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Phase 2a Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the surface antigens for influenza A?

A
  1. Haemagglutinin

2. Neuraminidase

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2
Q

What is the function of haemagglutinin?

A

Virus binding and entry to cells

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3
Q

What is the function of neuraminidase?

A

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

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4
Q

What causes seasonal epidemics?

A

Antigenic drift

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5
Q

What causes pandemics?

A

Antigenic shift

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6
Q

How do new virus strains form?

A

Genetic reassortment

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7
Q

What are the symptoms of influenza?

A
  1. URT symptoms
  2. LRT symptoms
  3. Fever
  4. Headache
  5. Myalgia
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8
Q

What are the risk factors for influenza mortality?

A
  1. Chronic cardiac and pulmonary diseases
  2. Old age
  3. Chronic metabolic disease
  4. Chronic renal disease
  5. Immunosuppressed
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9
Q

What is the Rx of influenza?

A
  1. Oxygen
  2. Hydration/nutrition
  3. Tamiflu
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10
Q

What makes pandemics worse?

A
  1. More travel
  2. Bigger population
  3. Intensive farming
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11
Q

What will make coping with a pandemic better?

A
  1. Better nutrition
  2. Better supportive care
  3. Vaccination
  4. Antivirals
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12
Q

How was avian flu controlled?

A
  1. Cull affected birds
  2. Disinfect farms
  3. Control poultry movement
  4. Vaccinate workers
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13
Q

What is the Rx for swine flu?

A
  1. Oseltamivir

2. Zanamivir

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14
Q

What happens in containment phase?

A
  1. Identify cases
  2. Treat cases
  3. Contact tracing
  4. Large scale prophylaxis
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15
Q

What happens in treatment phase?

A
  1. Treat cases only

2. National flu pandemic service

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16
Q

What happens in type 1 respiratory failure?

A

Low PaO2, normal or low PaCO2

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17
Q

What happens in type 2 respiratory failure?

A

Low PaO2 and raised PaCO2

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18
Q

What can cause raised A-a gradient?

A
  1. Diffusion limitation

2. Shunt (right to left)

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19
Q

What is the pathophysiology of high altitude pulmonary oedema?

A

Exaggerated hypoxic pulmonary vasoconstriction

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20
Q

What is the Rx for high altitude pulmonary oedema?

A
  1. Descent
  2. Oxygen
  3. Pulmonary vasodilators e.g. nifedipine
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21
Q

What factors determine transfer factor?

A
  1. Alveolar volume
  2. Diffusing capacity of membrane
  3. Pulmonary capillary blood volume
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22
Q

What does low TLCO indicate?

A
  1. Thickening of alveolar-capillary membrane

2. Reduced lung volume

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23
Q

What does high TLCO indicate?

A
  1. Increased capillary blood volume

2. Pulmonary haemorrhage

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24
Q

What inhibits O2 transfer in ILD?

A

Thickening of alveolar layer

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25
Q

What is seen on CT chest in ILD?

A

Honeycombing

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26
Q

How can ILD be physiologically measured?

A
  1. Restricted FVC
  2. Reduced TLCO
  3. Hypoxia on exertion
  4. Reduction in exercise capacity
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27
Q

What is the histology of idiopathic pulmonary fibrosis (IPF)?

A
  1. Fibroblastic foci

2. Honeycombing and thickening of alveoli

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28
Q

What is the pathophysiology of IPF?

A
  1. Fibroblasts resistant to apoptosis
  2. Myofibroblasts proliferate and for fibroblastic foci
  3. Lower GE efficiency in lungs
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29
Q

What is the imaging for IPF?

A

High resolution CT - honeycombing, traction bronchi

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30
Q

What is the Rx for IPD?

A
  1. Pirfenidone

2. Nintedanib

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31
Q

What is the mechanism of action for pirfenidone?

A
  1. Inhibits TGF-B

2. Reduces apoptosis of myofibroblasts

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32
Q

What are the SE of pirfenidone?

A
  1. Photosensitivity

2. GI upset

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33
Q

What are the SE of nintedanib?

A
  1. GI upset

2. Diarrhoea

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34
Q

What type of reaction is hypersensitivity pneumonitis (HP)?

