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Medicine Term 2 > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

what is FEV1

A

Forced Expiratory Volume of air exiting the lung in the first second after taking a deep breath and blowing out

is usually about 70-80% of FVC
usually 3.5-4litres

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2
Q

what is FVC

A

Final Total amount or air expired
around 5 litres

(forced vital capacity)

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3
Q

what is the normal ratio FEV1 : FVC

A

Normal ratio FEV1 : FVC is 0.7 – 0.8

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4
Q

how do you carry find out FEV1 and FVC

A

spirometry

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5
Q

how else can obstructive lung diseases be demonstrated

A

Peak Expiratory Flow Rate (PEFR)

Normal 400 – 600 litres/min

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6
Q

what are the key features in Obstructive Lung Disease

A 
There is AIRFLOW LIMITATION
Peak Expiratory Flow Rate (PEFR) is reduced
FEV1 is REDUCED
FVC may be reduced
FEV1 is less than 70% of FVC
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7
Q

what are the most common obstructive airway diseases

A

CHRONIC BRONCHITIS
EMPHYSEMA
ASTHMA

COPD - chronic obstructive pulmonary disease

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8
Q

what is the aetiology of COPD

A

smoking
atmospheric - pollution
occuaption - dust
age

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9
Q

what is Chronic Bronchitis defined CLINICALLY as

A

Cough productive of sputum most days

in at least 3 consecutive months for 2 or more consecutive years

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10
Q

Complicated chronic bronchitis when sputum turns mucopurulent (acute infective exacerbation) or FEV1 falls

A

gg

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11
Q

what are morphological changes in chronic bronchitis in large airways

A

Mucous gland hyperplasia
Goblet cell hyperplasia (increase)
Inflammation and fibrosis is a minor component

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12
Q

what are morphological changes in chronic bronchitis in small airways

A

Goblet cells appear (produce muscous)

Inflammation and fibrosis in long standing disease

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13
Q

what is emphysema

A

Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising either from dilatation or from destruction of their walls and without obvious fibrosis.

alveoli are damaged. inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones

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14
Q

what is the acinus

A

everything distal from the terminal bronchi (respiratory zone)

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15
Q

what is centriacinar emphysema

A

in upper part of lungs
alveoli are damaged, increased spaces in lungs
just after terminal bronchi

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16
Q

what is pan-acinar emphysema

A

large areas of lung lost in lower parts of lung

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17
Q

what is peri-acinar emphysema

A

tissue lost around edges of acinus, next to pleura usually

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18
Q

whats a bulla

A

is an emphysematous space greater than 1cm

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19
Q

what does the term ‘bleb’ mean

A

air containing spaces just underneath

the pleura

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20
Q

what is the protease-antiprotease imbalance and what induces it

A

smoking induces

elastase (protease) from neutrophils + macrophages
anti-elastase, protect elastin framework in alveolar tissue as prevent build of elastase

if alpha 1 trypsin deficiency, no anti-elastase, build of elastase = tissue destruction = emphysema

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21
Q

In EMPHYSEMA LOSS OF ALVEOLAR ATTACHMENTS, mechanism of airway obstruction, cant hold alveoli open

A

hhh bb

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22
Q

what force holds alveoli open

A

radial force

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23
Q

why do you get hypoxaemia in COPD

A
  • airway obstruction
  • reduced respiratory drive
  • loss of alveolar surface area
  • shunt
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24
Q

what pulmonary vascular changes occur in hypoxia

A

pulmonary arteriolar vasoconstriction

protective mechanism
Dont send blood to alveoli short of oxygen!

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25
Q

what can happen to the heart if there is chronic hypoxia in the lungs

A

Hypertrophy of the Right Ventricle
Cor Pulomale - right sided heart failure
due to inc pressure in right ventricle

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26
Q

what are distinct features of asthma

A

wheeze
variability
respond to treatment

No wheeze = No asthma!
its reversible

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27
Q

what is asthma

A

chronic
wheeze, cough, SOB
difficulty on expiration

increased reactivity of the trachea and bronchi to various stimuli - inc airway reactivity
narrowing of airways (smooth muscles constrict)
inflammation
airflow obstruction

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28
Q

what causes asthma

A

Genes
ADAM33, ORMDL3
Interact with environment
Epigenetics

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29
Q

how can an allergy cause asthma

A

epithelial abnormality
allergen gets through
fuels eczema/asthma

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30
Q

how can you diagnose asthma in children

A

all in history taking

examination unhelpful
no diagnostic test for children

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31
Q

what are the NICE guidelines for diagnosing asthma in children

A

Spirometry
BDR (broncho dilator response)
FeNO (nitric oxide)
Peak flow

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32
Q

at what age is uncertainty greatest for asthma diagnosis

A

under 5 year olds

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33
Q

asthma - SoB at rest
<30% lung function

  • dry cough
A

fdfd

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34
Q

what asthma treatment would you give to children

A

ICS for 2 months (inhaled corticosteroids) brown inhalor

if QoL affected

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35
Q

in under 18months it is mostly infection not asthma but could be if it points to it

A

fff

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36
Q

what are the goals of asthma treatment

A

“minimal” symptoms during day and night
minimal need for reliever medication
no attacks (exacerbations)
no limitation of physical activity

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37
Q

what questions can you ask to work out the lung function of children for asthma

A 
SANE
Short acting beta agonist/week (blue inhaler) 
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week
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38
Q

what are the classes of medication for asthma

A 
Short acting beta agonist (blue)
Inhaled corticosteroids (ICS) (brown)

add ons:
long acting beta agonists (LABA)
leukotriene receptor antagonist (LTRA)

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39
Q

what is the max dose of ICS in under 12 year olds

A

800 microg

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40
Q

what is an adverse effect of Inhaled corticosteroids

A

Height suppression 0.5-1cm

oral thrush

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41
Q

what do you have to use long acting beta agonist with

A

must use with ICS

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42
Q

what add ons do you use to ICS in children

A

long acting beta agonists (LABA)
leukotriene receptor antagonist (LTRA)

inc ICS dose

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43
Q

in under 5s what is the first line preventer for asthma

A

leukotriene receptor antagonist (LTRA)

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44
Q

what are the 2 types of delivery systems for asthma

A

MDI/spacer - shake and wash (reduce static)
around 20% lung deposition w spacer
Dry powder device 20% deposition (for 8-11yr olds) girls

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45
Q

nebulisers for asthma not that great

A

ff

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46
Q

what other management can be done to reduce asthma

A

Stop tobacco smoke exposure
Remove environmental triggers
Cat, Dog

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47
Q

what does asthma treatment depend on

A

Respiratory rate
Work of breathing
Oxygen saturations

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48
Q

for acute asthma what treatment would you use, for light symptoms

A

SABA via spacer, is a bronchodilator

oral prednisolone

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49
Q

for acute asthma what treatment would you use, for moderate symptoms

A

SABA via nebuliser + oral prednisolone

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50
Q

whats an effect of SABA

A

can give palpitations

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51
Q

for acute asthma what treatment would you use, for severe symptoms

A 
IV salbutamol
IV magnesium (nebuliser)
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52
Q

what is the pathophysiology of asthma

A

increased airway reactivity
narrowing of airways

walls become thickened and inflamed

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53
Q

what are the risk factors for asthma

A

-hereditary
atopy - predisposition to develop immunoglobulin E (IgE) in response to allergens

