Respiratory Lectures Flashcards
1
Q
Define FEV1.
A
Volume forcibly expired after maximal inspiration within 1 second.
2
Q
Define FVC.
A
Total volume forcibly expired after maximal inspiration.
3
Q
What is a normal FEV1?
A
> 80% of predicted FEV1.
4
Q
What is an abnormal FEV1?
A
<80% of predicted FEV1.
5
Q
What is a normal FVC?
A
> 80% of predicted FVC.
6
Q
What is an abnormal FVC?
A
<80% of predicted FVC.
7
Q
What does a low FVC indicate?
A
Airway restriction.
8
Q
Define airway obstruction using FEV1 and FVC. (3)
A
1) FEV1/FVC < 0.7 (low)
2) FEV1 < 0.8 (low)
3) FVC > 0.8 (normal)
9
Q
Define airway restriction using FEV1 and FVC. (3)
A
1) FEV1/FVC > 0.7 (normal)
2) FEV1 < 0.8 (low)
3) FVC < 0.8 (low)
10
Q
Define type 1 respiratory failure. (2)
A
1) low pO2
2) low/normal pCO2
11
Q
What can cause type 1 respiratory failure?
A
Pulmonary embolism.
12
Q
Define type 2 respiratory failure. (2)
A
1) low pO2
2) high pCO2
13
Q
What can cause type 2 respiratory failure?
A
Hypoventilation.
14
Q
What is an easy way to remember the difference between type 1 and type 2 respiratory failure?
A
1) type 1 has 1 partial pressure change (low pO2)
2) type 2 has 2 partial pressure changes (low pO2 and high pCO2)
15
Q
List 3 general causes of respiratory failure.
A
1) impaired ventilation
2) impaired perfusion
3) impaired gas exchange
16
Q
List 5 signs of hypercapnoea (high CO2).
A
1) bounding pulse
2) flapping tremor
3) confusion
4) drowsiness
5) loss of consciousness
17
Q
Define transfer co-efficient.
A
Ability of oxygen to diffuse across alveolar membrane.
18
Q
How can transfer co-efficient be measured?
A
1) small amount of CO inspired
2) breath held for 10 seconds
3) CO transferred is measured
19
Q
List 5 causes of a low transfer coefficient.
A
1) COPD (inc. emphysema)
2) fibrosing alveolitis
3) idiopathic pulmonary fibrosis
4) pulmonary hypertension
5) anaemia
20
Q
What is a cause of a high transfer coefficient?
A
Pulmonary haemorrhage.
21
Q
What two things generally coexist in COPD?
A
Chronic bronchitis and emphysema.
22
Q
What V/Q is found in chronic bronchitis?
A
V/Q mismatch.
23
Q
What V/Q is found in emphysema?
A
Matched V/Q deficit.
24
Q
Describe how chronic bronchitis leads to heart failure. (4)
A
1) alveolar hypoxia
2) pulmonary shunting
3) pulmonary hypertension
4) cor pulmonale
25
What causes early onset COPD?
Alpha-1-antitrypsin deficiency.
26
How is chronic bronchitis defined?
Clinically.
27
Define chronic bronchitis.
Cough with sputum for 3 months for 2 years running.
28
How is emphysema defined?
Histologically.
29
Define emphysema.
Enlarged acini distal to terminal bronchioles with alveolar destruction.
30
What can patients not have both of? (2)
1) chronic obstructive pulmonary disease
| 2) asthma
31
List 2 types of asthma.
1) allergic/atopic/extrinsic (70%)
| 2) non-allergic/non-atopic/intrinsic (30%)
32
Where are IgEs produced in atopic asthma?
Systemically.
33
Where are IgEs produced in non-atopic asthma?
Locally.
34
List the atopic triad. (3)
1) asthma
2) atopic dermatitis
3) allergic rhinitis
35
What type of helper t-cells are predominately found in healthy lungs?
T helper 1 cells - cell mediated immunity.
36
What type of helper t-cells are predominately found in asthmatic lungs?
T helper 2 cells - humoral mediated immunity.
