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Phase 2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

name influenzae A antigenic sites

A 
haemagglutinin = 15 subtypes
neuraminidase = 9 subtypes
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2
Q

describe the action of haemagglutinin

A

virus binding and entry into the cells

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3
Q

describe the action of neuraminidase

A

cut newly formed virus loose from infected cells and prevents it clumping together

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4
Q

describe influenza A

A

causes severe and extensive outbreaks

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5
Q

describe influenza B

A

less severe

often in children

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6
Q

describe influenza C

A

minor, mild symptoms

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7
Q

describe endemic

A

disease permanently present within the population

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8
Q

what is an epidemic

A

more cases in one region/country

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9
Q

what is a pandemic

A

epidemics that span international boundaries

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10
Q

what is seasonal flu

A

influenza most common in winter months

H1N1 most common strain currenlty

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11
Q

what are the symptoms of influenza

A 
fever
headache
myalgia
weakness
cough, sore throat, runny nose
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12
Q

how is influenza spread

A

aerosol droplets

hand to hand

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13
Q

what is a complication of influenza

A

bacterial pneumonia = life threatening

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14
Q

how is flu treated

A

oxygen, nutrition, hydration = maintain homeostasis
treat secondary infections
antivirals prevent spread = no treatment effect = TAMIFLU

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15
Q

what underlying medical conditions increase the mortality of influenza

A

chronic cardiac/pulmonary diseases
old age
chronic metabolic/renal disease
immunosuppressed

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16
Q

describe type 1 respiratory failure

A

low PaO2 with normal or low PaCO2

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17
Q

describe type 2 respiratory failure

A

low PaO2 with raised PaCO2

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18
Q

what is the normal value for alveolar-arterial gradient

A

normally less than 2kPa

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19
Q

describe the FEV1 differences between obstructive and restrictive lung diseases

A 
obstructive = low amount out in 1 seconds but total amount expelled nearly the same as normal, FEV1/FVC ratio = less than 70%
restrictive = high volume expelled in 1 second but low volume air expelled in total, FEV1/FVC ratio normal
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20
Q

what FEV1 is considered low

A

less than 80% of predicted FEV1

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21
Q

what part of the lung has a problem in obstructive and restrictive lung disease

A 
obstructive = airways
restrictive = lung parenchyma, chest wall/pleura
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22
Q

what does a low TLCO/high TLCO indicate

Transfer factor of carbon monoxide

A 
low = thickening of alveolar/capillary membranes, reduced lung volume
high = increased capillary blood volume, pulmonary haemorrhage
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23
Q

what is interstitial lung disease

A

increased amount of lung tissue and thickening of alveolar wall usually caused by excessive connective tissue
causes hypoxia, particularly on exertion

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24
Q

what are the main types of interstitial lung disease (acute)

A

adult respiratory distress syndrome ARDS

radiation pneumonitis

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25
Q

what are the main types of interstitial lung disease (chronic)

A

upper: charts
Coal workers
Histiocytosis
Ank. spond
Radiation
TB
Silicosis/sarcoidosis

lower: RASCO
RA
Asbestosis
Scleroderma
Cytogenic fibrosing alveolitis
Other - drugs

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26
Q

what is extrinsic allergic alveolitis

A

inflammation of alveoli caused by type 3 hypersensitivity reaction
can lead to progressive fibrosis and emphysema
e.g. pigeon fanciers lung

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27
Q

describe the pathophysiology of extrinsic allergic alveolitis/hypersensitivity pneumonitis

A

immune complexes of antibody and antigen are formed and deposited in the lung
clinical history must include previous exposure e.g. to mould/pets/occupation

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28
Q

what is pneumoconiosis

A

lung scarring caused by inhalation of dust such as asbestos/coal dust/silicon
results in pulmonary fibrosis and then emphysema

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29
Q

what is sarcoidosis

A

chronic inflammation characterised by granulomas principally in the lymph nodes around the mediastinum but possible in lungs too
type 4 hypersensitivity reaction