  • smoking
  • occupation
  • obesity
  • diet
  • reduced exposure to microbes
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54
Q

in adults how would you diagnose asthma

A

present w symptoms
look at history
clinical examination

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55
Q

what are the symptoms of asthma

A

Wheeze
Shortness of breath (dyspnoea)
Chest tightness
Cough, paroxysmal, usually dry

are variable symptoms

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56
Q

what do you look for in clinical examination in asthma

A

Breathless on exertion
Hyperinflated chest
Wheeze

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57
Q

what could it be instead of asthma that has wheeze, cough, chest tightness

A

COPD
bronchiectasis
cystic fibrosis
tumour

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58
Q

what investigations would you do for asthma

A

Spirometry
Peak Flow tests

Full pulmonary function testing, excludes COPD/emphysema
Check response to bronchodilator, reversibility
Response to oral corticosteroids , reversibility

chest x-ray
skin prick testing
total and specific IgE
full blood count

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59
Q

what objective assessment can you do to assess acute asthma

A 
Ability to speak
Heart rate
Respiratory rate
PEF
Oxygen saturation / Arterial blood gases
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60
Q

what are the features of moderate asthma

A

Able to speak, complete sentences
HR < 110
RR < 25
PEF 50 - 75% predicted or best

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61
Q

what are the features of severe asthma

A

Inability to complete sentences in one breath
HR ≥110
RR ≥25
PEF 33 - 50% predicted or best

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62
Q

what are the features of life threatening asthma

A 
Grunting
Impaired consciousness, confusion, exhaustion
Bradycardia/ arrhythmia/ hypotension
PEF < 33% predicted or best
Cyanosis
Silent chest
Poor respiratory effort

PaO2 < 8kPa (60mmhg)

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63
Q

what are the features of fatal asthma

A

Raised PaCO2

Need for mechanical ventilation

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64
Q

what are the features of complete control of asthma

A 
no daytime symptoms 
no night time wakening 
no need for rescue medication 
no asthma attacks 
no limitations on activity including exercise 
normal lung function
minimal side effects from medication.
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65
Q

what is some non pharmacological management of asthma

A 
Patient Education and Self management plans
Exercise
Smoking cessation
Weight management
Flu vaccinations
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66
Q

what are the benefits of inhalers

A

Small dose of drugs
Delivery directly to the target organ (airways and lung)
Onset of effect is faster
Minimal systemic exposure

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67
Q

what are some reliever drugs for asthma in adults, symptom control

A

Short acting β2 agonists (SABA)

e.g. salbutamol

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68
Q

whats pharmacological treatment is there for asthma in adults

A

Inhaled therapy

Oral therapy

Specialist treatments

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69
Q

what inhaled therapy would you start with for asthma

A

inhaled coritcosteroids
increase dose
long acting beta agonists

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70
Q

what oral therapy is there for asthma

A

Leukotriene Receptor Antagonist

Theophylline

Prednisolone

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71
Q

what specialist treatment is there for asthma

A

Omalizumab (Anti- IgE)

Mepolizumab (Anti-Interleukin-5)

Bronchial thermoplasty

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72
Q

what would you do for someone having a mild/moderate asthma attack

A

increase inhaler use
oral steroid
treat trigger

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73
Q

what would you do for moderate/severe asthma in the hospital

A

Nebulisers - Salbutamol/Ipratropium
Oral/IV Steroid
Aminophylline

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74
Q

what are the two types of inhaler

A

dry powder inhalers

metered dose inhalers w spacer

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75
Q

what is COPD

A

chronic obstruction of lung airflow that interferes with normal breathing
is not fully reversible.

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76
Q

what is the pathophysiology of COPD

A

chronic inflammation causes structural changes

-narrowing of small airways
- destruction of lung parenchyma
- loss of alveolar attachment, decrease lung elastic recoil
decrease ability of airways to remain open during expiration

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77
Q

what is the main cause of COPD

A

smoking
pollutants
inc age

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78
Q

what is alpha-1 antitrypsin defiiceny

A

inherited disease
protease inhibitor made in the liver, limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke

When absent/low -> alveolar damage and emphysema

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79
Q

what are symptoms of COPD

A 
Cough
Breathlessness
Sputum
Frequent chest infections
Wheezing
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80
Q

what may you find on clinical examination for COPD

A 
cyanosis 
raised JVP
wheeze
hyperinflated chest 
use of accessory muscles to breath 
peripheral oedema
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81
Q

what test can you do to see if its COPD

A

spirometry

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82
Q

what criteria’s must you meet to diagnose COPD

A

Typical symptoms
>35 years
Presence of risk factor (smoking or occupational exposure)
Absence of clinical features of asthma
Airflow obstruction confirmed by post-bronchodilator spirometry

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83
Q

what would the FEV1/FVC be for COPD

A

FEV1/FVC <0.7 post bronchodilator

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84
Q

what would FEV1 be in mild copd

A

FEV1 80% of predicted value or higher

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85
Q

what would FEV1 be in moderate copd

A

FEV1 50–79% of predicted value

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86
Q

what would FEV1 be in severe copd

A

FEV1 30–49% of predicted value.

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87
Q

what would FEV1 be in very severe copd

A

FEV1 less than 30% of predicted valu

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88
Q

what investigation can you do to exclude other pathologies in copd

A

Chest X-ray

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89
Q

how can you ensure its COPD and not a differential diagnosis

A

pulmonary function tests, inc residual volume

radiology, CT

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90
Q

what is an exacerbation

A

Worsening of symptoms

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91
Q

what are exacerbations of COPD

A 
SOB					
Wheeze					
Chest tightness				
Cough					
Sputum – purulence / volume
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92
Q

what are severe exacerbations of COPD

A 
Breathless (RR>25/min) 			
Accessory muscle use at rest			
Purse lip breathing				Fluid retention
Cyanosis (Sats <92% o/a)
confusion
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93
Q

what investigations would you do for acute exacerbation of COPD in 2ndry care

A

CXR, blood gases, FBC, U&E, sputum culture, VT

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94
Q

what is type 1 respiratory failure

A

dec pO2

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95
Q

what is type 2 respiratory failure

A

dec pO2 and inc pCO2 (reduced sensitivity to pCO2 - hypoxic drive)

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96
Q

in emphysema what happens to V/Q relationship

A

reduced V/Q matched

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97
Q

what is cor pulmonale, what does it look like on ecg

A

right sided heart failure due to lungs

T wave inversion V1-V4

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98
Q

what is secondary polycythaemia

A

Body produces ↑ erythropoietin in response to low O2
↑ Haemoglobin, ↑ Haematocrit
↑ bloody viscosity

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99
Q

what is the overall effect of alveolar hypoxia

A

compensatory vasoconstriction, shunt blood flow to healthy alveoli
Back pressure leading to Pulmonary arterial hypertension + RH failure
RV enlarges, reduces the LV function,
reduced circulating volume – activates kidneys Renin-aldosterone-angiotensin system – fluid retention

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100
Q

what are some Non- Pharmacological

Managements for COPD

A 
Smoking Cessation
• Vaccinations – Flu and Pneumococcal vaccine
• Pulmonary Rehabilitation
• Nutritional assessment
• Psychological support
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101
Q

what are inhaled therapies for COPD

A

Short acting Bronchodilators
– SABA (eg- Salbutamol)
– SAMA (eg- Ipratropium)