37
List the asthmatic triad. (3)
1) airway obstruction
2) airway hyperresponsiveness
3) airway inflammation
38
What type of hypersensitivity reaction is asthma?
Type 1 (IgE mediated).
39
What are peak expiratory flow measurements compared to? (2)
1) normal values based on height and gender
OR
2) past measurements
40
What age of onset asthma is associated with a more genetic cause?
Childhood.
41
What age of onset asthma is associated with a more environmental cause?
Adult.
42
Define silent chest.
Inability to generate enough airflow to wheeze due to fatigue/exhaustion.
43
How is ADAM33 cause asthma? (2)
1) airway hyperresponsiveness
| 2) tissue remodelling
44
List 2 foods that protective against asthma.
1) fruit
| 2) veg
45
What drug should you never prescribe to asthmatic?
Beta-blockers.
46
What is a good indicator of mast cell activity and why?
Tryptase, its only found in mast cells.
47
How do corticosteroids affect eosinophils?
Decrease eosinophil activation.
48
List 5 types of lung cancer.
1) lung adenocarcinoma (45%)
2) lung squamous cell carcinoma (25%)
3) lung small cell carcinoma (20%)
4) lung large cell carcinoma (10%)
49
What is small cell lung carcinoma also known as?
Oat cell carcinoma.
50
What percentage of small cell lung carcinomas present with metastasis?
67%.
51
List 3 hormones secreted by small cell lung carcinoma.
1) PTH
2) ADH
3) ACTH
52
List 7 substances that are occupational risk factors for lung cancer.
1) asbestos
2) coal
3) arsenic
4) chromium
5) nickel
6) petroleum products
7) iron oxide
53
What lung cancer is most associated with smoking?
Lung squamous cell carcinoma.
54
What cells are lung squamous cell carcinomas associated with?
Keratin producing epithelial cells.
55
What lung cancer is most common in non-smokers?
Lung adenocarcinoma.
56
List 6 common metastasis sites of lung cancers.
1) pleura
2) lymph nodes
3) bone
4) brain
5) liver
6) adrenal
57
What is the main lung lymphoma?
BALToma (bronchus associated tissue lymphoid tissue lymphoma —> B cells).
58
What is more common a primary or secondary lung cancer?
Secondary lung cancer.
59
List 4 organs whose cancers commonly metastases to the lungs.
1) kidney
2) breast
3) bowel
4) bladder
60
What is the most common cancer to metastases to the lungs?
Renal cell carcinoma.
61
What percentage of lung tumours are paraneoplastic?
10%.
62
Define hypertrophic pulmonary osteoarthopathy.
Condition characterised by clubbing, periostitis, arthropathy.
63
What triad characterises hypertrophic pulmonary osteoarthropathy?
1) digital clubbing
2) periostitis (esp. of small hand joints - DIP, MCP)
3) arthropathy (esp. of large joints - knee)
64
Define paraneoplastic syndrome.
Syndrome due to humoral (hormones, cytokines) factors secreted by tumour cells or immune cells against tumour cells
65
List 5 paraneoplastic complications of lung cancer.
1) hypercalcaemia (PTH)
2) SIADH (ADH)
3) Cushing’s syndrome (ACTH)
4) hypertrophic pulmonary osteoarthropathy (VEGF)
5) DIC
66
Define superior vena cava syndrome.
Partial blockage or compression of the superior vena cava.
67
List 3 treatments of superior vena cava syndrome.
1) stent
2) radiotherapy
3) dexamethasone
68
List 3 symptomatic treatments of airway narrowing.
1) tracheal stunting
2) cryotherapy
3) brachytherapy
69
What percentage of pleural mesotheliomas are caused by pulmonary asbestosis?
20%.
70
What is the latency period between asbestos exposure and mesothelioma development?
20-40 years.
71
What is the average time between diagnosis and death in mesothelioma?
8 months.
72
In what lung cancer are all deaths reported to the HM coroner?
Mesothelioma.
73
List 2 lung cancers found centrally.
1) lung small cell carcinoma
| 2) lung squamous cell carcinoma
74
List 2 lungs cancers found peripherally.
