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
1
Q
What is the rate of diffusion affected by?
A
Area
Resistance to diffusion
Gradient of partial pressure
2
Q
Along the diffusion pathway what is the rate of diffusion affected by most
A
Solubility of gas in water
3
Q
How much faster can carbon dioxide diffuse by compared to oxygen?
A
21x
4
Q
What is the partial pressure of oxygen in the alveoli?
A
13.3kPa
5
Q
What is the partial pressure of carbon dioxide in the alveoli?
A
5.3 kPa
6
Q
What is the tidal volume?
A
The volume that enters and leaves with each breath
7
Q
What is the inspiratory reserve volume?
A
Where you breathe in more than normal
8
Q
What is the expiratory reserve volume?
A
When you breathe out more than at rest
9
Q
What is the residual volume?
A
The volume left after expiration
10
Q
What is the inspiratory capacity?
A
From quiet expiration to maximum inspiration
11
Q
What is the functional residual capacity?
A
Volume of air in lungs at the end of quiet expiration
12
Q
What is the vital capacity?
A
Inspiratory reserve volume + tidal volume + expiratory reserve volume
13
Q
What is the total lung volume?
A
Vital capacity + reserve volume
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
15
Q
What is alveolar dead space?
A
Volume of air not taking part in gas exchange
Ie. alveoli is damaged
Insufficient blood supply
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
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
18
Q
What is the dead space ventillation rate?
A
Movement of air into and out of dead space
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
20
Q
What is COPD?
A
Chronic obstructive pulmonary disease Obstruction of the airways Slow, progressive disease Fev1 reduced Fev1/fvc ratio reduced
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
22
Q
Explain the causes of COPD
A
Smoking
Air pollution
Coal mining etc
Noxious particles in the lungs
23
Q
Name the main symptoms of COPD
A
Cough Breathlessness Wheeze Sputum blood or clear Following years of a smokers cough
24
Name the signs of COPD
Blood or clear sputum
Hyperventilation with prolonged expiration
Hyper-inflammation of the lungs
Accessory muscles needed
25
Explain the assessment of COPD
```
History
Chest X ray
CT
Fev1
Other lung function tests
```
26
What is spirometry?
A lung function test used to assess lung volume, you take a maximum inspiration and then you breathe out over the spirometer
27
What is type 1 respiratory failure?
Hypoxia
Low or normal CO2
Respiratory rate increased
28
What is type 2 respiratory failure?
Increased ventilation
Hypoxia
High CO2
29
Why is oxygen used with COPD?
```
Long term
Hypoxia
Not breathlessness
Can be used intermediately too
Long term use prolongs life
```
30
Outline the management of COPD
```
Stop smoking
Corticosteroids
Beta adreno agonists
Antibiotics
Pulmonary rehab
Oxygen
Treat co morbidities
```
31
What is an alternative, less common cause of COPD?
Alpha 1 antitrypsin deficiency
32
List the common normal flora in the respiratory tract
Candida spp
Neisserra spp
Anaerobes
Viridius streptococci
33
What are some less common normal flora of the respiratory tract?
Haemophillus influenza
Streptococci pneumonia
Streptococci pyogenes
34
Name some other respiratory tract normal flora
E. coli
| Pseudomonas
35
Name the defences of the respiratory tract
```
Epithelia ciliated
Cough
Sneezing
Mucous
Nasal hair
Lymphoid
Macrophages
```
36
Name some upper respiratory tract infections
```
Rhinitis
Laryngitis
Pharyngitis
Epiglottitia
Sinusitis
Tracheitis
```
37
Name some common respiratory tract infections caused by viruses
Coronovirus
Influenza
RSV
Rhinovirus
38
Name some common respiratory tract infections caused by bacteria
Meningitis
Brain abcesses
Mastoiditis
39
Define pneumonia
Inflammation of the parenchyma of the lungs
| Affects gas exchanging region of the lungs
40
What is lobar pneumonia and what is it commonly caused by?
Pneumonia restricted to one lobe
| Streptococcus pneumoniae
41
What is broncho pneumonia and what is it commonly caused by?
Pneumonia which starts off in the large airways and spreads to alveoli and lung tissue.
Coliforms, anaerobes, streptococci pneumoniae, haemophilus influenza, staphylococcus aureus
42
What is aspiration pneumonia and what is it commonly caused by?
