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M1 > week 8 > Flashcards

week 8 Flashcards

1
Q

what is the medical imaging definition for cardiomegaly

A

when the heart takes up greater than 50% of the thoracic cavity

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2
Q

what is evidence of pleural effusion on a CXR

A

blunted costophrenic angles

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3
Q

when you lose the right heart border due to pleural effusion on an CXR whcih lobe is affected

A

middle

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4
Q

when you lose the hemi-diaphragm due to pleural effusion on an CXR which right lobe is affected

A

lower lobe

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5
Q

what are air bronchograms indicative of

A

pulmonary oedema

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6
Q

how many phases of covid 19 and brief description of each

A

3
stage 1 = asymptomatic, innate immune response
stage 2 = severe symptoms uncontrolled immune response due to cytokine storm
stage 3 = post covid symptoms (long covid)

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7
Q

what are the primary targets of covid 19

A

epithelial cells of the resp tract, specifically binding to ACE2 receptors

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8
Q

two receptors taht covid 19 uses

A

ACE 2 receptor to attach to host cell
TMPRSS2 receptor to fuse into host cell

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9
Q

role of ACE 2 receptors

A

convert angiotensin 2 into its anti-inflammatory form ANG1-7

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10
Q

functions of ANG 1-7 5

A

decrease inflammation
decrease autophagy
decrease vasodilation
decrease insulin resistance
decrease oxidative stress

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11
Q

what cytokine activates the cytokine storm

A

PANoptosis

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12
Q

what does the cytokine storm mean?

A

Panoptosis triggers the formation of panaptosome complexes which trigger excessive cytokine release resulting in the cytokine storm which leads to end organ damage

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13
Q

symptoms of covid 7

A

fever
cough
fatigue
anosmia
dyspnoea
headache

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14
Q

what is anosmia

A

abrupt loss in someones ability to taste

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15
Q

what causes ARDS in covid

A

cytokine storm leading the destruction of type 2 pnuemocytes causing lack of surfactant causing alveolar collapse

build up of fluid in the lungs

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16
Q

how does ARDS lead to multi organ collapse 3

A

the two changes (cytokine storm=type 2 pneumoycte destruction=lack of surfactant + build up of fluid)

can causes respiratory failure, penuomothroax and barotrauma which leads to a lack of ventilation and perfusion

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17
Q

treatments for covid 3

A

analgesics
oxygen therapy
antivirals

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18
Q

pneumonia definition

A

acute infection of the lung parenchyma

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19
Q

aetiological classification of pneumonia 5

A

bacterial
viral
aspiration
atypical
opportunistic

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20
Q

what is the most common cause of pneumonia

A

streptococcus penumoniae

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21
Q

acquisition based classification of pneumonia

A

community acquired
healthcare acquired
ventilator acquired

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22
Q

presentation of pneumonia (symptoms) 5

A

productive cough
pleuritic chest pain
dyspnoea
fatigue
fever

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23
Q

phsyical examination symptoms of pneumonia 4

A

dullness on percussion
decreased breath sounds
bronchial breathing
coarse crackles

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24
Q

what is required for diagnosis of pneumonia? 1 +1 of 4

A

consolidation on CXR with one of the following symptoms:
fever >38
dyspnoea
pleuritic pain
productive cough

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25
Q

curb 65 score def

A

score to assess the severity of community acquired pneumonia

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26
Q

curb 65 definition

A

c = confusion
u = urea
r = resp rate
b = blood pressure
65 = greater than 65

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27
Q

how do clinical symptoms in TB vary to taht of pneumonia aka what are the clinical symptoms of TB 6

A

chronic cough
night sweats
weight loss
persistent low grade fever
persistent fatigue and malaise

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28
Q

general differentiation in symptoms of pneumonia to TB

A

pneumonia presentation and symtpoms more acute - TB commonly low grade persisting

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29
Q

diagnostic investigations in TB 2

A

lesions on CXR
positive TB skin test

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30
Q

pathogenesis of pneumonia

A
  1. aspiration
  2. colonisation in nasopharynx
  3. micro aspiration transmission to lung parenchyma
  4. replication in lung parenchyma
  5. cytokine release causing inflammation
  6. systemic inflammation
    end organ damage
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31
Q

complictations of pneumonia 5

A

sepsis
lung absces
respiratory failure
kidney failure
neurological effects

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32
Q

key investigation in pneumonia

A

CXR

33
Q

other investigations in pneumonia 6

A

CBE
EUC
viral swab
Sputum MCS
Pleural fluid aspirate+culture
bronchoscopy

34
Q

when would you do a bronchoscopy in pneumonia 4

A
  • immunosupressed
  • severe pneumonia unresponsive to normal treatment
  • conern of endo-bronchial obstruction
  • concern of hyper sensitivity pneumonitis
35
Q

pneumonia treatment (viral, bacterial, mild, severe)

A

viral = wait and watch
bacterial = antibiotics
mild = oral
severe = intravenous

36
Q

additional management therapies in pneumonia 4

A

oxygen if <92
IV fluids
analgesia
pulmonary rehabilitation

37
Q

oral antibiotics in pneumonia 2

A

amoxicillin and doxycyclin

38
Q

intravenous antibiotics in pneumonia

A

axzythromyosin

39
Q

three things whcih need to be assessed prior to antibiotic treatment in pneumonia 3

A

CXR and tests to diagnose pneumonia and pathogen

kidney tests to determine funciton and which antibiotic to use

whether pneumonia is mild or severe to determine whether intravenous or oral antibiotics are used

