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Conditions + definitions > Respiratory important > Flashcards

Respiratory important Flashcards

1
Q

What bacteria are responsible for TB?

A

Mycobacterium tuberculosis

M. bovis (“bovine TB”)

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2
Q

How is TB transmitted?

A

From “open” TB coughing/sneezing
Remain airborne for long periods of time
Bovine - through infected cow’s milk

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3
Q

What can indicate post primary pulmonary TB?

A 
Diabetes
Immunosupressive diseases/drugs
Previous TB
Alochol
Imigrants from high incident areas
Poor social circumstances
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4
Q

How do you diagnose TB?

A

3 sputum specimins on successive days
>Sputum smear
>Sputum culture
>Sputum PCR potentially

Chest xray
CT if above positive

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5
Q

What do you see on an Xray for TB?

A 
Patchy shadowing 
Often of Apices/apexes of lower zones
Often bilateral
Cavitation in advanced disease
May be calcified if chronic/healed
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6
Q

How do you treat TB?

A 
Rifampicin 6 months
Isoniazid  6 months
Ethambutol 2 months
Pyrazinamide 2 months
Must also notify comission
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7
Q

What are the side effects of rifampicin?

A 
Orange ‘Irn Bru’ urine, tears 
Induces liver enzymes, >prednisolone, 
>anticonvulsants
>Oral contraceptive pill ineffective
Hepatitis
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8
Q

What are the side effects of isoniazid?

A

Hepatitis

Peripheral neuropathy

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9
Q

What are the side effects of ethambutol?

A

Optic neuropathy

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10
Q

What are the side effects of pyrazinamide?

A

Gout

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11
Q

Why does CF lead to recurrent pulmonary infections?

A

Decreased mucociliary clearance
Increase bacterial adherance
Decrease endocytosis of bacteria
Leads to increased colonisation

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12
Q

Which bacteria reduce life expectancy dramatically in CF?

A

Pseudomonas aeruginosa
Burkholderia cepacia
Stenotrophomonas maltophilia?

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13
Q

How do you treat CF infections?

A

Early and aggressively with antibiotics
Oral antibiotics for Staph, Haemophilus, Pneumococcus
IV antibiotics for Pseudomonas, Stenotrophomonas, Burkholderia
Two antibiotics (-lactam + aminoglycoside)
Two week course

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14
Q

What are the indications for lung transplant with CF?

A 
(Done as double lung)
Rapidly deteriorating lung function
FEV1 < 30% predicted
Life threatening exacerbations
Estimated survival <2 years
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15
Q

What is Ivacaftor?

A

Drug addressing primary defect in CF
Currently too expensive
However only helps in some patients

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16
Q

How does CF affect fertility?

A

No effect on sexual function
Affects fertility in men
Females fertile, however poor nutritional state may affect chances of conception

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17
Q

What are the contraindications to transplant in CF?

A 
Other organ failure
Malignancy within 5 years
Significant peripheral vascular disease
Drug, nicotine, alcohol dependency
Active systemic infection
Microbiological issues (eg. M. abscessus)
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18
Q

What is the defect in CF?

A

A defect in the Cystic fibrosis transmembrane conductance regulator (CFTR)
Without it, cilia collapse
And excessive inflammation

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19
Q

What is the CFTR?

A

Active transport channel for chlorine

>Regulates liquid volume on epithelial surface through chloride emission

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20
Q

How do you screen for CF?

A

Guthrie test - heel blood prick day 5
Intially immuno-reactive trypsinogen
If positive then analysis of mutation

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21
Q

What are the features of pancreatic insufficiency (in CF)?

A 
Abnormal stools (steatorrhea)
Failure to thrive
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22
Q

How do you treat pancreatic insufficiency?

A

Enteric coated enzyme pellets
High energy diet
Fat soluble vitamins/mineral supplements
PPIs

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23
Q

What are the main features of CF?

A

Recurrent bronchopulmonary infection

Pancreatic insufficiency

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24
Q

What are the respiratory organisms in CF?

A

Common organisms
>Staphylococcus aureus and >Haemophilus influenzae in early years
>Pseudomonas aeruginosa later

Less common organisms
>Burkholderia cepacia
>Stenotrophomonas maltophilia
>Alcaligenes xylosoxidans
>Atypical mycobacteria e.g. M abscessus
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25
Q

What are the common occupational interstitial lung diseases?

A

Extrinsic allergic alveolitis
Coal workers’ pneumoconiosis
Silicosis
Asbestosis

26
Q

What can cause occupational COPD?

A

Coal mining
Hard rock mining
Cadmium fume
Organic dusts

27
Q

What is occupational asthma?

A

A substance is considered to cause occupational asthma if, as a result of exposures in the workplace, it both:

produces the biological change known as the hypersensitive state in the airways and

triggers a subsequent reaction in those airways”

28
Q

How do you diagnose occupational asthma?

A

Work related symptoms
Working with occupational sensitiser
Symptoms better when not at work
Symptoms may be worst after shift

29
Q

What causes farmer’s lung?