A

Type III hypersensitivity

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35
Q

Give 3 causes of HP

A
  1. Pets
  2. Mould
  3. Bird handler
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36
Q

What is the Dx for HP?

A
  1. Clinical Hx
  2. Precipitin IgG level
  3. Bronchoalveoalr lavage
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37
Q

What is the Rx for HP?

A
  1. Avoidance allergen

2. Steroids

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38
Q

What are the symptoms of systemic sclerosis?

A
  1. Tightness around mouth
  2. Calcinosis
  3. Loss of distal digits
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39
Q

What are the symptoms of cutaneous syndrome of CREST?

A
  1. Calcinosis
  2. Raynaud’s phenomenon
  3. Oesophageal dysmotility
  4. Sclerodactyly
  5. Telangiectasia
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40
Q

What is seen on scans for sarcoidosis?

A

Honeycombing at base and periphery of lung

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41
Q

What is the Rx for sarcoidosis?

A
  1. Immunosuppressants

2. Nintedanib

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42
Q

What is the palliative Rx for ILD?

A
  1. Opioids
  2. Benzodiazepine
  3. Supplementary O2
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43
Q

What are the symptoms of asthma?

A
  1. Cough
  2. SOB
  3. Wheezing
  4. Chest tightness
  5. Secretions
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44
Q

What is atopy?

A

Tendency to develop IgE mediated reactions to common aeroallergens

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45
Q

What are the types of asthma?

A
  1. Eosinophilic

2. Non-eosinophilic

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46
Q

Why does asthma have diurnal variation?

A

Natural dip in adrenaline levels

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47
Q

What are the provoking factors for asthma?

A
  1. Allergens
  2. Infections
  3. Menstrual cycle
  4. Exercise
  5. Cold air
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48
Q

How are asthma exacerbations assessed?

A
  1. A&E attendance
  2. GP
  3. Admissions
  4. ITU
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49
Q

What problems are associated with asthma?

A
  1. Eczema
  2. Hayfever
  3. Nasal disease
  4. Other allergies
  5. Reflux disease
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50
Q

What are the tests for asthma?

A
  1. Eosinophils, SPT, IgE
  2. CXR
  3. Skin prick tests
  4. LFTs
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51
Q

What is present on LFTs in asthma?

A
  1. Reduced FEV1
  2. Reduced FEV1/FVC ratio
  3. PEFR reductions
  4. Increased responsiveness to challenge
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52
Q

What is a marker of eosinophilic inflammation?

A

Exhaled nitric oxide

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53
Q

Who is at risk of asthma death?

A
  1. > 3 classes of Rx
  2. Recent admission
  3. Previous near fatal
  4. Brittle disease
  5. Psychosocial factors
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54
Q

What is the DDx for asthma?

A
  1. COPD
  2. Bronchiectasis
  3. Bronchial obstruction
  4. Aspiration
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55
Q

What drugs are available for asthma?

A
  1. Bronchodilators e.g. beta agonists
  2. Steroids
  3. Omalizumab
  4. Mepolizumab
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56
Q

What are some SE of oral steroids?

A
  1. Hoarse voice
  2. Oral candida
  3. Skin thinning
  4. Osteoporosis
  5. Adrenal suppression
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57
Q

What is the ladder of asthma Rx?

A
  1. Low dose steroids
  2. Long acting beta agonist
  3. Lacertine receptor antagonist
  4. Regular long term oral steroids
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58
Q

What is the Rx for non-eosinophilic asthma?

A
  1. Steroids
  2. Bronchodilator
  3. Bronchial thermoplasty
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59
Q

What is the initial management for acute asthma?

A
  1. High flow O2
  2. Emergency beta agonists
  3. Brief Hx
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60
Q

What classifies severe asthma?

A
  1. PEFR 33-50%
  2. RR >25
  3. HR >110
  4. Inability to complete sentences
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61
Q

What defines a life threatening asthma attack?

A

Normal CO2 in acute asthma

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62
Q

What is the Rx for severe asthma?

A
  1. O2
  2. Salbutamol nebuliser
  3. Prednisolone
  4. ABGs
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63
Q

What makes up lung immune defence?