Long acting bronchodilator
- LAMA (Long acting anti – muscarinic agents)
– LABA (Long acting B
2 agonist, eg- Salmeterol)

high dose inhaled corticosteroids (ICS) and LABA

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102
Q

what would you give to a patient with COPD with exacerbations

A

SABA and LAMA

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103
Q

when would you give someoone with COPD long term oxygen

A

when PaO2 <7.3kPa

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104
Q

what primary care management would you do for COPD

A

SABA
steroids - prednisolone
antibiotics
hospital admission if unwell

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105
Q

what investigations would you do for someone amditted into hospital for COPD

A 
FBC
biochemistry + glucose
arterial blood gas
electrocardiograph
CXR
blood cultures
sputum microscopy
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106
Q

in the ward how would you treat a patient w COPD

A 
Oxygen- target Saturation
88-92%
• Nebulised bronchodilators
• Corticosteroids
• Antibiotics (Oral Vs IV)
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107
Q

what are some palliative car e methods for COPD patients

A
  • Management of Breathlessness and Dysfunctional
    breathing
  • Anticipatory Care Plan
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108
Q

what is acute epiglottis, what causes it

A

URTI
Haemophilus influenzae
Group A beta-haemolytic Streptococci

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109
Q

what are some respiratory Tract Defence Mechanisms

A

Macrophage-mucociliary escalator system
General immune system
Respiratory tract secretions
Upper respiratory tract as a ‘filter’

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110
Q

what is the macrophage-mucociliary escalator syste

A

alveolar macrophages, towards ciliated airways
mucociliary escalator
cough reflex

keeps lower resp tract sterile

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111
Q

what aetiological classification of Pneumonia are there

A

Community Acquired Pneumonia
Hospital Acquired (Nosocomial) Pneumonia
Pneumonia in the Immunocompromised
etc

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112
Q

what are the patterns of pneumonia

A

Bronchopneumonia
Segmental, part of lobe
Lobar

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113
Q

whats bronchopneumonia

A

multifocal, both lungs

infect in small airways -> alveoli -> pus from inflammation -> fill airspaces

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114
Q

what are the outcomes of pneumonia

A

resolve
pleural Effusion and Empyema
lung abscess
bronchiectasis

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115
Q

what circumstances may cause a lung abscess

A

obstructed bronchus - tumour
food aspiration
partic organism - staph aureus, pneumococci

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116
Q

what is bronchiectasis

A

Pathological dilatation of bronchi due to

  • Severe Infective Episode
  • Recurrent Infections
  • Proximal Bronchial Obstruction

dilate to inappropriate size, fill up w mucus and become infected

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117
Q

what are the symptoms of bronchiectasis

A

COUGH, ABUNDANT PURULENT FOUL SPUTUM, haemoptysis, signs of chronic infection
Coarse crackles, clubbing

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118
Q

how may you get aspiration pneumonia

A

Vomiting
Oesophageal Lesion
sedation

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119
Q

what are opportunist infections

A

Infection by organisms not normally capable of producing disease in patients with intact lung defences - opportunistic pathogens

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120
Q

where can you get URTI

A

note, mouth, pharynx, larynx, epiglottis

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121
Q

what is otitis media

A

infection in ear, red
ear ache, self limiting
primary viral infection
2ndry pneumococcus

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122
Q

how do you treat tonsilitis

A

Either nothing or 10 days penicillin

Don’t give amoxycillin

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123
Q

what can you use to treat otitis media

A

analgesia (relieve pain)

antibiotics may work

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124
Q

what are self-limiting infections

A

can resolve without any treatment

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125
Q

what causes croup and what are the symptoms

A

Para’flu I

stridor, hoarse voice, “barking” cough

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126
Q

what cause epiglottitis

A

H. influenzae Type B

Stridor, drooling

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127
Q

what can treat croup

A

Oral dexamethasone

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128
Q

what can treat epiglottitis

A

Intubation and antibiotics

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129
Q

what are common infective agents

A

bacterial - Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,

viral - RSV, parainfluenza III, influenza

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130
Q

how do you assess patient with LTRI

A

check oxygenation, hydration, nutrition

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131
Q

what is tracheitis and what can u use to treat

A

swollen tracheal wall, narrowed lumen and lumen debris

staph or strep invasive infection

augmentin - antibiotic

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132
Q

what is bronchitis

A

Endobronchial infection
Loose rattly cough with URTIChest free of wheeze/creps
Haemophilus/Pneumococcus
Mostly self-limiting

may have disturbed mucociliary clearance - so secretions pool in airways

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133
Q

whats bronchiolitis

A 
LRTI of infants in <12 months
one off, not recurrent 
RSV - Respiratory syncytial virus
crackles +/- wheeze 
Nasal stuffiness, tachypnoea, poor feeding
rarely fever >38
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134
Q

how do you manage bronchiolitis in infants

A

Maximal observation

Minimal intervention

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135
Q

what investigations do you do for bronchiolitis

A 
nasopharyngeal aspirin (NPA)
oxygen saturations
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136
Q

what medications do not work for bronchiolitis

A 
salbutamol 
Ipratropium bromide
Adrenalin
Steroids
Antibiotics
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137
Q

what are LTRI characterized by

A

48 hrs, fever (>38.5oC), SOB, cough, grunting
wheeze make bacterial cause unlikely
Reduced or bronchial breath sounds

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138
Q

what are the key feautres of pneumonia

A

Signs are focal, ie in one area (LLZ)
Creps
High fever

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139
Q

what is the management of pneumonia

A

Nothing if symptoms are mild
Oral Amoxycillin first line
Oral Macrolide second choice
Only for iv if vomiting

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140
Q

what is pertussis

A

whooping cough
vaccination reduces risk and severity
vomiting and colour change

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141
Q

whats empyeama

A

Complication of pneumonia
Extension of infection into pleural space, pus
Chest pain and very unwell
Antibiotics+/- drainage

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142
Q

what is acute bronchitis

A

Inflammation of bronchi
Temporary <3 weeks
Cough and sputum
Usually viral

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143
Q

what are some copd exacerbations

A 
Change in colour of sputum
Fevers
Increased breathlessness
Wheeze
Cough
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144
Q

how would you treat exacerbations of COPD

A 
Steroids
Antibiotics - amoxicillin
		- doxycycline
		- co-trimoxazole
		- clarithromycin
\+/- nebulisers
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145
Q

what is pneumonia

A

Inflammation of lung parenchyma

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146
Q

what is lung consolidation

A

solidification due to cellular exudate in alveoli leads to impaired gas exchange

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147
Q

what are risk factors of pneumonia

A 
Smoking, alcohol XS
Extremes of age
Preceding viral illness
Pre-existing lung disease
Chronic illness
Immunocompromised
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148
Q

what are signs of pneumonia

A 
Tachypnoea
Tachycardia
Reduced expansion
Dull percussion
Bronchial breathing
Crepitations
Vocal resonance inc
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149
Q

what are symptoms of pneumonia

A

Fever, rigors, myalgia
Cough and sputum
Chest pain (pleuritic)
Dyspnoea

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150
Q

what colour of sputum does streptococcus pneumoniae have

A

rusty brown sputum

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151
Q

when does mycoplasma pneumoniae occur

A

occurs in 4-5 year cycles epidemics

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152
Q

what bacteria causes pneumonia from alcoholism

A

klebsiella pneumoniae

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153
Q

what pathogen cause LRTI in COPD

A

moraxella catarrhalis

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154
Q

what investigations would you carry out for pneumonia in the community

A

maybe none

CXR

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155
Q

what investigations would you carry out for pneumonia in the hospital

A 
Bloods – serum biochemistry, FBC, CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen
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156
Q

what is the main microorganism responsible for pneumonia

A

Streptococcus Pneumoniae

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157
Q

what microorganisms are typically communtiy aqquired for pneumonia

A

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae

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158
Q

what microorganisms are typically nosocomial aqquired for pneumonia

A

Enterobacteria
Staphylococcus aureus
Pseudomonas aerigunosa
Klebsiella pneumoniae

