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Semester 3 - me > Respiratory + ur9 > Flashcards

Respiratory + ur9 Flashcards

0
Q

What is the diffusion pathway from the alveoli to the blood

A 
Alveolar epithelial cell 
Interstitial fluid 
Capillary endothelial cell 
plasma 
Red cell membrane
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1
Q

What is the rate of diffusion affected by?

A

Area
Resistance to diffusion
Gradient of partial pressure

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2
Q

Along the diffusion pathway what is the rate of diffusion affected by most

A

Solubility of gas in water

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3
Q

How much faster can carbon dioxide diffuse by compared to oxygen?

A

21x

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4
Q

What is the partial pressure of oxygen in the alveoli?

A

13.3kPa

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5
Q

What is the partial pressure of carbon dioxide in the alveoli?

A

5.3 kPa

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6
Q

What is the tidal volume?

A

The volume that enters and leaves with each breath

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7
Q

What is the inspiratory reserve volume?

A

Where you breathe in more than normal

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8
Q

What is the expiratory reserve volume?

A

When you breathe out more than at rest

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9
Q

What is the residual volume?

A

The volume left after expiration

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10
Q

What is the inspiratory capacity?

A

From quiet expiration to maximum inspiration

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11
Q

What is the functional residual capacity?

A

Volume of air in lungs at the end of quiet expiration

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12
Q

What is the vital capacity?

A

Inspiratory reserve volume + tidal volume + expiratory reserve volume

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13
Q

What is the total lung volume?

A

Vital capacity + reserve volume

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14
Q

What is anatomical dead space?

A

The volume that’s left in the airways ~150ml

Can be measured by the nitrogen wash out test

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15
Q

What is alveolar dead space?

A

Volume of air not taking part in gas exchange
Ie. alveoli is damaged
Insufficient blood supply

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16
Q

What is the physiological dead space?

A

Anatomical dead space and the alveolar dead space

Measure the po2 of expired air to alveolar air

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17
Q

What is the pulmonary ventillation rate?

A

The total amount of movement of air in and out of the lungs. Depends upon:

  • pulmonary ventillation rate
  • dead space ventillation rate
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18
Q

What is the dead space ventillation rate?

A

Movement of air into and out of dead space

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19
Q

What is the alveolar ventillation rate?

A

Deeper the breath, higher the proportion of air available for gas exchange
Deeper breathing in is more effective but much hard less work to take frequent, shallow breaths

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20
Q

What is COPD?

A 
Chronic obstructive pulmonary disease
Obstruction of the airways 
Slow, progressive disease 
Fev1 reduced
Fev1/fvc ratio reduced
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21
Q

Describe the epidemiology of COPD

A 
1 million hospital days a year 
3.7 million people in UK 
1 million symptomatic 
30,000 deaths
89% of people don't know what it is
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22
Q

Explain the causes of COPD

A

Smoking
Air pollution
Coal mining etc
Noxious particles in the lungs

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23
Q

Name the main symptoms of COPD

A 
Cough
Breathlessness 
Wheeze
Sputum blood or clear 
Following years of  a smokers cough
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24
Q

Name the signs of COPD

A

Blood or clear sputum
Hyperventilation with prolonged expiration
Hyper-inflammation of the lungs
Accessory muscles needed

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25
Q

Explain the assessment of COPD

A 
History
Chest X ray 
CT
Fev1
Other lung function tests
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26
Q

What is spirometry?

A

A lung function test used to assess lung volume, you take a maximum inspiration and then you breathe out over the spirometer

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27
Q

What is type 1 respiratory failure?

A

Hypoxia
Low or normal CO2
Respiratory rate increased

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28
Q

What is type 2 respiratory failure?

A

Increased ventilation
Hypoxia
High CO2

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29
Q

Why is oxygen used with COPD?

A 
Long term 
Hypoxia
Not breathlessness 
Can be used intermediately too
Long term use prolongs life
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30
Q

Outline the management of COPD

A 
Stop smoking 
Corticosteroids 
Beta adreno agonists 
Antibiotics 
Pulmonary rehab
Oxygen
Treat co morbidities
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31
Q

What is an alternative, less common cause of COPD?