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30
Q

what systemic rheumatological disease can develop and present as lung disease

A

systemic sclerosis - diffuse scleroderma form = pulmonary fibrosis

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31
Q

which drugs can cause drug induced interstitial lung disease

A

nitrofurantoin
methotrexate
amiodarone
bleomycin

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32
Q

what is asthma

A

chronic inflammatory disease that is characterised by reversible airway obstruction caused by bronchospasm

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33
Q

describe the side effects of long term use of oral steroids

A 
DM
cataracts
osteoporosis
hypertension
skin thinning
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34
Q

describe the side effects of topical steroids

A

hoarse voice
oral candida
skin thinning
easy bruising

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35
Q

what orgasnisms cause rhinitis and sinusitis (common cold)

A

rhinovirus and coronavirus

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36
Q

describe bacterial sinusitis

A

caused by strep. pneumoniae and haemophilus influenzae
causes unilateral pain, purulent discharge, fever
can cause brain abscess/sinus vein thrombosis

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37
Q

what are the main host defences of the lungs

A 
commensal flora
swallowing
alveolar macrophages
soluble factors (IgA, defencins, lysosomes)
mucociliary escalator
coughing/sneezing
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38
Q

who is most as risk of developing respiratory tract infections

A
  1. those with dysphagia (cant swallow) = stroke, tumours
  2. altered lung physiology = CF, bronchiectasis, emphysema, muscular weakness etc
  3. immune dysfunction = immunodeficiencies, immunosuppression
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39
Q

what causes pharyngitis

A 
viral:
rhinovirus/adenovirus
RBV/acute HIV (rare)
bacterial:
strep. pyogenes
mycoplasma pneumoniae/N.gonorrhoea/C. diptheriae (rare)
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40
Q

what are the symptoms of pharyngitis

A

painful/dry/scratchy throat
pharyngeal erythema
dry cough
swollen lymph nodes

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41
Q

what is the diagnostic criteria for pharyngitis

A 
= centor criteria:
tonsillar exudate
cervical lymphadenopathy
38 fever
no cough
0-2 = viral
3-4 = 50% chance bacterial = treat with penicillin/amoxicillin
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42
Q

describe epiglottitis

A

caused by Haemophilus influenzae B
cause pain on swallowing (odynophagia) and inspiratory stridor (weird sound)
treat with ceftriaxone
HiB vaccine prevent children getting it

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43
Q

what is diptheria

A

acute bacterial disease causing mucosal membrane inflammation
caused by cornyebacterium diptheria

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44
Q

how does diptheria present

A 
severe sore throat
malaise
pyrexia
lymphadenopathy
rapid breathing
grey membrane over tonsils
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45
Q

how is diptheria diagnosed and treated

A

throat swab showing irregular gram positive rods

treated with an antitoxin

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46
Q

how does sinusitis present and how is it treated

A

unilateral face pain, worse when lying
thick nasal discharge
pyrexia
treated with co-amoxiclav or doxycycline/erythromycin if penicillin allergy

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47
Q

what is pneumonia

A

inflammation of lung parenchyma due to infection

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48
Q

how is pneumonia prevented

A

over 65s = pneumonia vaccine
flu vaccine
smoking cessation

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49
Q

who is most at risk of developing pneumonia

A 
infants/elderly
COPD
immunocompromised
IVDU
alcoholics
smokers
difficulty swollowing
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50
Q

what causes pneumonia in the immunocompromised

A 
bacterial = CAP + pseudomonas aeruginosa
fungal = PCP + aspergillus
viral = CMV + adenovirus + RSV
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51
Q

what is the most common cause of pneumonia

A

streptococcus pneumoniae = RUSTY SPUTUM

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52
Q

what causes viral pneumonia

A

cytomegalovirus

adenovirus

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53
Q

how does atypical pneumonia present

A 
mycoplasm = rash, haemolytic anaemia
legionella = diorrhoea, abnormal LFT, hyponatraemia, interstitial nephritis, encephalitis, confusion
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54
Q

how is CAP pneumonia assessed and describe it

A

CURB65 score = 1 point for each

  • Confusion
  • Urea above 7mmol/L
  • RR above 30/min
  • BP below 90/60mmHg
  • Age above 65
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55
Q

describe the CURB65 scores and outcomes

A

0-1 = mild, only admit if at-risk group
2 = moderate, admit to hospital
3-4 = severe, admit and monitor closely
5 admit to ICU

