resp Flashcards
1
Q
features of asthma?
A
wheeze ±dry cough atopy/allergen sensitisation reversible airway obstructiom airway inflammation - eosinophils , type 2 lymphocytes
2
Q
pathogenesis of asthma?
A
bronchial epithelium exposed allergen eg mild → inflammation → SM hypertrophy , ↑ ECM → airway remodelling
3
Q
immune response ion asthma?
A
antigen presented to MHC II on APC → Th0 bind → Th2 → IL 4, 13, 5 → VCAM1 expression, ↑mast cells, IGE synthesis, mucin secretion, eosinophilic airway inflammation
4
Q
how is allergic sensitaization tested for in asthma?
A
blood tests for specific IgE antibodies to allergens of interest
total IgE not sufficient
5
Q
tests for eosinophilia?
A
blood eosinophil ≥300
sputum eosiniphil ≥2.5%
exhaled nitric oxide
6
Q
what is FeNO used for?
A
asthma diagnosis
steroid responsiveness prediction
corticosteroid adherence
7
Q
objective tests for asthma?
A
airway obstructi9on on spirometry - FEV1/FVC <0.7
reversible airway obstruction - bronchodilator , ≥12%
exhaled NO , ≥35 child, ≥40 adult
8
Q
asthma management?
A
- ↓ inflammation - inhaled corticosteroids , leukotriene receptor antagonists
- acute relief - beta 2 agonists, anticholinergics (smooth muscle relaxation)
- severe asthma - anti-IgE antibody , anti-IL5 antibody / anti-IL5 receptor antibody
9
Q
how do corticosteroids work?
A
↓ xcytokines ↓ eosinophils ↓ macrophages , dendritic cells ↓ leak from endothelial cells ↑ b2 receptors in SM ↓mucus secretion
10
Q
most important of asthma management?
A
adherence to ICS
11
Q
why do children with asthma often have prolonged illnesses?
A
↓ IFN a, B y → reduced antiviral responses
12
Q
how does anti-IgE antibody therapy work?
A
binds to circulating IgE → cannot activate mast cells cells and basophils → stop allergic cascade
reduces IgE production over time
13
Q
anti-IgE antibody?
A
omalizumab
14
Q
indicati9ons for omalizumab?
A
severe persistent IgE asthma ≥6yrs old
4 or more oral corticosteroids in past year
documented compliance
serum IgE 30-1500
15
Q
anti-IL5 antibody?
A
mepolizumab
16
Q
function of IL5?
A
regulates growth recruitment activation and survival of eosinophils
17
Q
mepolizumab indications?
A
severe eosinophilic asthma
blood eosinophils ≥300
4+ exacerbations requiring oral corticosteroids in past year
18
Q
risk factors for lung cancer?
A
75-90
M≥F
lower SES
smoking
19
Q
non smoking causes of cancer?
A
asbestos radon indoor cooking fumes chronic lung diseases eg copd, fibrosis immunodeficiency familial
20
Q
4 types of lung cancer?
A
adenocarcinoma - peripheral, mucous tissue
squamous cell carcinoma - central, bronchial epithelium
large cell cancer
small cell cancer - pulmonary neuroendocrine cells
21
Q
lung cancer oncogenes?
A
EGFR tyrosine kinase - adenocarcinoma, women, asian, never smoekrs
ALK tyrosine kinase & cROS1 receptor tyrosine kinase - NSCLC , young patients, never smokers
BRAF 1 - NSCLC, smokers !!
22
Q
symptoms of lung cancer?
A
wt loss cough breathlessness fatigue chest pain haemoptysis or asymptomatic
23
Q
features of advanced / metastatic lung cancer?
A
bone fain seizures , focal weakness clubbing hypercalacemia hyponatraime cushings horners syndrome pembertons sign (obstructed SVC) cachexia
24
Q
imaging options for lung cancer?