1) lung large cell carcinoma
| 2) lung adenocarcinoma
75
What is the triad in Horner’s syndrome?
1) miosis
2) ptosis
3) anhidrosis
76
What are the ECG changes in pulmonary embolism? (3)
S1, Q3, T3
1) prominent S wave in lead 1
2) prominent Q wave in lead 3
3) inverted T wave in lead 3
77
What percentage of DVTs cause PEs?
51%.
78
Why do you check for atrial septal defects after a pulmonary embolism?
1) patient at risk of emboli stroke
| 2) embolus can bypass lungs —> systemic circulation —> brain
79
Define pulmonary infarction.
Necrosis of lung tissue due to ischaemia.
80
What should you suspect in a patient who collapses 1-2 weeks after surgery?
Pulmonary embolism.
81
Where do the most clinically relevant pulmonary embolisms occur from?
DVTs from abdominal and pelvic veins.
82
What is the 5 year survival rate of idiopathic pulmonary fibrosis?
50%.
83
What should you not administer in idiopathic pulmonary fibrosis?
High dose steroids.
84
Describe basal and subpleural reticulation and honeycombing.
Net and honeycomb appearance of the lung base and between pleura and body wall.
85
List 4 types of interstitial lung disease.
1) idiopathic pulmonary fibrosis
2) sarcoidosis
3) hypersensitivity pneumonitis
4) asbestosis
86
Define interstitial lung disease.
Fibrosis distal to terminal bronchioles.
87
What organs does sarcoidosis generally effect? (4)
1) lungs*
2) lymph nodes (esp. hilar)
3) skin
4) eyes
88
How are Afro-Caribbeans affected by sarcoidosis?
More severely, with more extra-thoracic manifestations.
89
List 2 hormones realised by sarcoidosis granulomas.
1) ACE
| 2) calcitriol —> hypercalcaemia
90
What sarcoidosis patients should not be treated? (3)
1) symptomatic stage 1
2) asymptomatic stage 2
3) asymptomatic stage 3
91
What sarcoidosis patients should be treated? (3)
1) symptomatic stage 2
2) symptomatic stage 3
3) stage 4
92
Define lupus pernio.
Hardened purple plaques on forehead, nose, cheeks, lips, ears.
93
What percentage of cystic fibrosis has lung and GI involvement?
80%.
94
What percentage of cystic fibrosis has only lung involvement?
15%.
95
What is the cause of death in majority of cystic fibrosis patients?
Respiratory disease.
96
What is a general presenting feature of children with cystic fibrosis?
Recurrent respiratory infections.
97
Define meconium ileus.
Bowel obstruction due to thickened meconium - 1st stool.
98
What’s the median survival rate of cystic fibrosis in the UK?
41 years old.
99
List 5 professionals involved in a cystic fibrosis MDT.
1) general practitioner
2) physician
3) physiotherapist
4) specialist nurse
5) dietician
100
List 6 features of Mycobacterium tuberculosis.
```
1) bacilli (rods)
2 aerobic
3) non-motile
4) non-sporing
5) thick waxy capsule
6) slow growing (15-20 hour generation)
```
101
Why does Mycobacterium tuberculosis form granulomas?
Resistant to macrophage phagocytosis.
102
List 2 stains of Mycobacterium tuberculosis.
1) Ziehl-Nielsen stain - red/pink (acid-fast bacilli)
| 2) Gram stain - weakly positive (purple) (high lipid cell wall)
103
What percentage of latent tuberculosis reactivate?
10%.
104
What part of the GI tract can be affect ed by tuberculosis?
Ileocaecal valve.
105
List 4 lymph nodes associated to tuberculosis.
1) hilar
2) mediastinal
3) paratracheal
4) subclavicular
106
List organs other than the lungs that can be affected by tuberculosis
1) gastrointestinal
2) spinal (Pott’s vertebrae)
3) CNS (meningitis and high ICP)
4) genitourinary
5) cardiac (esp. pericardium)
6) skin (lupus vulgaris)
107
What is another name for the tuberculin skin test of latent TB?
Mantoux test.