A
  1. Commensal flora
  2. Swallowing
  3. Lung anatomy
  4. Innate and adaptive immunity
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64
Q

What is the DDx for pneumonia?

A
  1. HF
  2. PE
  3. Cancer
  4. TB
  5. ILD
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65
Q

Which groups are at risk of pneumonia?

A
  1. Elderly
  2. COPD
  3. Immunocompromised
  4. Nursing home residents
  5. DM
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66
Q

What is the pathophysiology of pneumonia?

A
  1. Bacteria translocate to sterile airway
  2. Overwhelm resident host defence
  3. Develop inflammatory response
  4. Neutrophils and inflammatory exudate fill alveolar space
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67
Q

What are the symptoms of pneumonia?

A
  1. Fever
  2. Cough
  3. Sputum
  4. SOB
  5. Pleuritic chest pain
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68
Q

What are the signs of pneumonia?

A
  1. Raised HR
  2. Raised RR
  3. Lung dull to percussion
  4. Decreased air entry
  5. Hypoxia
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69
Q

What are the Ix for pneumonia?

A
  1. CXR
  2. FBC
  3. Biochemistry (LFT, urea)
  4. CRP
  5. Pulse oximetry
  6. Microbiological tests
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70
Q

What can be seen on CXR in pneumonia?

A
  1. Air bronchogram
  2. Interstitial or diffuse shadowing
  3. Pleural collections
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71
Q

What are the signs of sepsis?

A
  1. Delirium
  2. Renal impairment
  3. High RR
  4. Lactic acid production
  5. BP drop
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72
Q

How is communist acquired pneumonia assessed?

A

CURB65

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73
Q

What does CURB65 mean?

A
  1. Confusion
  2. Urea >7 mmol/L
  3. RR > 30
  4. BP low
  5. 65+
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74
Q

What are the main pathogens to cause pneumonia?

A
  1. S. pneumoniae
  2. H. influenzae
  3. S. aureus
  4. Klebsiella pneumoniae
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75
Q

What Abx are used to treat S. pneumoniae?

A
  1. Amoxicillin
  2. Cefuroxime
  3. Cefotaxime
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76
Q

What is used to treat pneumonia with abnormal pathogens?

A
  1. Erythromycin
  2. Ciprofloxacin
  3. Doxycycline
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77
Q

What features are seen in mycoplasma pneumoniae?

A
  1. Haemolytic anaemia
  2. Raynaud’s
  3. Bullous myringitis
  4. Encephalitis
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78
Q

What are the extra-pulmonary features in Legionella pneumonia?

A
  1. Diarrhoea
  2. Abnormal LFTs
  3. Hyponatraemia
  4. Myalgia
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79
Q

Who is most at risk of Legionella pneumonia?

A
  1. Travellers
  2. Elderly
  3. Immunocompromised
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80
Q

What is the Ix for pneumonia?

A
  1. Sputum culture
  2. Serology
  3. Urinary antigen
  4. PCR
  5. Blood culture
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81
Q

What is the prevention for pneumonia?

A
  1. Vaccine against pneumococcal disease, influenza

2. Smoking cessation

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82
Q

What are the signs of empyema?

A
  1. Failure of fever to settle on Abx
  2. Pain on deep inspiration
  3. Signs of pleural collection
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83
Q

What is the Ix for parapneumonic effusion?

A

Thoracentesis

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84
Q

What is the Rx for empyema?

A
  1. Chest drainage

2. Co-amoxiclav

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85
Q

Which groups is lung abscess more common in?

A
  1. Aspiration
  2. Alcoholics
  3. Poor dentition
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86
Q

Who is at risk of hospital acquired pneumonia?

A
  1. Elderly
  2. Ventilator assisted
  3. Post-operative
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87
Q

What is the Dx for hospital acquired pneumonia?

A
  1. New infection
  2. Purulent secretions
  3. New radiological infiltrates
  4. New CRP increase
  5. Increased O2 requirements
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88
Q

What are the Abx for hospital acquired pneumonia?

A
  1. Piperacillin-tazobactam
  2. Linezolid or vancomycin
  3. Colistin
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89
Q

What causes most bronchiolitis?