A

Alpha 1 antitrypsin deficiency

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32
Q

List the common normal flora in the respiratory tract

A

Candida spp
Neisserra spp
Anaerobes
Viridius streptococci

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33
Q

What are some less common normal flora of the respiratory tract?

A

Haemophillus influenza
Streptococci pneumonia
Streptococci pyogenes

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34
Q

Name some other respiratory tract normal flora

A

E. coli

Pseudomonas

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35
Q

Name the defences of the respiratory tract

A 
Epithelia ciliated 
Cough
Sneezing
Mucous 
Nasal hair 
Lymphoid
Macrophages
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36
Q

Name some upper respiratory tract infections

A 
Rhinitis
Laryngitis 
Pharyngitis
Epiglottitia
Sinusitis 
Tracheitis
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37
Q

Name some common respiratory tract infections caused by viruses

A

Coronovirus
Influenza
RSV
Rhinovirus

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38
Q

Name some common respiratory tract infections caused by bacteria

A

Meningitis
Brain abcesses
Mastoiditis

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39
Q

Define pneumonia

A

Inflammation of the parenchyma of the lungs

Affects gas exchanging region of the lungs

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40
Q

What is lobar pneumonia and what is it commonly caused by?

A

Pneumonia restricted to one lobe

Streptococcus pneumoniae

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41
Q

What is broncho pneumonia and what is it commonly caused by?

A

Pneumonia which starts off in the large airways and spreads to alveoli and lung tissue.
Coliforms, anaerobes, streptococci pneumoniae, haemophilus influenza, staphylococcus aureus

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42
Q

What is aspiration pneumonia and what is it commonly caused by?

A

Choking, vomit, food, drink
Oral flora
Anaerobes

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43
Q

What is interstitial pneumonia and what is it commonly caused by?

A

Pneumonia in the capillary endothelium, basement membrane, alveolar epithelium, peri vascular and peri lymphoid tissue

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44
Q

Name some commonly community acquired bacterium

A 
Klebsiella pneumoniae
Streptococcus pneumoniae
Haemophilus influenza 
Chlamydia pneumophilla
Legionella pneumophilla 
Mycoplasma pneumoniae
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45
Q

Name some common hospital acquired bacteria

A

MRSA
Staphylococcus aureus
Gram negative enteric bacterium
Pseudomonas

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46
Q

Name some symptoms of pneumonia

A

Myalgia, headache, diarrhoea
Malaise, dyspnoea, vomitting
Lethargy, chest pain, cough
Wheeze, stained sputum

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47
Q

What is the curb score?

A

A scoring system used for hospital acquired pneumonia
2 or more is an indication for hospital treatment
C - new mental Confusion
U - urea conc >7mmol/L
R - resp rate >30 per minute
B - BP of <60

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48
Q

What samples are used to investigate pneumonia?

A 
Sputum 
Nose and throat swabs
Lung biopsy 
Blood culture
Serum
Urine
Endotracheal aspirates
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49
Q

What are microbiological investigations of pneumonia?

A 
Macroscopic 
Microscopy
PCR
culture
Antibodies
Antigens
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50
Q

How do you manage pneumonia?

A 
IV fluid 
Anti pyretics
Analgesics
Oxygen
Antibiotics
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51
Q

What are the outcomes of pneumonia?

A

Resolution
Lung abscess
Bronciectasis
Emphyma

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52
Q

How do you prevent pneumonia?

A

Chemophrophylaxis
Flu vaccine
Pneumonia vaccine

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53
Q

Name some opportunistic pathogens of pneumonia in immunosuppressed hosts

A

Cytomegalovirus
Mycobacterium avium intracellulare
Aspergilus, candida, pneumocystis jiroveci
Cryptosporidium, toxoplasma

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54
Q

What are the associated features of S.pneumoniae?

A

Elderly, co morbidities, acute onset, high fever, pleuritic chest pain

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55
Q

What are the associated features of haemophilus influenza?

A

COPD

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56
Q

What are the associated features of legionella?

A

Recent travel, younger patient, smokers, illness, multi system involvement

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57
Q

What are the associated features of mycoplasma?

A

Young, prior antibiotics, extra pulmonary involvement

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58
Q

What are the associated features of staphylococcus aureus?

A

Post viral, intra venous drug user

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59
Q

What are the associated features of chlamydia?

A

Contact with birds

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60
Q

What are the associated features of coxiella?

