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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
what are the main types of interstitial lung disease (chronic)
upper: charts Coal workers Histiocytosis Ank. spond Radiation TB Silicosis/sarcoidosis lower: RASCO RA Asbestosis Scleroderma Cytogenic fibrosing alveolitis Other - drugs
26
what is extrinsic allergic alveolitis
inflammation of alveoli caused by type 3 hypersensitivity reaction can lead to progressive fibrosis and emphysema e.g. pigeon fanciers lung
27
describe the pathophysiology of extrinsic allergic alveolitis/hypersensitivity pneumonitis
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
28
what is pneumoconiosis
lung scarring caused by inhalation of dust such as asbestos/coal dust/silicon results in pulmonary fibrosis and then emphysema
29
what is sarcoidosis
chronic inflammation characterised by granulomas principally in the lymph nodes around the mediastinum but possible in lungs too type 4 hypersensitivity reaction
30
what systemic rheumatological disease can develop and present as lung disease
systemic sclerosis - diffuse scleroderma form = pulmonary fibrosis
31
which drugs can cause drug induced interstitial lung disease
nitrofurantoin methotrexate amiodarone bleomycin
32
what is asthma
chronic inflammatory disease that is characterised by reversible airway obstruction caused by bronchospasm
33
describe the side effects of long term use of oral steroids
``` DM cataracts osteoporosis hypertension skin thinning ```
34
describe the side effects of topical steroids
hoarse voice oral candida skin thinning easy bruising
35
what orgasnisms cause rhinitis and sinusitis (common cold)
rhinovirus and coronavirus
36
describe bacterial sinusitis
caused by strep. pneumoniae and haemophilus influenzae causes unilateral pain, purulent discharge, fever can cause brain abscess/sinus vein thrombosis
37
what are the main host defences of the lungs
``` commensal flora swallowing alveolar macrophages soluble factors (IgA, defencins, lysosomes) mucociliary escalator coughing/sneezing ```
38
who is most as risk of developing respiratory tract infections
1. those with dysphagia (cant swallow) = stroke, tumours 2. altered lung physiology = CF, bronchiectasis, emphysema, muscular weakness etc 3. immune dysfunction = immunodeficiencies, immunosuppression
39
what causes pharyngitis
``` viral: rhinovirus/adenovirus RBV/acute HIV (rare) bacterial: strep. pyogenes mycoplasma pneumoniae/N.gonorrhoea/C. diptheriae (rare) ```
40
what are the symptoms of pharyngitis
painful/dry/scratchy throat pharyngeal erythema dry cough swollen lymph nodes
41
what is the diagnostic criteria for pharyngitis
``` = centor criteria: tonsillar exudate cervical lymphadenopathy 38 fever no cough ``` ``` 0-2 = viral 3-4 = 50% chance bacterial = treat with penicillin/amoxicillin ```
42
describe epiglottitis
caused by Haemophilus influenzae B cause pain on swallowing (odynophagia) and inspiratory stridor (weird sound) treat with ceftriaxone HiB vaccine prevent children getting it
43
what is diptheria
acute bacterial disease causing mucosal membrane inflammation caused by cornyebacterium diptheria
44
how does diptheria present
``` severe sore throat malaise pyrexia lymphadenopathy rapid breathing grey membrane over tonsils ```
45
how is diptheria diagnosed and treated
throat swab showing irregular gram positive rods | treated with an antitoxin
46
how does sinusitis present and how is it treated
unilateral face pain, worse when lying thick nasal discharge pyrexia treated with co-amoxiclav or doxycycline/erythromycin if penicillin allergy
47
what is pneumonia
inflammation of lung parenchyma due to infection
48
how is pneumonia prevented
over 65s = pneumonia vaccine flu vaccine smoking cessation
49
who is most at risk of developing pneumonia
``` infants/elderly COPD immunocompromised IVDU alcoholics smokers difficulty swollowing ```
50
what causes pneumonia in the immunocompromised
``` bacterial = CAP + pseudomonas aeruginosa fungal = PCP + aspergillus viral = CMV + adenovirus + RSV ```
51
what is the most common cause of pneumonia
streptococcus pneumoniae = RUSTY SPUTUM
52
what causes viral pneumonia
cytomegalovirus | adenovirus
53
how does atypical pneumonia present
``` mycoplasm = rash, haemolytic anaemia legionella = diorrhoea, abnormal LFT, hyponatraemia, interstitial nephritis, encephalitis, confusion ```
54