A

Respiratory syncytial virus (RSV)

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90
Q

What is the pathophysiology of bronchiolitis?

A

Inflammation of bronchioles and mucus production cause airway obstruction

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91
Q

What are the symptoms of bronchitis?

A
  1. Cough
  2. Phlegm
  3. Breathlessness
  4. Wheeze
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92
Q

What is the pathophysiology of bronchitis?

A

Self-limited inflammation of epithelia of bronchi due to URI

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93
Q

What distinguishes chronic bronchitis?

A

COPD pt. with cough for at least 3 months in each of 2 successive years

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94
Q

What are the Ix for bronchitis?

A
  1. CXR normal
  2. Throat swabs
  3. Serology
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95
Q

Give 3 causes of upper respiratory tract infections (URI)

A
  1. Rhinovirus
  2. Influenza A virus
  3. Coronavirus
96
Q

What are the complications of URIs?

A
  1. Sinusitis
  2. Pharyngitis
  3. Otitis media
97
Q

What groups are at high risk of flu?

A
  1. Chronic respiratory condition
  2. Heart disease
  3. DM
  4. Renal disease
98
Q

What are the Rx for flu?

A
  1. Oseltamivir

2. Zanamivir

99
Q

What viruses commonly cause pharyngitis?

A
  1. Rhinovirus

2. Adenovirus

100
Q

What are the complications of bacterial pharyngitis?

A
  1. GABHS associated disease
  2. PSGN
  3. Scarlet fever
  4. Rheumatic disease
101
Q

What is the result of acute localised obstruction in lungs?

A
  1. Atelectasis
  2. Valve effect
  3. Pneumonia
102
Q

What are the main forms of chronic obstruction?

A
  1. Chronic bronchitis
  2. Asthma
  3. Bronchiectasis
103
Q

What are the signs of chronic bronchitis?

A
  1. Productive cough for 3 months over 2 years
  2. Mucus hypersecretion
  3. Respiratory bronchiolitis
104
Q

Who is most at risk of chronic bronchitis?

A

Middle aged heavy smokers

105
Q

What are the consequences of chronic bronchitis?

A
  1. Hypercapnia
  2. Hypoxaemia
  3. Cyanosis
  4. Right heart failure
106
Q

What is emphysema?

A

Enlargement of alveolar airspaces with destruction of elastin in walls

107
Q

What are the causes of emphysema?

A
  1. Smoking
  2. Alpha1 antitrypsin deficiency
  3. Coal dust
  4. Cadmium toxicity
108
Q

What are the clinical features of emphysema?

A
  1. Reduced PaCO2
  2. Normal PaO2
  3. Weight loss
  4. Right HF
  5. Overinflated chest
109
Q

What is bronchiectasis?

A

Permanent dilation of bronchi and bronchioles due to obstruction and severe inflammation

110
Q

What are the symptoms of bronchiectasis?

A
  1. Chronic cough

2. Foul-smelling sputum flecked with blood

111
Q

What is the pathophysiology of bronchiectasis?

A
  1. Dilation of bronchi and bronchioles
  2. Inflammation
  3. Fibrosis
112
Q

What are the complications of bronchiectasis?

A
  1. Pneumonia
  2. Asthma
  3. Metastatic abscesses
  4. Amyloid formation
113
Q

What are the causes of adult respiratory distress syndrome (ARDS)?

A
  1. Drugs and toxins
  2. Gastric aspiration
  3. Radiation pneumonitis
  4. Shock
  5. Diffuse intrapulmonary haemorrhage
114
Q

What are the signs of ARDS?

A
  1. Acute respiratory distress
  2. Tachypnoea
  3. Dyspnoea
  4. Pulmonary oedema
115
Q

What is the pathogenesis of ARDS?

A
  1. Massive insult to alveoli and capillaries
  2. Related O2 toxicity
  3. Polymorphs release enzymes and activate complement
116
Q

What is pneumoconiosis?

A

Lung disease caused by inhaled dust

117
Q

What is the pathophysiology of coal workers’ pneumoconiosis (CWP)?

A
  1. Coal dust ingested by macrophages

2. Aggregate around bronchioles

118
Q

What are the types of CWP?