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159
Q

what is pneumonia severity score

A 
CURB 65
confusion
blood urea >7
respiratory rate >30/min
systol BP <90 dias <60
age >65
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160
Q

what does a CURB 65 score of 0-1 mean

A

low risk - could be treated in community

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161
Q

what does a CURB 65 score of 2 mean

A

moderate risk - hospital treatment usually required

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162
Q

what does a CURB 65 score of 3-5 mean

A

high risk of death and need for ITU

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163
Q

how do you treat curb score 0-1

A

Amoxicillin

penicillin allergy - Clarithromycin or doxycycline

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164
Q

how do you treat curb score 2

A

Amoxicillin + clarithromycin (atypicals)

penicillin allergy - Levofloxacin

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165
Q

how do you treat curb score 3-5

A

Co-amoxiclav + clarithromycin (atypicals
penicillin allergy - Levofloxacin or
co-trimoxazole

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166
Q

what supportive management would you give for pneumonia

A

Oxygen, fluids (IV or oral)
Antipyretics, NSAIDs
intubation and ventilation

167
Q

what are the causes of bronchiectasis

A 
Idiopathic
Childhood infection
CF
Ciliary dyskinesia
Hypogammaglobulinaemia
Allergic Broncho-Pulmonary Aspergillosis
168
Q

what are signs of bronchiectasis

A 
Chronic productive cough
Breathlessness
Recurrent LRTI
Haemoptysis
Finger clubbing
Crepitations (coarse)
Wheeze
169
Q

what is bronchiectasis

A

dilated distal bronchi, sputum in thickened inflammed airways

170
Q

what microorganism is it likely to be in lung abscess

A

Staph aureus, pseudomonas, anaerobes

171
Q

what is an endemic

A

the constant presence and/or usual
prevalence of a disease or infectious
agent in a population within a
geographic area

172
Q

what is an epidemic

A

an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.

173
Q

what is an outbreak

A

carries the same definition of
epidemic, but is often used for a
more limited geographic area

174
Q

what i a pandemic

A

an epidemic that has spread over
several countries or continents,
usually affecting a large number of
people

175
Q

what is corona virus

A

• ‘Crown like’ Spikes on surfaces
• Enveloped, RNA based
• Zoonotic
beta coronavirus

176
Q

what proteins are on the viral envelop of COVID

A

– Spike proteins
– Envelope Proteins
– Membrane proteins

177
Q

how does covid replicate

A

virus enters host cell
releases genome
replicates genome and is assembled

178
Q

how is covid transmitted

A

cough, sneeze, touch

179
Q

what is the reproduction number

A

The number of people acquiring infection from an infected individual

180
Q

what is the pathophysiology of covid, what r the phases

A

viral entry and early infection in lungs
host immune response - immune cells and clearance (macrophages and dendritic cells -> cytotoxic T cells)
hyperinflammatory phase - cytokine storm
multiorgan dysfunction

181
Q

what are symptoms of covid

A

Rhinorrhoea, General
Malaise, Headache,
Sore Throat, Cough, Fever
x-ray - white patches, alveoli inflammed

182
Q

how can you prevent covid

A 
Hand washing
Social Distancing
Mask Wearing
Isolation
Vaccines
183
Q

what are the types of mRNA vaccine for covid

A

Pfizer, moderna

184
Q

what attenuated virus vaccine is there for covid

A

AstraZeneca

185
Q

what is herd immunity

A

prevention

if most people are vaccinated, virus will stay contained

186
Q

what are treatments for covid

A

antipyretics
steroids
supportive therapy
clinical trials

187
Q

what is the oxygen flow and concentration in nasal cannula

A

1-6 litres

25-50%

188
Q

what is the oxygen flow and concentration in simple face mask

A

5-10 L

40-60%

189
Q

what is the oxygen flow and concentration in reservoir mask

A

15 L

60-90%

190
Q

what is the oxygen flow and concentration in CPAP

A

15L

100%

191
Q

what is the oxygen flow and concentration in nasal high flow oxygen

A

up to 70L

100%

192
Q

what is the oxygen flow and concentration in venturi mask , for type 2 resp failure

A

2-15L

24-60%

193
Q

what is the oxygen flow and concentration in non-invasive ventilation

A

0-15 L

194
Q

who are vulnerable groups for TB

A
  • From high prevalence countries
    • 70% are non-UK born, most aged between 15 and 44
    • HIV positive, Immunosuppressed
    • Elderly, Neonates, Diabetics
  • Homeless, Alcohol dependency, IV drug users
195
Q

what is mycobacteria

A

ubiquitous in the soil, water
few species cause TB, non-TB mycobacteria, leprosy

• Non-motile bacillus, very slowly growing
• Aerobic
- a very thick fatty cell wall (resistant)

196
Q

how is TB spread

A

airborne
TB bacteria in aerosol droplets in air
requires prolonged close contact
not by shaking hands etc

197
Q

how is mycobacteria eliminated outdoor

A

by UV radiation and dilution

198
Q

how can mycobacterium bovis be transmitted

A

consumption of unpasteurized infected cows’ milk

199
Q

what is the immune response to TB in alveoli

A
  1. Activated macrophages > epithelioid cells > Langhan’s giant cells
  2. Accumulation of those cells -> GRANULOMA
  3. Central caseating necrosis (after progression)
200
Q

TB primary infection
Mycobacteria spread via lymphatics to draining hilar lymph nodes
Usually no symptoms, can be fever, malaise. Erythema nodosum, rarely chest signs

A

tg

201
Q

what is the primary complex of TB and ghon focus + complex

A

Initial lesion + local lymph node

heals with/without scar, may calcify

202
Q

what are the outcomes of primary infection of TB

A

progressive disease
contained latent
cleared cured

203
Q

what can primary infection of TB progress to

A

Tuberculous bronchopneumonia
cavitation
Enlarged hilar lymph compress bronchi, lobar collapse
Enlarged lymph node discharges into bronchus

204
Q

what can miliary TB progress to

A

hematogenous spread of bacteria to multiple organs

205
Q

what is post primary disease of TB

A

1) TB in dormant stage w low/no replication over prolonged periods of time
2) balance of replication + destruction by immune mechanisms

206
Q

what are the presentations of TB

A

cough
fever
sweats (night)
weight loss

207
Q

how do you diagnose active TB

A

CXR

apices soft, fluffy

208
Q

how do you diagnose active pulmonary TB

A

CXR
Mediastinal lymphadenopathy
• Pleural effusion
• Miliary

209
Q

how do you sample TB microorganism

A

sputum sample
bronchoscopy with BAL
endobronchial US w biopsy
lumbar puncture in CNS TB