A

Thermophillic actinomyectes

30
Q

What is silicosis?

A

Caused by inhalation of silicon dioxide - miners, stomemasons etc
Rarely fatal
Can cause silicoTB

31
Q

What is asbestos?

A

Mineral used often for insulation etc
Commonly foundin building materials
Highly toxic (Increased cancer risk)

32
Q

What is asbestos related disease?

A 
Pleural plaques (benign)
Benign asbestos pleurisy
Pleural fibrosis
Asbestosis (progressive pulmonary fibrosis)
Lung cancer
Mesothelioma (malignant pleural tumour)
33
Q

What are pleural plaques?

A

Asymptomatic
No affect on lung function
Not premalignant

34
Q

What is benign asbesto pleurisy?

A

Presents with pleural effusion
Often blood stained
May lead to DPT

35
Q

What is asbestosis?

A

Latency of 20+ years
Progressive breathlessness
Cough

Signs
Crackles
Clubbing

Restrictive lung function
Interstitial fibrosis on radiology

36
Q

What is mesothelioma?

A

Pleural malignancy
Can occur in peritoneum

Presents with SOB + chest wall pain
Usualy unilateral pleural thickening

37
Q

What are the symptoms of COPD?

A 
SOB
Cough/recurrent chest infection
Loss of muscle mass/weight loss
Cardiac disease
Depression
38
Q

What are the examination signs of COPD?

A 
Reduced chest expansion
Prolonged expiration/wheeze
Hyperinflated chest
Respiratory failure
>Tachypneoa, cyanosis, accessory muscles etc
39
Q

How do you manage COPD?

A

Smoking cessation
Inhalers for SOB + exacerbation
Long term oxygen (if not smoker)

40
Q

What drugs are used in COPD?

A

SABAs
LABAs
Short/long acting antimuscarinis (SAMA/LAMA)
Inhaled corticosteroids

41
Q

What are the signs/symptoms of an exacerbation of COPD?

A 
Increased SOB
Cough
Sputum volume/purulence increase
Wheeze worsens
Chest tightness
42
Q

What is the presentation of lung cancer>?

A 
Haemoptysis
Recurrent bronchopulmonary infection
Cough, increasing breathlessness
Chest or other pain
Weight loss
Lump
43
Q

What are the signs of lung cancer?

A 
Finger clubbing
Reduced expansion/dull percussion etc
Cervical lymphadenopathy
Horner's syndrom
Hepatomegally
44
Q

What are the treatment options of lung cancer?

A

Surgery
Radiotherapy
Chemotherapy

45
Q

What are the types of lung cancer?

A 
Non small cell
>Squamous
>Adenocarcinoma
Small cell
Mesothelioma
46
Q

How do you treat malignant pleural effusion?

A

Drain + send fluid to cytology + microbiology

Follow up with chemo/radio dependent on stage

47
Q

What is the interstitium?

A

Connective tissue space around
airways,
vessels and
space around basement membrane of alveolar walls

48
Q

What are the trends in restrictive lung disease?

A

FEV normal or low
FVC very down
Ratio above 70%

49
Q

What are the trends in obstructive lung disease?

A

FEV massively down
FVC normal
Ratio below 70%

50
Q

What is sarcoidosis?

A 
Multisystem disorder
More common in temperate climates
Acute arthralgia
Erythema nodosum
Bilateral hilar lymphadenopathy
51
Q

How do you diagnose sarcoidosis?

A

Clinical/imaging findings

Serum calcium and ACE up

52
Q

What can cause restriction?

A 
Interstitial lung disease
Pleural effusions
Pneumothorax
Pleural thickening
Skeletal causes
Muscle causes (eg ALS)
Obesity/pregnancy
53
Q

What are the main intersitial lung diseases?

A

Sarcoidosis
Idiopathic pulmonary fibrosis
Hypersensitivity pneumoniitis

54
Q

How do you treat sarcoidosis?

A

No treatment if mild
NSAIDs in arthralgia
Topical steroids
Systemic steroids

55
Q

What is the presentation of idiopathic pulmonary fibrosis?

A

Chronic SOB + cough
Often older men
Clubbing
Crackles

56
Q

How do you diagnose asthma?

A

S&S
Peak flow
Spirometry

57
Q

What are the steps for treating asthma?

A 
Inhaled SABA
Inhaled corticosteroids
Inhaled LABA
4th step - increase or new drug
5th corticosteroids oral
58
Q

What are the examples of SABA?

A

Salbutamol

Terbutaline

59
Q

What new drugs can be considered in the 4th step?

A

Leukotrine receptor antagonists
Beta2 agonist tablet
Theophylline

60
Q

How do you treat mild acute asthma?

A

Oral steroids for 7 days
SABA frequently
Assess within 24 hours

61
Q

How do you treat a severe asthma attack?

A

Oral/IV steroids
Nebulised bronchodilators
IV magnesium sulphate if no response

Antibiotics if infection

Conditions + definitions (68 decks)

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