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Phase 2 - Marc's Respiratory > Respiratory Lectures > Flashcards

Respiratory Lectures Flashcards

1
Q

Define FEV1.

A

Volume forcibly expired after maximal inspiration within 1 second.

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2
Q

Define FVC.

A

Total volume forcibly expired after maximal inspiration.

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3
Q

What is a normal FEV1?

A

> 80% of predicted FEV1.

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4
Q

What is an abnormal FEV1?

A

<80% of predicted FEV1.

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5
Q

What is a normal FVC?

A

> 80% of predicted FVC.

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6
Q

What is an abnormal FVC?

A

<80% of predicted FVC.

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7
Q

What does a low FVC indicate?

A

Airway restriction.

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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)

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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)

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10
Q

Define type 1 respiratory failure. (2)

A

1) low pO2

2) low/normal pCO2

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11
Q

What can cause type 1 respiratory failure?

A

Pulmonary embolism.

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12
Q

Define type 2 respiratory failure. (2)

A

1) low pO2

2) high pCO2

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13
Q

What can cause type 2 respiratory failure?

A

Hypoventilation.

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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)

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15
Q

List 3 general causes of respiratory failure.

A

1) impaired ventilation
2) impaired perfusion
3) impaired gas exchange

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16
Q

List 5 signs of hypercapnoea (high CO2).

A

1) bounding pulse
2) flapping tremor
3) confusion
4) drowsiness
5) loss of consciousness

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17
Q

Define transfer co-efficient.

A

Ability of oxygen to diffuse across alveolar membrane.

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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

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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

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20
Q

What is a cause of a high transfer coefficient?

A

Pulmonary haemorrhage.

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21
Q

What two things generally coexist in COPD?

A

Chronic bronchitis and emphysema.

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22
Q

What V/Q is found in chronic bronchitis?

A

V/Q mismatch.

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23
Q

What V/Q is found in emphysema?

A

Matched V/Q deficit.

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24
Q

Describe how chronic bronchitis leads to heart failure. (4)

A

1) alveolar hypoxia
2) pulmonary shunting
3) pulmonary hypertension
4) cor pulmonale

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25
Q

What causes early onset COPD?

A

Alpha-1-antitrypsin deficiency.

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26
Q

How is chronic bronchitis defined?

A

Clinically.

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27
Q

Define chronic bronchitis.

A

Cough with sputum for 3 months for 2 years running.

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28
Q

How is emphysema defined?

A

Histologically.

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29
Q

Define emphysema.

A

Enlarged acini distal to terminal bronchioles with alveolar destruction.

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30
Q

What can patients not have both of? (2)

A

1) chronic obstructive pulmonary disease

2) asthma

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31
Q

List 2 types of asthma.

A

1) allergic/atopic/extrinsic (70%)

2) non-allergic/non-atopic/intrinsic (30%)

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32
Q

Where are IgEs produced in atopic asthma?

A

Systemically.

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33
Q

Where are IgEs produced in non-atopic asthma?

A

Locally.

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34
Q

List the atopic triad. (3)

A

1) asthma
2) atopic dermatitis
3) allergic rhinitis

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35
Q

What type of helper t-cells are predominately found in healthy lungs?

A

T helper 1 cells - cell mediated immunity.

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36
Q

What type of helper t-cells are predominately found in asthmatic lungs?

A

T helper 2 cells - humoral mediated immunity.

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37
Q

List the asthmatic triad. (3)

A

1) airway obstruction
2) airway hyperresponsiveness
3) airway inflammation

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38
Q

What type of hypersensitivity reaction is asthma?

A

Type 1 (IgE mediated).

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39
Q

What are peak expiratory flow measurements compared to? (2)

A

1) normal values based on height and gender
OR
2) past measurements

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40
Q

What age of onset asthma is associated with a more genetic cause?

A

Childhood.

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41
Q

What age of onset asthma is associated with a more environmental cause?

A

Adult.

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42
Q

Define silent chest.

A

Inability to generate enough airflow to wheeze due to fatigue/exhaustion.

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43
Q

How is ADAM33 cause asthma? (2)

A

1) airway hyperresponsiveness

2) tissue remodelling

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44
Q

List 2 foods that protective against asthma.

A

1) fruit

2) veg

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45
Q

What drug should you never prescribe to asthmatic?