210
Q

what is the clinical management of TB

A

Isoniazid (H)
Pyrazinamide (Z)
Rifampicin (R)
Ethambutol (E)

multi drug therapy essential

211
Q

what are the side effect of Isoniazid (H)

A

can cause polyneuropathy
Vitamin B6 to prevent
hepatitis

212
Q

what are the side effect of Rifampicin (R)

A

reduce effectiveness of oral contraceptive pill
hepatitis
induces liver enzymes

213
Q

what are the side effect of Ethambutol (E)

A

vision monitored can cause optic neuritis

214
Q

what is the standard treatment for TB

A

2 R/H/Z/E + 4 R/H

215
Q

what are the side effect of Pyrazinamide (Z)

A

Hepatitis

Gout

216
Q

what is the treatment of latent TB

A

Rifampicin & Isoniazid for three months, or
• Isoniazid/rifampicin only for six months, or
• Rifapentine & Isoniazide once weekly for 12 weeks

217
Q

lung cancer is most common cause of cancer related death

A

ggd

218
Q

what is the aetiology for lung cancer

A 
TOBACCO
Asbestos 
Environmental radon 
Air pollution and Urban environment
Other radiation
Pulmonary fibrosis
219
Q

how does smoking affect risk of lung cancer in m and f

A

males - inc 22times
f - 12times

f more susceptible

220
Q

what are 2 main pathways of carcinogenesis in the lung

A

In the lung periphery -> adenocarcinoma

in central lung airways -> squamous cell carcinoma

221
Q

what are non-small cell carcinomas

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinomas
Others

222
Q

primary lung cancer, grow clinically silent for years, v few signs/symptoms

A

gg

223
Q

what are local effects of lung cancer

A 
Bronchial Obstruction : 
Collapse						      	      	       
Endogenous Lipoid Pneumonia
Infection / Abscess						
Bronchiectasis

pleural - inflammatory, malignant

direct invasion - chest wall

lymph node metastases

224
Q

what effect can you get if lung cancer invades phrenic nerve

A

diaphragmatic paralysis

225
Q

what effect can you get if lung cancer invades Recurrent laryngeal nerve

A

Hoarse, Bovine cough

226
Q

what effect can you get if lung cancer invades Brachial plexus

A

Pancoast T1 damage

227
Q

what effect can you get if lung cancer invades Cervical Sympathetic

A

Horner’s syndrome

228
Q

where can lung cancer metastases to distantly

A

Liver, Adrenals, Bone, Brain, Skin

229
Q

what are some non-metastatic effects of lung cancer

A

Finger clubbing and
Hypertrophic Pulmonary
Osteoarthropathy

230
Q

what investigations would you do for lung cancer

A

Chest X-Ray

Sputum Cytology rarely used
Bronchoscopy
Pleural effusion cytology and Biopsy
CT, MRI, PET

231
Q

what is the 5 year survival of non-small cell carcinoma

A

Anywhere between 10-25%

232
Q

what is the 5 year survival rate of small cell carcinoma

A

4%

Median survival 9 months

233
Q

what biomarkers can be used for predictive therapy in adenocarcinomas

A

EGFR, KRAS, HER2, BRAF mutations,

ALK translocations, ROS1 translocations etc

234
Q

what are the symptoms of lung cancer

A 
chronic coughing > 3 weeks
coughing blood
wheeze
chest +bone pain
SOB
weight loss
nail clubbing
235
Q

what are the symptoms of metastatic lung cancer

A

• Bone pain

• Spinal cord compression
– Limb weakness

Cerebral metastases
– Headache

• Thrombosis

236
Q

what are the symptoms of paraneoplastic lung cancer

A

Hyponatraemia
Anaemia
Hypercalcaemia

237
Q

what are the clinical signs of lung cancer

A 
- Chest signs
• Clubbing
• Lymphadenopathy
• Horner’s syndrome
• Pancoast tumour
• Superior vena cava
obstruction
• Lymphadenopathy
238
Q

what investigations would you do for lung cancer at the GP

A 
CXR
• FBC
• Renal, Liver functions
and Calcium
• Clotting screen
• Spirometry
239
Q

what investigation would you use to stage lung cancer

A

CT of thorax + abdomen

PET scan

240
Q

what investigations for lung cancer for tissue diagnosis

A 
- Bronchoscopy
• EBUS endobronchial US
• Image guided lung biopsy
• Image guided liver biopsy
• Excision of cerebral
metastasis!
• Bone biopsy
• Mediastinoscopy/otomy
• Surgical excision biopsy
241
Q

what do you use for staging lung cancer

A

T - tumour size, spread, position
N - spread to l nodes?
M - metastases

242
Q

how many stages does lung cancer have

A

1-4

4 has worst survival

243
Q

what are the two treatment types for lung cancer

A

radical or palliative

244
Q

what is the performative status

A
  • 0 = fully active
  • 1 = symptoms but ambulatory
  • 2 = “up and about” > 50%, unable to work
  • 3 = “up and about” < 50%, limited self care
  • 4 = bed or chair bound
245
Q

what treatments are there for lung cancer

A

surgery
radiotherapy
chemotherapy
supportive care

246
Q

what is included in palliative management in lung cancer

A

symptom control
- chemotherapy, radiotherapy, opiates
QoL
community support

247
Q

what investigation do you do for systematic review of lung cancer

A

CXR
Hilar vascular structures crisply defined
No widening of mediastinum
Trachea should be central

look at lungs upper, middle, lower zone
look behind heart and diaphragm

248
Q

what do you look for in CT for lung cancer

A

evaluate size, shape atelectasis, border, density ,solid or non solid, dynamic contrast enhancement >25 HU, growth

249
Q

what is a pulmonary mass

A

opacity in lung over 3cm with no mediastinal adenopathy or atelectasis (collapse)

250
Q

what is a pulmonary nodule

A

opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis (collapse)

251
Q

what things do you use to stage lung cancer

A

Clinical history/examination
Performance status
Pulmonary function
TNM

252
Q

what is T1 of TNM

A

Tumour ≤3 cm

253
Q

what is T2 of TNM

A

Tumour >3 cm but 5 cm

254
Q

what is T3 of TNM

A

Tumour >5 cm but <7cm

invades chest wall, phrenic nerve, parietal pericardium

255
Q

what is T4 of TNM

A

Tumour >7cm

invades diaphragm, mediastinum, heart

256
Q

what may you see in a CXR for staging of lung cancer

A

Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung

257
Q

what may you see in a blood tests for staging of lung cancer

A

Anaemia
Abnormal LFTs (liver function)
Abnormal bone profile

258
Q

what may you see in a CT for staging of lung cancer

A 
Size of tumour
Mediastinal nodes
Metastatic disease - other parts of lungs, liver, adrenals, kidneys
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement
259
Q

what other tests can you do for staging of lung cancer

A

PET
MRI
Bone scan
ECHO

260
Q

what pathologies do you need to check for when assessing patients fitness for lung cancer surgery

A

angina, heart problems, smoking, stroke, asthma, URTI, exercise capacity

261
Q

what are some respiratory function tests to check fitness for lung cancer surgery