A

Animal contact (sheep)

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61
Q

What are the associated features of klebsiella?

A

Thrombocytopenia, leucopenia

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62
Q

What are the associated features of S. Milleri?

A

Dental infections, abdominal source, aspiration

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63
Q

Why is it important to control pCO2?

A

Because it controls blood pH

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64
Q

Define hypoxia

A

A fall in alveolar, hence arterial pO2

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65
Q

Define hypercapnia

A

A rise in alveolar, hence arterial pCO2

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66
Q

Define hypoxia

A

A fall in arterial, hence alveolar pCO2

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67
Q

Define hyperventilation

A

Increase in breathing which is more than you actually have to
pCO2 decreases
pH increases

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68
Q

Define hypoventilation

A

A decrease in breathing, less than you have to
pH decreases
pCO2 increases

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69
Q

Describe the effects of hyperventilation

A

Respiratory alkalosis
Hypocapnia
pH rises above 7.6

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70
Q

Why is respiratory alkalaemia dangerous?

A

Because it causes a rise in free calcium which can lead to tetany or parasthesia

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71
Q

What are the effects if hypoventilation?

A

Fall in pH <7.0
Respiratory acidaemia
Hypercapnia

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72
Q

What should the ratio of HCO3- and CO2 be to maintain pH?

A

20:1

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73
Q

What is respiratory acidosis?

A

When the pCO2 rises above 5.3 kPa
More than it can be removed
Fall in plasma pH

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74
Q

How do you compensate for respiratory acidosis?

A

You compensate by changing HCO3- in the kidney - more absorption
If it’s fully compensated then the pH will be normal
If it’s partially compensated then the HCO3- and pCO2 will change but the ph will still be abnormal

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75
Q

What is respiratory alkalosis?

A

pCO2 is decreased

pH is increased

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76
Q

How do you compensate for respiratory alkalosis?

A

You compensate by changing HCO3- in the kidney - more excretion
If it’s fully compensated then the pH will be normal
If it’s partially compensated then the HCO3- and pCO2 will change but the ph will still be abnormal

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77
Q

What is metabolic acidosis?

A

When a lot of metabolic acid is produced which displaces HCO 3-
pH in blood falls

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78
Q

How do you compensate for metabolic acidosis?

A

You breathe more

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79
Q

What is metabolic alkalosis?

A

When less acid is produced and HCO3- rises

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80
Q

How do you compensate for metabolic alkalosis?

A

You decrease ventilation however this can only be partially compensated for because you will decrease oxygen this way

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81
Q

How do you get metabolic alkalosis?

A

Persistent vomiting so you lose lots of acid

You need to correct the dehydration and the alkalosis will correct itself

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82
Q

What is a fall in pO2 detected by?

A

Peripheral chemoreceptors in the carotid bodies and aortic bodies
Stimulated by a decrease but it must be a big decrease

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83
Q

What do the peripheral chemoreceptors that detect oxygen cause upon stimulation?

A

Increase in the tidal volume and respiratory rate
Increase in blood flow to the kidneys and the heart
Increased pumping of blood by the heart

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84
Q

What is a fall in pCO2 detected by?

A

Chemoreceptors in the medulla
Increase ventilation for an increase in pCO2
Decrease in ventilation for a decrease in pCO2
Responds to negative feedback

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85
Q

What do the chemoreceptors of the medulla do?

A

Change the CSF pCO2 and bicarbonate

Choroid plexus cells

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86
Q

Under what kPa is hypoxia?

A

8kPa

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87
Q

What are the 5 factors necessary to maintain arterial pO2 in huge normal range?

A 
Right to left cardiac shunt
Diffusion pathway
Hypoventilation 
Air po2
Ventilation perfusion mismatch
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88
Q

Explain where you’d get a change in air pO2 and how this can lead to respiratory failure

A

Hypoxia

High altitudes

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89
Q

Explain how ventilation perfusion mismatch can lead to respiratory failure

A

Type 1 respiratory failure because O2 diffuses much less readily
Pulmonary embolism impairs the pathway so that some alveoli are not perfused
Lobar pneumonia cam reduce the ventilation of alveoli

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90
Q

Explain how a diffusion gradient being affected can lead to respiratory failure

A

Type 1 respiratory failure
Fibrosis which affects the diffusion
Pulmonary oedema which increases the path length
Emphysema which destroys the lung tissue therefore reduces the area

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91
Q

Explain how hypoventilation can cause respiratory failure

A

Increased pCO2, decreased pO2

Due to neuro, chest wall abnormalities or hard to ventilate the airways such as COPD

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92
Q

Define asthma

A

Asthma is a chronic disorder characterised by airway remodelling, airway inflammation and is a reversible airflow obstruction

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93
Q

What changes occur to the airways in asthma?