Choking, vomit, food, drink
Oral flora
Anaerobes
43
What is interstitial pneumonia and what is it commonly caused by?
Pneumonia in the capillary endothelium, basement membrane, alveolar epithelium, peri vascular and peri lymphoid tissue
44
Name some commonly community acquired bacterium
```
Klebsiella pneumoniae
Streptococcus pneumoniae
Haemophilus influenza
Chlamydia pneumophilla
Legionella pneumophilla
Mycoplasma pneumoniae
```
45
Name some common hospital acquired bacteria
MRSA
Staphylococcus aureus
Gram negative enteric bacterium
Pseudomonas
46
Name some symptoms of pneumonia
Myalgia, headache, diarrhoea
Malaise, dyspnoea, vomitting
Lethargy, chest pain, cough
Wheeze, stained sputum
47
What is the curb score?
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
48
What samples are used to investigate pneumonia?
```
Sputum
Nose and throat swabs
Lung biopsy
Blood culture
Serum
Urine
Endotracheal aspirates
```
49
What are microbiological investigations of pneumonia?
```
Macroscopic
Microscopy
PCR
culture
Antibodies
Antigens
```
50
How do you manage pneumonia?
```
IV fluid
Anti pyretics
Analgesics
Oxygen
Antibiotics
```
51
What are the outcomes of pneumonia?
Resolution
Lung abscess
Bronciectasis
Emphyma
52
How do you prevent pneumonia?
Chemophrophylaxis
Flu vaccine
Pneumonia vaccine
53
Name some opportunistic pathogens of pneumonia in immunosuppressed hosts
Cytomegalovirus
Mycobacterium avium intracellulare
Aspergilus, candida, pneumocystis jiroveci
Cryptosporidium, toxoplasma
54
What are the associated features of S.pneumoniae?
Elderly, co morbidities, acute onset, high fever, pleuritic chest pain
55
What are the associated features of haemophilus influenza?
COPD
56
What are the associated features of legionella?
Recent travel, younger patient, smokers, illness, multi system involvement
57
What are the associated features of mycoplasma?
Young, prior antibiotics, extra pulmonary involvement
58
What are the associated features of staphylococcus aureus?
Post viral, intra venous drug user
59
What are the associated features of chlamydia?
Contact with birds
60
What are the associated features of coxiella?
Animal contact (sheep)
61
What are the associated features of klebsiella?
Thrombocytopenia, leucopenia
62
What are the associated features of S. Milleri?
Dental infections, abdominal source, aspiration
63
Why is it important to control pCO2?
Because it controls blood pH
64
Define hypoxia
A fall in alveolar, hence arterial pO2
65
Define hypercapnia
A rise in alveolar, hence arterial pCO2
66
Define hypoxia
A fall in arterial, hence alveolar pCO2
67
Define hyperventilation
Increase in breathing which is more than you actually have to
pCO2 decreases
pH increases
68
Define hypoventilation
A decrease in breathing, less than you have to
pH decreases
pCO2 increases
69
Describe the effects of hyperventilation
Respiratory alkalosis
Hypocapnia
pH rises above 7.6
70
Why is respiratory alkalaemia dangerous?
Because it causes a rise in free calcium which can lead to tetany or parasthesia
71
What are the effects if hypoventilation?
Fall in pH <7.0
Respiratory acidaemia
Hypercapnia
72
What should the ratio of HCO3- and CO2 be to maintain pH?
20:1
73
What is respiratory acidosis?
When the pCO2 rises above 5.3 kPa
More than it can be removed
Fall in plasma pH
74
How do you compensate for respiratory acidosis?
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
75
What is respiratory alkalosis?
pCO2 is decreased
| pH is increased
76
How do you compensate for respiratory alkalosis?
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
77
What is metabolic acidosis?
When a lot of metabolic acid is produced which displaces HCO 3-
pH in blood falls
78
How do you compensate for metabolic acidosis?
You breathe more
79
What is metabolic alkalosis?
When less acid is produced and HCO3- rises
80
How do you compensate for metabolic alkalosis?
You decrease ventilation however this can only be partially compensated for because you will decrease oxygen this way
81
How do you get metabolic alkalosis?
Persistent vomiting so you lose lots of acid
| You need to correct the dehydration and the alkalosis will correct itself
82
What is a fall in pO2 detected by?