A

Spirometry
Diffusion studies
ABG on air/SLV
Fractionated V/Q scan

262
Q

what are some cardiac assessments to check fitness for lung cancer surgery

A 
ECG
ECHO
CT scan
ETT
Coronary angiogram
If in doubt, don’t operate
263
Q

what is the aim of surgical treatment for lung cancer

A

Curative resection
Remove the minimum amount of lung tissue
Resection of parietal structures is feasible

264
Q

what types of surgery are there for lung cancer

A

Pneumonectomy 5-10%
Lobectomy 3-5%
Wedge resection 2-3%
Open/ close thoracotomy 5%

(operative mortality)

265
Q

what are non-small cell lung cancers

A 
85% of lung cancer
Adenocarcinoma - 55%
Squamous – 30%
Large cell undifferentiated ~5%
Others
266
Q

By what percent does a PET scan upstage lung cancer

A

15%

267
Q

what percent of non-small cell lung cancers are operable

A

25%

268
Q

what adjuvant therapy may you give post-operatively after lung cancer surgery

A

Chemotherapy - to increase chance of cure/reduce risk of recurrence

no radiotherapy for stage 1 and 2

269
Q

what are the side effects of radical radiotherapy

A

lethargy
Acute: oesophagitis, pneumonitis, dysphagia
Long term: pulmonary fibrosis, oesophageal stricture, cardiac

270
Q

Pulmonary function tests essential for radical RT

A

ffd

271
Q

Radiotherapy is planned and there are variety of regimes

A

fff

272
Q

what is chemotherapy

A

systemic treatment
survival better than RT alone
addition increases toxicity

273
Q

what are side effect of chemotherapy

A 
it increases toxicity
Nausea, GI upset, 
marrow suppression (Neutropaenic sepsis) and risk of life threatening infection
hair loss
neuropathy
274
Q

what is Stereotactic Ablative Radiotherapy (SABR)

A

can give high doses or in fractions
Can have similar outcomes to surgery
Tumours up to 4 cm
>2cm away from airways and proximal bronchial tree

275
Q

when would you offer palliative treatment for lung cancer

A

80% of patients with disease that is not curable
Stage IV – distant metastasis
Stage III – very locally advanced disease

also affected by co-morbid disease eg. angina, COAD

276
Q

what does palliative treatment include for lung cancer

A 
Chemotherapy
Immunotherapy
TKI
Palliative radiotherapy 
Combination of above
277
Q

what is palliative immunotherapy

A

works by upregulating immune system and ‘unmasking’ cancers

278
Q

what are palliative tyrosine kinase inhibitors

A

Targeted drugs for adenocarcinoma with driver mutation

shrinks tumour

279
Q

what is palliative radiotherapy

A

For Management of symptoms:
Bone metastasis
Cord compression
Haemoptysis

280
Q

what is the doubling time of small cell lung cancer

A

29 days

281
Q

what is small cell lung cancer staged as

A

Limited disease – confined to one hemithorax

Extensive disease – more advanced

282
Q

for limited small cell lung cancer what treatment may you give

A

ChemoRT curative treatment
Followed by prophylactic cranial radiation (PCI)

combo of drugs

283
Q

for limited small cell lung cancer what treatment has no benefit

A

High dose chemo

Alternating chemo

Maintenance chemo

284
Q

for extensive small cell lung cancer what treatment may you give

A

4 cycles only of combination chemotherapy
Consolidation thoracic RT
prophylactic cranial radiation (PCI)

285
Q

describe the pleura

A

smooth, thin membrane which covers the thoracic cavity and the lung

Outer layer : Parietal Pleura

Inner Layer : Visceral Pleura

In between : Pleural fluid

286
Q

what is the protein content in pleural fluid

A

1.5-2g/dl

287
Q

what is pleural effusion

A

Collection of fluid in the pleural space

Imbalance between production and absorption

288
Q

what are the types of pleural effusion

A

transudate - non-inflam

exudate - inflam, protein content 3g or more

289
Q

what is transudate

A

is non-inflam pleural effusion

290
Q

what is exudate

A

is inflammatory pleural effusion

protein content 3g or more

291
Q

what is the lights criteria

A

Protein : Pleural fluid /serum fluid ratio > 0.5

LDH : Pleural fluid /serum fluid ratio > 0.6

Pleural fluid LDH > 2/3 rd ULN serum LDH

292
Q

in lights criteria what is the ratio of protein in pleural fluid/serum

A

> 0.5

293
Q

in lights criteria what is the ratio of LDH in pleural fluid/serum

A

> 0.6

294
Q

what are the causes of transudate pleural effusions

A

Left ventricular failure
Liver cirrhosis
mitral stenosis

295
Q

what are the causes of exudate pleural effusions

A

Malignancy ( Pulmonary and non pulmonary)
Parapneumonic effusions, empyema
Tuberculosis

296
Q

what investigations do you do for pleural effusions

A

US, mark site for aspiration, assess pleura
CXR
CT thorax, for complex effusions, visualise pleura and structures

297
Q

what analysis do you do of pleural fluid

A

pH, biochemistry, microbio and cytology

298
Q

how do you manage pleural effusions with pH <7.2

A

PH less than 7.2 with pneumonia, pus or blood may need a chest drain

299
Q

how do you treat transudate pleural effusion

A

treat the underlying cause

300
Q

how do you treat exudate pleural effusion

A

Unless cause identified will need further investigation e.g. further imaging , and or pleural biopsy

301
Q

what is a pneumothorax

A

collection of air within pleural space

chest pain/breathlessness

302
Q

what would you see on examination for pneumothorax

A

Breathing fast

Hypoxic

Reduced chest wall movement and reduced or no breath sounds

303
Q

how do you diagnose pneumothorax

A

CXR
US
CT thorax

304
Q

how do you manage pneumothorax

A

observe
aspiration, >2cm in size take air out
chest drain insertion, safe triangle 2nd ICS midclavicular
surgery

305
Q

what primary malignancy is most common in pleural tumours

A

mesothelioma

306
Q

what is mesothelioma

A

pleural tumour
rare, aggressive
inhaled asbestos fibres reach pleura -> inflammation -> tumour formation

307
Q

what are the signs of mesthothelioma

A

Breathlessness

Chest Pain

Weight loss

Clubbed , signs of a pleural effusion

308
Q

how do you diagnose mesothelioma

A

CXR
CT thorax and biopsy
thickened pleura, pleural plaques, effusion

309
Q

how do you treat mesothelioma

A

treat effusion
chemotherapy
palliative surgery

310
Q

how many carcinogens are in cigarette smoke what does it do to immune cells

A

60

suppresses T cell function

311
Q

how many deaths a year are due to smoking

A

10,000

1/5 of deaths

312
Q

in deprived areas how much more likely are you to smoke

A

3 times

313
Q

what are the effects of maternal smoking

A

350g lighter birth weight

double likelihood of still birth

314
Q

after 15 years of quitting smoking your risk of heart attack is the same as someone who never smoked

A

ggg

315
Q

how does smoking affect the NHS and society

A

nhs - copd, lung cancer, cardiac diseases

spciety - loss of productivity/economic output, fires, passive smoking effect

316
Q

what strategies are there to protect children from smoking

A

X sell tobacco products to anyone < 18
X smoke in private vehicle with kids in it
X proxy purchase
X vending machines

317
Q

what strategies are there to reduce smoking in public

A

Banned in virtually all public places and workplaces

318
Q

how does packaging of cigarettes reduce smoking

A

65% of pack must be covered with picture warnings
ban on flavours
minimum pack size 20

