?
Haemoptysis/diffuse pulmonary haemorrhage
171
What is Goodpasture's caused by?
Antiglomerular basement membrane antibodies binding to kidney's basement membrane and alveolar membrane
172
What does a CXR show in Goodpasture's?
Infiltrates due to pulmonary haemorrhage, often in lower zones
173
What does a kidney biopsy show in Goodpasture's?
Crescentic glomerulonephritis
174
How do we treat Goodpasture's?
- ) Treat shock - ) Immunosuppressants - ) Plasmapheresis
175
What is the second most common cancer in the UK?
Carcinoma of the bronchus
176
Give 3 risk factors for lung tumours
- ) CIGARETTE SMOKING - ) Passive smoking - ) Asbestos - ) Chromium - ) Arsenic - ) Iron oxides - ) Radiation
177
What is the most important clinical/histological division between lung tumours?
Small cell (SCLC) and non-small cell (NSCLC)
178
Give 3 NSCLCs
- ) Squamous - ) Adenocarcinoma - ) Large cell - ) Adenocarcinoma in situ
179
What do SCLCs arise from?
Endocrine cells (Kulchitsky cells)
180
Give 4 symptoms of lung tumours
- ) Cough - ) Haemoptysis - ) Dyspnoea - ) Chest pain - ) Recurrent/slowly resolving pneumonia - ) Lethargy, anorexia, weight loss
181
Give 3 signs of lung tumours
- ) Cachexia - ) Anaemia - ) Clubbing - ) Hypertrophic pulmonary osteoarthropathy, wrist pain - ) Supraclavicular/axillary nodes - ) Consolidation, collapse, pleural effusion
182
Give 3 signs of lung tumour metastases
- ) Bone tenderness - ) Hepatmegaly - ) Confusion, fits, focal CNS signs, cerebellar syndrome - ) Proximal myopathy, peripheral neuropathy
183
Give 3 local complications of lung tumours
- ) Recurrent laryngeal nerve palsy - ) Phrenic nerve palsy - ) SVC obstruction - ) Horner's syndrome (Pancoast's tumour) - ) Rib erosion - ) Pericarditis - ) AF
184
Give 3 metastatic locations for lung tumours
- ) Brain - ) Bone - ) Liver - ) Adrenals
185
What causes a horse voice?
Recurrent laryngeal nerve compression
186
What does a CXR show in lung tumours?
- ) Peripheral nodule - ) Hilar enlargement - ) Consolidation - ) Lung collapse - ) Pleural effusion - ) Bony secondaries
187
What do we use to stage a lung tumour?
CT
188
What do we use a bronchoscopy for in lung tumours?
Histology and assessing operability
189
What is the treatment for a NSCLC?
- ) Lobectomy - ) Radical radiotherapy - ) Chemo and radio - ) Cetuximab (monoclonal antibody)
190
What is the treatment for a SCLC?
- ) Consider surgery - ) Chemo and radio - ) Palliation with radio - ) SVC stent and radio - ) Endobronchial therapy - ) Pleural drainage/pleurodesis - ) Drugs (analgesia, steroids, anti-emetics, bronchodilators, antidepressants)
191
What is interstitial lung disease? (ILD)
A number of conditions that primarily affect the parenchyma in a diffuse manner
192
What is ILD characterised by?
Chronic inflammation and/or progressive interstitial fibrosis
193
Give 2 signs/symptoms of ILD
- ) Dyspnoea on exertion - ) Non-productive paroxysmal cough - ) Abnormal breath sounds
194
What does a spirometry shew in ILD?
Restrictive
195
What are the pathological features of ILD?
- ) Fibrosis and remodelling of the interstitium | - ) Hyperplasia of type II epithelial cells or type II pneumocytes
196
What are the 3 categories of ILD?
- ) Those with a known cause - ) Those associated with systemic disorders - ) Idiopathic
197
Give 4 causes of ILD
- ) Asbestosis etc - ) Drugs - ) Hypersensitivity reactions - ) Infections - ) GORD - ) Sarcoidosis - ) RA - ) SLE and other connective tissue diseases - ) UC - ) Idiopathic pulmonary fibrosis
198
What is idiopathic pulmonary fibrosis? (IPF)
A type of idiopathic interstitial pneumonia
199
What is the pathogenesis of IPF?