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56
Q

what is pleural effusion

A

collection of fluid in lungs
usually due to pneumonia/lung abscess/bronchiectasis
can be transudate = low protein content
can be exudate = high protein content

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57
Q

what is empyema and how does it present

A 
= pus within the pleural space
recurrent fever even after pneumonia resolved
inflammation markers remain high
pain on deep inspiration
stony dull percussion
CXR = indicate pleural effusion
aspirated fluid = yellow with low pH
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58
Q

how is empyema treated

A

chest drain

antibiotics

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59
Q

what is a lung abscess and how is it treated

A

cavity filled with pus within the lung
treated with antibiotics and surgical drainage
seen in aspiration/alcoholics/poor dentition

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60
Q

what are the HAP causes of pneumonia

A

MRSA
pseudamonas aeruginosa
S. aureus = ventilator related
klebsiella pneumoniae = homeless, hospitals, alcoholics

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61
Q

what is bronchiolitis

A

inflammation and increased mucus production in bronchioles due to respiratory syncytial virus (RSV)
typically occurs in children
results in airway obstruction

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62
Q

what is MERS-CoV and how does it present

A

middle east respiratory syndrome caused by coronavirus = severe resp illness
pyrexia, cough, pneumonia, dyspnoea

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63
Q

what is whooping cough, how does it present and how is it treated

A 
infectious disease caused by Bordatella pertussis
paroxysmal cough
post-tutive vomiting after cough
malaise/myalgia
pyrexia
treated with clarithromycin
prevented by vaccine
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64
Q

what is the disease progression of whooping cough

A

7-10 day incubation
1-2 week catarrhal stage
1-6 week paroxysmal stage

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65
Q

what causes acute bronchitis

A

nearly always viral

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66
Q

how is bronchitis diagnosed and distinguished from pneumonia

A

cough, SOB, wheeze, NO systemic features of infection
CXR normal = no features of pneumonia
viral/bacterial throat swabs
serology for mycoplasma/chlamydia
usually no Tx, antimicrobials are NOT helpful

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67
Q

what are -mab drugs

A

monoclonal antibodies = reslizumab

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68
Q

what are -sone drugs

A

corticosteroids = dexamethasone

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69
Q

what are -lone drugs

A

corticosteroids = prednisolone

70
Q

what are -terol drugs

A

bronchodilators = salmeterol

71
Q

what are -nib drugs

A

kinase inhibitors = nintedanib

72
Q

what causes obstructive lung disease

A 
tumours/foreign bodies = acute
chronic:
asthma
bronchiectasis
cystic fibrosis
COPD
73
Q

what causes restrictive lung disease

A 
sarcoidosis
ARDS
pulmonary fibrosis
plural thickening
obesity
= restrict lung expansion and result in decreased lung volume
74
Q

what causes ARDS

A 
drug reactions
toxin reactions
gastric aspiration
radiation pneumonitis
diffuse intrapulmonary haemorrhage
75
Q

how does ARDS present

A

tachypnoea
dyspnoea
pulmonary oedema
arterial hypoxemia occurs refractory to O2 therapy

76
Q

what is fibrosing alveolitis (similar to pulmonary fibrosis) and how does it present

A

fibrosis of the alveolar
finger/toe clubbing
honeycomb appearance of lungs on CXR
cor pulmonae = heart failure due to lung disease

77
Q

what is a tension pneumothorax

A

= develops from spontaneous/traumatic pneumothorax
air drawn into pleural space with each inspiration
air has nowhere to escape = compress great veins and lungs
causes respiratory and circulatory impairment

78
Q

what are the main types of eosinophil asthma

A
  1. atopic = IgE mediated type 1 reaction
  2. occupation = type 1/3 reaction
  3. allergic bronchopulmonary aspergillosis = type 1 and delayed type 3 reaction
  4. non-atopic
79
Q

what is bronchiectasis

A

chronic inflammation of bronchi and bronchioles leading to permanent dilation and thinning of these airways
usually affect lower lobes
CT CHEST IS GOLD STANDARD DIAGNOSIS