A
  1. Anthracosis
  2. Macular CWP
  3. Nodular CWP
119
Q

What happens in progressive massive fibrosis?

A

Fusion of nodules creates a large zone of dense scarred and black lung

120
Q

What is extrinsic allergic alveolitis?

A

Type 3 hypersensitivity causing bronchiolitis, chronic inflammation and granulomas

121
Q

What are the common types of extrinsic allergic alveolitis?

A
  1. Bird fancier’s lung

2. Farmer’s lung

122
Q

What nodule type is seen on CWP?

A

Caplan’s nodules

123
Q

What is lymphangitis?

A

Process with diffuse permeation of lung by malignant cells

124
Q

What are the causes of lung cancer?

A
  1. Cigarettes
  2. Asbestos
  3. Radon
  4. Nickel
  5. Lung fibrosis
125
Q

What are the symptoms of lung cancer?

A
  1. Cough
  2. Recurrent chest infection
  3. Haemoptysis
  4. Increasing SOB
  5. Malaise
  6. Weight loss
126
Q

What are the majority of thoracic neoplasia?

A

Carcinoma

127
Q

What are the commonest primary lung cancers?

A
  1. Squamous cell carcinoma
  2. Adenocarcinoma
  3. Large cell undifferentiated carcinoma
  4. Small cell carcinoma
128
Q

Describe small cell lung carcinoma (SCLC)

A

High grade epithelial neoplasm with strong cigarette association

129
Q

What is the Rx for SCLC?

A

Chemotherapy

130
Q

Describe non-small cell lung carcinoma (NSCLC)

A

Variable grade epithelial neoplasm with cigarette smoking association

131
Q

What is the Rx for NSCLC?

A
  1. Chemotherapy
  2. Gene based chemo
  3. Surgery
  4. Radiotherapy
132
Q

What are the targets for new NSCLC drugs?

A
  1. EGFR
  2. ALK1
  3. ROS1
  4. PDL1
133
Q

What can cause lung nodules appear from cancer?

A
  1. TB
  2. Lymph nodes
  3. Hamartoma
134
Q

What are the main primary tumours affecting pleura?

A
  1. Pleural fibroma

2. Malignant mesothelioma

135
Q

What is the main cause of mesothelioma?

A

Asbestos

136
Q

What are the Rx for mesothelioma?

A
  1. Chemo
  2. Surgery
  3. Radiotherapy
137
Q

What happens during bronchoconstriction?

A
  1. Tightening airway smooth muscle
  2. Lumenal occlusion by mucus and plasma
  3. Airway wall thickening
138
Q

What is an example of a short acting beta agonist?

A

Salbutamol

139
Q

What is an example of a long acting beta agonist?

A

Formaterol

140
Q

Give examples of inhaled corticosteroids (ICS)

A
  1. Beclomethasone dipropionate
  2. Budesinide
  3. Ciclesonide
141
Q

How do ICS work?

A
  1. Suppress production of chemotactic mediators
  2. Reduce adhesion molecule expression
  3. Inhibit inflammatory cell survival
142
Q

What are the SE of ICS?

A
  1. Loss of bone density
  2. Adrenal suppression
  3. Cataracts
  4. Glaucoma
143
Q

What is the Rx of bronchiectasis?

A
  1. Abx
  2. Physical therapy
  3. Transplantation
144
Q

What is respiratory failure?

A

Inability of lungs to adequately oxygenate arterial blood supply +/- eliminate CO2 from venous supply

145
Q

What defines type 1 respiratory failure?

A

PaO2 <8kPa

146
Q

What defines type 2 respiratory failure?

A

PaCO2 >6kPa

147
Q

What are the causes of respiratory failure?

A
  1. Reduced FiO2
  2. VQ mismatch
  3. Increased shunt
  4. Diffusion impairment
  5. Alveolar hypoventilation
148
Q

What are the types of VQ mismatch?

A
  1. Shunt

2. Dead space

149
Q

What is dead space (increased VQ)?

A

Ventilation of under perfused alveoli

150
Q

What is shunt (reduced VQ)?

A

Perfusion of under ventilated alveoli

151
Q

What are the causes of diffusion impairment?

A
  1. Emphysema
  2. ILD
  3. Pulmonary oedema
152
Q

What are the signs of type 1 respiratory failure?