319
Q

describe normal airflow in airways

A

Bulk flow – laminar or turbulent

Depends on pressure difference

320
Q

what are 4 types of abnormal pulmonary gas exchange

A

Ventilation / Perfusion imbalance - V/Q - airway obstruction
Diffusion impairment - loss of alveolar surface area, thickened interstitium
Alveolar Hypoventilation - red respiratory drive
Shunt

321
Q

what is normal V/Q and what causes low V/Q

A

Normally breathing ~4 l/min. Cardiac Output is ~5 l/min so normal V/Q is 4/5 or 0.8
low due to local alveolar hypoventilation

322
Q

what is shunt

A

Blood passing from Right to Left side of Heart WITHOUT contacting ventilated alveoli

Pathological shunt in AV malformations, congenital heart disease and PULMONARY DISEASE

323
Q

do large shunts respond well to inc in FI O2

A

no

324
Q

what is alveolar hypoventilation

A

ventilation - air moved in and out lungs
less air
PaCO2 inc
PaO2 decrease

325
Q

what is restrictive lung disease

A

forced vital capacity is <80% normal

but FEV1/FV ratio is normal

326
Q

what causes restriction of lung

A

lungs, pleura, nerve/muscle, bone

327
Q

what are some restrictive lung disease

A

interstitial lung disease
idiopathic pulmonary fibrosis
sarcoidosis
hypersensitivity pneumonitis

328
Q

how does pleura cause restrictive lung disease

A

effusions (fluid)
pneumothorax
thickening of pleura

329
Q

how does skeletal cause restrictive lung disease

A

kyphoscoliosis
rib fractures
ankolysing spondylitis

330
Q

how does muscle/nerve cause restrictive lung disease

A

amyotrophic lateral sclerosis

331
Q

how do sub-diaphragmatic cause restrictive lung disease

A

obesity, pregnancy

332
Q

where is the interstitium

A

between alveolus and capillary wall

333
Q

what are interstitial lung disease

A

cause thickening of interstitium and can result in pulmonary fibrosis

334
Q

what is Obstructive Sleep Apnoea Syndrome?

A

Recurrent episodes of upper airway obstruction leading to apnoea (cessation of breathing) during sleep and waking up

impaired QoL

335
Q

what is the pathophysiology of sleep apnoea

A

muscle relaxation
narrow pharynx
obesity
= repeated closure of upper airway

336
Q

how is sleep apnoea diagnosed

A 
Clinical history and examination
Epworth Questionnaire
Overnight sleep study
-pulse oximetry
-limited sleep studies
-full polysomnography
337
Q

what conditions are associated with sleep apnoea

A

hypertension, increased risk of stroke and probably increased risk of heart disease.

338
Q

how do you treat sleep apnoea

A 
Identify exacerbating factors
- weight
- alcohol
Continuous positive airways pressure (CPAP)
Mandibular repositioning splint
339
Q

what is narcolepsy

A

neurological condition that affects the brain’s ability to regulate the normal sleep-wake cycle, wake up and sleep at inappropriate times

340
Q

what are clinical features of narcolepsy

A

Cataplexy - sudden muscular weakness
Excessive daytime sleepiness
Hypnagogic / hynopompic hallucinations
Sleep paralysis

341
Q

what investigations do you do for narcolepsy

A

Polysomnography PSG
MSLT (>1 SOREM and mean sleep latency <8 min). measure time to fall asleep
Low CSF orexin

342
Q

how do you treat narcolepsy

A

Modafinil
Dexamphetamine
Venlafaxine (for cataplexy)
Sodium Oxybate (Xyrem)

343
Q

what are features of chronic ventilatory failure

A

Elevated pCO2 (> 6.0 kPA)
pO2 < 8 kPA
Normal blood pH
Elevated bicarbonate (HCO3-)

344
Q

what is the aetiology of chronic ventilatory failure

A

Airways disease
-COPD
-bronchiectasis
Chest wall abnormalities

Respiratory muscle weakness

Central hypoventilation

345
Q

what are symptoms of chronic ventilatory failure

A 
Breathlessness
Orthopnoea
Ankle swelling
Morning headache
Recurrent chest infections
Disturbed sleep
346
Q

what would you find on examination for chronic ventilatory failure

A

paradoxical abdominal wall motion in suspected neuromuscular disease
Ankle oedema

347
Q

what treatment do you give for chronic ventilatory failure

A

Domicillary Non Invasive Ventilation (NIV)

Oxygen therapy

348
Q

what are the stages of lung development

A 
embryonic 3-8 weeks
pseudoglandular 5-17
canalicular 16-26
saccular 24-38
alveolar 36 to 2/3yrs
349
Q

what happens in embryonic stage of lung development

A

lung buds form - lobar buds

350
Q

what happens in pseudoglandular stage of lung development

A

rapid branching of airways, specialised cell devlopment

351
Q

what happens in canalicular stage of lung development

A

lung develop distal architecture, terminal bronchiole, alveolar sacs, capillary units
Type 1 and 2 pneumocytes
point of viability

352
Q

what happens in saccular stage of lung development

A

alveoli grow, surfactant produced

can have gas diffusion now

353
Q

what happens in postnatal lung growth

A

Alveolar septation continue after birth

354
Q

what are common upper resp congenital abnormailities

A

Laryngomalacia and Tracheomalacia

Tracheo-oesphageal fistula ( abnormal connection)

355
Q

what are common lower resp congenital abnormailities

A

CPAM pulmonary artery malformation

Congenital Diaphragmatic Hernia

356
Q

how do you diagnose congenital abnormalities antenatally

A

Ultrasound

MRI

357
Q

how do you diagnose congenital abnormalities postnatally, what signs are there

A

Tachypnoea
Respiratory distress
Feeding issues

358
Q

what is Laryngomalacia

A

softening/collapse of larynx, obstructed airway

- stridor

359
Q

what is Tracheomalacia

A

floppiness of trachea
barking cough
genetic condition associated

360
Q

what happens with the lungs when the child is born

A

after first breath lungs inflate and fluid in lungs is absorbed

361
Q

what is Respiratory Distress Syndrome and what is it due to

A

Neonatal Lung Disease

Due to surfactant deficiency

362
Q

how do you treat Respiratory Distress Syndrome

A

Antenatal steroids
Surfactant replacement
Appropriate ventilation and nutrition

363
Q

what factors affect lung function, ‘tracking’ of lung function from early life to adulthood

A

individual - sex, age
early life events - parental education, season of birth, birth weight
environment and lifestyle - air pollution, smoking
allergic diseases - asthma. food allergen

364
Q

what is remodelling

A

Alteration of airway structure following external influence
-Environmental exposures
-Chronic diseases of childhood
-Infection
Leads to abnormalities due to interference of inter-cellular signalling

365
Q

what are the genetics of cystic fibrosis

A

autosomal recessive

occurs when 2 mutated genes inherited from both parents

366
Q

how does cystic fibrosis occur

A

occurs due to mutation in the transmembrane conductance regulator protein (CFTR) which is coded on chromosome 7

Cl trapped in cell, Na and water stay in cell too
Dehydrates airway surface liquid and mucous layer
Thick mucous sticks to mucosal surface, causing shearing
Difficult to cough up
Mucous collects bacteria, reduced ability to fight infection

367
Q

what protein is mutated in cystic fibrosis and on what chromosome

A

transmembrane conductance regulator protein (CFTR)

chromosome 7

368
Q

what are the different classes of mutation for the CFTR protein (cystic fibrosis)

A

1-6

1-3 severe diseases
4-6 milder

369
Q

how do you diagnose cystic fibrosis antenatally

A

Pre-implantation genetic diagnosis
Chorionic villous sampling (from placenta)
Amniocentesis (amniotic fluid tested)

370
Q

how do you diagnose cystic fibrosis neonatally

A

Newborn bloodspot day 5
(Guthrie test)
then clinical assessment and sweat test

371
Q

what is sweat testing

A

Measures the concentration of chloride excreted in sweat.