Peripheral chemoreceptors in the carotid bodies and aortic bodies
Stimulated by a decrease but it must be a big decrease
83
What do the peripheral chemoreceptors that detect oxygen cause upon stimulation?
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
84
What is a fall in pCO2 detected by?
Chemoreceptors in the medulla
Increase ventilation for an increase in pCO2
Decrease in ventilation for a decrease in pCO2
Responds to negative feedback
85
What do the chemoreceptors of the medulla do?
Change the CSF pCO2 and bicarbonate
| Choroid plexus cells
86
Under what kPa is hypoxia?
8kPa
87
What are the 5 factors necessary to maintain arterial pO2 in huge normal range?
```
Right to left cardiac shunt
Diffusion pathway
Hypoventilation
Air po2
Ventilation perfusion mismatch
```
88
Explain where you'd get a change in air pO2 and how this can lead to respiratory failure
Hypoxia
| High altitudes
89
Explain how ventilation perfusion mismatch can lead to respiratory failure
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
90
Explain how a diffusion gradient being affected can lead to respiratory failure
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
91
Explain how hypoventilation can cause respiratory failure
Increased pCO2, decreased pO2
| Due to neuro, chest wall abnormalities or hard to ventilate the airways such as COPD
92
Define asthma
Asthma is a chronic disorder characterised by airway remodelling, airway inflammation and is a reversible airflow obstruction
93
What changes occur to the airways in asthma?
Damaged epithelium
Thickened basement membrane
Thickened smooth muscle
94
Explain the obstruction in asthma
Trigger causes smooth muscles to contract which reduces airway radius, which increases resistance and reduces airflow
95
Explain the epidemiology of asthma
```
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
```
96
What are the common causes of asthma?
```
Air pollution
Smoking
House dusts
Pollens
Genetic risk
Animals
```
97
What are the symptoms of asthma?
```
Wheeze - polyphonic
Cough - dry, worse at night, and in the cold, exercise induced
Breathlessness - exercise induced
Tight chest
Barrel chest
```
98
How you do diagnose asthma?
```
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
What tests can be used for asthma?
Spirometry - increased with salbutamol of >12%
Low fev1/fvc ratio
Allergy testing - blood IgE
Chest x ray
100
What type of immune cells are related to asthma?
Mast cells
Eosinophils
Dendritic cells
Lymphocytes
101
What can cause an asthma attack?
Not taking medication
Allergy
Respiratory infection
102
What mediation is used for asthma?
Corticosteroids
| Salbutamol - beta adrenoagonists
103
What are the primary preventions of asthma?
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
What is the normal partial pressure of oxygen?
13.3 kPa which means 0.13mmol/L is dissolved in the plasma
105
What is the normal partial pressure of carbon dioxide?
5.3 kPa
106
How much oxygen do we need per minute?
12mmol of oxygen per minute
107
How is oxygen transported in the blood?
Binds to haemoglobin
Reversible
Oxygen binds to haem
4 per haemoglobin molecule
108
Explain the properties of haemoglobin
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
Explain the sigmoid oxygen saturation binding curve
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
How much oxygen does normal blood have bound to haemoglobin?
8.8mmol/L
111
What factors decrease the affinity for haemoglobin?
Acid, increased temperature, increase in CO2
Shifts the haemoglobin curve to the right
Bohr effect
112
What percentage of oxygen is given up to the tissues usually?
35%
113
What factors influence the diffusion across the alveolar membrane?
Area available
Concentration gradient
Resistance
114
List the reactions of CO2 with blood
Dissolves in water
Reacts with water
Binds to proteins to make carbamino proteins
115
What is the Henderson hasselbach equation?
pH = 6.1 + log ([HCO3-]/(pCO2 x 0.23))
116
What is the significance of carbamino compounds?
Transport of co2 but does not contribute to acid base balance
117
What is the arterial content of blood CO2?
21.5 mmol/L
80% travels as HCO3-
11% travels as carbamino compounds
8% dissolved as CO2
118
What is the venous blood concentration of CO2?
23.5 mmol/L
119
Describe how air is drawn into the lungs
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
What is a pneumothorax?
When air gets into the 2 layers of the pleural cavity so the integrity is lost due to a loss of negative pressure
121
Define lung compliance
The stretchiness of the lungs
| Volume change per unit pressure change
122
What cells is surfacant produced by?
