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MAY MEDICINE 1 REVISION > Respiratory pathology 3 > Flashcards

Respiratory pathology 3 Flashcards

1
Q

Names the different types of emphysema

A

Centriacinar emphysema
Panacinar
Periacinar
Scar

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2
Q

Describe centriacinar emphysema

A

Starts with bronhcial dilation and then causes loss of surface area in the proximal acini. Occurs at the top of the lungs. Caused by smoking.

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3
Q

Describe panacinar emphysema

A

Occurs in large sections of the lung. Occurs at the bottom of the lungs. Caused by genetics.

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4
Q

Describe periacrinar emphysema

A

Occurs in the distal part of the acini and may burst into the pleura causing empyema.

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5
Q

Describe scar emphysema

A

Develops around a scar. Clinically insignificant.

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6
Q

mMRC breathlessness scale

A 
0 = Only breathless on strenuous exercise 
1 = Breathless when hurrying on the flat or when walking up a slight incline
2 = Breathless when walking at own pace and will have to stop or walks slower than others there age
3 = Can't walk further than 10 yds before stopping for breath
4 = Doesn't leave the house, is breathless doing basic tasks
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7
Q

What is the GOLD scale used for ?

A

Determining the severity of COPD

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8
Q

What does the GOLD scale say ?

A

1 = FEV1/FVC > 80% of predicted
2 = FEV1/FVC 50-79% of predicated
3 = FEV1/FVC 30-49% of predicted
4 FEV1/FVC < 30%

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9
Q

What are some of the difference between Asthma and COPD ?

A 
Smoking 
Age 
Breathlessness 
Productive cough 
Night disturbances 
Variation of symptoms
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10
Q

What is the inhaler treatment given to a patient with COPD and breathlessness ?

A 
SABA 
(Using SABA daily) 
SABA + LAMA 
(using SABA > 3 times a week)
SABA + LAMA/LABA 
(Using SABA > 3 times a week)
No help from further treatment
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11
Q

What inhaler treatment is given to a COPD patient with exacerbations ?

A 
SABA + LAMA 
(Continues exacerbations)
SABA + LAMA/LABA 
(Continued exacerbations)
SABA + LAMA/LABA /ICS
(Continues exacerbations)
No further treatment
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12
Q

Criteria for giving LTOT

A

PaO2 < 7.3 kPa
or
PaO2 < 8 and complications of chronic hypoxia such as pulmonary hypertension or peripheral oedema

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13
Q

Examination findings for COPD

A 
Hyper-resonance (Hyperinflation)
Crackles and wheeze 
Raised JVP 
Fine tremor 
Flapping tremor 
pursed lip breathing 
peripheral oedema
Cachexia  
Cyanosis
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14
Q

What is mild Asthma attack?

A

Use inhalers, oral steroids, have an early follow up

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15
Q

What is moderate asthma attack?

A

HR < 100
RR < 25
Can speak and complete sentences
Increased symptoms

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16
Q

What is a severe asthma attack ?

A

HR > 100
RR > 25
Can speak but cant complete sentences

17
Q

What is a life threatening asthma attack ?

A 
Confused 
Grunting 
Cant speak 
Normal PCO2 
PaO2 < 8kPa
SaO2 < 92%
18
Q

What is a near fatal asthma attack ?

A

Increased CO2

Need to mechanical ventilation

19
Q

What is the treatment pathways for asthma in children ?

A 
Very low dose ICS (LTRA in < 5s) + SABA 
Use of SABA > 2 times a week
Very low dose ICS (LTRA in < 5s) + LABA (LTRA in < 5s) 
Use of SABA > 2 times a week 
Very low dose ICS (LTRA in < 5s) + LTRA + LABA 
or 
Low dose ICS (LTRA in < 5s) + LABA 
or 
Low dose ICS
20
Q

What is the treatment pathways for asthma in adults ?

A 
SABA + Low dose ICS 
Use of SABA > 2 times a week 
SABA + Low does ICS + LABA 
Use of SABA > 2 times a week 
SABA + Medium dose ICS + LABA 
or SABA + Low dose ICS + LABA + LTRA
21
Q

Types of bronchiectasis

A

Veracious
Cylindrical
Cystic

22
Q

Describe CURB 65

A 
Confusion 
Urea > 7 mmHg
RR > 30 
SBP > 90 DBP > 60
Age > 65

Score of 1 = Manage at home
Score of 2 = Maybe bring into hospital
Score of 3-5 = bring into hospital and treat as severe

23
Q

What is CURB 65 used for ?

A

Determining the severity of pneumonia

24
Q

Treatment for Pneumonia

A

CURB 0-1. Amoxicillin (or clarithromycin or doxycycline if penicillin allergy) for 5 days
CURB 2. Amoxicillin + clarithromycin (Levofloxacin if penicillin allergy) for 5-7 days
CURB 3 -5. Co-Amoxiclav + clarithromycin (Levofloxacin or co-trimoxazole if penicillin allergy) for 7-10 days

25
Q

What are three bacteria which cause TB ?

A

M.Tuberculosis
M.Africanum
M.Bovis

26
Q

Describe the treatment for TB

A

Isoniazid (H) = 6 months= Causes peripheral neuropathy, Hepatitis and rash
Pyrazinamide (Z) = 2 months = Gout, Hepatitis and rash
Ramipril (R)= 2 months = Causes orange urine etc, rash, Hepatitis, makes oral contraception inactive
Ethambutol (E)= 6 months = Optic neuropathy, rash

27
Q

Where in the body should a chest drain be inserted ?

A

2ns intercostal space

Midclavicular line

28
Q

What is the name of the protein mutated in CF ?

A

CFTR

29
Q

What is the most common CF causing mutation ?

A

Delta F508

30
Q

Results from sweat tests

A

> 60 Likely to have CF
< 30 Not likely to have CF
30-60 may have CF

31
Q

What is the sweat test used for ?

A

Identifying people with CF

32
Q

Name of enzyme’s given to CF patients

A

CREON

33
Q

Treatment for CF

A 
Replacement enzymes
Chest physiotherpy 
Bronchodilators 
Mucolytics 
Antibiotics 
Azithromycin 
High calorie, high fat diet 
Lung transplant
34
Q

What would mean someone with CF was suitable for a lung transplant?

A

Estimated survival < 2 years
FEV1<30%
life threatening condition

35
Q

TNM staging system

A 
Tx = Tumour size was not able to be determined 
T0 = Tumour doesn't exist 
T1 = < 3cm 
T2 = 3-5 cm or Bronchial or pleural involvement 
T3 = 5-7 cm or Pericardial or chest wall involvement 
T4 = > 7cm or involvement of other thoracic structures or metastasis
N0 = No nodal involvement 
N1 = 1 node 
N2 = 2 nodes 
N3 = 3 nodes 
M0 = No metastasis 
M1a = Metastasis to other parts of the lung 
M1b = 1 extrathoracic metastasis 
M1c = 2 extrathorastic metastasis
36
Q

What is used to determine T N and M ?

A 
T = CT, PET/CT or bronchoscopy 
N = CT, PET/CT, mediastinoscopy, EBUS 
M = CT, PET/CT, bone scan
37
Q

FEV1 required for different surgeries

A

FEV1 > 1 for a lobectomy

FEV1 > 2 for a pneumonectomy

38
Q

Typical radiotherapy and SABR cycles

A

Radiotherapy 55Gy in 20 fractions

SABR 54Gy in 3 fractions

MAY MEDICINE 1 REVISION (23 decks)

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