40
Q

what is the main cause of pulmonary tb

A

mycobacterium tuberculosis

41
Q

what are two characteristics of TB which increase its virulence

A

slow growth which makes it hard to treat and prolongs infection

waxy cell wall which is lipid rich protecting it from environmental stresses and host immune responses

42
Q

pathogenesis of TB 4

A

myocbacterium TB enters upper airways

attempted phagocytosis by alveolar macrophages

migrates to lung parenchyma or to lymph nodes

further cuases

43
Q

what happens when TB enters the lung parenchyma 4

A

active infection
inflammation
granuloma development
causes lung damage and dysfunction

44
Q

what happens when TB enters the lymph nodes

A

activates B and T cells
they will differentiate into epithelioid cells to form granulomas

45
Q

advanced symptoms of TB 4

A

haemoptysis
chest pain
loss of appetite
dyspnoea

46
Q

clinical findings in TB 3

A

pallor
wasted appearance
clubbing

47
Q

systemic manifestations of TB 5

A

haematuria
headache
backpain
hoarseness
abdominal discomfort

48
Q

investigations in TB 5

A

CXR
sputum microscopy and culture
TB skin test
TB blood test

48
Q

Sputum microscopy use in TB 2

A

used to observe for acid fast bacilli of which mycobacterium TB is one

its not specific, only confirms diagnosis

49
Q

sputum culture in TB diagnosis

A

key diagnostic tool used to identify mycobacterium TB

50
Q

what is used to detect latent TB 3 points

A

TB skin test
TB blood test
they cannot distinguish between active and latent

51
Q

what can be present on CXR for TB

A

fibro-nodular changes and lesions
not diagnostic though

52
Q

complications of TB

A

pleural effusion
haematogenous
cardiac TB
ocular TB
hepatic TB
GIT TB

53
Q

what are the rules for good treatment in TB 3

A

combination drug therapy
standardised
good treatment adherance

54
Q

what is the standard treatment for TB (overall duration, phase duration)

A

6 months divided into 2 phases
2 months: intensive phase w 4 drugs to kill multiplying baccili
4 months: continuation phase w 2 drugs killing semi-dormant

55
Q

what is DOT in TB treatment

A

Directly observing therapy used to ensure strict adherence and assess any side effects from high drug load

56
Q

what is the key drug used in the first phase of TB

A

isoniazid

57
Q

what is the key drug used in the second phase of TB

A

Rifampicin

58
Q

example of drug resistant TB strain

A

MDR-TB = multi drug resistant TB resistant to both isoniazid and rifampicin

59
Q

definition of an acute chest infection

A

infection that lasts <3 weeks

60
Q

definition of a chronic chest infection

A

infection that lasts >3 weeks often characterised by periods of stability and then exacerbations

61
Q

physiological risk factors for chest infection development

A

impaired mucous removal

reduced respiratory effort

decreased cough reflex

immunocomprimised patients

62
Q

bronchiectasis definition

A

chronic inflammation of upper airways leading to:
- mucous build up
- scarring
- abnormal widening of bronchi

63
Q

Pathogenesis of bronchiectasis 6

A

impaired drainage

obstruction due to structural abnormalities and mucuous accumulation

inflammatory response

transmural inflammation

loss of elasticity in bronchial walls

airway remodelling and dilatation

64
Q

symptoms features of bronchiectasis 4

A

productive cough
dyspnoea
wheeze
recurrent infections

65
Q

clinical findings in bronchiectasis 2

A

clubbing
coarse crackles

66
Q

clincal investigations in bronchiectasis 5

A

sputum culture
CXR
lung function tests
CBE
blood test

67
Q

treatments for bronchiectasis 4

A

mucolytics
antibiotics
physiotherapist
pulmonary rehabilitation

68
Q

genetic characteristics of CF 2

A

autosomal recessive

most common genetic disease

69
Q

6 classes of cystic fibrosis

A

these are based off of severity of gene mutation
1 = no protein produced
2 = no trafficking, cell degrades protein prior to docking
3 = no function
4 = reduced function
5 = less protein
6 = less stable

70
Q

pathogenesis of CFTR protein

A

mutation in CFTR gene

CFTR protein not produced properly

Causes defective chlorine channel

affects ion transportation

More sodium retained in cells

Liquid depletion in fluids

leaves thickened mucous

decreased mucociliary clearance

inflammation and infection

71
Q

what and why does CFTR impact so many organs 5

A

CFTR protein found on epithelial cells across the body, therefore affects multiple systems including:
- lungs
- pancreas
- liver
-glandular
- reproductive organs

72
Q

why is genotyping useful in CF management

A

determine the specific mutation and therefore direct management

73
Q

groups of treatment pathways in CF 3

A

symptomatic therapy
CFTR modulator drugs
genetic therapies

74
Q

symptomatic therapy treatments in CF 4

A

mucolytics
pancreatic enzymes
chest physio
antibiotics

75
Q

CFTR modulator drugs characteristics 4

A

only for certain mutations
increase CFTR activity
slow disease progression
example is Trikafka

76
Q

where is ground glass opacity common

A

interstitial lung disease

77
Q

what are miliaries

A

multiple well defined nodules spread diffusely through the lungs

78
Q

what includes correct procedure for inhaler usage 5

A
  1. shaking puffer before use
  2. if using spacer coating inside w one puff prior to use
  3. exhale fully first
  4. large inhale
  5. rinse mouth after

M1 (13 decks)

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