how is CAP pneumonia assessed and describe it
CURB65 score = 1 point for each - Confusion - Urea above 7mmol/L - RR above 30/min - BP below 90/60mmHg - Age above 65
55
describe the CURB65 scores and outcomes
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
56
what is pleural effusion
collection of fluid in lungs usually due to pneumonia/lung abscess/bronchiectasis can be transudate = low protein content can be exudate = high protein content
57
what is empyema and how does it present
``` = 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 ```
58
how is empyema treated
chest drain | antibiotics
59
what is a lung abscess and how is it treated
cavity filled with pus within the lung treated with antibiotics and surgical drainage seen in aspiration/alcoholics/poor dentition
60
what are the HAP causes of pneumonia
MRSA pseudamonas aeruginosa S. aureus = ventilator related klebsiella pneumoniae = homeless, hospitals, alcoholics
61
what is bronchiolitis
inflammation and increased mucus production in bronchioles due to respiratory syncytial virus (RSV) typically occurs in children results in airway obstruction
62
what is MERS-CoV and how does it present
middle east respiratory syndrome caused by coronavirus = severe resp illness pyrexia, cough, pneumonia, dyspnoea
63
what is whooping cough, how does it present and how is it treated
``` infectious disease caused by Bordatella pertussis paroxysmal cough post-tutive vomiting after cough malaise/myalgia pyrexia treated with clarithromycin prevented by vaccine ```
64
what is the disease progression of whooping cough
7-10 day incubation 1-2 week catarrhal stage 1-6 week paroxysmal stage
65
what causes acute bronchitis
nearly always viral
66
how is bronchitis diagnosed and distinguished from pneumonia
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
67
what are -mab drugs
monoclonal antibodies = reslizumab
68
what are -sone drugs
corticosteroids = dexamethasone
69
what are -lone drugs
corticosteroids = prednisolone
70
what are -terol drugs
bronchodilators = salmeterol
71
what are -nib drugs
kinase inhibitors = nintedanib
72
what causes obstructive lung disease
``` tumours/foreign bodies = acute chronic: asthma bronchiectasis cystic fibrosis COPD ```
73
what causes restrictive lung disease
``` sarcoidosis ARDS pulmonary fibrosis plural thickening obesity = restrict lung expansion and result in decreased lung volume ```
74
what causes ARDS
``` drug reactions toxin reactions gastric aspiration radiation pneumonitis diffuse intrapulmonary haemorrhage ```
75
how does ARDS present
tachypnoea dyspnoea pulmonary oedema arterial hypoxemia occurs refractory to O2 therapy
76
what is fibrosing alveolitis (similar to pulmonary fibrosis) and how does it present
fibrosis of the alveolar finger/toe clubbing honeycomb appearance of lungs on CXR cor pulmonae = heart failure due to lung disease
77
what is a tension pneumothorax
= 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
what are the main types of eosinophil asthma
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
what is bronchiectasis
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
what are the risk factors for lung cancer
``` male (2x) smoking lung fibrosis occupational RFs = Radon Uranium Chromate Asbestos Arsenic Nickel ```
81
what are the rare extrapulmonary ways lung cancer may present? (7)
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
what type of neoplasms are lung cancer most commonly?
carcinomas | BUT metastatic carcinoma more common than primary lung carcinoma
83
name the types of lung neoplasm (7)
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
what are the different types of lung carcinoma
``` 1. non-small cell carcinoma: squamous cell carcinoma adenocarcinoma large undifferentiated carcinoma carcinoid tumour 2. small cell carcinoma ```
85
what are the most common primary lung carcinomas
35% adenocarcinoma 25% squamous cell carcinoma 20% small cell lung carcinoma 10% large undifferentiated carcinoma
86
describe a small cell lung carcinoma
high grade epithelial neoplasm strongly associated with cigarette smoking usually disseminated (spread beyond chest) at presentation
87
what are the 2 types of pleural neoplasia and describe them
pleural fibroma = small, localised, fibrosed tumour normally benign malignant mesothelioma = aggressive neoplasm, cause chronic chest infections (asbestos) (dont forget METS!!!)
