Pneumology Flashcards
(42 cards)
What’s Bupropion?
Norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist
What’s Varenicline?
Nicotinic receptor partial agonist
What gene mutation is associated with bronchiectasis?
HLA-DR1
Asthma or cystic fibrosis+signs of asthma +proximal bronchiectasis+upper/mid zones fibrosis+eosinophilia+high IgE(<1000)+positive RAST+IgG precipitins positive=
Allergic bronchopulmonary aspergillosis
Treatment of Allergic bronchopulmonary aspergillosis?
1st line: Oral corticosteroids
2nd line: Itraconazole
Major criteria for the diagnosis of Allergic bronchopulmonary aspergillosis?
- Clinical features of asthma
- Proximal bronchiectasis
- Blood eosinophilia
- Immediate skin reactivity to Aspergillus antigen
- Increased serum IgE (>1000 IU/ml)
What type of allergic hypersensitivity is involved in Allergic Bronchopulmonary Aspergillosis?
Type II Hypersensitivity
Causes of Extrinsinc allergic alveolitis?
- Farmer’s lung: spores of Saccharopolyspora rectivirgula → Contaminated hay ++
- Malt workers’ lung: ASPERGILLUS CLAVATUS
- Wood workers
- Bird fanciers
- Cheese worker’s lung: Inhalation of mold spores in cheese factories
- Humidifier lung: Exposure to contaminated water reservoirs or air conditioning systems.
Upper/mid fibrosis + lymphocytosis in bronchoalveolar lavage + NO EOSINOPHILIA + ground glass appearance in high-resolution CT?
Extrinsic allergic alveolitis
Management of extrinsic allergic alveolitis?
Avoid exposure to allergen + oral corticosteroids
Mode of inheritance of Alpha-1 antitrypsin deficiency?
Autosomal recessive / co-dominant fashion
Features of A1AD?
Panacinar emphysema mostly marked in the lower lobes in young patients who do not smoke (picture of COPD in young patient)
Liver cirrhosis and hepatocellular carcinoma in adults, cholestasis in children
Management of A1AD?
No smoking + supportive treatment with bronchodilators and physiotherapy
- Intravenous alpha1-antitrypsin protein concentrates
- Surgery: lung volume reduction surgery, lung transplantation
Genotypes of A1AD?
(Chromosome 14)
Alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow
- normal: PiMM
- heterozygous: PiMZ
evidence base is conflicting re: risk of emphsema
however, if non-smoker low risk of developing emphsema but may pass on A1AT gene to children
- homozygous PiSS: 50% normal A1AT levels
- homozygous PiZZ: 10% normal A1AT levels
What is the role of Alpha-1 antitrypsin?
It’s a protease inhibitor that protects the body from neutrophil elastase, a protein that can degrade elastin and other structural protein in liver and lungs
In A1AD, PiZZ phenotype equals what percentage of A1A level?
10% (10% off your PiZZa)
Management and prophylaxis of HACE and HAPE?
HACE: Dexamethasone
HAPE: Nifedipine
Prophylaxis for both: Acetazolamide
Cause of occupational asthma?
ISOCYANATES - the most common cause: spray painting and foam moulding using adhesives
BYSSINOSIS - rare, caused by cotton bacteria endotoxins (EXAM QUESTION)
- platinum salts
-soldering flux resin
-glutaraldehyde
-flour
-epoxy resins
-proteolytic enzymes
Diagnosis of occupational asthma?
Serial measurements of peak expiratory flow in and out of work
Severe pneumonia (CURB 3) management?
IV co-amoxiclav + clarithromycin
SOB + cough + fever + malaise in 5th or 6th decade of life + bilateral patchy or consolidative or ground glass opacities + raised CRP and ESR + poor responsiveness to ATB
Cryptogenic organizing pneumonia
Management of cryptogenic organizing pneumonia?
Watch and wait or high dose oral steroids if severe
Lower lobe fibrosis (interstitial shadowing/ground glass opacities later turning into honeycomb) + restrictive picture in spirometry + low transfer factor TLCO?
Idiopathic pulmonary fibrosis
Diagnosis of idiopathis pulmonary fibrosis?
High-resolution CT scan.