Type 2 alveolar cells
123
What is poisuelles law?
The resistance of a tube increases sharply with size
124
With reference to poiseulles law, why is the resistance in the lungs low?
Because alveoli are in parallel to one another which decreases the resistance and therefore the larger airways are at a higher pressure
125
What is work done against in the lungs?
Elastic recoil
Elasticity
Resistance to flow
Surface tension
126
How much of the total oxygen consumption does breathing contribute to at rest?
0.01%
127
What is the forced vital capacity?
The maximum volume that can be expired from the full lungs
128
What is the forced expiratory volume in 1 second
The maximum expiration in one second
129
What is a vitilograph?
The graph used for a spirometer
Volume expired on the y
Time on the x
130
For a restrictive deficit, what is affected?
Fev1 is normal or higher
But fvc is reduced
Easy to breathe out
Hard to breathe in
131
For an obstructive deficit, what is effected?
It is easy to breathe in but hard to breathe out
Fvc is normal
Fev1 is reduced
132
What is the helium dilution test used for?
To measure the functional residual capacity
Residual volume
Helium is inert and not in air so cannot cross the lungs gas exchanging membrane
133
What is the transfer factor used for?
Uses carbon monoxide as this crosses the alveolar membrane and binds to haemoglobin so you can calculate the gas exchange rate
134
Why is the nitrogen washout test used?
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
Describe the epidemiology of lung cancer in men
Most common cancer
Incidence rate decreasing
100/100,000 mortality
90% due to smoking
136
Describe the epidemiology of lung cancer in women
Exceeds threshold for breast cancer
Increasing prevalence
40/100,000 mortality
80% due to smoking
137
What are the other causes of lung cancer?
```
Genetics
Radon
Diet
Asbestos
Smoking
```
138
What are the symptoms of the primary tumour?
```
Cough
Wheeze
Chest pain
Breathless
Haematotysis
Weight loss
Malaise
Lethargy
Pneumonia
```
139
What are the symptoms of the regional metastasis?
Dyspnoea
Dysphasia
Recurrent laryngeal nerve compression - hoarseness
Svc damage
140
What are the symptoms of distant metastasis?
Bone pain
Fractures
CNS
141
What is paraneoplastic syndrome?
Symptoms not due to the primary tumour but due to its effects elsewhere in the body by secreting cytokines and hormones
142
What are some endocrine responses of lung cancer?
Hypercalcaemia
| Cushing's syndrome
143
What are some neurological responses of lung cancer?
Encephalopathy
| Peripheral neuropathy
144
What are the skeletal effects of lung cancer?
Finger clubbing
145
What are the haematological effects of lung cancer?
Anaemia
Thrombocytopenia
DIC
146
What other things can occur due to lung cancer?
Nephrotic syndrome
| Anorexia or cachexia
147
What imaging techniques are used for lung cancer?
Pet
X ray
Ct
Isotopic bone scan
148
Define stage 1 of lung cancer?
Small cancer, localised to one area
149
Define stage 2 and 3 of lung cancer?
Larger cancer, may have gone into surrounding tissues
150
What is stage 4 of lung cancer?
Cancer has metastasised
151
What does TNM stand for?
Primary tumour
Nodes
Metastasis
152
Explain the T stage of lung cancer
TIS - carcinoma in situ
T1 - cancer contained in the lung 7cm into pleura, pleura, diaphragm
T4 - into trachea, oesophagus, recurrent laryngeal nerve, heart
153
Explain the N stage of lung cancer
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
Explain the M stage of lung cancer?
M0 - no metastasis
| M1 - metastasised
155
What methods are used for histology samples in lung cancer?
Bronchoscopy
Needle biopsy
Surgical biopsy
156
What does the prognosis depend upon?
```
Cell type
Stage of disease
Performance status
Biochemical markers
Co morbidities
```
157
What are the different treatments used in treatment of lung cancer?
```
Surgery
Radiotherapy
Chemotherapy
Combined
Biological targets
Palliative care
```
158
What stain is used to look for TB?
Acid fast
| Also called Ziehl Nelson
159
Why does TB need this stain?
High lipid content in its cell wall
160
How is TB spread?
Person to person
| Aerosol
161
Explain the primary TB infection?