A

Beta-blockers.

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46
Q

What is a good indicator of mast cell activity and why?

A

Tryptase, its only found in mast cells.

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47
Q

How do corticosteroids affect eosinophils?

A

Decrease eosinophil activation.

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48
Q

List 5 types of lung cancer.

A

1) lung adenocarcinoma (45%)
2) lung squamous cell carcinoma (25%)
3) lung small cell carcinoma (20%)
4) lung large cell carcinoma (10%)

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49
Q

What is small cell lung carcinoma also known as?

A

Oat cell carcinoma.

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50
Q

What percentage of small cell lung carcinomas present with metastasis?

A

67%.

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51
Q

List 3 hormones secreted by small cell lung carcinoma.

A

1) PTH
2) ADH
3) ACTH

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52
Q

List 7 substances that are occupational risk factors for lung cancer.

A

1) asbestos
2) coal
3) arsenic
4) chromium
5) nickel
6) petroleum products
7) iron oxide

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53
Q

What lung cancer is most associated with smoking?

A

Lung squamous cell carcinoma.

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54
Q

What cells are lung squamous cell carcinomas associated with?

A

Keratin producing epithelial cells.

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55
Q

What lung cancer is most common in non-smokers?

A

Lung adenocarcinoma.

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56
Q

List 6 common metastasis sites of lung cancers.

A

1) pleura
2) lymph nodes
3) bone
4) brain
5) liver
6) adrenal

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57
Q

What is the main lung lymphoma?

A

BALToma (bronchus associated tissue lymphoid tissue lymphoma —> B cells).

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58
Q

What is more common a primary or secondary lung cancer?

A

Secondary lung cancer.

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59
Q

List 4 organs whose cancers commonly metastases to the lungs.

A

1) kidney
2) breast
3) bowel
4) bladder

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60
Q

What is the most common cancer to metastases to the lungs?

A

Renal cell carcinoma.

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61
Q

What percentage of lung tumours are paraneoplastic?

A

10%.

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62
Q

Define hypertrophic pulmonary osteoarthopathy.

A

Condition characterised by clubbing, periostitis, arthropathy.

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63
Q

What triad characterises hypertrophic pulmonary osteoarthropathy?

A

1) digital clubbing
2) periostitis (esp. of small hand joints - DIP, MCP)
3) arthropathy (esp. of large joints - knee)

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64
Q

Define paraneoplastic syndrome.

A

Syndrome due to humoral (hormones, cytokines) factors secreted by tumour cells or immune cells against tumour cells

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65
Q

List 5 paraneoplastic complications of lung cancer.

A

1) hypercalcaemia (PTH)
2) SIADH (ADH)
3) Cushing’s syndrome (ACTH)
4) hypertrophic pulmonary osteoarthropathy (VEGF)
5) DIC

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66
Q

Define superior vena cava syndrome.

A

Partial blockage or compression of the superior vena cava.

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67
Q

List 3 treatments of superior vena cava syndrome.

A

1) stent
2) radiotherapy
3) dexamethasone

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68
Q

List 3 symptomatic treatments of airway narrowing.

A

1) tracheal stunting
2) cryotherapy
3) brachytherapy

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69
Q

What percentage of pleural mesotheliomas are caused by pulmonary asbestosis?

A

20%.

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70
Q

What is the latency period between asbestos exposure and mesothelioma development?

A

20-40 years.

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71
Q

What is the average time between diagnosis and death in mesothelioma?

A

8 months.

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72
Q

In what lung cancer are all deaths reported to the HM coroner?

A

Mesothelioma.

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73
Q

List 2 lung cancers found centrally.

A

1) lung small cell carcinoma

2) lung squamous cell carcinoma

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74
Q

List 2 lungs cancers found peripherally.

A

1) lung large cell carcinoma

2) lung adenocarcinoma

75
Q

What is the triad in Horner’s syndrome?

A

1) miosis
2) ptosis
3) anhidrosis

76
Q

What are the ECG changes in pulmonary embolism? (3)

A

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
Q

What percentage of DVTs cause PEs?

A

51%.

78
Q

Why do you check for atrial septal defects after a pulmonary embolism?

A

1) patient at risk of emboli stroke

2) embolus can bypass lungs —> systemic circulation —> brain

79
Q

Define pulmonary infarction.

