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Respiratory > Revision > Flashcards

Revision Flashcards

1
Q

Localised Oedema

A

Pneumonia (fluid filled airspaces leading to consolidation)

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2
Q

What is lobar pneumonia most often due to?

Who does this typically present in?

A
  1. Strep pneumoniae (pneumococcus) = most common

Klebsiella and Legionella as well

  1. Healthy young adults in the community
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3
Q

Describe the pathology of lobar pneumonia

A

ACUTE inflammatory response involving:

  • exudation if fibrin rich fluid in alveoli
  • neutrophil > macrophage infiltration
  • resolution
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4
Q

What is Bronchopneumonia?

A

Infection that starts in the airways and spreads to adjacent alveolar lung

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5
Q

Who gets Bronchopneumonia?

A

Usually in the context of pre-existing disease:

  • COPD
  • Cardiac failure in the elderly
  • Complication of viral infection (influenza)
  • Aspiration
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6
Q

Organisms involved in Bronchopneumonia

A

Strep. pneumoniae, H. influenza, Staph, anaerobes, coliforms

ASPIRATION = staph, anaerobes, coliforms

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7
Q

Lung abscess context

A

Aspiration

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8
Q

Pathology of TB

A

A delayed Type IV Hypersensitivity reaction: granulomas with necrosis, accumulation of neutrophils and gram cells

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9
Q

Lesion in secondary TB

A

Fibrosing and cavitating apical lesion (cancer is important lesion)

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10
Q

Galloping consumption

A

Rapidly progressing TB pneumonia

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11
Q

Opportunistic pathogens in immunocompromised hosts

A

Virus - CMV

Bacteria - Mycobacterium avium intracellulare

Fungi - aspergillus, candida, pneumocystis

Protozoa - cryptosporidia, toxoplasma

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12
Q

Appearance of CMV (cytomegalovirus) pneumonia on transbronchial biopsy

A

‘Pulmonary Oedema’

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13
Q

Fungal pneumocystis on biopsy

A

‘Bubbly fluid’

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14
Q

Pulmonary Interstitium

A

Alveolar lining + thin elastin-rich connective component which contains capillary blood vessels

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15
Q

Alveolitis

A

Early interstitial disease due to injury with inflammatory cell infiltration

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16
Q

Fibrosing alveolitis

A

Idiopathic Pulmonary Fibrosis

Cryptogenic Fibrosing Alveolitis

Usual Interstitial Pneumonia

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17
Q

Pathology of Fibrosing Alveolitis

A
  • In subpleural and basal areas
  • Variable immune component

END STAGE: lung structure replaced by dilated spaces, surrounded by fibrous walls (honeycombing)

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18
Q

Other names for EAA

A

Hypersensitivity pneumonitis

Chronic Inflammatory disease (affecting small airways, interstitium, occasional granulomas)

Allergic origin in Type III + IV hypersensitivity

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19
Q

Farmer’s Lung

Bird Fancier’s Lung

Malt Worker’s Lung

A
  1. Thermophilic bacteria
  2. Avian proteins
  3. Fungi
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20
Q

Lung scarring in Sarcoidosis

A

Apical

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21
Q

Severity of Pneumoconiosis

A
  • Particle size
  • Particle reactivity
  • Clearance of particle
  • Host response
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22
Q

Describe the pathology and pathogenesis of ARDS

A

Injury (ie. bacterial endotoxin) > infiltration of inflammatory cells > cytokines > oxygen free radicals > injury to cell membranes

  • May lead to death/resolution/fibrosis (chronic restrictive lung disease)
  • Fibrous exudate lining alveolar walls (hyaline membranes) > cellular regeneration > inflammation
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23
Q

Primary Pulmonary Hypertension

A

Rare, usually young women

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24
Q

What inflammatory cell characterises the late phasa of asthma?

What does this do?