A

Damaged epithelium
Thickened basement membrane
Thickened smooth muscle

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94
Q

Explain the obstruction in asthma

A

Trigger causes smooth muscles to contract which reduces airway radius, which increases resistance and reduces airflow

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95
Q

Explain the epidemiology of asthma

A 
Increased in the developed world
Increased with developing countries moving to developed worlds 
5.4 million uk
1.1 million children
4.3 million adults
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96
Q

What are the common causes of asthma?

A 
Air pollution 
Smoking 
House dusts
Pollens
Genetic risk 
Animals
97
Q

What are the symptoms of asthma?

A 
Wheeze - polyphonic 
Cough - dry, worse at night, and in the cold, exercise induced 
Breathlessness - exercise induced 
Tight chest
Barrel chest
98
Q

How you do diagnose asthma?

A 
History 
Eczema, hayfever
Chest - deformities 
Lethargy
Children giggle and cough after
No symptoms on examination are likely as they aren't in an attack 
Wheeze
99
Q

What tests can be used for asthma?

A

Spirometry - increased with salbutamol of >12%
Low fev1/fvc ratio
Allergy testing - blood IgE
Chest x ray

100
Q

What type of immune cells are related to asthma?

A

Mast cells
Eosinophils
Dendritic cells
Lymphocytes

101
Q

What can cause an asthma attack?

A

Not taking medication
Allergy
Respiratory infection

102
Q

What mediation is used for asthma?

A

Corticosteroids

Salbutamol - beta adrenoagonists

103
Q

What are the primary preventions of asthma?

A

Weight loss
Exercise
Reduced allergies
No point in getting rid of pets as it takes 2 years to completely irradiate the irritants so just don’t replace them

104
Q

What is the normal partial pressure of oxygen?

A

13.3 kPa which means 0.13mmol/L is dissolved in the plasma

105
Q

What is the normal partial pressure of carbon dioxide?

A

5.3 kPa

106
Q

How much oxygen do we need per minute?

A

12mmol of oxygen per minute

107
Q

How is oxygen transported in the blood?

A

Binds to haemoglobin
Reversible
Oxygen binds to haem
4 per haemoglobin molecule

108
Q

Explain the properties of haemoglobin

A

2 alpha and 2 beta chains
Low affinity T state - does not like to bind with oxygen
High affinity R state - likes to bind with oxygen

109
Q

Explain the sigmoid oxygen saturation binding curve

A

In the high state all of the haemoglobin is bound, and saturated.
Under 8 kPa Hb is not saturated
Then the curve starts to decline and at about 3-4 it’s only half saturated
Becomes in the T state so O2 can be given to the tissues

110
Q

How much oxygen does normal blood have bound to haemoglobin?

A

8.8mmol/L

111
Q

What factors decrease the affinity for haemoglobin?

A

Acid, increased temperature, increase in CO2
Shifts the haemoglobin curve to the right
Bohr effect

112
Q

What percentage of oxygen is given up to the tissues usually?

A

35%

113
Q

What factors influence the diffusion across the alveolar membrane?

A

Area available
Concentration gradient
Resistance

114
Q

List the reactions of CO2 with blood

A

Dissolves in water
Reacts with water
Binds to proteins to make carbamino proteins

115
Q

What is the Henderson hasselbach equation?

A

pH = 6.1 + log ([HCO3-]/(pCO2 x 0.23))

116
Q

What is the significance of carbamino compounds?

A

Transport of co2 but does not contribute to acid base balance

117
Q

What is the arterial content of blood CO2?

A

21.5 mmol/L
80% travels as HCO3-
11% travels as carbamino compounds
8% dissolved as CO2

118
Q

What is the venous blood concentration of CO2?