A

Necrosis of lung tissue due to ischaemia.

80
Q

What should you suspect in a patient who collapses 1-2 weeks after surgery?

A

Pulmonary embolism.

81
Q

Where do the most clinically relevant pulmonary embolisms occur from?

A

DVTs from abdominal and pelvic veins.

82
Q

What is the 5 year survival rate of idiopathic pulmonary fibrosis?

A

50%.

83
Q

What should you not administer in idiopathic pulmonary fibrosis?

A

High dose steroids.

84
Q

Describe basal and subpleural reticulation and honeycombing.

A

Net and honeycomb appearance of the lung base and between pleura and body wall.

85
Q

List 4 types of interstitial lung disease.

A

1) idiopathic pulmonary fibrosis
2) sarcoidosis
3) hypersensitivity pneumonitis
4) asbestosis

86
Q

Define interstitial lung disease.

A

Fibrosis distal to terminal bronchioles.

87
Q

What organs does sarcoidosis generally effect? (4)

A

1) lungs*
2) lymph nodes (esp. hilar)
3) skin
4) eyes

88
Q

How are Afro-Caribbeans affected by sarcoidosis?

A

More severely, with more extra-thoracic manifestations.

89
Q

List 2 hormones realised by sarcoidosis granulomas.

A

1) ACE

2) calcitriol —> hypercalcaemia

90
Q

What sarcoidosis patients should not be treated? (3)

A

1) symptomatic stage 1
2) asymptomatic stage 2
3) asymptomatic stage 3

91
Q

What sarcoidosis patients should be treated? (3)

A

1) symptomatic stage 2
2) symptomatic stage 3
3) stage 4

92
Q

Define lupus pernio.

A

Hardened purple plaques on forehead, nose, cheeks, lips, ears.

93
Q

What percentage of cystic fibrosis has lung and GI involvement?

A

80%.

94
Q

What percentage of cystic fibrosis has only lung involvement?

A

15%.

95
Q

What is the cause of death in majority of cystic fibrosis patients?

A

Respiratory disease.

96
Q

What is a general presenting feature of children with cystic fibrosis?

A

Recurrent respiratory infections.

97
Q

Define meconium ileus.

A

Bowel obstruction due to thickened meconium - 1st stool.

98
Q

What’s the median survival rate of cystic fibrosis in the UK?

A

41 years old.

99
Q

List 5 professionals involved in a cystic fibrosis MDT.

A

1) general practitioner
2) physician
3) physiotherapist
4) specialist nurse
5) dietician

100
Q

List 6 features of Mycobacterium tuberculosis.

A 
1) bacilli (rods)
2 aerobic
3) non-motile
4) non-sporing
5) thick waxy capsule
6) slow growing (15-20 hour generation)
101
Q

Why does Mycobacterium tuberculosis form granulomas?

A

Resistant to macrophage phagocytosis.

102
Q

List 2 stains of Mycobacterium tuberculosis.

A

1) Ziehl-Nielsen stain - red/pink (acid-fast bacilli)

2) Gram stain - weakly positive (purple) (high lipid cell wall)

103
Q

What percentage of latent tuberculosis reactivate?

A

10%.

104
Q

What part of the GI tract can be affect ed by tuberculosis?

A

Ileocaecal valve.

105
Q

List 4 lymph nodes associated to tuberculosis.

A

1) hilar
2) mediastinal
3) paratracheal
4) subclavicular

106
Q

List organs other than the lungs that can be affected by tuberculosis

A

1) gastrointestinal
2) spinal (Pott’s vertebrae)
3) CNS (meningitis and high ICP)
4) genitourinary
5) cardiac (esp. pericardium)
6) skin (lupus vulgaris)

107
Q

What is another name for the tuberculin skin test of latent TB?

A

Mantoux test.

108
Q

Describe timeline of tuberculosis sputum diagnosis. (3)

A

1) sputum NAAT - <8 hours
2) sputum smear - <24 hours
3) sputum culture - 1-3 weeks (liquid media), 4-8 weeks (solid media)

109
Q

Is testing for latent TB good?

A

No, both tuberculin skin test and interferon gamma release assays have a false negative of 20-25%.

110
Q

When should TB be considered in chronic illness?

A

Fever and weight loss present.

111
Q

Why is neonatal BCG no onset offered?