88
what cancers commonly metastasise to the lung
``` kidney prostate breast bone colorectal ```
89
which organs commonly develop metastasis FROM the lung
``` lymph nodes liver bone brain adrenals ```
90
what does asbestos exposure cause
``` plaques = not malignant persistant pleural effusions pleural fibrosis diffuse interstitial fibrosis mesothelioma ```
91
describe the difference between the conducting airways and the respiratory region
conducting airways = smaller SA and regional bloodflow | respiratory region = 95% of lungs SA and highly vascularised
92
what types of inhaled medicine devices are there
pressurised metered dose PMDIS spacers dry powder inhalers DPIS nebulizers
93
what are the properties of inhaled medicines
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
describe bronchoconstriction
tightening of airway smooth muscle ASM lumenal occlusion by mucus and plasma airway wall thickening == airflow obstruction
95
what are the 2 types of bronchodilators
1. adrenergic = sympathetic NS = cause bronchodilation | 2. anti-cholinergic = parasympathetic NS = block bronchoconstriction
96
describe the action of beta 2 adrenoceptor agonists and give an example
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
describe the action of anticholinergics and give an example
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
describe the action of glucocorticoids on inflammation (6)
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
what are the side effects of inhaled corticosteroids (ICS)
= in long term use e.g. in COPD loss of bone density adrenal suppression cataracts/glaucoma
100
what is common for patients with COPD who take ICS
they develop corticosteroid resistance
101
describe how b2 agonists and ICS work together to treat asthma
``` 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
what new drugs have been developed for pulmonary fibrosis
``` pirfenidone = antifibrotic nintedanib = tyrosine kinase inhibitor ```
103
what are the CXR features of heart failure
``` ABCDE alveolar oedema kerley B lines (lines from peripheral - inwards) cardiomegaly upper lobe venous distension effusions ```
104
how does bronchopneumonia appear on CXR
extensive bilateral consolidation
105
what is respiratory failure
inability of lungs to adequately oxygenate the arterial blood supply and/or adequately remove carbon dioxide
106
what are the 2 types of respiratory failure
type 1 = lung failure | type 2 = pump failure
107
what causes type 1 respiratory failure
``` reduced FiO2 = high altitude V/Q mismatch = asthma, pneumonia, PE, pulmonary fibrosis etc. left to right cardiac shunts diffusion impairment alveolar hypoventilation ```
108
whats a normal V/Q
0.8
109
how does type 1 respiratory failure present
``` peripheral cyanosis tachypnoea (increased RR) tachycardia accessory muscle usage confusion signs of underlying cause ```
110
describe and give examples of alveolar hypoventilation
``` = obstruction COPD asthma cystic fibrosis bronchiectasis etc. ```
111
how is type 1 respiratory failure treated
treat underlying cause oxygen therapy = aim for sats 92-98 recheck ABG after treatment = may need CPAP if still hypoxic
112
what causes type 2 respiratory failure
= something wrong with pump asthma/COPD pneumonia end stage pulmonary fibrosis obstructive sleep apnoea sedatives diaphragm paralysis CNS tumours/cervical cord lesions
113
what does a raised V/Q indicate
decreased perfusion e.g. PE
114
what does a decreased V/Q indicate
decreased ventilation
115
what does V/Q of 0 indicate
= a shunt | normal blood supply but no ventilation
116
what does a V/Q of infinity indicate
normal ventilation but lack of blood supply = dead space
117
how does type 2 respiratory failure present
``` confusion drowsiness warm peripheries flapping tremor = CO2 flao bounding pulse papilloedema ```
118
how is type 2 resp failure treated
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
what does CPAP stand for
continuous positive pressure airway | = spontaneously breathing patient
120
what ABG result in patients with asthma is especially significant
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
what 2 things could be responsible for a high CO2 level
1. chronically reduced O2 levels (COPD) | 2. lungs are tiring and cannot remove CO2 effectively (asthma)
122
how is TB spread
mycobacterium tuberculosis = aerosol | mycobacterium bovis = unpasteurised milk
123
who is most at risk of contracting TB
``` IVDU prisoners alcoholics homeless HIV positive close contacts of those with TB southern Africa, SE Asia, mongolia ```
124
how is TB prevented
case identification contact tracing detection and treatment of latent TB through community testing vaccination = BCG
125
how is active TB treated
2 months = pyrazinamide and ethambutol 6 months = rifampicin and izoniazid RIPE
126
how is latent TB treated
3 months = rifampicin | 6 months = isoniazid
127
what should you think of with chronic illness of weight loss and fever
TB!!