108
Describe timeline of tuberculosis sputum diagnosis. (3)
1) sputum NAAT - <8 hours
2) sputum smear - <24 hours
3) sputum culture - 1-3 weeks (liquid media), 4-8 weeks (solid media)
109
Is testing for latent TB good?
No, both tuberculin skin test and interferon gamma release assays have a false negative of 20-25%.
110
When should TB be considered in chronic illness?
Fever and weight loss present.
111
Why is neonatal BCG no onset offered?
Not cost effective.
112
Define Ghon focus.
Initial subpleural caseating granuloma in tuberculosis.
113
Define Ghon complex.
Subpleural and associated lymph nodal caseating granulomas in tuberculosis.
114
Define Ranke complex.
Calcified subpleural and associated lymph nodal caseating granulomas in tuberculosis.
115
List 5 mechanisms the upper respiratory tract has against infection.
1) cough reflex
2) mucus
3) mucocillary escalator
4) surface secretions (e.g. defensins, complement)
5) immune system
116
List 2 upper respiratory tract infections that difficult to differentiate between.
1) tonsillitis
| 2) pharyngitis
117
What is an important differential diagnosis of tonsillitis?
Glandular fever.
118
What antibiotics can Haemophilus influenza be resistant to?
Amoxicillin.
119
What age does epiglottis generally present.
<5 years old.
120
What age does whooping cough generally present?
<5 years old.
121
Why does the use of acid-reducing drugs (e.g. PPI or H2a) increase the risk of pneumonia?
Decreased gastric acid secretion allows bacteria to colonise the upper respiratory tract.
122
What is better at diagnosing pneumonia, x-ray or CT scan?
CT scan.
123
List 3 reasons that an x-ray is preferred to a CT scan when diagnosing pneumonia.
1) cheaper
2) less radiation
3) bedside testing
124
Why aren’t blood/sputum MS&Cs required investigations in community acquired pneumonia?
Good prognosis with empirical antibiotics.
125
Define empirical therapy.
Therapy based on experience, i.e. educated clinical guess.
126
List 3 macrolide antibiotics.
1) azithromycin
2) clarithromycin
3) erythromycin
127
Define lung abscess.
Pus filled cavity within lung parenchyma.
128
Define empyema.
Pus within pleural space.
129
What is the difference between empyema and lung abscess?
Pus in pleural space (empyema), vs pus in lung parenchyma (lung abscess).
130
List 2 tests that repeated if pneumonia worsens.
1) chest x-ray
| 2) CRP
131
What is the mortality of CAP with a CURB-65 ≥3?
15-40%
132
When is there a follow up for pneumonia?
6 weeks ± chest x-ray.
133
Define ventilator associated pneumonia.
Pneumonia >48 hours after endotracheal intubation (type of HAP).
134
How many serotypes of Streptococcus pneumoniae does the pneumococcal vaccine protect against?
23.
135
What is another name for thoracentesis?
Pleural tap.
136
Define consolidation.
Lung tissue filled with fluid instead if air.
137
List 3 occasions when ITU is considered in pneumonia.
1) shock
2) hypercapnia
3) persistent hypoxia
138
What is the mortality of HAP?
21%.
139
What percentage of CAP is caused by viral infections?
15% (esp. Haemophilus influenzae).
140
Define hospital acquired pneumonia.
New onset purulent productive cough with chest x-ray consolidation signs in patients hospital admitted greater than 48 hours ago.
141
What is the second most common hospital acquired infection after UTI?
HAP.
142
Why does pneumonia generally not respond well to penicillin?
Most causative pathogens of pneumonia don’t have cell walls.
143
Absence of what type of symptoms is indicative of pneumonia?
Upper respiratory tract symptoms (e.g. rhinorrhoea).
144
List 4 upper respiratory tract symptoms.
1) rhinorrhoea
2) sore throat
3) odynophagia
4) dysphagia
145
Why is a chest x-ray repeated 2-3 days later if CAP is clinically suspected but not radiologically confirmed?
Radiological abnormalities lag behind clinical signs.
146
What is type I respiratory failure also known as?
Hypoxia respiratory failure.
147
What is type II respiratory failure also known as?