A

Not cost effective.

112
Q

Define Ghon focus.

A

Initial subpleural caseating granuloma in tuberculosis.

113
Q

Define Ghon complex.

A

Subpleural and associated lymph nodal caseating granulomas in tuberculosis.

114
Q

Define Ranke complex.

A

Calcified subpleural and associated lymph nodal caseating granulomas in tuberculosis.

115
Q

List 5 mechanisms the upper respiratory tract has against infection.

A

1) cough reflex
2) mucus
3) mucocillary escalator
4) surface secretions (e.g. defensins, complement)
5) immune system

116
Q

List 2 upper respiratory tract infections that difficult to differentiate between.

A

1) tonsillitis

2) pharyngitis

117
Q

What is an important differential diagnosis of tonsillitis?

A

Glandular fever.

118
Q

What antibiotics can Haemophilus influenza be resistant to?

A

Amoxicillin.

119
Q

What age does epiglottis generally present.

A

<5 years old.

120
Q

What age does whooping cough generally present?

A

<5 years old.

121
Q

Why does the use of acid-reducing drugs (e.g. PPI or H2a) increase the risk of pneumonia?

A

Decreased gastric acid secretion allows bacteria to colonise the upper respiratory tract.

122
Q

What is better at diagnosing pneumonia, x-ray or CT scan?

A

CT scan.

123
Q

List 3 reasons that an x-ray is preferred to a CT scan when diagnosing pneumonia.

A

1) cheaper
2) less radiation
3) bedside testing

124
Q

Why aren’t blood/sputum MS&Cs required investigations in community acquired pneumonia?

A

Good prognosis with empirical antibiotics.

125
Q

Define empirical therapy.

A

Therapy based on experience, i.e. educated clinical guess.

126
Q

List 3 macrolide antibiotics.

A

1) azithromycin
2) clarithromycin
3) erythromycin

127
Q

Define lung abscess.

A

Pus filled cavity within lung parenchyma.

128
Q

Define empyema.

A

Pus within pleural space.

129
Q

What is the difference between empyema and lung abscess?

A

Pus in pleural space (empyema), vs pus in lung parenchyma (lung abscess).

130
Q

List 2 tests that repeated if pneumonia worsens.

A

1) chest x-ray

2) CRP

131
Q

What is the mortality of CAP with a CURB-65 ≥3?

A

15-40%

132
Q

When is there a follow up for pneumonia?

A

6 weeks ± chest x-ray.

133
Q

Define ventilator associated pneumonia.

A

Pneumonia >48 hours after endotracheal intubation (type of HAP).

134
Q

How many serotypes of Streptococcus pneumoniae does the pneumococcal vaccine protect against?

A

23.

135
Q

What is another name for thoracentesis?

A

Pleural tap.

136
Q

Define consolidation.

A

Lung tissue filled with fluid instead if air.

137
Q

List 3 occasions when ITU is considered in pneumonia.

A

1) shock
2) hypercapnia
3) persistent hypoxia

138
Q

What is the mortality of HAP?

A

21%.

139
Q

What percentage of CAP is caused by viral infections?

A

15% (esp. Haemophilus influenzae).

140
Q

Define hospital acquired pneumonia.

A

New onset purulent productive cough with chest x-ray consolidation signs in patients hospital admitted greater than 48 hours ago.

141
Q

What is the second most common hospital acquired infection after UTI?

A

HAP.

142
Q

Why does pneumonia generally not respond well to penicillin?

A

Most causative pathogens of pneumonia don’t have cell walls.

143
Q

Absence of what type of symptoms is indicative of pneumonia?

A

Upper respiratory tract symptoms (e.g. rhinorrhoea).

144
Q

List 4 upper respiratory tract symptoms.

A

1) rhinorrhoea
2) sore throat
3) odynophagia
4) dysphagia

145
Q

Why is a chest x-ray repeated 2-3 days later if CAP is clinically suspected but not radiologically confirmed?

A

Radiological abnormalities lag behind clinical signs.

146
Q

What is type I respiratory failure also known as?

A

Hypoxia respiratory failure.

147
Q

What is type II respiratory failure also known as?

A

Hypercapnic respiratory failure.

148
Q

What is the mnemonic for respiratory failure symptoms? (4)

A

A) anxiety
B) breathlessness
C) confusion
D) drowsiness

149
Q

What does CPAP stand for?