Inflammatory cell infiltrate and pulmonary fibrosis of unknown cause
200
Give 3 symptoms of IPF
- ) Dry cough - ) Exertional dyspnoea - ) Malaise - ) Weight loss - ) Arthralgia
201
Give 3 signs of IPF
- ) Finger clubbing - ) Cyanosis - ) Fine end-inspiratory crepitations
202
Give 2 complications of IPF
Respiratory failure, increased risk of lung cancer
203
What does an ABG show in IPF?
Decreased PaO2, high PaCO2 if severe
204
What 4 things may be increased/positive in the blood in IPF?
- ) CRP - ) Igs - ) ANA (30%) - ) RF (10%)
205
What does a CT/CXR show in IPF?
- ) Decreased lung volume - ) Bilateral lower zone reticula-nodular shadows - ) Honeycomb lung (advanced)
206
What does spirometry show in IPF?
Restrictive
207
What are the usual histological changes in IPF referred to as?
Usual interstitial pneumonia
208
What is the treatment for IPF?
- ) Supportive care (O2, analgesia, palliative) | - ) Possible lung transplantation
209
What is asthma characterised by?
Recurrent episodes of dyspnoea, cough and wheeze caused by reversible obstruction
210
What are the 3 factors that contribute to airway narrowing in asthma?
- ) Bronchial muscle contraction - ) Mucosal swelling/inflammation - ) Increased mucus
211
What is mucosal swelling/inflammation caused by in asthma?
Mast cell and basophil degranulation resulting in the release of inflammatory mediators
212
Give 3 symptoms of asthma
- ) Intermittent dyspnoea - ) Wheeze - ) Cough (often nocturnal) - ) Sputum
213
Give 4 precipitants of asthma
- ) Cold air - ) Exercise - ) Emotion - ) Allergens (house dust mite, pollen, fur) - ) Infection - ) Smoking/passive smoking - ) Pollution - ) NSAIDs, beta blockers
214
What is diurnal variation?
Symptoms or peak flow may vary over the day
215
When is peak flow worst in asthma?
Morning
216
What may also be present in asthma due to it being an atopic disease?
Eczema, hay fever
217
Give 3 signs of asthma
- ) Tachypnoea - ) Audible wheeze - ) Hyperinflated chest - ) Hyper-resonant percussion note - ) Decreased air entry - ) Widespread, polyphonic wheeze
218
What marks a near fatal attack of asthma?
Increased PaCO2
219
What marks a severe asthma attack?
Inability to complete sentences
220
What marks a life-threatening asthma attach?
Silent chest, confusion, exhaustion, cyanosis, bradycardia
221
What is an exacerbation?
An acute event characterised by a worsening of the patient's symptoms that is beyond normal day to day variations
222
How do we diagnose asthma?
≥15% improvement in FEV1 following beta-2-agonists or steroid trial
223
What does PEF monitoring show in asthma?
Diurnal variation of >20% on ≥3d a week for 2 weeks
224
Why do we do a CXR in an acute attack of asthma?
To exclude infection or pneumothorax
225
What does spirometry show in asthma?
Obstructive defect
226
What is a marker of eosinophilic inflammation?
Exhaled nitric oxide
227
Give 3 differential diagnoses for asthma
- ) Pulmonary oedema - ) COPD - ) Large airway obstruction - ) SVC obstruction - ) Pneumothorax - ) PE - ) Bronchiectasis - ) Obliterative bronchiolitis
228
What are the treatment steps for asthma? (5)
1) SABA, short acting beta-2-agonist as needed (salbutamol) 2) ICS, add inhaled steroid (beclometasone) 3) LABA, Add long acting beta-2-agonist (salmeterol) 4) Consider high dose beclometasone, theophylline, beta-2-agonist tablets, oral leukotriene receptor antagonist 5) Oral prednisolone
229
What do beta-2-adrenoceptor agonists do?
Relax bronchial smooth muscle by increasing cAMP within minutes
230
What do corticosteroids do?
Act over days to decrease bronchial mucosal inflammation
231
What can corticosteroids cause if the mouth is not rinsed after use?
Oral candidiasis
232
What does aminophylline do?
It is metabolised to theophylline, and acts by inhibiting phosphodiesterase, thus decreasing bronchocontriction by increasing cAMP levels
233
What is the main cause of the common cold?