80
Q

what are the risk factors for lung cancer

A 
male (2x)
smoking
lung fibrosis
occupational RFs = 
Radon
Uranium
Chromate
Asbestos
Arsenic
Nickel
81
Q

what are the rare extrapulmonary ways lung cancer may present? (7)

A

3-10% patients

  1. finger clubbing
  2. non-infective endocarditis
  3. hypertrophic pulmonary osteoarthropathy (HPOA)
  4. Lambert-Eaton myasthenia syndrome = small cell carcinoma
  5. SIADH = small cell lung cancer
  6. excess ACTH = small cell carcinoma
  7. excess PTH = squamous cell carcinoma
82
Q

what type of neoplasms are lung cancer most commonly?

A

carcinomas

BUT metastatic carcinoma more common than primary lung carcinoma

83
Q

name the types of lung neoplasm (7)

A
  1. lung carcinoma
  2. metastatic carcinoma
  3. bronchial gland neoplasia
  4. pleural neoplasm
  5. soft tissue sarcoma/benign tumours
  6. lymphomas
  7. hamartomas = benign
84
Q

what are the different types of lung carcinoma

A 
1. non-small cell carcinoma:
squamous cell carcinoma
adenocarcinoma
large undifferentiated carcinoma
carcinoid tumour
2. small cell carcinoma
85
Q

what are the most common primary lung carcinomas

A

35% adenocarcinoma
25% squamous cell carcinoma
20% small cell lung carcinoma
10% large undifferentiated carcinoma

86
Q

describe a small cell lung carcinoma

A

high grade epithelial neoplasm
strongly associated with cigarette smoking
usually disseminated (spread beyond chest) at presentation

87
Q

what are the 2 types of pleural neoplasia and describe them

A

pleural fibroma = small, localised, fibrosed tumour normally benign
malignant mesothelioma = aggressive neoplasm, cause chronic chest infections (asbestos)
(dont forget METS!!!)

88
Q

what cancers commonly metastasise to the lung

A 
kidney
prostate
breast
bone
colorectal
89
Q

which organs commonly develop metastasis FROM the lung

A 
lymph nodes
liver
bone 
brain
adrenals
90
Q

what does asbestos exposure cause

A 
plaques = not malignant
persistant pleural effusions
pleural fibrosis
diffuse interstitial fibrosis
mesothelioma
91
Q

describe the difference between the conducting airways and the respiratory region

A

conducting airways = smaller SA and regional bloodflow

respiratory region = 95% of lungs SA and highly vascularised

92
Q

what types of inhaled medicine devices are there

A

pressurised metered dose PMDIS
spacers
dry powder inhalers DPIS
nebulizers

93
Q

what are the properties of inhaled medicines

A

rapid absorption
cleared from blood quickly = local efficacy is short
can act directly on the lung
lungs have large SA
non-invasive drug entry into systemic circulation

94
Q

describe bronchoconstriction

A

tightening of airway smooth muscle ASM
lumenal occlusion by mucus and plasma
airway wall thickening
== airflow obstruction

95
Q

what are the 2 types of bronchodilators

A
  1. adrenergic = sympathetic NS = cause bronchodilation

2. anti-cholinergic = parasympathetic NS = block bronchoconstriction

96
Q

describe the action of beta 2 adrenoceptor agonists and give an example

A

act on beta 2 adrenoceptors to cause smooth muscle relaxation and bronchodilation
also inhibit histamine release from lung mast cells (asthma)
e.g. SABA = salbutamol

97
Q

describe the action of anticholinergics and give an example

A

usually = parasympathetic NS release ACh = binds to muscarinic receptors = cause bronchoconstriction
anticholinergics = block ACh binding to muscarinic receptors = block bronchoconstriction
e.g. atropine, ipratropium bromide

98
Q

describe the action of glucocorticoids on inflammation (6)

