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4th Year Exam > Respiratory ILOs > Flashcards

Respiratory ILOs Flashcards

1
Q

Define type 1 and type 2 respiratory failure and give one cause of each

A

1: low O2, normal/low CO2 - COPD

2. low O2, high CO2 - severe asthma

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2
Q

Give 3 causes of hypoxaemia

A

Hypoventilation
Shunt
Ventilation/perfusion mismatch

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3
Q

Define COPD

A

Progressive airflow obstruction which is not fully reversible, associated with CD8+ cells, macrophages and neutrophils

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4
Q

Which deficiency is commonly seen in COPD patients?

A

Alpha-1-antitrypsin (can’t counterbalance destructive enzymes)

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5
Q

Outline the pathology of chronic bronchitis

A

Productive of sputum most days for at least 3 months in at least 2 years

  • narrow airways, interstitial support loss = mucus plugging
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6
Q

Outline the pathology of emphysema

A

Permanent enlargement of airspaces distal to terminal bronchioles

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7
Q

How does airflow obstruction occur in COPD?

A
  • Loss of elasticity
  • Air trapping + hyperinflation
  • Increased work of breathing
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8
Q

What may be seen on X-Ray and spirometry in COPD?

A

X-Ray: hyperinflation, black lungs, flat hemi-diaphragm, thin heart

S: <70% FEV1/FVC ratio

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9
Q

Give 5 management options for COPD

A
  • SA bronchodilator e.g. salbutamol
  • LA bronchodilator e.g. salmeterol
  • SAMA e.g. ipratropium
  • LAMA e.g. tiotropium
  • Pulmonary rehab
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10
Q

Define asthma and its cause

A

Chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

Immune mediated intolerance of external factor

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11
Q

Outline the pathology of asthma

A

Physiological: reversible/variable airflow obstruction

Pathological: airway inflammation/allergy

Clinical triggers: cold, exercise, cats…

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12
Q

Which 2 interleukins are implicated in asthma?

A

IL4 and IL33

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13
Q

What may be seen on spirometry in asthma?

A

FEV1/FVC ratio >70%

Reversibility of 15% and 400ml after salbutamol

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14
Q

Give 5 Tx steps in asthma management

A
  1. Inhaled SABA
  2. Add inhaled steroid
  3. Add inhaled LABA
  4. Consider more inhaled steroid or add leukotriene receptor e.g. Montelukast
  5. Daily steroid tablet
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15
Q

Outline the management steps in an acute asthma exacerbation

A 
Oxygen 
Salbutamol 
Hydrocortisone 
Ipratropium 
Theophylline 
Magnesium
Anaesthetics
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16
Q

Give 5 risks of a DVT/PE

A
  • Active malignancy
  • Recent major surgery
  • Recent hospitalisation
  • Recent trauma
  • Pregnancy
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17
Q

Give 2 investigations for DVT

A

D-dimer

Proximal duplex US

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18
Q

Which Wells score makes DVT likely

A

2 or more

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19
Q

Outline the steps of anticoagulation for DVT/PE

A
  • Apixaban/Rivaroxaban (if pt. has no other disease)
  • Apixaban/Rivaroxaban/LMWH (in renal impairment), CrCl<15 = LMWH
  • DOAC or LMWH in active cancer
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20
Q

What is Virchow’s triad in PE development?

A
  • Venous stasis
  • Vessel wall damage
  • Hypercoagulability
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21
Q

Which imaging technique is used in PE?

A

CTPA

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22
Q

Which Wells score makes PE likely?

A

Over 4

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23
Q

What anticoagulation can be used in confirmed PE?

A

Heparin

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24
Q

Define pneumothorax and give 4 types

A

Air within the pleural cavity leading to collapse of the elastic lung

  • Traumatic
  • Iatrogenic
  • Spontaneous
  • Tension
25
Q

Outline the pathology of a tension pneumothorax

A

One-way valve = increased intrapleural pressure

Impaired venous return and BP fall = arrest

26
Q

Give 3 signs and symptoms of pneumothorax

A
  • Pleuritic chest pain
  • Hyper-resonance on percussion
  • Tracheal deviation – late sign
27
Q

What is defined as a small and large pneumothorax?

A

Small <2cm

Large >2cm

28
Q

Give 4 management options for pneumothorax

A
  • Intercostal drain + underwater seal
  • VATS
  • Talc pleurodesis
  • Pleural abrasion
29
Q

How is a tension pneumothorax immediately managed?