A

23.5 mmol/L

119
Q

Describe how air is drawn into the lungs

A

The thorax is at a negative pressure
The lungs are at a low pressure
Air flows from an area of high pressure to low pressure
The thorax expands and brings the lungs with it due to the surface tension created by a small amount of pleural fluid

120
Q

What is a pneumothorax?

A

When air gets into the 2 layers of the pleural cavity so the integrity is lost due to a loss of negative pressure

121
Q

Define lung compliance

A

The stretchiness of the lungs

Volume change per unit pressure change

122
Q

What cells is surfacant produced by?

A

Type 2 alveolar cells

123
Q

What is poisuelles law?

A

The resistance of a tube increases sharply with size

124
Q

With reference to poiseulles law, why is the resistance in the lungs low?

A

Because alveoli are in parallel to one another which decreases the resistance and therefore the larger airways are at a higher pressure

125
Q

What is work done against in the lungs?

A

Elastic recoil
Elasticity
Resistance to flow
Surface tension

126
Q

How much of the total oxygen consumption does breathing contribute to at rest?

A

0.01%

127
Q

What is the forced vital capacity?

A

The maximum volume that can be expired from the full lungs

128
Q

What is the forced expiratory volume in 1 second

A

The maximum expiration in one second

129
Q

What is a vitilograph?

A

The graph used for a spirometer
Volume expired on the y
Time on the x

130
Q

For a restrictive deficit, what is affected?

A

Fev1 is normal or higher
But fvc is reduced
Easy to breathe out
Hard to breathe in

131
Q

For an obstructive deficit, what is effected?

A

It is easy to breathe in but hard to breathe out
Fvc is normal
Fev1 is reduced

132
Q

What is the helium dilution test used for?

A

To measure the functional residual capacity
Residual volume
Helium is inert and not in air so cannot cross the lungs gas exchanging membrane

133
Q

What is the transfer factor used for?

A

Uses carbon monoxide as this crosses the alveolar membrane and binds to haemoglobin so you can calculate the gas exchange rate

134
Q

Why is the nitrogen washout test used?

A

To measure the anatomical space
Nitrogen is in air
Patient inspires 100% volume and you can measure the % of nitrogen that a patient breathes out

135
Q

Describe the epidemiology of lung cancer in men

A

Most common cancer
Incidence rate decreasing
100/100,000 mortality
90% due to smoking

136
Q

Describe the epidemiology of lung cancer in women

A

Exceeds threshold for breast cancer
Increasing prevalence
40/100,000 mortality
80% due to smoking

137
Q

What are the other causes of lung cancer?

A 
Genetics
Radon
Diet
Asbestos
Smoking
138
Q

What are the symptoms of the primary tumour?

A 
Cough
Wheeze
Chest pain
Breathless
Haematotysis
Weight loss
Malaise 
Lethargy
Pneumonia
139
Q

What are the symptoms of the regional metastasis?

A

Dyspnoea
Dysphasia
Recurrent laryngeal nerve compression - hoarseness
Svc damage

140
Q

What are the symptoms of distant metastasis?

A

Bone pain
Fractures
CNS

141
Q

What is paraneoplastic syndrome?

A

Symptoms not due to the primary tumour but due to its effects elsewhere in the body by secreting cytokines and hormones

142
Q

What are some endocrine responses of lung cancer?

A

Hypercalcaemia

Cushing’s syndrome

143
Q

What are some neurological responses of lung cancer?

A

Encephalopathy

Peripheral neuropathy

144
Q

What are the skeletal effects of lung cancer?

A

Finger clubbing

145
Q

What are the haematological effects of lung cancer?

A

Anaemia
Thrombocytopenia
DIC

146
Q

What other things can occur due to lung cancer?

A

Nephrotic syndrome

Anorexia or cachexia

147
Q

What imaging techniques are used for lung cancer?

A

Pet
X ray
Ct
Isotopic bone scan

148
Q

Define stage 1 of lung cancer?

A

Small cancer, localised to one area

149
Q

Define stage 2 and 3 of lung cancer?

A

Larger cancer, may have gone into surrounding tissues

150
Q

What is stage 4 of lung cancer?

A

Cancer has metastasised

151
Q

What does TNM stand for?