A
  1. reduce number inflammatory cells in the airway
  2. inhibit inflammatory cell survival in the airway
  3. suppress production of chemotactic mediators
  4. reduce adhesion molecule expression
  5. increase b2 receptors on airway smooth muscle
  6. decrease mucus secretion
99
Q

what are the side effects of inhaled corticosteroids (ICS)

A

= in long term use e.g. in COPD
loss of bone density
adrenal suppression
cataracts/glaucoma

100
Q

what is common for patients with COPD who take ICS

A

they develop corticosteroid resistance

101
Q

describe how b2 agonists and ICS work together to treat asthma

A 
ICS = increase transcription of b2 receptor gene = increased expression of cell surface receptors
b2 agonists (beclomethasone) = increase translocation of glucocorticoid receptor from cytoplasm to nucleus once activated by ICS 
= overall greater efficacy
102
Q

what new drugs have been developed for pulmonary fibrosis

A 
pirfenidone = antifibrotic
nintedanib = tyrosine kinase inhibitor
103
Q

what are the CXR features of heart failure

A 
ABCDE
alveolar oedema
kerley B lines (lines from peripheral - inwards)
cardiomegaly
upper lobe venous distension
effusions
104
Q

how does bronchopneumonia appear on CXR

A

extensive bilateral consolidation

105
Q

what is respiratory failure

A

inability of lungs to adequately oxygenate the arterial blood supply and/or adequately remove carbon dioxide

106
Q

what are the 2 types of respiratory failure

A

type 1 = lung failure

type 2 = pump failure

107
Q

what causes type 1 respiratory failure

A 
reduced FiO2 = high altitude
V/Q mismatch = asthma, pneumonia, PE, pulmonary fibrosis etc.
left to right cardiac shunts
diffusion impairment 
alveolar hypoventilation
108
Q

whats a normal V/Q

A

0.8

109
Q

how does type 1 respiratory failure present

A 
peripheral cyanosis
tachypnoea (increased RR)
tachycardia
accessory muscle usage
confusion
signs of underlying cause
110
Q

describe and give examples of alveolar hypoventilation

A 
= obstruction
COPD
asthma
cystic fibrosis
bronchiectasis
etc.
111
Q

how is type 1 respiratory failure treated

A

treat underlying cause
oxygen therapy = aim for sats 92-98
recheck ABG after treatment = may need CPAP if still hypoxic

112
Q

what causes type 2 respiratory failure

A

= something wrong with pump
asthma/COPD
pneumonia
end stage pulmonary fibrosis

obstructive sleep apnoea
sedatives
diaphragm paralysis
CNS tumours/cervical cord lesions

113
Q

what does a raised V/Q indicate

A

decreased perfusion e.g. PE

114
Q

what does a decreased V/Q indicate

A

decreased ventilation

115
Q

what does V/Q of 0 indicate

A

= a shunt

normal blood supply but no ventilation

116
Q

what does a V/Q of infinity indicate

A

normal ventilation but lack of blood supply = dead space

117
Q

how does type 2 respiratory failure present

A 
confusion 
drowsiness
warm peripheries
flapping tremor = CO2 flao
bounding pulse
papilloedema
118
Q

how is type 2 resp failure treated

A

treat underlying cause
controlled O2 therapy = aim for sats 88-92%
recheck ABG after 20 mins of treatment = if still hypoxic = consider non-invasive positive pressure ventilation (NIPPV)
intubation/ventilation if NIPPV doesnt work

119
Q

what does CPAP stand for

A

continuous positive pressure airway

= spontaneously breathing patient

120
Q

what ABG result in patients with asthma is especially significant

A

well controlled asthma = patient blowing off a lot of CO2 so will have low CO2
normal or high CO2 = urgent treatment = lungs need help removing CO2 as lung are getting exhausted

121
Q

what 2 things could be responsible for a high CO2 level

A
  1. chronically reduced O2 levels (COPD)

2. lungs are tiring and cannot remove CO2 effectively (asthma)

122
Q

how is TB spread

A

mycobacterium tuberculosis = aerosol

mycobacterium bovis = unpasteurised milk

123
Q

who is most at risk of contracting TB

A 
IVDU
prisoners
alcoholics
homeless
HIV positive
close contacts of those with TB
southern Africa, SE Asia, mongolia
124
Q

how is TB prevented

A

case identification
contact tracing
detection and treatment of latent TB through community testing
vaccination = BCG

125
Q

how is active TB treated

A

2 months = pyrazinamide and ethambutol
6 months = rifampicin and izoniazid
RIPE

126
Q

how is latent TB treated

A

3 months = rifampicin

6 months = isoniazid

127
Q

what should you think of with chronic illness of weight loss and fever

A

TB!!