Rhinoviruses
234
What are the symptoms of a common cold?
Self limiting nasal discharge becoming mucopurulent over a few days
235
Give a complication of the common cold
- ) Otitis media | - ) Pneumonia
236
What pharyngitis look like?
- ) Glandularfever EBV | - ) Acute HIV
237
What is the main symptom of pharyngitis?
Sore throat
238
Give 3 causes of pharyngitis
- ) Rhinovirus - ) Adenovirus - ) Group A beta haemolytic strep - ) Strep. pyogenes - ) STIs
239
Give 2 associated diseases of pharyngitis
- ) Scarlet fever - ) Poststreptococcal glomerulonephritis - ) Rheumatic fever
240
What is the centor criteria?
The likelihood of a sore throat being due to a bacterial infection
241
What are the centor criteria? (4)
- ) Tonsillar exudate - ) Tender anterior cervical adenopathy - ) Fever over 38 - ) Absence of cough
242
What is influenza?
A viral respiratory infection spread via droplets
243
What is influenza caused by?
Influenza virus
244
Give 3 complications of influenza
- ) Bronchitis - ) Pneumonia - ) Sinusitis - ) Otitis media - ) Encephalitis - ) Pericarditis
245
Give 4 symptoms of influenza
- ) Headache - ) Malaise - ) Low mood - ) Myalgia - ) Prostration - ) Nausea - ) Vomiting - ) Conjunctivitis - ) Photophobia
246
How do we test for influenza?
Serology and culture from nasal swab
247
What is the treatment for influenza?
Bed rest and paracetamol
248
What can we use within 48 hours of symptoms beginning in influenza?
Oseltamivir (tamiflu)
249
What is oseltamivir?
Neuraminidase inhibitor that reduces the time and severity of illnesss
250
What types of influenza can we use oseltamivir with?
A and B
251
Why do we use oseltamivir?
To reduce spread in at risk groups
252
What is antigenic drift?
Minor variation, seasonal epidemics
253
What is antigenic shift?
Major variation, pandemics
254
What is an outbreak?
2 or more linked cases
255
What is an epidemic?
More than 2 linked cases in a region/country
256
What is a pandemic?
Epidemic that spans international boundaries
257
What is pneumonia?
An acute lower respiratory tract illness
258
What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae
259
What is the most common cause of hospital-acquired pneumonia?
Gram negative enterobacteria or staph aureus
260
What is hospital-acquired pneumonia defined as?
>48 hours after admission
261
Give 3 circumstances with a greater risk of acquiring pneumonia through aspiration
- ) Stroke - ) Myasthenia - ) Bulbar palsies - ) Decreased consciousness - ) Oesophageal disease - ) Poor dental hygiene
262
Give 2 of the most common causative organisms in pneumonia
- ) Strep. pneumoniae - ) H. influenzae - ) Staph aureus
263
Give 4 symptoms of pneumonia
- ) Fever, rigors, malaise, anorexia - ) Dyspnoea - ) Cough - ) Purulent sputum - ) Haemoptysis - ) Pleuritic pain
264
Give 4 signs of pneumonia
- ) Pyrexia - ) Cyanosis - ) Confusion - ) Tachypnoea - ) Tachycardia - ) Hypotension - ) Signs of consolidation - ) Pleural rub
265
Give 2 signs of consolidation
- ) Reduced expansion - ) Dull percussion - ) Increased tactile vocal fremitus/vocal resonance - ) Bronchial breathing
266
What does a CXR show in pneumonia?
Lobal or multilobar infiltrates, cavitation, pleural effusion
267
What tests do we do in pneumonia?
- ) CXR - ) O2 saturation and BP - ) Blood - ) Sputum - MC&S - ) Pleural fluid aspiration - ) Bronchoscopy/BAL - ) Urine fo atypical organisms - ) ABG
268
Give 3 complications of pneumonia
- ) Pleural effusion - ) Empyema - ) Lung abscess - ) Respiratory failure - ) Septicaemia - ) Brain absces - ) Pericarditis - ) Myocarditis - ) Cholestatic jaundice
269
What do we use to assess he severity of pneumonia?
``` CURB-65 Confusion (AMT ≤8) Urea >7mmol/L Respiratory rate ≥30/min BP <90 systolic +/or 60 diastolic Age ≥65 ```
270
How do we treat pneumonia?