128
why does TB not grow on gram stain
has different cell wall to other bacteria
129
how is breathlessness assessed in COPD
MRC score | 1 to 5 of SOB depending on different tasks
130
describe the MRC score for breathlessness
``` 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
how many respiratory deaths a year are linked to workplace exposures
12,000 | 18,000 new cases annually
132
what are the causes of occupational lung disease
Vapour Gasses Dusts Fume
133
name the 6 types of occupational lung disorders from most immediate to most latent and give examples
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
what are the important factors in occupational lung disorders
susceptibility - population/individual severity reversibility employment
135
describe the types of occupational asthma
90% = induced by sensitisation to agent inhaled at work 10% = induced by massive accidental exposure causative agents = flour, cleaning products, wood dusts, enzymes
136
describe the asbestos related lung diseases
= used in fire retardant/insulation 1. pleural plaques 2. diffuse pleural thickening 3. asbestosis = pulmonary fibrosis 4. mesothelioma
137
how are occupational lung diseases prevented
exposure prevention/minimisation health surveillance = ID early, prevent further harm review control measures
138
what are the key public health issues with COPD
unpredictable illness trajectory difficulty to determine/poor prognosis poor patient understanding limited access to specialist palliative care
139
why do COPD patients end up dying in hospital
communication = death not discussed carers exhausted co-morbidity prognosis uncertain
140
what is the philosophy of palliative care
holistic individualised patient and carer multidisciplinary approach
141
what are the care needs for older patients with chronic lung disease
multiple co-morbs greater risk of impairment from treatment increase psychological distress increased social isolation/economic hardship
142
how are chronic illness and inequalities related
lower SE status = higher incidence chronic illness poverty + poor living conditions increase with age most severe deprivation experienced by pensioners living alone
143
name 5 occupational diseases
``` asbestosis silcosis coalminer's pneumoconiosis occupational dermatitis occupational deafness mesothelioma ```
144
what were the top 4 work related ill health in 2017
1. occupational stress 2. MSK disorders 3. occupational lung disease 4. occupational cancer
145
name 4 sources of occupational illness data
labour force survey death certificates disablement benefit surveillance schemes
146
define hazard
potentially harmful
147
define risk
probability of harm
148
what are Marmots 10 key components of good work
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
how are occupational causes identified
illness that fails to respond to standard treatment illness does not fit typical demographic profile illness is of unknown cause = maybe occupational
150
describe primary, secondary and tertiary prevention of occupational health problems
``` 1 = monitor risk, control hazard, promotion 2 = screening, early detection, task modification 3 = rehabilitation, support ```
151
what are the signs and symptoms of sarcoidosis
asymptomatic = incidental finding on CXR dry cough, progressive SOB, chest pain lymphadenopathy erythema nodosum granulatomous uveitis
152
how is sarcoidosis diagnosed
bloods = high ESR, high ACE, lymphopenia broncheoalveolar lavage = increased lymphocytes lung biopsy = DIAGNOSTIC
153
how is sarcoidosis managed
acute = NSAIDS/bed rest no pulmonary infiltrate = w&w pulmonary infiltrate = prednisolone
154
what is wegner's granulomatosis
necrotising granulomatous vasculitis of arterioles, capillaries and venules associated with ANCA 25-60 yr olds
155
how does wegner's granulomatosis present
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
how is wegners granulomatosis treated
no end organ threat = moderate steroids = methotrexate | severe = high dose steroids, cyclophosphamide, biologics
157
what is goodpastures syndrome
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
how does goodpastures syndrome present
``` nephritic syndrome = haematuria/hypertension/azotaemia malaise/weight loss/fever chest pain dyspnoea haemoptysis arthralgia ```
159
how is goodpastures treated
plasmapheresis to remove anti-GBM antibodies IV prednisolone and cyclophosphamide rituximab
160
describe the medications that can effect the lung and how
``` BB/NSAIDs = bronchoconstriction ACEi = dry cough cytotoxic agent = ILD oestrogen/OCP/HRT = PE risk amioderone/methotrexate = pleural effusion/ILD ```
161
what cells are involved in asthma vs COPD
``` asthma = mast cells/eosinophils/CD4 T cells COPD = neutrophils/CD8 T cells ```
162
what monoclonal antibody be given as a late stage treatment option in eosinophilic asthma
omalizumab
163
describe the staging for lung cancer
``` I = T1-2 II = T1-3, N1 III= T1-4, N2-3 IV = M1 ```
164
what is a ghon complex
primary focuses + lymph node swelling present | in TB
165
what drug treatment is given in CAP pneumonia (mild, moderate, severe)
``` mild = 500mg amoxicillin OR 500mg clarithromycin moderate = 500mg amoxicillin AND 500mg clarithromycin severe = IV co-amoxiclav 1.2g AND 500mg clarithromycin ```
166
what drug treatment is given in pneumonia caused by Legionella and P. Aeruginosa (respectively)
``` legionella = flouroquinalone AND clarithromycin P.aeruginosa = IV ceftazidime AND gentamycin ```
167
what drug treatment is given to HAP pneumonia
``` early = metronidazole OR co-amoxiclav (beta lactam + betalactamase i) late = vancomycin (MRSA) OR IV colistin (treat gram -ve) ```
168
describe the difference in presentation between a pneumothorax and a pleural effusion
pneumothorax = hyper-resonance chest percussion | pleural effusion = dull percussion
169
describe the WHO classification of pulmonary hypertension
``` 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
what is the gold standard for diagnosing pulmonary hypertension
right heart catheterisation
171
what test is used to diagnose cystic fibrosis and what is a positive result
sweat test | if Na > Cl = positive as Na should be less than Cl
172
what are the side effects of salbutamol
tremor | hypokalaemia

Phase 2a (15 decks)

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