Usually asymptomatic
Lymph nodes involved
Within the first 2 weeks
162
Explain the post primary TB infection?
Happens after first 2 weeks
Could be decades
Latent period
Miliary spread or confined
163
Explain the pathology of TB/the host response?
```
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
What does the intense immune response cause?
Destruction of lung tissue to form cavities
| A systemic response due to release of cytokines
165
What does TB mimick?
Inflammatory and metastasis diseases
166
Give the symptoms of pulmonary TB
```
Fever
Weight loss
Night sweats
Cough
Haemoptysis
```
167
Give the symptoms of TB meningitis
Headache
Fever
Decreasing consciousness
168
Give the symptoms of a kidney infection due to TB
weight loss
Fever
Hydronephropathy
Uterine stone formation
169
What does an infection in the spine due to TB cause and where is it most likely?
Lumbosacral
Collapse of vertebrae
Nerve compression
170
What does TB in the joints cause?
Inflammation
| Degenerative arthritis
171
What are the symptoms of post primary TB?
Night sweats
Fever
Cough
Weight loss
172
What findings would you see on an X-ray for TB?
```
Calcification
Millary seeds
Cavities
Shadows
Apex
Cardiomegaly
Consolidation
```
173
What are the 2 causes of pulmonary TB and who is most likely to get it?
Males
Hypersensitivity
Empyema in the chest wall eroding into it
174
Who is most likely to get lymphatic TB and what does it result in?
Women, children, Asians
Asymptomatic
Swollen neck
175
What does osteo-articular TB do?
Burrows into bone
176
What happens in tuberculous spondylitis?
TB spreads into vertebral bodies, down longitudinal ligament and causes compression and collapse
Usually in lumbosacral spine
Form of osteo-articular TB
177
What is poncets disease?
Aseptic poly arthritis
| Knees, ankles and elbows
178
What happens in miliary TB?
Spreads through bloodstream
Always reaches lungs
Few pulmonary symptoms
Headaches suggest meningal involvement
179
Describe the clinical diagnosis of TB
Clinical features
Radiological features
Microscopic
180
What antibiotics are used for TB and for how long?
Rifampicin, Pyrazinamide, Isoniazid, Ethambutol for 2 months
Rifampicin and isoniazid for 4 months
181
Why do you use more than 1 antibiotic for TB?
Because there is so much resistant TB now
182
What causes multi drug resistant TB?
In a country where this strain is common
Non compliance with treatment
Non responsive
183
What are the side effects of rifampicin?
```
Thrombocytopenic purpura
Hepatitis
Rash
Flu like
Shock
ARF
```
184
What are the side effects of isoniazid?
Rash
Hepatitis
Peripheral neuropathy
185
What are the side effects of ethambutol?
Optic neuritis
186
What is the BCG vaccine?
A vaccine prepared from live TB bacillus
Not very effective
Low efficacy
Retain a strong enough antigen
187
List the groups at high risk of TB infection
```
HIV
IV drug users
Malnutrition
Corticosteroids
Diabetes
Smokers
Silicosis
Overcrowding
Ethnicity
```
188
Describe the relationship between TB and HIV
20-37 x more likely to get TB
189
What happens if someone in the uk is suspected to have TB?
Immediate radiograph
Call clinic
Treatment within 7 days commences
190
What is a primary glomerular injury?
Only affects the glomeruli directly
191
What is a secondary glomerular injury?
Where a systemic disease in turn affects the glomerulus
192
What are the 4 types of glomerular injury?
Subepithelial - podocytes
Subendothelial - in BM
Basement Membrane
Mesangial - capillary loop
193
What can happen to the glomerulus?
The filter can block - hypertension, haematuria, renal failure
OR
The filter can leak - haematuria and proteinurea
194
What is proteinurea?
A high protein content in the urine, however still below 3.5g. It is due to damage to the podocyte layer
195
What is nephrotic syndrome?
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
What are common secondary causes of nephrotic syndrome?
Diabetes mellitis
| Amyloidosis
197
Describe minimal change glomerulonephritis
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
Describe minimal change focal segmental glomerulosclerosis
```
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
Describe membranous glomerulonephritis
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
Define nephritic syndrome
Blockage in the glomerulus
201
Describe IgA neuropathy
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
What is alport syndrome?