A
  1. Cyanosis
  2. Increased RR
  3. Accessory muscle use
  4. Tachycardia
  5. Confusion
153
Q

What is alveolar hypoventilation?

A

Alveolus poorly ventilated can’t remove CO2, levels rise and pass into arterial blood

154
Q

What are the causes of alveolar hypoventilation?

A
  1. COPD
  2. CF
  3. Obesity
  4. Sleep apnoea
  5. Drug OD
155
Q

What is the pathophysiology of obstructive sleep apnoea?

A

Relaxation of pharynx during sleep

156
Q

What are the signs of hypercapnia?

A
  1. Bounding pulse
  2. Flapping tremor
  3. Confusion
  4. Drowsiness
  5. Reduced consciousness
157
Q

What is the Rx of type 1 respiratory failure?

A
  1. Oxygen (94-98%)
  2. Treat underlying cause
  3. CPAP
158
Q

What is the Rx of type 2 respiratory failure?

A
  1. Oxygen (88-92%)
  2. Treat underlying cause
  3. Non-invasive ventilaiton
159
Q

What is the special stain for TB mycobacteria?

A

Ziehl-Neelsen stain for acid fast bacilli

160
Q

What are the risk factors for TB?

A
  1. Born in high prevalence area
  2. IVDU
  3. Homeless
  4. Alcoholic
  5. Prisons
161
Q

How is TB spread?

A

Aerosol

162
Q

What is the pathophysiology of TB?

A
  1. Bacilli and macrophages coalesce to form granuloma (primary focus)
  2. Mediastinal lymph nodes enlarge
  3. Mediastinal LN and primary focus join to make primary complex
  4. Granuloma grows into cavity full of bacilli
163
Q

What is the presentation of TB?

A
  1. Weight loss
  2. Night sweats
  3. Cough >3/52
  4. Chest pain
  5. Breathlessness
164
Q

What is the disease progression of TB?

A
  1. Primary infection
  2. Acute TB
  3. Latent TB
  4. Re-activation
165
Q

What are the types of extra pulmonary TB?

A
  1. Lymph node TB
  2. Miliary TB
  3. Bone TB
  4. Abdominal TB
166
Q

What is miliary TB?

A

Bacteria everywhere in body and cause tiny granulomas widespread

167
Q

How is active TB diagnosed?

A
  1. Prolonged inflammatory response
  2. CXR
  3. Microbiology
  4. Microscopy AFB, PCR, culture
  5. Biopsy
168
Q

How is latent TB diagnosed?

A

Tuberculin skin test Mantoux

169
Q

Which type of TB gives false negative to Mantoux test?

A

Miliary TB

170
Q

What can be used to test for M. tuberculosis in patients who had BCG vaccine?

A

Interferon gamma release assays

171
Q

What is the Rx for TB?

A
  1. Rifampicin
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol
172
Q

What drugs commonly interact with rifampicin?

A

OCP

173
Q

What are some side effects for TB drugs?

A
  1. Red urine
  2. Hepatitis
  3. Neuropathy
  4. Rash
174
Q

What are the risk factors for drug resistant TB?

A
  1. Previous Rx
  2. High risk area
  3. Contact of resistant TB
  4. Poor response to therapy
175
Q

What is the prevention for TB?

A
  1. Active case finding
  2. Detection and Rx of latent TB
  3. Vaccination
176
Q

What re the risk factors for latent TB?

A
  1. Recent infection
  2. New entrants
  3. HCPs
  4. Immunocompromised
177
Q

How is latent TB diagnosed?

A

Mantoux test or IGRA

178
Q

What is the Rx for latent TB?

A
  1. Isoniazid

2. Rifampicin + isoniazid

179
Q

What is COPD?

A

COPD is characterised by airflow obstruction, usually progressive, not fully reversible and doesn’t change markedly over several months

180
Q

What are the mechanisms underlying COPD?

A
  1. Airway inflammation
  2. Airway fibrosis
  3. Increased airway resistance
  4. Loss of alveolar attachments
  5. Decrease of elastic recoil
181
Q

Why do airways collapse during expiration in COPD?

