Respiratory Medicine Flashcards
Causes of upper zone fibrosis?
CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
Causes of lower zone fibrosis?
- Idiopathic pulmonary fibrosis
-Most connective tissue disorders (except ankylosing spondylitis) e.g. SLE - Drug-induced: Amiodarone, bleomycin, methotrexate
- Asbestosis
Most common causative organism for IECOPD?
- Haemophilus influenzae (most common cause)
- Streptococcus pneumoniae
- Moraxella catarrhalis
How much does smoking increase your risk factor for lung cancer?
Smoking increases risk of lung ca by a factor of 10.
Asbestos - increases risk of lung ca by a factor of 5
Smoking and asbestos are synergistic, i.e. a smoker with asbestos exposure has a 10 * 5 = 50 times increased risk
What is the landmarks for chest drain insertion?
The triangle of safety for chest drain insertion involves the base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi.
Paraneoplastic features of Small cell lung carcinoma?
- Ectopic ADH
- Ectopic ACTH - hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump, moon facies etc
- Lambert-Eaton syndrome
Paraneoplastic features of squamous cell carcinoma?
- Parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
- Clubbing
- Hypertrophic pulmonary osteoarthropathy (HPOA)
- Hyperthyroidism due to ectopic TSH
Cystic fibrosis is due to a defect in the CFTR gene. Which chromosome is this gene located on?
Cystic fibrosis (CF) is an autosomal recessive disorder causing increased viscosity of secretions (e.g. lungs and pancreas). It is due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which codes a cAMP-regulated chloride channel.
In the UK 80% of CF cases are due to delta F508 on the long arm of chromosome 7.
Cystic fibrosis affects 1 per 2500 births, and the carrier rate is c. 1 in 25.
Most common organism isolated in patients with bronchiectasis?
Bronchiectasis: most common organism = Haemophilus influenzae
What is bronchiectasis?
Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or inflammation.
After assessing for treatable causes (e.g. immune deficiency) management is as follows:
- Physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
- Postural drainage
- Antibiotics for exacerbations + long-term rotating antibiotics in severe cases
- Bronchodilators in selected cases
- Immunisations
- Surgery in selected cases (e.g. Localised disease)
What causes a shift in the oxygen dissociation curve to the left?
- HbF, methaemoglobin, carboxyhaemoglobin
- Low [H+] (Alkali)
- Low pCO2
- Low 2,3-DPG
- Low temperature
The L rule
Shifts to L → Lower oxygen delivery, caused by
Low [H+] (alkali)
Low pCO2
Low 2,3-DPG
Low temperature
Organism responsible for Farmer’s lung?
Spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni).
Organism responsible for malt worker’s lung?
Malt workers’ lung: Aspergillus clavatus.
Medication used to prevent and treat acute mountain sickness (AMS)?
Acetazolamide (a carbonic anhydrase inhibitor) is widely used to prevent AMS. It causes a primary metabolic acidosis and compensatory respiratory alkalosis which increases respiratory rate and improves oxygenation.
Alpha-1 Antitrypsin?
Protease inhibitor of neutrophil elastase. Alpha1-antitrypsin is produced by the liver and by inhibiting neutrophil elastase helps protect the lungs against the functions of this enzyme. Deficiency can cause emphysema and cirrhosis.
