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Flashcards in Deck 1 Deck (34)
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1

Q. What are the two main categories of lung disease? Name two diseases from each category.

A. Obstructive – reversible (asthma) and irreversible (COPD)
B. Restrictive – interstitial lung disease (fibrosing alveolitis) and chest cell disease (kyphoscoliosis)

2

Q. Name two clinical features of; a) asthma b) COPD c) bronchiectasis

A. Asthma –obstruction varies over time, FEV1/FVC ratio less than 80%, younger people? May be wheezing in response to; exertion, fumes, cold air
B. COPD – constant obstruction, FEV1/FVC ratio less than 80%, older smokers? Lung cancer?
C. Dilated bronchi which pool secretions, copious purulent sputum, may be a mix of restrictive and obstructive

3

Q. Name some mast cell mediators involved in asthma pathophysiology

A. Mast cells: granules, high affinity IgE. Mast cell may form crosslinks to allergens releasing histamine, granules fuse and other enzymes are released (+ve feedback)
B. Tryptase: enzyme involved in mast cell activation (measured for diagnosis)
C. Cytokkines TNF, IL-3/4/5
D. Eicosanoids
E. Histamine

4

1. Q. Name two types of medication that can be used to treat asthma

A. Bronchodilators: beta-agonist, muscarinic antagonists, methylxanthines
B. Beta agonists: short acting (salbutamol, terbutaline), long acting (Salmeterol, formoterol), ultra-long (indacaterol used in USA)
C. Steroids

5

Q. How do beta agonists work in the lung

A. Lung: Beta-2-receptor is a G-protein-coupled receptor, beta agonists bind to the receptor resulting in a conformational change, this activates adenyl cyclase which converts ATP to C-AMP, the increased levels of C-AMP cause smooth muscles to relax (by activating kinase A and decreasing calcium levels)

6

Q. Name a short-acting and a long-acting muscarinic antagonist

A. Short acting: ipratropium
B. Long acting: tiotropium (has a high affinity so it dissociates slowly and has a longer affect)
C. Affects the intrinsic tone of airways (parasym – chorionic receptors)
D. Acetyl-coA contracts airway smooth muscles by activating muscarinic receptors – M3 (G-protein coupled)
E. Antagonists block ACh binding to muscarinic receptors

7

Q. What are the two main types of COPD?

A. Chronic bronchitis – inflammation of bronchi
B. Emphysema – damage to lung tissue and small airways, loss of elasticity

8

Q. What clinical features may be suggestive of lung cancer?

A. Airflow obstruction, low FEV1/FVC ratio, smoker, recent onset, over >40 years old
B. Change in cough, wheeze, haemoptysis (coughing up blood)
C. Later symptoms; weightloss, lethargy

9

Q. Name two clinical features of restrictive lung disease

A. Low lung volume – FVC
B. FEV1/FVC ratio > 80% as most of breath is out within the first second

10

Q. Name two clinical features of obstructive disease

A. History of wheezing/bronchitis, wheezing/hyperinflation on examination, obstructive spirometry, hyperinflated chest xray

11

Q. What is pulmonary vascular disease? Describe the three typical presentations

A. Pulmonary hypertension can lead to pulmonary embolism (clots in pulmonary arterial tree arising from deep veins in the legs)
B. Minor – breathlessness, haemoptysis, pleuritic chest pain
C. Acute massive – circulatory collapse, life-threatening emergency
D. Multiple/submassive – isolated dyspna, often missed
E. Often due to environment/occupation, pet allergy/asbestos/dust fume exposure

12

Q. Describe the following terms from a spirometry graph, give an estimated volume in mls for each. A) Tidal volume B) Functional residual capacity, C) Expiratory reserve volume, D) Inspiratory capacity, E) Total lung capacity, F) Vital capacity, G) Inspiratory reserve capacity

A. Tidal volume 500ml– The volume of air that enters and leaves the lungs during inspiration and expiration in normal breathing. (smallest value)
B. Functional residual capacity 2400ml – Amount of air remaining in the lungs at the end of normal breathing
C. Expiratory reserve volume 1200ml – The maximal additional volume of air that can be exhaled after a normal expiration to functional residual capacity, with residual volume remaining in the lungs
D. Inspiratory capacity 3500ml – The maximal volume of air that can be inhaled from functional residual capacity, this made of up tidal volume and inspiratory reserve volume
E. Total lung capacity 5900ml – This is the volume of air in the lungs after maximal inspiration
F. Vital capacity 4700ml – The maximal volume of air that can be exhaled from the lungs after a maximal inspiration
G. Inspiratory reserve capacity 3000ml – the amount of air in excess of tidal inspiration that can be inhaled with maximal effort
H. Residual volume 1200ml – The volume of air remaining in the lungs after maximal exhalation

13

Q. What is the transfer co-efficient? How is this lung function test carried out?

A. Measures the ability of oxygen to diffuse across the alveolar membrane
B. Patient inspires a low of carbon monoxide and holds breath from 10 seconds at total lung capacity, the gas transferred is then measured