A

Eosinophil

  • Releases major basic and cationic proteins
  • These cause epithelial damage which results in airway hyper-responsiveness and inflammation
  • This leads to bronchospasm, wheezing and mucous over secretion

Infiltration of cytokine releasing Th2 cells and monocytes also occurs here > delayed response

Eosinophils + Lymphocytes

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25
Q

Inflammatory cells which show the immediate phase of asthma

A

Mast Cells

  • Which release spasmogens, cysLTs and histamine to cause bronchospasm and early inflammation
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26
Q

SABA

A

Salbutamol

Terbutaline

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27
Q

LABA

A

Salmeterol

Formoterol

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28
Q

Ultra-LABA

A

Indacaterol

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29
Q

cysLT receptor antagonists

A

Montelukast

Zafirlukast

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30
Q

Methylxanthines (PDE inhibitors)

A

Theophylline

Aminophylline

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31
Q

Glucocorticoids

A

Beclometasone

Budenoside

Fluticasone

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32
Q

Cromones (mast cell stabilisers)

A

Sodium cromogylcate

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33
Q

Mono-clonal Antibodies

A

Omalizumab (anti IgE)

Mepolizumab (anti IL-5)

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34
Q

SAMA

A

Ipratropium

Oxtitropium

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35
Q

LAMA

A

Tiotropium

Aclindinium

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36
Q

PDE4 Inhibitor

A

Rofumilast

Used in COPD

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37
Q

H1 receptor antagonists

A

Loratidine

Fexofenadine

Cetirizine

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38
Q

A1 adrenoceptor agonist

A

Oxymetazoline

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39
Q

Mucolytics

A

Carbocistein

40
Q

Location of peripheral chemoreceptors

A

Aortic arch and carotid arteries

41
Q

Where are the central chemorecptors located?

What is their role?

A
  • Near the surface if the medulla of the brainstem
  • To respond to the H+ ion concentration of the cerebrospinal fluid
42
Q

Blood Brain Barrier

A
  • Impermeable to H+ and HCO3-
  • Permeable to CO2 and O2
43
Q

Chronic Adaptations to high altitude hypoxia

A
  • Increased RBCs and 2,3 BPG
  • Increased capillaries, acid conservation in the kindeys, mitochondria
44
Q

Peripheral Chemoreceptors

A

Adjust for acidosis caused by non-carbonic acid H+

45
Q

Normal Tidal Volume

A

500ml

46
Q

Airflow

A

Change in Pressure / Resistance

47
Q

Peak Flow Rate

A

Speed at which you can bring air out of the lungs/airways

48
Q

How is pulmonary compliance measured?

A

Volume change/ unit pressure change across the lungs

49
Q

TLCO (Transfer factor for the lung of CO) is increased in…

A

Alveolar haemorrhage

50
Q

To increase pulmonary ventilation, why is it more advantageous to increase the depth of breathing?

A

Due to dead space

51
Q

Type I alveolar cells

A
  • Simple squamous epithelium that lines the alveolar surface, providing a thin barrier that is permeable to gases

-

52
Q

Respiratory Epithelium

A

Psuedostratified ciliated epithelium with goblet cells

53
Q

Which antbiotic is streptococcus sensitive to?

A

Amoxicillin

54
Q

Primary Influenza Pneumonia

A

A disease of young adults in pandemic years

55
Q

Complication of coxiella

A

Endocarditis

56
Q

Flu vaccines

A

Killed - adults at risk, HC workers, babies age 2 (influenza A + 1B virus)

Live attenuated - intranasal, all children aged 2-5 years

57
Q

Pneumonia in…

OLD

YOUNG

A

Old = strep pneumoniae

Young = mycoplasma

58
Q

Formoterol/Salmeterol - which has the advantage?