128
Q

why does TB not grow on gram stain

A

has different cell wall to other bacteria

129
Q

how is breathlessness assessed in COPD

A

MRC score

1 to 5 of SOB depending on different tasks

130
Q

describe the MRC score for breathlessness

A 
1 = SOB on exertion
2 = SOB on hills
3 = SOB on flat, have to stop/slow
4 = 100-200 yards exercise on flat before SOB
5 = housebound SOB
131
Q

how many respiratory deaths a year are linked to workplace exposures

A

12,000

18,000 new cases annually

132
Q

what are the causes of occupational lung disease

A

Vapour
Gasses
Dusts
Fume

133
Q

name the 6 types of occupational lung disorders from most immediate to most latent and give examples

A
  1. direct injury = irritant asthma, pulmonary oedema
  2. infection = silicotuberculosis
  3. chronic inflammation = COPD, bronchiolitis
  4. destruction lung tissue = emphysema
  5. lung/pleural fibrosis = asbestos
  6. carcinogenesis = mesothelioma, cancer etc
134
Q

what are the important factors in occupational lung disorders

A

susceptibility - population/individual
severity
reversibility
employment

135
Q

describe the types of occupational asthma

A

90% = induced by sensitisation to agent inhaled at work
10% = induced by massive accidental exposure
causative agents = flour, cleaning products, wood dusts, enzymes

136
Q

describe the asbestos related lung diseases

A

= used in fire retardant/insulation

  1. pleural plaques
  2. diffuse pleural thickening
  3. asbestosis = pulmonary fibrosis
  4. mesothelioma
137
Q

how are occupational lung diseases prevented

A

exposure prevention/minimisation
health surveillance = ID early, prevent further harm
review control measures

138
Q

what are the key public health issues with COPD

A

unpredictable illness trajectory
difficulty to determine/poor prognosis
poor patient understanding
limited access to specialist palliative care

139
Q

why do COPD patients end up dying in hospital

A

communication = death not discussed
carers exhausted
co-morbidity
prognosis uncertain

140
Q

what is the philosophy of palliative care

A

holistic
individualised
patient and carer
multidisciplinary approach

141
Q

what are the care needs for older patients with chronic lung disease

A

multiple co-morbs
greater risk of impairment from treatment
increase psychological distress
increased social isolation/economic hardship

142
Q

how are chronic illness and inequalities related

A

lower SE status = higher incidence chronic illness
poverty + poor living conditions increase with age
most severe deprivation experienced by pensioners living alone

143
Q

name 5 occupational diseases

A 
asbestosis
silcosis coalminer's pneumoconiosis
occupational dermatitis
occupational deafness
mesothelioma
144
Q

what were the top 4 work related ill health in 2017

A
  1. occupational stress
  2. MSK disorders
  3. occupational lung disease
  4. occupational cancer
145
Q

name 4 sources of occupational illness data

A

labour force survey
death certificates
disablement benefit
surveillance schemes

146
Q

define hazard

A

potentially harmful

147
Q

define risk

A

probability of harm

148
Q

what are Marmots 10 key components of good work

A
  1. precariousness
  2. individual control
  3. work demands
  4. fair employment
  5. opportunities
  6. prevents (social isolation/discrimination)
  7. share info
  8. work/life balance
  9. reintegrates
  10. promotes health and wellbeing
149
Q

how are occupational causes identified

A

illness that fails to respond to standard treatment
illness does not fit typical demographic profile
illness is of unknown cause
= maybe occupational

150
Q

describe primary, secondary and tertiary prevention of occupational health problems