14

Q. In which conditions may there be a low transfer co-efficient?

A. May be low in severe emphysema
B. Fibrosing alveolitis
C. Anaemia
D. (high in pulmonary haemorrhage)

15

Q. What other tests may be performed to test lung function?

A. 6 min walk, incremental shuttle walking test, Cardio-respiratory excersie test
B. lung function and transfer co-efficient test

16

Q. What characteristics are associated with lung parenchyma (alveoli) and fibrotic (scarring) conditions?

A. Associated with finger clubbing
B. lungs become stiff and smaller (lower VLC)
C. gas exchange impaired – hypoxia
D. Often profound breathlessness on exertion
E. May be caused by a range of conditions; idoipathtic pulmonary fibrosis, asbestosis, sarcoidosis, extrinsic allergic alveolitis, post-infective, radiation

17

Q. What is the “safe” triangle?

A. Anatomical triangle created by mid-axillary line/border of latissimus dorsi, lateral border of pec major and imaginary horizontal line from the nipple
B. Chest drains are usually inserted in the 4, 5, 6th intercostal space
Tube is inserted into the plural space to allow drainage of contents
A. Indications – pneumothorax, haemothorax (abnormal collection of air/blood in the thorax)

18

Q. Describe the pathophysiology of ANCA-associated vasculitis

A. Rare autoimmune diseases, ANCA = antineutrophil cytoplasmic antibody-(ANCA) associated vascultides (AAV)
B. Characterised by inflammatory cell infiltrate and necrosis of blood vessel walls
C. Few or no immune deposits, predominantly affecting small vessels
D. Mainly IgG type antibodies against antigens in the cytoplasm of neutrophil granules
E. Recruitment of activated neutrophils, production of ROS and neutrophil degranulation
F. Generation of micro abscesses, recruitment of monocytes and macrophages, lymphocytes to make granulomas
G. Devastating inflammation – affects many organs including lung and kidney

19

Q. How should ANCA-associated vasculitis be treated?

A. Immunosuppression: steroids and cyclophosphamide
B. Plasma exchange
C. E.g. rituximab – an anti-B cell drug

20

Q. Name two immune-mediated lung diseases (other than ANCA-AAV)

A. Rheumatoid arthiritis
B. Guillain-Barre syndrome
C. CF (non-immune defects)
D. Asthma

21

Q. Why is influenza A very prone to mutation; give two reasons

A. 8 single-stranded RNA segments: gene-re-assortment
B. Gene swapping due to co-infection with human and avian flu virus
C. No proof reading mechanism

22

Q. How is influenza spread?

A. Aerosol spread: coughs and sneezes
B. Droplet spread: also hand-to-hand contract and other personal contact

23

What is the difference between antigenic drift and antigenic shift?

A. Antigenic drift – due to minor antigenic variation causes seasonal epidemics
B. Antigenic shift – gene re-assortment and major antigenic variation – associated with pandemics

24

Q. What differences occur between influenza A, B, and C subtypes?

A. Influenza A “Sloppy, capricious, promiscuous”: can infect pigs, cats, horses, birds and sea mammals - Causes the severe and extensive outbreaks and pandemics.
B. Influenza B - Like Influenza A, also prone to mutation but tend to cause sporadic outbreaks (e.g. schools, care homes, garrisons) that are less severe. - More often seen in children
C. Influenza C – Relatively minor disease: mild symptoms or even asymptomatic

25

What is a pathogen’s reproduction number?

A. The average number of secondary cases generated by a primary case
B. Crucial quantity for identifying the intensity of interventions required to control an epidemic
C. E.g. measles = 12-18, HIV = 2-5, seasonal influenza = 1.3-1.5

26

Q. What signs and symptoms are associated with influenza? Who has a higher risk of mortality?

A. Upper/lower resp tract infection: fever, headache, myalgia, weakness
B. May include bacterial pneumonia complications
C. Mortality risk higher in patients with: chronic cardiac and pulmonary disease, old age, chronic metabolic or renal disease, immunosuppressed Pts

27

Q. Who is affected in A) Outbreaks B) Epidemics, C) Pandemics

A. Outbreak: 2 or more linked cases
B. Epidemic: more cases in one region or country
C. Pandemic: Epidemics that span international borders

28

Q. What is the annual flu vaccine comprised of?

A. 3 strains of flu circulating USA, Australia, hongkong and the UK
B. Changes each year due to antigenic drift, occurs in the winter months Dec-March
C. Offered to at-risk groups and children

29

Q. How may pandemic flu affect society? How can this be prevented?

A. High morbidity, excess mortality, social disruption, economic disruption
E.g. travel restrictions, restrictions of mass gatherings, school closures, home isolation, quarantine of known cases, screening of people entering UK ports
B. Culling of affected animals, international surveillance, virus/vaccine research, public education, containment
C. Infection control: hand hygiene, cough etiquette, masks/apron/gowns/gloves

30

Q. Which type of studies are most useful in the study of epidemiology?

A. Ecological studies: studies relationships not causes using population data. e.g. smoking and mortality, Cheap and easy to preform
B. Cross-sectional studies: prevalence study, relationships/links
C. Case control study: Retrospective, compares case group to a control group
D. Cohort study: incidence, follows group of people over period of time
E. Intervention study: randomised control trial, compare case group to control group