A

Formoterol has the faster onset of action

59
Q

2 Neutrophil chemotactic factors

A

Il-8

LTB4

60
Q

Isoprenaline

A

Non-selective B adrenoceptor agonist

61
Q

Thrombophlebitis

A

Increased coaguability of blood in cancer patients

62
Q

IPF on Chest X ray

A

Rounded areas of honeycombing

63
Q

Causes of macrocytic cells

A

B12/Folate deficiency Anaemia

Alcohol excess

Liver Disease

Hypothyroidism

64
Q

Types of hypoxia

A

Circulatory = due to blockage e.g. abcess

Anaemic

Hypoxaemic

Toxic

65
Q

Exhaled breath NO

A
  • Measure of eosinophilic airway inflammation in asthma

Used with bronchial challenge to assess asthmatic inflammation especially if bronchial challenge is normal

66
Q

Diagnosis and management of pleural effusion

A

Diagnosis: CXR, Aspirate, Pleural biopsy

Treatment: Drain, Pleurodesis

67
Q

Diagnostic features of ARDS

A
  1. Acute onset
  2. CXR showing bilateral infiltrates
  3. Pulmonary capillary wedge pressure <19mm Hg (not congestive heart failure)
  4. Refractory hypoxaemia
  5. Cyanosis, Tachypnoea, Tachycardia, fine inspiratory crackles
68
Q

Croup

A

Steeple sign

Treat with steroids

69
Q

Squeaks and crackles…

A

Bronchiolitis

70
Q

Pleural click

A

Pneumothorax

71
Q

Coarse crackles

Fine crackles

A

Oedema, consolidation, bronchiectasis

Fibrosis

72
Q

Signs of Cor Pulmonale

A

Cyanosis, raised JVP, pitting oedema, parasternal heave and loud P2

73
Q

Diagnosis of sarcoidosis

A

Do a transbronchial biopsy of hilar lymph nodes

74
Q

Monoclonal antibody against RSV

A

Palivizumab

75
Q

Intrinsic Asthma

A

Not IgE mediated

76
Q

Treatment of anaphylaxis

A

IM adrenaline

IV anti-histamine

IV corticosteroids

High flow O2

Nebulised bronchodilators

Intubation (if needed)

77
Q

Why do B-Lactams not act on mycoplasma pneumoniae?

A

They don’t have a peptidogylcan cell wall

78
Q

Methaemoglobin

A

A form of Hb made from Fe3+ which has a decreased ability to bind O2

79
Q

Expression of adhesion molecules on leukocytes is increased by

A

C5a

LTB4

TNF

80
Q

Expression of adhesion molecules on endothelial cells is increased by

A

IL-1

TNF

Endotoxins

81
Q

Bronchial arteries

A

2 left

1 right

82
Q

Cells which are effectors in allergic reactions

A

Basophils

83
Q

Endothelium

A

Epithelium of the blood vessels - simple squamous

84
Q

Management of Sarcoidosis

A

NSAIDs

Systemic corticosteroids

85
Q

Mycoplasma pneumoniae

A

Treat: Claryithromycin/Doxycycline/Fluroquinalone

Resistant to B Lactams

86
Q

Klebsiella pneumoniae

A

Treat: Carbopenem (Cefotaxine or Imipenem)

87
Q

Pseudomonas

A

Treat: Ciprofloxacin, Gentamicin

88
Q

Stapylococcus aureus

A

Treat: Flucloxacillin +/- Rifampicin

MRSA > Vancomycin

89
Q

Streptococcus pneumoniae

A

0-2 CURB 65 score: Amoxicillin

3-5: Co-amoxiclav, Doxycycline

ICU/HDU: Co-amoxiclav, Clarithromycin

90
Q

Legionella

A

Treat: Clarithromycin/Erythromycin

OR Levofloxacin

91
Q

Chlamydophila pneumoniae

A

Treat: Doxcycline OR Clarithromycin

92
Q

Chlamydophila psittaci

A

Treat: Doxycycline OR Clarithromycin

93
Q

Pneumocystis pneumonia (PCP)

A

Treat: Co-trimoxazole or Pentanamide

94
Q

Phrenic Nerve

A

Passes into the chest and runs anterior to the lung hilum on the lateral aspect of the firbrous pericardium

95
Q

Sensitisation of airway smooth muscle by asthmatic inflammatory mediators

A

Results in airway hyperactivity (excessively twitchy)

96
Q
A

Respiratory (5 decks)

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