A 
1 = monitor risk, control hazard, promotion
2 = screening, early detection, task modification
3 = rehabilitation, support
151
Q

what are the signs and symptoms of sarcoidosis

A

asymptomatic = incidental finding on CXR
dry cough, progressive SOB, chest pain

lymphadenopathy
erythema nodosum
granulatomous uveitis

152
Q

how is sarcoidosis diagnosed

A

bloods = high ESR, high ACE, lymphopenia
broncheoalveolar lavage = increased lymphocytes
lung biopsy = DIAGNOSTIC

153
Q

how is sarcoidosis managed

A

acute = NSAIDS/bed rest
no pulmonary infiltrate = w&w
pulmonary infiltrate = prednisolone

154
Q

what is wegner’s granulomatosis

A

necrotising granulomatous vasculitis of arterioles, capillaries and venules
associated with ANCA
25-60 yr olds

155
Q

how does wegner’s granulomatosis present

A

typical triad = lungs, kidney, upper resp tract
lungs = nodules and haemorrhage
kidneys = glomerulonephritis
URT = sinusitis, otitis, nasal crushing and bleeding
OTHER = purpura/ulcers/saddle nose

156
Q

how is wegners granulomatosis treated

A

no end organ threat = moderate steroids = methotrexate

severe = high dose steroids, cyclophosphamide, biologics

157
Q

what is goodpastures syndrome

A

autoimmune disease results in damage to BM of lungs and kidneys
causes anti-GBM antibodies (IgG) to form and deposit in lungs and kidney

158
Q

how does goodpastures syndrome present

A 
nephritic syndrome = haematuria/hypertension/azotaemia
malaise/weight loss/fever
chest pain
dyspnoea
haemoptysis
arthralgia
159
Q

how is goodpastures treated

A

plasmapheresis to remove anti-GBM antibodies
IV prednisolone and cyclophosphamide
rituximab

160
Q

describe the medications that can effect the lung and how

A 
BB/NSAIDs = bronchoconstriction
ACEi = dry cough
cytotoxic agent = ILD
oestrogen/OCP/HRT = PE risk
amioderone/methotrexate = pleural effusion/ILD
161
Q

what cells are involved in asthma vs COPD

A 
asthma = mast cells/eosinophils/CD4 T cells
COPD = neutrophils/CD8 T cells
162
Q

what monoclonal antibody be given as a late stage treatment option in eosinophilic asthma

A

omalizumab

163
Q

describe the staging for lung cancer

A 
I = T1-2
II = T1-3, N1
III= T1-4, N2-3
IV = M1
164
Q

what is a ghon complex

A

primary focuses + lymph node swelling present

in TB

165
Q

what drug treatment is given in CAP pneumonia (mild, moderate, severe)

A 
mild = 500mg amoxicillin OR 500mg clarithromycin
moderate = 500mg amoxicillin AND 500mg clarithromycin
severe = IV co-amoxiclav 1.2g AND 500mg clarithromycin
166
Q

what drug treatment is given in pneumonia caused by Legionella and P. Aeruginosa (respectively)

A 
legionella = flouroquinalone AND clarithromycin
P.aeruginosa = IV ceftazidime AND gentamycin
167
Q

what drug treatment is given to HAP pneumonia

A 
early = metronidazole OR co-amoxiclav (beta lactam + betalactamase i)
late = vancomycin (MRSA) OR IV colistin (treat gram -ve)
168
Q

describe the difference in presentation between a pneumothorax and a pleural effusion

A

pneumothorax = hyper-resonance chest percussion

pleural effusion = dull percussion

169
Q

describe the WHO classification of pulmonary hypertension

A 
WHO 1 = pulmonary arteries
WHO 2 = secondary to heart disease
WHO 3 = secondary to lung disease
WHO 4 = chronic arterial obstruction
WHO 5 = unclassified
170
Q

what is the gold standard for diagnosing pulmonary hypertension

A

right heart catheterisation

171
Q

what test is used to diagnose cystic fibrosis and what is a positive result

A

sweat test

if Na > Cl = positive as Na should be less than Cl

172
Q

what are the side effects of salbutamol

A

tremor

hypokalaemia

Phase 2a (15 decks)

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