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1
Q

what is COPD

A

poorly reversible airflow obstruction usually progressive assoc w persistent inflam
consists of emphysema and chronic bronchitis

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2
Q

define emphysema

A

dilation and destruction of lung tissue distal to the terminal bronchiole and destruction of alveolar walls

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3
Q

how does smoking lead to COPD

A

smoke leads to mucus gland hypertrophy and increase in neutrophils, macrophages and lymphocytes - these release inflam mediatiors leading to structural changes and connective tissue breakdown
smoking also inhibits a1-AT which is a protease inhibitor

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4
Q

characteristic clinical features of COPD

A

chronic productive cough (for >3m for 2 consec years)
wheeze and breathlessness
- above 2 w hx of smoking
others: recurrent chest infs, pursed lips on expiration, poor chest expansion - hyperinflation of lungs (barrel-shaped chest), increased work of breathing - leaning forward and use of accessory muscles

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5
Q

most important factor in COPD mx

A

smoking cessation!

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6
Q

first line bronchodilator in COPD

A

antimuscarinic eg tiotropium bromide

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7
Q

why must you be careful giving O2 to COPD pts

A

in some pts hypoxia is only respiratory drive so if you correct hypoxia they lose any resp drive and can go into resp arrest

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8
Q

3 key characteristics of asthma pathology

A

REVERSIBLE AIRFLOW LIMITATION
airway hyperresponsiveness
inflam of bronchi

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9
Q

define atopy

A

the tendency to form IgE Ab against common (non-harmful) environmental agents

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10
Q

triad of atopy

A

asthma, eczema, hayfever

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11
Q

airway remodelling in asthma

A

SM undergoes hypertrophy and hyperplasia –> increased muscle in airway wall
also get collagen deposition in repair processes - further thickens wall
both lead to decrease in lumen size
columnar ciliated epi also replaced by squamous metaplasia and increased goblet cells

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12
Q

asthma precipitants/triggers

A

HOUSE DUST MITE AND ITS FAECES, cold, exercise, car fumes/perfumes/smoke, emotion, drugs (NSAIDs and BB) and occupational exposure

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13
Q

clinical presentation

A 
wheezing attacks
SOB
chest tightness
cough
DIURNAL VARIATION and provoked by triggers
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14
Q

steowise mx of asthma

A 
1 - SABA eg salbutamol/terbutaline
2 - add ICS eg beclametasone
3 - add SABA ed formoterol/salmeterol
4 - either: increase ICS, add leukoterine agonist eg montelukast, or oral B agonist
5. add oral steroid - prednis
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15
Q

emergency mx of asthma

A

high flow 02, nebulised SABA - salbutamol, IV hydrocortisone

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16
Q

what is EAA

A

= extrinsic allergic alveolitis - widespsread granulomatous inflam of lung parenchyma, alveoli and small airways
type III hypersensitivity reaction (immune-complex mediated)

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17
Q

3 subtypes of EAA

A

farmers, pigeon-fanciers, malt-workers

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18
Q

RF for EAA

A

preexisting lung condition
occupational exposures
bird-keeping
hot-tub use

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19
Q

key features of chronic exposure in EAA

A

GRANULOMA and OBLITERATIVE BRONCHIOLITIS
others: clubbing, cyanosis, SOBOE, type 1 resp failure, cor pulmonale, crackles
IPF - w HONEYCOMB LUNG

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20
Q

CXR findings in EAA

A

fluffy nodular shadows
ground glass appearance (fibrosis)
HONEYCOMB LUNG if severe

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21
Q

mx of EAA

A

REMOVE offending agent (if not possible - ie occupation, advise on protective equipment eg facemasks)
oral steroids (prednis)
COMPENSATION
(O2 in acute)

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22
Q

what is bronchiectasis

A

abnormal and permanent dilation of the bronchial airways w impaired clearance or bronchial secretions and subsequent recurrent infs and bronchial inflam

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23
Q

characteristic feature of bronchiectasis

A

Chronic PRODUCTIVE cough with COPIOUS amounts of discoloured sputum (and recurrent chest infections)

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24
Q

most common causes of bronchiectasis

A

CF or post-inf (pneumonia, whopping cough, TB, measles)