- ) Antibiotics - ) Oxygen - ) IV fluids - ) Analgesia
271
What is the empirical treatment for CAP pneumonia?
Amoxicillin or clarithromycin or doxycycline
272
What is the empirical treatment for severe CAP pneumonia?
Co-amoiclav or cephalosporin
273
What antibiotic do we add in CAP pneumonia treatment if staph is suspected?
Flucloxacillin +/- rifampicin
274
What antibiotic do we add in CAP pneumonia treatment if MRSA is suspected?
Vancomycin
275
What is tuberculosis caused by? (TB)
Mycobacterium tuberculosis
276
What is active infection of TB?
Continment by the immune system is inadequate
277
How does transmission of TB occur?
Inhalation of aerosol droplets (only pulmonary disease is communicable)
278
What is latent TB?
Infection without disease due to persistent immune system containment
279
How does the immune system contain TB?
Granuloma formation prevents bacterial growth and spread
280
Give 2 risk factors for reactivation of latent TB
- ) New infection - ) HIV - ) Organ transplantation - ) Immunosuppression - ) Silicosis - ) Ilicit drug use - ) Malnutrition - ) High risk settings, low socio-economic status - ) Haemodialysis
281
Where are TB granulomata most likely to form?
Apex of lung
282
Give 6 symptoms of TB
- ) Systemic - fever, anorexia, malaise, night sweats, clubbing - ) Pulmonary - cough, pleurisy, haemoptysis - ) Tuberculous lymphadenitis - painless enlargement of cervical/supraclavicular lymph nodes - ) GI - colicky abdominal pain, vomiting, bowel obstruction - ) Spinal - local pain and bony tenderness - ) Miliary - ) CNS - meningitis, headache, confusion, seizures - ) GU - dysuria, frequency, loin pain, haematuria - ) Cardiac - pericarditis, pericardial effusion, constrictive pericarditis - ) Skin - lupus vulgarisms, scrofuloderma
283
Where does most GI TB occur?
Ileocaecal
284
How do we test for latent TB?
Mantoux test
285
What does a CXR show in active pulmonary TB?
- ) Fibronodular/linear opacities in upper lobe (typical) - ) Cavitation - ) Calcification - ) Miliary disease - ) Effusion - ) Lymphadenonopathy
286
What stain do we do to detect acid fast bacilli?
Ziehl-Neelsen
287
What is smear positive TB?
Can see the mycobacterium in the sputum/spit under a microscope
288
Is smear positive or negative more infectious?
Positive
289
What tests do we do to diagnose TB?
- ) Mantoux test - ) CXR - ) Sputum smear/culture - ) Interferon-gamma release assays
290
What do interferon gamma release assays do?
Diagnose exposure to TB be measuring the release of interferon-gamma from T-cells reacting to TB antigen
291
What do interferon gamma release assays distinguish between?
BCG vaccination and TB latent infection
292
What 4 drugs do we give in TB?
``` RIPE Rifampicin Isoniazid Pyrazinamide Ethambutol ```
293
What are the 2 phases of TB treatment?
Initial - 8 weeks on RIPE | Continuation - 16 weeks on RI
294
Give a side effect of rifampicin
Red body fluids (sweat, urine, tears)
295
Give a side effect of isoniazid
Peripheral neuropathy
296
Give a side effect of pyrazinamide
Hepatitis
297
Give a side effect of ethambutol
Visual problems (optic neuritis)
298
What do we have to warn the patients of when taking rifampicin?
Take additional contraception - pill excreted too quickly
299
What is the transfer co-efficient?
A measure of the ability of oxygen to diffuse across the alveolar membrane, tested by inhaling low dose CO
300
What does LABA stand for?
Long acting beta 2 antagonist
301
What does SABA stand for?
Short acting beta 2 antagonist
302
What does LAMA stand for?
Long acting muscarinic antagonist
303
What does SAMA stand for?
Short acting muscarinic antagonist
304
What is the most common organism to cause hospital acquired pneumonia?
Staph aureus
305
What is the most common organism to cause community acquired pneumonia?
Strep pneumoniae
306
What causes a hoarse voice?
Recurrent laryngeal nerve compression
307
What is needed when a patient is taking rifampicin?
Barrier protection (pill excreted hepatically)

Medicine Year 2 5 (17 decks)

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