A

Large bore cannula into 2nd ICS, mid clavicular line

30
Q

Define pleural effusion

A

Fluid in pleural space >15ml

31
Q

Outline Light’s criteria and when it indicates an exudate

A
  1. Fluid protein: serum protein ratio >0.5
  2. Fluid LDH: serum LDH >0.6
  3. Fluid LDH>2/3 maximum serum normal
32
Q

Give 2 causes of a transudate and exudate PE

A

T: heart failure, renal failure

E: malignancy, empyema

33
Q

Describe small cell carcinoma

A
  • Most aggressive
  • Oval/spindle cells with nuclear moulding
  • In and around hilus
34
Q

Describe Squamous cell carcinoma

A
  • In dysplastic epithelium
  • Central and slow growing
  • Keratinisation +/- intracellular bridges
35
Q

Describe adenocarcinoma

A
  • Periphery
  • more common in female
  • Produce mucin
36
Q

Describe large cell carcinoma

A
  • Not squamous or glandular

- Usually central

37
Q

Give 3 targeted lung cancer therapies

A
  • EGFR mutation = tyrosine kinase inhibitor
  • EML4-ALK gene fusions = ALK inhibitor
  • PDL1 = PDL1 inhibitors
38
Q

What is mesothelioma?

A

Tumour of the pleura almost always due to asbestos exposure

39
Q

Define obstructive sleep apnoea and give 2 symptoms

A

Recurrent episodes of partial/complete upper airway obstruction during sleep, intermittent hypoxia and sleep fragmentation

Snoring
Witnessed apnoea

40
Q

Outline the pathology of OSA

A

Pharyngeal narrowing leads to arousal and one of:

  • Sleep disruption and risk of RTA
  • BP surge = heart attack and stroke
41
Q

Give 2 investigations of OSA

A
  • Limited sleep study (at home: O2, HR, flow, thoracic/abdo effort, position)
  • Full polysomnography (video, audio, thoracic + abdo bands, limb leads..)
42
Q

Give 3 management options for OSA

A

-Weight loss
-Avoid triggers e.g. alcohol
-Continuous positive airways pressure (CPAP)
o Splints airway open, fixed vs. autoset

43
Q

Define sarcoidosis

A

Multisystem inflammatory disease of unknown cause mainly affecting the lungs and intrathoracic lymph nodes. Non-necrotising granulomatous inflammation

44
Q

Give 4 features of sarcoidosis

A
  • Systemic symptoms e.g. fever, anorexia, night sweats
  • Pulmonary dyspnoea on exertion
  • Chest pain
  • Cough
45
Q

Define idiopathic pulmonary fibrosis

A

Characterised by progressive breathlessness, bibasilar crackles and subpleural honeycombing. More common in males and over 50s

46
Q

Define Pulmonary fibrosis

A

Scarring in the lungs with a specific cause such as smoking and is different from idiopathic pulmonary fibrosis

47
Q

Give 3 causes of PF

A
  • Occupational and environmental e.g. asbestosis
  • Drug induced e.g. amiodarone, methotrexate
  • Connective tissue disease e.g. RA, lupus
48
Q

How is pulmonary fibrosis diagnosed?

A

High resolution CT

49
Q

Define bronchiectasis and give 2 causes

A

Permanent dilation of bronchi due to destruction of elastic and muscular component of bronchial wall

  • Post-infectious
  • Immunodeficiency
50
Q

Give 3 symptoms of bronchiectasis

A
  • Cough
  • Sputum
  • Crackles
51
Q

Give 2 risks of bronchiectasis

A

Cystic Fibrosis

Host immunodeficiency

52
Q

Give 2 investigations and 2 Tx for bronchiectasis

A

CXR + CT chest

Airway clearance and inhaled bronchodilator

53
Q

Define pulmonary hypertension and give 2 symptoms

A

High blood pressure in pulmonary arteries

Dizziness
Peripheral oedema

54
Q

Define cor pulmonale

A

Enlargement and failure of right ventricle due to increased vascular resistance or high blood pressure in the lungs

55
Q

Give 2 management options for cor pulmonale

A

Oxygen

Diuretics

56
Q

Define Extrinsic Allergic Alveolitis and give 2 triggers

A

Allergy of lung parenchyma, beginning with trigger causing APCs to activate T-cells

Bird dander
Mushroom worker’s lung

57
Q

Outline what happens in the acute phase of illness of EAA

A
  • 4-6 hours post exposure, can last days
  • Serum sickness illness
  • Wheeze, fever, cough, myalgia
58
Q

Give 2 management options for EAA

A

Avoid triggers

Corticosteroids

4th Year Exam (20 decks)

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