A

Increased intrathoracic pressure

182
Q

What are the risk factors for COPD?

A
  1. Smoking
  2. Age
  3. Male
  4. Genetics
183
Q

What are the symptoms of COPD?

A
  1. Cough
  2. SOB
  3. Phlegm
  4. Wheeze
184
Q

What are the signs of COPD?

A
  1. Raised respiratory weight
  2. Hyperexpansion
  3. Barrel shaped chest
  4. Cyanosis
  5. Weight loss
185
Q

What does CAT tool assess?

A
  1. Cough
  2. Phlegm
  3. Chest tightness
  4. Breathlessness when using stairs
  5. Activity limitation at home
  6. Confidence leaving home
  7. Sleep
  8. Energy
186
Q

What is the DDx for COPD?

A
  1. HF
  2. PE
  3. Pneumonia
  4. Lung cancer
  5. Asthma
187
Q

What is the non-pharmacological Rx for COPD?

A
  1. Smoking cessation
  2. Exercise training programmes
  3. Pulmonary rehab programme
  4. Influenza and pneumococcal vaccine
188
Q

What are the pharmacological Rx for COPD?

A
  1. B2 agonist
  2. Anticholinergics e.g. tiotropium
  3. Theophylline
  4. ICS
  5. Oxygen therapy
  6. Ventilatory support (NIV)
189
Q

What surgeries can be used for COPD?

A
  1. Lung volume reduction surgery

2. Lung transplant

190
Q

What are the most common causes of COPD exacerbation?

A
  1. URI

2. Infection of tracheobronchial tree

191
Q

What is the Rx for COPD exacerbation?

A
  1. Short acting B2 agonist
  2. Abx
  3. Systemic corticosteroids
  4. Oxygen
192
Q

How are COPD exacerbations assessed?

A
  1. ABGs
  2. CXR
  3. ECG
  4. Bloods
  5. Purulent sputum
193
Q

Which COPD pt. should be given Abx?

A
  1. Increased dyspnoea
  2. Increased sputum volume
  3. Increased sputum purulence
  4. Mechanical ventilation
194
Q

What can cause occupational lung diseases?

A
  1. Dusts
  2. Mists
  3. Fumes
  4. Vapours
195
Q

What does response to a workplace exposure depend on?

A
  1. Physical and chemical nature of agent
  2. Duration and dose of exposure
  3. Individual susceptibility
196
Q

What conditions have a shorter latency?

A
  1. Occupational asthma

2. Pneumonitis

197
Q

What can cause occupational asthma?

A
  1. Spray paint
  2. Lab rats
  3. Metalwork
198
Q

What causes most occupational asthma?

A

Sensitisation to an agent inhaled at work

199
Q

What causes 10% of occupational asthma?

A

Massive accidental irritant exposure at work

200
Q

How does occupational asthma present?

A
  1. Latent period
  2. Deteriorating symptoms
  3. Gradual improvement
  4. Depression
201
Q

What causes occupational asthma?

A
  1. Wood
  2. Flour
  3. Metal working fluids
  4. Isocyanate paint
202
Q

What causes extrinsic allergic alveolitis?

A
  1. Moles
  2. Metalwork fluids
  3. Mushroom pickers
  4. Farmers lung
203
Q

What are the symptoms of extrinsic allergic alveolitis?

A
  1. Cough
  2. SOB
  3. Fever
  4. Flu like symptoms
204
Q

What is pneumoconiosis?

A

Lung disease caused by inhalation of mineral dust

205
Q

What are the types of pneumoconiosis?

A
  1. Asbestosis
  2. Coal worker’s pneumoconiosis
  3. Silicosis
206
Q

What is seen in asbestos related lung disease?

A
  1. Pleural disease
  2. Pulmonary fibrosis
  3. Cancer
207
Q

Describe pleural plaques

A

Layers of collagen, often calcified

208
Q

Describe diffuse pleural thickening

A
  1. Follows benign effusion
  2. Obliteration of costophrenic angle
  3. Lung expansion restricted by thickened pleura
209
Q

What is the presentation of asbestosis?

A
  1. Interstitial lung fibrosis
  2. Long latency
  3. Hx of heavy exposure
  4. Progressive breathlessness
210
Q

What is mesothelioma?