A
chest XR
CT abdo chest for staging
PET scan for occult metastases
25
methods of biopsy for lung cancer>
central tumours - bronchoscopy
staging - endo-bronchial US and trasnbrocnhial needle aspiration of mediating lymph nodes
peripheral - CT guided lung biopsy
26
what's used to determine patient fitness in lung cancer>
```
WHO performance status
0 -asymptomatic
1 - symptomatic but ambulatory
2 - symptomatic ≤50% day in bed
3- symptomatic ≥50% day in bed
4 - bedbound
5- death
```
radical treatment for 0-2
27
surgical management for lung cancer?
early stage disease standard care
lobectomy + lymphadenectomy
sublunar resection if stage 1
28
radical radiotherapy for lung cancer?
alt to surgery for early stage especially if comorbidity
| stereotactic ablative body radiotherapy
29
systemic treatments for lung cancer?
oncogene-directed - metastatic NSCLC with mutation
immunotherapy - metastatic NSCLC with no mutation and PDL1 ≥50%
cytotoxic chemo - metastatic NSCLC with no mutation and PDL1 ≤50% (+immunotherapy)
30
treatment for metastatic NSCLC with mutation? example?
oncogene directed (EGFR, ALK, ROS-1) erlotinib, crizotinib (tyrosine kinase inhibitors)
31
treatment for metastatic NSCLC with no mutation and PDL1 ≥50↓? example
immunotherapy eg pembro/atezo lizumab
32
treatment for metastatic NSCLC with no mutation and PDL1 ≤50↓? examples?
cytotoxic chemo , platinum based eg carbo/cisplatin
| + immunotherapy
33
palliative care for lung cancer?
```
all with advanced stage disease
symptom contorl
psychological support
education
end of life planning
```
34
treatment options for lung cancer if locally advanced/lymph nodes involved?
surgery + adjuvant chemo
| radio + chemo ± immunotherapy
35
symptoms of upper RTI?
```
cough
sneezing
runny nose
sore throat
headache
```
36
symptoms of lower RTI?
```
phlegm cough
muscle aches
wheezing
bretahlessness
fever
fatigue
```
37
symptoms of pneumonia?
chest pain
blue lips
sever fatigue
high fever
38
commonest cause of infant mortality ≤1 yr?
lower RTIs esp RSV
39
risk factors for pneumonia?
```
age ≤2 / ≥65
smoking
↑↑alchohol
contact with school aged children
poverty /ovrcrowding
ICS, PPIs, immunosuppressants
COPD , asthma , diabetes, HIV, malignancy
```
40
common pathogens of respiratory infection?
```
bacterial :
strep pneumoniae
myxoplasma pneumoniae
haemophilus pneumoniae
mycobacterium tuberculosis
```
```
viral:
influenza a or b
RSV
rhinovirus
cornoviruses
human metapneumovirus
```
41
common causes of CAP?
```
sterp pneumoniae*
myxoplasma pneumoniae**
staph aureus
chlamydia pneumoniae**
haemophilus influenzae*
```
* typical
* *aTYPICAL
42
common causes of HAP?
```
staph aureus *
pseudomonas aeurignoas*
klebsiella species
e coli
acinetobacter
enterobacter*
```
*ventialtor
43
how is potential bacterial pneumonia graded?
```
CURB-65 score
confusion
resp rate ≥30
blood pressure ≤90 SBP / ≤60 DBP
≥65
urea≥7 if hospital
```
44
treatments for bacterial pneumonia?
```
oxygen
fluids
analgesia
nebuliser saline
penicillins
macrolides
```
45
CURB-65 scores and treatments?
0 CAP - amoxicillin (/clarithromycin if pen allergic)
0 HAP - doxycycline PO
1-2 CAP - amoxicillin + clarithomycin
3-5 CAP - benzylpenicillin IV + clarithomycin PO (or teicoplanin)
severe HAP - tazocin IV ± gentamicin IV
46
strep pneumonia characteristics?
gram positive
extracellular
opportunistic (takes advantage of change in environment)
47
what is a pathobiont?
normally commensal microbe
| wrong environment → pathology
48
how do viral infections result in disease?
not pathobionts
cause cellular inflammation , mediator release, local immune memory , damage epithelium → loss of cilia , bacterial growth, poor antigen barrier, loss of chemoreceptors
49
what causes severe viral disease?
highly pathogenic strains eg zoonotic
innate immunodefieicny - absence of prior immunity
predisposing condition
frail/elderly/pregnant
50
where does H1N1 influenzaA infect?
URT - haemogluttinin binds a2,6 sialic acids
51
where does H5N1 avian flu infect?
LRT - haemogluttinin binds a 2,3 sialic acids
52
where does SARS CoV2 infect?
spike proteins bind ACE in nasal epithelium and type 2 pneumocytes
53
defence mechanisms of respiratory epithelium?
```
tight junctions
mucous linign and cilia clearance
anitmicrobials
pathogen recognition receptors
interferon pathways - up regulate anti viral proteins
```
54
antibodies in nasal cavity?