Hypercapnic respiratory failure.
148
What is the mnemonic for respiratory failure symptoms? (4)
A) anxiety
B) breathlessness
C) confusion
D) drowsiness
149
What does CPAP stand for?
Continuous positive airway pressure.
150
What is the aim of respiratory failure treatment?
Correct hypoxia.
151
Why should you be careful administering oxygen in type II respiratory failure? (4)
1) patient may have lost hypercapnic drive (e.g. COPD)
2) patient relying on hypoxic drive
3) administering oxygen dampens hypoxic drive
4) patient loses ability to breathe
152
What is the ABG in metabolic acidosis? (3)
1) low pH
2) low HCO3-
3) normal PaCO2
153
What is the ABG in metabolic alkalosis? (3)
1) high pH
2) high HCO3-
3) normal PaCO2
154
What is the ABG in respiratory acidosis?
1) low pH
2) normal HCO3-
3) high PaCO2
155
What is the ABG in respiratory alkalosis?
1) high pH
2) normal HCO3-
3) low PaCO2
156
What produces and reabsorbs pleural fluid?
Parietal pleura.
157
Where does the majority of pleural fluid reabsorption occur?
Posteriorly and inferiorly.
158
What is the parietal pleura highly sensitive to?
Pain.
159
List 4 substances that pleural effusions can rarely contain.
1) air - pneumothorax
2) blood - haemothorax
3) lymph - chylothorax
4) pus - empyema
160
List 3 appearances of pleural fluid in diagnostic thoracentesis and what they mean.
1) purulent - empyema
2) turbid - infected
3) milky - chylothorax
161
Define parapneumonic effusion.
Pneumonia with associate pleural effusion.
162
Define diaphoresis.
Sweating.
163
Define tension pneumothorax.
Pneumothorax displaces mediastinal structures, significantly impairing gas exchange and/or blood circulation.
164
How long does a 50% pneumothorax collapsed lung take to reabsorb?
40 days.
165
Define bronchopleural fistula.
Long term communication between lung and pleural space.
166
When should you not request a chest x-ray in pneumothorax?
If it is a tension pneumothorax.
167
What needs to be immediately carried out in a tension pneumothorax patient?
Needle aspiration.
168
List 2 alternative names for a tube thoracostomy.
1) chest tube
| 2) chest drain
169
Define apnoea.
Temporary cessation of breathing.
170
Why is surgery carried out in obstructive sleep apnoea?
To release pharyngeal or nasal obstruction.
171
What tests are involved in polysomnography for diagnosing obstructive sleep apnoea? (5)
During sleep:
1) pulse oximetry
2) airflow at nose and mouth
3) electrocardiogram
4) electromyogram
5) abdominal wall movement
172
Define somnolence.
Strong desire to sleep.
173
Define pleurodesis.
Adhesion of parietal and visceral pleura - prevents effusion re-accumulation.
174
Define intercostal space retraction.
Intercostal muscles pull ribs in.
175
List 4 types of causes of hypersensitivity pneumonitis.
1) bacteria
2) fungi
3) animal proteins (esp. avian)
4) chemicals (e.g. acid anhydrides)
176
List 5 conditions at that can make up occupational lung disorders.
1) acute bronchitis
2) pulmonary fibrosis
3) asthma
4) hypersensitivity pneumonitis
5) lung cancer
177
Inhalation of coal dust particles for how long leads to coal-workers pneumoconiosis?
15-20 years.
178
List 5 occupations associated with silicosis.
1) stonemasons
2) sand-blasters
3) pottery
4) ceramic workers
5) foundry workers
179
What is the chest x-ray pattern in silicosis? (2)
1) diffuse nodular in upper and mid zone
| 2) thin streak calcification of hilar nodes
180
What type of asbestos is most likely to cause asbestosis?
Crocidolite.
181
Define plasmapheresis.
Removal of anti-GBM antibodies from blood.
182
What are anti-GBM antibodies?
Autoantibodies to alpha-3 chain of type IV collagen found in Goodpasture’s syndrome.
183
What ethnicity is predominately affected by Wegener’s syndrome?
Caucasian (90%).