A

Primary tumour
Nodes
Metastasis

152
Q

Explain the T stage of lung cancer

A

TIS - carcinoma in situ
T1 - cancer contained in the lung 7cm into pleura, pleura, diaphragm
T4 - into trachea, oesophagus, recurrent laryngeal nerve, heart

153
Q

Explain the N stage of lung cancer

A

N0 - lymph nodes involved
N1 - cancer in nodes of that lung
N2 - cancer in that lung and mediastinum on that side
N3 - cancer in both lungs

154
Q

Explain the M stage of lung cancer?

A

M0 - no metastasis

M1 - metastasised

155
Q

What methods are used for histology samples in lung cancer?

A

Bronchoscopy
Needle biopsy
Surgical biopsy

156
Q

What does the prognosis depend upon?

A 
Cell type
Stage of disease
Performance status
Biochemical markers
Co morbidities
157
Q

What are the different treatments used in treatment of lung cancer?

A 
Surgery
Radiotherapy
Chemotherapy
Combined
Biological targets 
Palliative care
158
Q

What stain is used to look for TB?

A

Acid fast

Also called Ziehl Nelson

159
Q

Why does TB need this stain?

A

High lipid content in its cell wall

160
Q

How is TB spread?

A

Person to person

Aerosol

161
Q

Explain the primary TB infection?

A

Usually asymptomatic
Lymph nodes involved
Within the first 2 weeks

162
Q

Explain the post primary TB infection?

A

Happens after first 2 weeks
Could be decades
Latent period
Miliary spread or confined

163
Q

Explain the pathology of TB/the host response?

A 
Mycobacterium is ingested by macrophages
Escapes from phagolysosomes
Causes release of IL-12, TNF alpha and INF gamma from NK and CD4
Causes activation of macrophages
Formation of a granuloma
164
Q

What does the intense immune response cause?

A

Destruction of lung tissue to form cavities

A systemic response due to release of cytokines

165
Q

What does TB mimick?

A

Inflammatory and metastasis diseases

166
Q

Give the symptoms of pulmonary TB

A 
Fever
Weight loss
Night sweats
Cough
Haemoptysis
167
Q

Give the symptoms of TB meningitis

A

Headache
Fever
Decreasing consciousness

168
Q

Give the symptoms of a kidney infection due to TB

A

weight loss
Fever
Hydronephropathy
Uterine stone formation

169
Q

What does an infection in the spine due to TB cause and where is it most likely?

A

Lumbosacral
Collapse of vertebrae
Nerve compression

170
Q

What does TB in the joints cause?

A

Inflammation

Degenerative arthritis

171
Q

What are the symptoms of post primary TB?

A

Night sweats
Fever
Cough
Weight loss

172
Q

What findings would you see on an X-ray for TB?

A 
Calcification
Millary seeds
Cavities
Shadows
Apex 
Cardiomegaly
Consolidation
173
Q

What are the 2 causes of pulmonary TB and who is most likely to get it?

A

Males
Hypersensitivity
Empyema in the chest wall eroding into it

174
Q

Who is most likely to get lymphatic TB and what does it result in?

A

Women, children, Asians
Asymptomatic
Swollen neck

175
Q

What does osteo-articular TB do?

A

Burrows into bone

176
Q

What happens in tuberculous spondylitis?

A

TB spreads into vertebral bodies, down longitudinal ligament and causes compression and collapse
Usually in lumbosacral spine
Form of osteo-articular TB

177
Q

What is poncets disease?

A

Aseptic poly arthritis

Knees, ankles and elbows

178
Q

What happens in miliary TB?

A

Spreads through bloodstream
Always reaches lungs
Few pulmonary symptoms
Headaches suggest meningal involvement

179
Q

Describe the clinical diagnosis of TB

A

Clinical features
Radiological features
Microscopic

180
Q

What antibiotics are used for TB and for how long?

A

Rifampicin, Pyrazinamide, Isoniazid, Ethambutol for 2 months
Rifampicin and isoniazid for 4 months

181
Q

Why do you use more than 1 antibiotic for TB?

A

Because there is so much resistant TB now

182
Q

What causes multi drug resistant TB?

A

In a country where this strain is common
Non compliance with treatment
Non responsive

183
Q

What are the side effects of rifampicin?

A 
Thrombocytopenic purpura
Hepatitis
Rash
Flu like 
Shock
ARF
184
Q

What are the side effects of isoniazid?