IgA
epithelial cells have polyIgA receptor → export IgA to mucosal surface from plasma
homodimer very stable in protease rich environment
55
antibodies in bronchi?
IgG
| thin walled alveoli allow transfer of plasma IgG into alveolar space
56
leading cause of infant hospitilaztion?
respiratory syncytial virus
57
RSV symptoms?
```
nasal flaring
chest wall retractions
hypoxemia
cyanosis
croupy cough
wheezing on expiration
prolonged expiration
rales and rhonchi
tachypnea
apneic episodes
```
58
risk factors for RSV in oinfants?
premature birth
| congenital heart and lung diseases
59
treatment options for SARS CoV2?
```
oxygen
fluids
analgesia
dexamethasone
tocilizumab
remdesevir
paxlovid
monoclonal antibodies
vaccines
```
60
what is the SRDS Berlin definition?
within 1 week of a known clinical insult or new or worsening respiratory symptoms
bilateral opacities on imaging not explained baby collapses, effusions, nodules
oedema not explained by cardiac failure/fluid overload
oxygenation - PEEP ≥5
PaO2/FIO2:
mild 200-300
moderate 100-200
severe ≤100
61
what can cause acute resp failure?
```
infection
aspiration
primary graft dysfunction after lung Tx
trauma
pancreatitis
sepsis
myasthenia
Guillain-Barré syndrome
```
62
what can cause chronic resp failure?
```
copd
fibrosis
CF
lobectomy
muscular dystrophy
```
63
what can cause acute on chronic resp failure?
infective exacerbation of COPD/CF
myasthenia crises
post operative
64
what is type I resp failure? causes?
hypoxemic , PAO2 < 60
increased shunt fraction, alveolar flooding
```
collaspe
aspiration
pulmonary oedema
fibrosis
pulmonary embolism
pulmonary hypertension
```
65
what is type II resp failure? causes?
hypercapnic, pacCO2 ≥ 45
decreased alveolar minute ventilation ,↑ dead space ventilation
muscle failure, airway obstruction, chest wall deformity
66
what is type III resp failure? causes?
perioperartive resp failure
low functional residual capacity → ↑ atelectasis
hypoxaemia or hypercapnia
posture, incentive spirometry, analgesia, anaesthetic technique
67
what is type IV resp failure? causes?
shock → poor perfusion
| patients are ventilated and intubated
68
causes of ARDS?
```
pulmonary :
aspiration
trauma
inhalation burns
surgery
drugs
infection
```
```
extra pulmonary :
trauma
pancreatitis
burns
trasnfusion
sx
BM trasnplant
drugs
infection
```
69
what responses cause acute lung injury?
```
leucocyte activation and migration → macrophages and neutrophils
DAMP releaae - HMGB1 , RAGE
cytokine release , IL-6,8,1B, IFN-y
cell death
TNF signalling via TNFR-1
```
70
management for resp failure?
```
treat underlying cause:
bronchodilators, pulmonary vasodilators
steroids
Abx, antivirals
plasma exchange, ritixumab
```
resp support:
oxygen, nebulisers, ventilation, ECMO
multiple organ support:
CV
renal
immune therapies
71
sequelae of ARDS?
poor gas excahnge
infection →sepsis
inflammation
systemic effects
72
specific interventions for ARDS?
resp support
intubation and ventilation
mechanical intervention
pronation
73
imaging for ARDS?
CT- lung recruitment
| lung USS
74
scoring system for ARDS?
```
Murray score = average score of all 4:
PaO2/FiO2
CXR
PEEP
Compliance
```
0=normal
1-2.5 = mild
2.5-3 = severe
≥3 = ECMO
75
ECMO inclusion criteria?
severe resp failure with non-cardiac cause , Murray score ≥ 3
pH ≤ 7.2
positive pressure ventilation is inappropriate
reversible disease process, unlikely to lead to prolonged disability
76
ECMO exclusion criteria?
significant comorbidity
would be life dependent on ECMO
contraindicated to continuation of active support
77
issues with ecmo?
```
time to access
geographical inequity
obtaining access
clotting/bleeding
costs
```
78
how can exercise capacity be evaluated?
cardiopulmonary exercise test - cycle ergometer/treadmill
six minute walk test
incremental shuttle walk test
79
top 3 causative agents of resp infection?
human rhinovirus
influenza a/b
s pneumoniae