A

Continuous positive airway pressure.

150
Q

What is the aim of respiratory failure treatment?

A

Correct hypoxia.

151
Q

Why should you be careful administering oxygen in type II respiratory failure? (4)

A

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
Q

What is the ABG in metabolic acidosis? (3)

A

1) low pH
2) low HCO3-
3) normal PaCO2

153
Q

What is the ABG in metabolic alkalosis? (3)

A

1) high pH
2) high HCO3-
3) normal PaCO2

154
Q

What is the ABG in respiratory acidosis?

A

1) low pH
2) normal HCO3-
3) high PaCO2

155
Q

What is the ABG in respiratory alkalosis?

A

1) high pH
2) normal HCO3-
3) low PaCO2

156
Q

What produces and reabsorbs pleural fluid?

A

Parietal pleura.

157
Q

Where does the majority of pleural fluid reabsorption occur?

A

Posteriorly and inferiorly.

158
Q

What is the parietal pleura highly sensitive to?

A

Pain.

159
Q

List 4 substances that pleural effusions can rarely contain.

A

1) air - pneumothorax
2) blood - haemothorax
3) lymph - chylothorax
4) pus - empyema

160
Q

List 3 appearances of pleural fluid in diagnostic thoracentesis and what they mean.

A

1) purulent - empyema
2) turbid - infected
3) milky - chylothorax

161
Q

Define parapneumonic effusion.

A

Pneumonia with associate pleural effusion.

162
Q

Define diaphoresis.

A

Sweating.

163
Q

Define tension pneumothorax.

A

Pneumothorax displaces mediastinal structures, significantly impairing gas exchange and/or blood circulation.

164
Q

How long does a 50% pneumothorax collapsed lung take to reabsorb?

A

40 days.

165
Q

Define bronchopleural fistula.

A

Long term communication between lung and pleural space.

166
Q

When should you not request a chest x-ray in pneumothorax?

A

If it is a tension pneumothorax.

167
Q

What needs to be immediately carried out in a tension pneumothorax patient?

A

Needle aspiration.

168
Q

List 2 alternative names for a tube thoracostomy.

A

1) chest tube

2) chest drain

169
Q

Define apnoea.

A

Temporary cessation of breathing.

170
Q

Why is surgery carried out in obstructive sleep apnoea?

A

To release pharyngeal or nasal obstruction.

171
Q

What tests are involved in polysomnography for diagnosing obstructive sleep apnoea? (5)

A

During sleep:

1) pulse oximetry
2) airflow at nose and mouth
3) electrocardiogram
4) electromyogram
5) abdominal wall movement

172
Q

Define somnolence.

A

Strong desire to sleep.

173
Q

Define pleurodesis.

A

Adhesion of parietal and visceral pleura - prevents effusion re-accumulation.

174
Q

Define intercostal space retraction.

A

Intercostal muscles pull ribs in.

175
Q

List 4 types of causes of hypersensitivity pneumonitis.

A

1) bacteria
2) fungi
3) animal proteins (esp. avian)
4) chemicals (e.g. acid anhydrides)

176
Q

List 5 conditions at that can make up occupational lung disorders.

A

1) acute bronchitis
2) pulmonary fibrosis
3) asthma
4) hypersensitivity pneumonitis
5) lung cancer

177
Q

Inhalation of coal dust particles for how long leads to coal-workers pneumoconiosis?

A

15-20 years.

178
Q

List 5 occupations associated with silicosis.

A

1) stonemasons
2) sand-blasters
3) pottery
4) ceramic workers
5) foundry workers

179
Q

What is the chest x-ray pattern in silicosis? (2)

A

1) diffuse nodular in upper and mid zone

2) thin streak calcification of hilar nodes

180
Q

What type of asbestos is most likely to cause asbestosis?

A

Crocidolite.

181
Q

Define plasmapheresis.

A

Removal of anti-GBM antibodies from blood.

182
Q

What are anti-GBM antibodies?

A

Autoantibodies to alpha-3 chain of type IV collagen found in Goodpasture’s syndrome.

183
Q

What ethnicity is predominately affected by Wegener’s syndrome?

A

Caucasian (90%).

Phase 2 - Marc's Respiratory (9 decks)

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