A

Rash
Hepatitis
Peripheral neuropathy

185
Q

What are the side effects of ethambutol?

A

Optic neuritis

186
Q

What is the BCG vaccine?

A

A vaccine prepared from live TB bacillus
Not very effective
Low efficacy
Retain a strong enough antigen

187
Q

List the groups at high risk of TB infection

A 
HIV
IV drug users
Malnutrition
Corticosteroids
Diabetes
Smokers
Silicosis
Overcrowding
Ethnicity
188
Q

Describe the relationship between TB and HIV

A

20-37 x more likely to get TB

189
Q

What happens if someone in the uk is suspected to have TB?

A

Immediate radiograph
Call clinic
Treatment within 7 days commences

190
Q

What is a primary glomerular injury?

A

Only affects the glomeruli directly

191
Q

What is a secondary glomerular injury?

A

Where a systemic disease in turn affects the glomerulus

192
Q

What are the 4 types of glomerular injury?

A

Subepithelial - podocytes
Subendothelial - in BM
Basement Membrane
Mesangial - capillary loop

193
Q

What can happen to the glomerulus?

A

The filter can block - hypertension, haematuria, renal failure
OR
The filter can leak - haematuria and proteinurea

194
Q

What is proteinurea?

A

A high protein content in the urine, however still below 3.5g. It is due to damage to the podocyte layer

195
Q

What is nephrotic syndrome?

A

A urine protein content of over 3.5g in 24 hours. It decreases the oncotic pressure which can lead to oedema and is due to the podocyte being damaged

196
Q

What are common secondary causes of nephrotic syndrome?

A

Diabetes mellitis

Amyloidosis

197
Q

Describe minimal change glomerulonephritis

A

This usually occurs in the young, proteinurea, doesn’t usually progress to renal failure, responds well to steroids. Unknown pathology. On electron microscope it shows that the podocytes have widened, allowing protein to leak through

198
Q

Describe minimal change focal segmental glomerulosclerosis

A 
Sclerosis - scarring 
Segmental - part of glomerular tought
Focal - only affects 50% 
Visible with an e- microscope, doesn't respond well to steroids, often leads to renal failure.
A circulating factor is responsible
199
Q

Describe membranous glomerulonephritis

A

This is due to an autoimmune condition, immune deposits are layed down in the glomerulus which damages it. It leads to a thickened capillary and the BM appears speckly. It follows the rule of 3’s
1/3 get better, 1/3 have proteinuea, 1/3 renal failure

200
Q

Define nephritic syndrome

A

Blockage in the glomerulus

201
Q

Describe IgA neuropathy

A

Occurs at any age. IgA is deposited in the glomerulus. Presents with visible or invisible haematuria. Associated with mucosal infections. Some lead to renal failure

202
Q

What is alport syndrome?

A

A hereditary nephropathy.

X linked, associated with deafness, abnormal GBM, collagen IV abnormality, progression to renal failure

203
Q

What is thin GBM nephropathy?

A

Benign familial
Isolated haematuria
Thin GBM
Benign course

204
Q

Explain how diabetes mellitus can affect the glomerulus?

A 
Microscopic - affects glomerulus directly
Proteinurea
Renal failure
Mesangial sclerosis
BM thickened 4-5x
205
Q

What is goodpasture syndrome?

A

This is where an autoantibody in response to collagen IV affects the glomerulus. Treated with plasmaphoresis and immunosuppression. Only affects the kidney. IgG deposits

206
Q

What is vasculitis?

A

This is an inflammation of the blood vessels and therefore severely affects the kidney as it’s highly vascularised. Blood vessels are attacked by Anti Neutrophil Cytoplasmic Antigen

207
Q

Explain the 2 different immune mechanisms that affect the glomerulus

A

Either the mesangium is affected directly and there is no barrier by the podocytes or BM
OR
An antigen abnormally binds to the subepithelial layer and forms immune complexes when IgG binds to the antigen.

208
Q

Explain the epidemiology of prostate cancer

A

Increases with age, most common cancer in men and second most common cause of cancer deaths in men.
Patients usually die WITH it, not of it.

209
Q

Explain how family history can affect someone getting prostate cancer?