Elevated in CF

372
Q

what are some presentations of CF

A

Pancreatic insufficiency
Diabetes
Chest Infections and Bronchiectasis

373
Q

how does CFTR cause pulmonary infection

A

Abnormal electrolyte transport across cell membrane
Dehydration of airway surface layer
dec mucociliary clearance
Mucous sticks to mucosal surface and causes shearing and inflammation
inc access to bacteria
dec bacteria killing

374
Q

how does progressive respiratory decline occur in cystic fibrosis

A

Progressive bronchiectasis: chronic sputum production
recurrent chest infections
progressive airflow obstruction
can lead to respiratory failure

375
Q

how do you treat pancreatic insufficiency in CF

A
  1. REPLACE ENZYMES: (CREON)
  2. DIET: High energy plus high calorie supplement drinks
  3. NUTRITIONAL SUPPLEMENTS: Fat-soluble vitamin and mineral supplements
376
Q

how do you treat mucous obstruction inflammation in CF

A

Airway clearance
via physiotherapy,
Mucolytics
Bronchodilators

377
Q

how do you treat chronic infection in CF

A

Antibiotics (oral,
Intravenous or
Nebulised)

378
Q

how do you treat inc inflammation in CF

A

Azithromycin

379
Q

how do you treat Fibrosis/scarring/bronchiectasis in CF

A

Supportive treatment

and management of symptoms

380
Q

what type of diabetes can you get in CF

A

TYPE 2 DIABETES MELLITUS

Not enough insulin from pancreas, or insulin is not working properly

381
Q

how do you get osteoporosis in CF

A

Bone mineral density (BMD) falls

382
Q

may get haemoptysis, pneumothorax, diabetes and osteoporosis in CF

A

fsfs

383
Q

how does CF affect children socially

A

barrier to making friends
increased cost to family
inc depression/anxiety

384
Q

how does CF affect adults socially

A

transition
restriction on careers and hobbies
transport costs
missing work

385
Q

what microrganism is most common in infection in CF in adults

A

Pseudomonas Aeroginosa

386
Q

what are the indications for lung transplant

A

Rapidly deteriorating lung function
FEV1 < 30% predicted
Life threatening exacerbations
Estimated survival <2 years

Other: recurrent pneumothorax, recurrent severe haemoptysis

387
Q

what things can be considered to improve qol in CF

A

Oxygen and NIV
Exercise
Support – physical, mental, social, financial, . Alternative therapies (massage, reflexology, exercise equipment, gym memberships)
Advanced Care plans

388
Q

what can cause empyema

A

Post pneumonic
Post-operative
Oesophageal
Upper abdominal related

389
Q

what surgery can be done to treat empyema

A

Pleurectomy & Decortication

390
Q

what Thymic tumours can you get

A 
Thymoma
Thymolipoma
Thymic carcinoma
Carcinoid tumours of the thymus
Lymphoma
391
Q

when would you do tracheal surgery

A

Repair of iatrogenic injury
Tracheal tumours
-Salivary gland tumours
-Squamous carcinoma

392
Q

what are some benign lung tumours

A 
Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
393
Q

what the difference between primary and secondary pneumothorax

A

primary - occurs without an apparent cause and in the absence of significant lung disease

secondary - preexisting lung disease

394
Q

what is a spontaneous haemopneumothorax

A

after recurrent pneumothorax’s
adhesion forms between lung and chest wall
torn in pneumothorax -> bleed

395
Q

what is bullous lung disease

A

abnormal airspace in lung > 2cm

396
Q

Indications for Surgery in Pneumothorax

A

Recurrence
Persistence
Sometimes after one episode

397
Q

what Surgery is there for pneumothorax

A

Pleurodesis

Pleurectomy

398
Q

what are Bronchogenic Cysts

A

Cause symptoms by pressing on the trachea or oesophagus

399
Q

what are the requirements for lung transplantation

A 
Age < 65 years
Not overweight
Not diabetic
No renal failure
No mental illness
Good social support
400
Q

what is a pulmonary embolism

A

Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries.

401
Q

what are major risk factors for Venous Thromboembolism

A 
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy
402
Q

what are the symptoms of pulmonary embolism (PE)

A
  1. Pleuritic chest pain, cough and haemoptysis
  2. Isolated acute dyspnoea
  3. Syncope or cardiac arrest (massive PE)
403
Q

what are the signs of PE

A
  1. Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
  2. Tachycardia, tachypnoea, hypoxia
  3. Tachycardia, hypotension, tachypnoea, hypoxia
404
Q

what pre- test probability can you do for pulmonary embolisms

A

Wells Score
Includes symptoms and signs of VTE, previous VTE and risk factors
Revised Geneva Score
Based on risk factors, symptoms and signs

405
Q

what investigations for PE

A 
Full blood count, biochemistry, TnI, blood gases
Chest X-Ray
ECG
D-dimer
CT Pulmonary Angiogram (CTPA)
V/Q scan
Echocardiography
406
Q

what treatment for PE

A 
Oxygen
Low molecular weight heparin e.g. dalteparin
Warfarin
Direct Oral Anticoagulants (DOAC)
rivaroxaban, apixaban
Thrombolysis
Alteplase (rt-PA)
Pulmonary Embolectomy
407
Q

what is pulmonary hypertension

A

Elevated blood pressure in the pulmonary arterial tree.

mean pulmonary artery pressure of > 25 mmHg.

408
Q

what are the causes of pulmonary hypertension

A

Idiopathic (group 1)
Secondary to left heart disease (2)
Secondary to chronic respiratory disease (3)
Chronic Thromboembolic PH (CTEPH) (4)

409
Q

what are the symptoms of pulmonary hypertension

A

Exertional dyspnoea
Chest tightness
Exertional presyncope or syncope
Haemoptysis

410
Q

what are the signs of pulmonary hypertension

A 
Elevated JVP
Right ventricular heave
Loud pulmonary second heart sound
Hepatomegaly
Ankle oedema
411
Q

what investigations for pulmonary hypertension

A 
ECG
Lung function tests
Chest X-Ray
Echocardiography
V/Q scan
CTPA
Right heart catheterisation
- direct measure of pulmonary artery pressure
412
Q

what is the general treatment for pulmonary hypertension

A

Treat underlying condition
Oxygen
Anticoagulation
Diuretics

413
Q

what specific treatment is there for pulmonary hypertension

A

Calcium channel antagonists
Prostaglandins e.g. iloprost
Prostacyclin agonist
Endothelin receptor antagonists

414
Q

what surgical treatments are there for pulmonary hypertension

A

Thromboendarterectomy

Lung or heart lung transplant

Medicine Term 2 (5 decks)

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