many cases idiopathic

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25
symptoms of bronchiectasis
(chronic productive cough with LOTS OF SPUTUM and recurrent infs) halitosis febrile w malaise episodes of pneumonia severe disease = foul-smelling, khaki/green mucus clubbing and coarse crackles haemoptysis (may be MASSIVE haemorrhage - life threatening) breathlessness, wheeze, chest pain
26
DDX for bronchiectasis
COPD, CF, TB
27
most useful ix in bronchiectasis and what does it show
CT of chest = gold standard - bronchial dilation and wall thickening (airways bigger than corresponding artery)
28
major causative organisms of bronchiectasis
staph. a, pseudomonas aureginosa, h. influenzae, anaerobes | others: strep and klebsiella
29
mx of bronchiectasis
POSTURAL DRAINAGE = essential, PT teach pt to tip themselves 3x/day ABX for inf/cause - flucloxacillin if staph a bronchodilators ICS/oral steroid - delay progression surgery in few pts prevention/supportive - annual flu vac/pneumococcal, smoking cessation, prompt ABX in inf
30
what is CF
= autosomal recessive condition mutation (deletion of phenylalanine)in signle gene on chromosome 7 resulting in mutation in CFTR deletion most commonly at △F508 alteration of CFTR --> deranged transport of Cl --> alterations to composition of secretions (viscosity and tenacity changed)
31
where are CFTRs found
in epi cells of lungs, pancreas, GI and reproductive tracts
32
what is CFTR
chloride channel and regulatory protein (=cystic fibrosis transmembrane conductance regulator)
33
CF syndrome characterised by?
thickened secretions --> bronchopulm inf andpancreatic insufficiency w increased sodium and cl conc in sweat
34
resp symps of CF
``` babies born with structurally normal lungs --> recurrent infs --> inflam damage --> bronchiectasis --> airflow limitation and resp failure recurrent infs (presenting feature) sinusitis and nasal polyps breathlessness and haemoptysis spontaneous pneumothorax cor pulmonale eventually ```
35
GI/alimentary effects of CF
pancreatic insufficiency --> steatorrhoea (85%) and DM meconium ileus cholesterol gallstones cirrhosis/hepatic failure
36
Nutritional effects of CF
malabsorption, deficiency states, WL, poor growth, malnutrition
37
urogenital effects of CF
in male - atrophy of vas leads to 98% infertile women - able to conceive but often get secondary amenorrhoea renal impairment
38
waht sodium level in swaet is diagnostic of CF
>60mmol/L
39
what infections do you have to especially careful with in regards to CF
pseudomonas aureginosa burkholderia cepecia complex MYCOBACTERIA ABSCESSUS --> poor prognosis and multiresistant to ABX
40
waht drug can be used in CF to inhibit sodium transport
amiloride
41
what is sarcoidosis
a multisystem granulomatous chronic inflam condition characterised by epithelioid non-caseating granuloma formation at various sites in the body unknown aetiology
42
4 resp s and s of sarcoidosis
breathlessness, wheeze, chronic non-productive cough, coarse crackles, pulm infiltrates
43
4 skin s and s of sarcoidosis
erythema nodosum, lupus pernio, waxy maculopapular lesions, granulomas infiltrating scars
44
4 eye s and s of sarcoidosis
ant and post uveitis, conjunctivitis, lacrimal gland enlargement later on: glaucoma and dry eyes
45
liver s and s of sarcoidosis
granulomatous hepatitis, hepatomegaly
46
4 neurological s and s of sarcoidosis
bell's palsy, facial nerve palsy, dysphasia, hoarseness, seizures, mass lesions, visual defects
47
bone involvement in sarcoidosis
arthralgias, bone cysts, bone and joint pain and inflam arthritis
48
Common sites for bx in sarcoidosis
enlarged LN TBBx skin lesions
49
when would you give steroids (prednis) in sarcoid
2/3 remit spontaneously, give steroids if: lung infil/abnormal function persists for 6m or hypercalcaemia neurological/myocardial/optic involvement
50
define pulm HTN
mPAP>25mmhg at rest measured on R heart catheterization
51
three early symps of pulm HTN and why do you get them
dyspnoea, fatigue, weakness - due to inability to increase CO on exercise
52
features of advanced pulm HTN
``` = features of R HF increased JVP hepatomegaly ascites pleural effusion periph oedema pulsatile liver ```
53
s and s of R heart hypertrophy in pulm HTN
angina, syncope, periph oedema and abdo distension (due to hepatic congestion), lethargy
54
best ix in pulm HTN
r heart catheterization = gold standard
55
what would an ECG show in pulm HTN
right heart hypertrophy and p pulmonale
56
clinical presentation of pneumothorax
sudden onset pleuritic chest pain and breathlessness if large: decreased breath sounds and hyper-resonant percussion others: pallor, tachycardia, decreased chest expansion and deviated trachea
57
typical signs of pleural effusion
reduced chest expansion reduced breathing sounds stony dull to percussion
58
define pneumothorax
air in the pleaural space leading to partial or complete collapse of lung (primary/secondary) unilateral increase in pleural pressure
59
mx of pneumothorax
PRIMARY: needle aspiration, if lung fails to reexpand - intercostal tube drainage nad if pneumothorax reamins a 48hrs --> surgery - pleurectomy/pleurodesis SECONDARY: if
60
name three pleurodesis agents
talc, tetracycline, bleomycin
61
what lung cancer is most associated with asbestos exposure
adenocarcinoma (no small cell) local and distant mets
62
what it the most common form of lung cancer
squamous cell carcinoma (NSCLC) local spread common, widespread mets late
63
what LC do you get in non smokers
adenocarcinoma
64
what cell type do SCLC arise from
endocrine cells (kulchitsky cells) -- secrete polypeptide hormones
65
4 most common causes of pneumonia
strep pneumoniae (most common), h influenzae, influenza A, mycoplasma pneumoniae
66
treatment of TB
``` RIPE rifampicin isoniazid pyrizinamide ethambutol (first 2 for 6m second 2 only for first 2m) add corticosteroid and tx for 12m if CNS involvement DOTS -- better prognosis ```
67
3 components of global strategy to reduce TB prevalence
contact tracing identification and tx of dormant phase screening of healthcare proffessionals/new entries to country
68
tx for mild CAP
amoxicillin/clarythromycin
69
tx for moderate CAP
amox and claryth
70
tx for severe CAP
IV coamoxiclav and clarythromycin/cefuoxime
71
tx for HAP
gentamycin and meropenam
72
tx for HAP caused by MRSA
VANCOMYCIN
73
two tests specific to TB
TST (Mantoux) and Interferon gamma release assays (IGRAs)
74
complications of pneumonia
empyema and lung abscess
75
how do you predict mortality in CAP
``` CURB65 c-confused u-urea>7 r-RR>30 b-BP -- SBP65yrs ``` 1 point for each - score of 0-1 = outpt tx, 2 = closely supervised outpt tx, 3-5 = admission

Phase 2A HT (11 decks)

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