A

There is a 4x increased risk of a patient getting prostate cancer if a member of their first degree family had it under 60, if over 60 then it was likely to be age

210
Q

Explain the relationship with race and prostate cancer?

A

Asians<Afro-carribbean

211
Q

Describe the presentation of prostate cancer

A 
Sometimes asymptomatic
Enlargement of the prostate
Bladder over-activity
\+/- CaP
Bone pain
212
Q

What is an unusual symptom of prostate cancer?

A

Haematuria, usually occurs in developed prostate cancer

213
Q

How do you diagnose prostate cancer?

A

DRE
PSA levels
and based on these, biopsy with ultrasound

214
Q

What factors influence treatment of prostate cancer?

A 
Age
PSA levels
DRE results
Gleason staging - biopsy
MRI and bone scan for metastases
215
Q

How do you treat established prostate cancer?

A

Surveillance - sometimes treatment can make it worse
Radiotherapy, brachytherapy (radiation internal beads)
Prostectomy

216
Q

How do you treat developmental prostate cancer?

A

Cryotherapy (freeze prostate)
Brachytherapy
HIFU - high intensity focused ultrasound

217
Q

How do you treat metastatic prostate caner?

A

Hormones

Pallation - chemo/radio/bisphosphonates

218
Q

How do you treat locally advanced prostate cancer?

A

Surveillance
Hormones
Radiotherapy

219
Q

Describe haematuria

A

Blood in urine
Can be visible or non visible
20% visible due to cancer and metastasis
See with dipstick or culture of urine

220
Q

What is the differential diagnosis of haematuria?

A 
Bladder cancer
Upper tract transitional cell carcinoma
Renal cell carcinoma
Prostate cancer 
Stones
Infection
Inflammation
Benign prostate englargment
Nephrological
221
Q

Describe the history investigation of haematuria

A 
smoking
occupation
pain/painless
urinary tract symptoms
family history
222
Q

Describe the examinations for haematuria

A

BP
Abdominal Mass
Varicoeles
Leg swelling

223
Q

Describe the clinical investigations for haematuria

A 
DRE
Urine culture
Cystoscopy
US
Full blood count
224
Q

Describe the epidemiology of bladder cancer

A

7th most common cancer in the UK
2.5:1 male:female
90% are TCC

225
Q

What are the risk cancers for bladder cancer?

A

Smoking
Occupational: hairdressers, mechanics, polycyclic hydrocarbons, printers, hairdressers
schistosomiasis

226
Q

Describe the staging of bladder cancer

A

75% are T1
5% are TIS
20% are muscle invasive

227
Q

What is the treatment for high risk non muscle invasive TCC?

A

chemo/immunotherapy

check cystoscopy

228
Q

What is the treatment for low risk non muscle invasive TCC

A

Check cystoscopy

229
Q

What is the treatment for muscle invasive TCC?

A

Potentially curative
radical cystectomy
radiotherapy

for non curative pallative chemo/radio

230
Q

What is a radical cystectomy?

A

Bladder is removed and the small intestine can be used to make a conduit from ureter to abdomen or it can be used to try and make a new blader

231
Q

Explain the epidemiology of renal cell carcinoma

A

8th most common cancer
95% of urinary tract tumours
male:female 3:2
30% have metastases on presentation

232
Q

What are the risk factors for RCC?

A

Obesity
Smoking
Dialysis

233
Q

Where do RCC metastases spread?

A

Lymph nodes

Up the IVC from renal vein into the right atrium

234
Q

How do you treat an established RCC?

A

Surveillance
Nephrectomy (kidney, adrenal, fat and upper ureter)
Partial nephrectomy

235
Q

How do you treat a developmental RCC?

A

Ablation - removal of tumour from surface of kidney via an erosive process

236
Q

How do you pallatively treat a RCC?

A

Immunotherapy

237
Q

Explain the epidemiology of a TCC

A

5% of alll malignancies of upper tract
40% spread to bladder
5% are due to bladder spreading up

238
Q

How would you investigate a TCC?

A

Ultrasound for hydronephrosis (swelling increased urine)
CT urogram for a filling defect or strictures
Retrograde pyelogram
Uteroscopy biopsy

239
Q

How do you treat TCC?

A

Nephro-ureterectomy - removal of fat, ureter, kidney and cuff of bladder

Semester 3 - me (8 decks)

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