A hereditary nephropathy.
| X linked, associated with deafness, abnormal GBM, collagen IV abnormality, progression to renal failure
203
What is thin GBM nephropathy?
Benign familial
Isolated haematuria
Thin GBM
Benign course
204
Explain how diabetes mellitus can affect the glomerulus?
```
Microscopic - affects glomerulus directly
Proteinurea
Renal failure
Mesangial sclerosis
BM thickened 4-5x
```
205
What is goodpasture syndrome?
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
What is vasculitis?
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
Explain the 2 different immune mechanisms that affect the glomerulus
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
Explain the epidemiology of prostate cancer
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
Explain how family history can affect someone getting prostate cancer?
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
Explain the relationship with race and prostate cancer?
Asians
211
Describe the presentation of prostate cancer
```
Sometimes asymptomatic
Enlargement of the prostate
Bladder over-activity
+/- CaP
Bone pain
```
212
What is an unusual symptom of prostate cancer?
Haematuria, usually occurs in developed prostate cancer
213
How do you diagnose prostate cancer?
DRE
PSA levels
and based on these, biopsy with ultrasound
214
What factors influence treatment of prostate cancer?
```
Age
PSA levels
DRE results
Gleason staging - biopsy
MRI and bone scan for metastases
```
215
How do you treat established prostate cancer?
Surveillance - sometimes treatment can make it worse
Radiotherapy, brachytherapy (radiation internal beads)
Prostectomy
216
How do you treat developmental prostate cancer?
Cryotherapy (freeze prostate)
Brachytherapy
HIFU - high intensity focused ultrasound
217
How do you treat metastatic prostate caner?
Hormones
| Pallation - chemo/radio/bisphosphonates
218
How do you treat locally advanced prostate cancer?
Surveillance
Hormones
Radiotherapy
219
Describe haematuria
Blood in urine
Can be visible or non visible
20% visible due to cancer and metastasis
See with dipstick or culture of urine
220
What is the differential diagnosis of haematuria?
```
Bladder cancer
Upper tract transitional cell carcinoma
Renal cell carcinoma
Prostate cancer
Stones
Infection
Inflammation
Benign prostate englargment
Nephrological
```
221
Describe the history investigation of haematuria
```
smoking
occupation
pain/painless
urinary tract symptoms
family history
```
222
Describe the examinations for haematuria
BP
Abdominal Mass
Varicoeles
Leg swelling
223
Describe the clinical investigations for haematuria
```
DRE
Urine culture
Cystoscopy
US
Full blood count
```
224
Describe the epidemiology of bladder cancer
7th most common cancer in the UK
2.5:1 male:female
90% are TCC
225
What are the risk cancers for bladder cancer?
Smoking
Occupational: hairdressers, mechanics, polycyclic hydrocarbons, printers, hairdressers
schistosomiasis
226
Describe the staging of bladder cancer
75% are T1
5% are TIS
20% are muscle invasive
227
What is the treatment for high risk non muscle invasive TCC?
chemo/immunotherapy
| check cystoscopy
228
What is the treatment for low risk non muscle invasive TCC
Check cystoscopy
229
What is the treatment for muscle invasive TCC?
Potentially curative
radical cystectomy
radiotherapy
for non curative pallative chemo/radio
230
What is a radical cystectomy?
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
Explain the epidemiology of renal cell carcinoma
8th most common cancer
95% of urinary tract tumours
male:female 3:2
30% have metastases on presentation
232
What are the risk factors for RCC?
Obesity
Smoking
Dialysis
233
Where do RCC metastases spread?
Lymph nodes
| Up the IVC from renal vein into the right atrium
234
How do you treat an established RCC?
Surveillance
Nephrectomy (kidney, adrenal, fat and upper ureter)
Partial nephrectomy
235
How do you treat a developmental RCC?
Ablation - removal of tumour from surface of kidney via an erosive process
236
How do you pallatively treat a RCC?
Immunotherapy
237
Explain the epidemiology of a TCC
5% of alll malignancies of upper tract
40% spread to bladder
5% are due to bladder spreading up
238
How would you investigate a TCC?
Ultrasound for hydronephrosis (swelling increased urine)
CT urogram for a filling defect or strictures
Retrograde pyelogram
Uteroscopy biopsy
239
How do you treat TCC?
Nephro-ureterectomy - removal of fat, ureter, kidney and cuff of bladder