A

Rapidly progressive and incurable pleural cancer

211
Q

What are the symptoms of mesothelioma?

A
  1. Unexplained pleural effusion
  2. Progressive breathlessness
  3. Chest pain
  4. Weight loss
212
Q

What is the prevention of occupational lung disease?

A
  1. Risk assessment
  2. Prevent or minimise exposures to harmful substances
  3. Surveillance of workers
  4. Identify health problems early
213
Q

What is the pathophysiology of CF?

A
  1. Mucus secretions are stick and thick

2. Secretions block passageways in lungs and pancreas

214
Q

What gene is mutated in CF?

A

CFTR

215
Q

What are the symptoms of CF?

A
  1. Persistent cough with thick mucus
  2. Wheezing
  3. Exercise intolerance
  4. Foul-smelling greasy stools
  5. Poor weight gain
216
Q

What is the Dx for CF?

A
  1. Newborn screening (IRT level)
  2. Sweat test
  3. Genetic tests
217
Q

What is the Rx for CF?

A
  1. Trikafta
  2. Physiotherapy
  3. Dornase alfa
218
Q

What is the pathophysiology of pleural effusion?

A

Build up of excess fluid between layers of pleura

219
Q

What are the symptoms of pleural effusion?

A
  1. Chest pain
  2. Dry cough
  3. Fever
  4. SOB
  5. Difficulty breathing when lying down
220
Q

What is the Dx of pleural effusion?

A
  1. CXR
  2. CT chest
  3. USS chest
  4. Thoracentesis
221
Q

What is the Rx of pleural effusion?

A
  1. Chemo
  2. Therapeutic thoracentesis
  3. Tube thoracostomy
222
Q

What is the pathophysiology of pneumothorax?

A

Air leaks into space between lung and chest wall causing lung collapse

223
Q

What are the symptoms of pneumothorax?

A
  1. SOB
  2. Chest pain (unilateral)
  3. Sharp pain on inhalation
  4. Tachycardia
  5. Blue discolouration of lips
224
Q

What is the Dx of pneumothorax?

A
  1. CXR
  2. CT chest
  3. USS
225
Q

What is the Rx for pneumothorax?

A
  1. Needle aspiration
  2. Chest tube
  3. Pleurodesis
  4. Surgery
226
Q

What are the symptoms of pulmonary HT?

A
  1. SOB
  2. Fatigue
  3. Syncope
  4. Chest pain
  5. Peripheral oedema
227
Q

How is pulmonary HT diagnosed?

A
  1. Bloods
  2. CXR
  3. ECG
  4. Echocardiogram
  5. Right heart catheterisation
228
Q

What are the Rx for pulmonary HT?

A
  1. Epoprostenol
  2. Riociguat
  3. Sildenafil
229
Q

What is the pathophysiology of Goodpasture’s syndrome?

A

Autoantibodies to alpha-3 chain of type IV collagen

230
Q

What are the symptoms of Goodpasture’s syndrome?

A
  1. Reduced urine output
  2. Haemoptysis
  3. Oedema
231
Q

What are the Ix for Goodpasture’s syndrome?

A
  1. Renal function test
  2. Renal biopsy
  3. Anti-GBM antibody titre
  4. ANCA
232
Q

What is the Rx for Goodpasture’s syndrome?

A
  1. Cyclophosphamide
  2. Prednisone
  3. Plasmapheresis
233
Q

What is the pathophysiology of Wegener’s granulomatosis?

A

Inflammation in blood vessels, especially in respiratory tract and kidneys

234
Q

What are the symptoms of Wegener’s granulomatosis?

A
  1. Pus drainage with crusts from nose
  2. Cough with bloody phlegm
  3. SOB
  4. Fever
  5. Fatigue
235
Q

What is the Ix for Wegener’s granulomatosis?

A
  1. High CRP
  2. Anti-neutrophil cytoplasmic antibodies
  3. CXR
  4. Biopsy
236
Q

What is the Rx for Wegener’s granulomatosis?

A
  1. Prednisone
  2. Cyclophosphamide
  3. Rituximab
  4. Plasmapheresis

Phase 2a Medicine (15 decks)

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