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Respiratory Flashcards

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1
Q

what two pathologies make up COPD?

A

emphysema

bronchitis

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2
Q

what is emphysema?

A

loss of elastic recoil in the alveoli

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3
Q

what is chronic bronchitis in COPD?

A

mucus

fibrosis/thickening of airways = impaired flow of air

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4
Q

is COPD restrictive or obstructive?

A

obstructive

lung volume is fine but nt able to blow air in/out

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5
Q

in chronic COPD what provides the inspiratory drive?

A

hypoxia

CO2 is permanently high as not able to blow it off, so body becomes desensitised

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6
Q

5 signs/symptoms that indicate COPD?

A 
dyspnoea
cough 
wheeze 
odema secondary to heart failure 
tachypnoea 
chest 'tightness'
weight loss 
recurrent infections
exacerbations and better periods
barrel chest 
pursed lip breathing, bent over
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7
Q

3 symptoms of chronic disease that are generally NOT seen in COPD?

A

clubbing
haemoptysis
chest pain

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8
Q

in COPD what does spirometry show?

A

FVC fairly normal
FEV1 is low, less than 80% of expected
FEV1/FVC ratio less than 0.7
poor response to bronchodilators eg salbutamol

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9
Q

what might a chest x ray show in COPD?

A

only see severe disease
enlarged lungs
bullae (air pockets)
flattened diaphragm

excludes cancer and infection

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10
Q

what part of the lung is most affected in alpha 1 antitrypsin deficiency?

A

the bottom
panacinar
use a CT or CXR to see this

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11
Q

what is TCLO and what does it tell you?

A

transfer factor for carbon monoxide
low in COPD
high in asthma

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12
Q

what is first line for COPD?

A

smoking cessation
short acting b2 agonist eg salbutamol
or short acting anti muscarinic eg ipratropium bromide
vaccinations

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13
Q

what is second line for COPD?

A

long acting b2 agonist + long acting antimuscarinic

eg oladaterol/tiotropium combo

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14
Q

what is third line for COPD, or 2nd line for COPD with asthmatic features?

A

inhaled corticosteroid (eg beclomethasone) + LABA (eg salmeterol)

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15
Q

when is ipratropium bromide contraindicated?

A

closed angle glaucoma

urinary retention eg BPH

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16
Q

side effects of ipratropium bromide / antimuscarinics?

A 
arrythmia
dizziness 
blurred vision
glaucoma 
G| upset
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17
Q

side effects of salbutamol?

A

tachycardia, arrythmia

hypokalaemia esp in diabetes

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18
Q

an example of a long acting beta 2 agonist?

A

salmeterol

oladaterol

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19
Q

what drugs interact syngerstically with steroids?

A

beta agonists
steroids = increased expr of beta2receptor
beta agonist = increased expression of steroid receptor

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20
Q

as well as relax smooth muscle, what else do beta 2 agonists do?

A

reduce histamine release

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21
Q

what is pirfenidone?

A

antifibrotic

for advanced resp conditions

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22
Q

what is theophylline?

A

phosphodiesterase inhibitor
bronchodilation
reduces reactivity to histamine

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23
Q

what is carbocysteine?

A

mucolytic

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24
Q

type 1 vs type 2 resp failure?

A

type 1 = low O2

type 2 = low O2 high CO2, resp acidosis

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25
how can you tell if a respiratory acidosis is chronic?
the bicarbonate will be raised, kidneys trying to compensate, but this can't happen immediately so you only see it in chronic
26
5 triggers for asthma?
``` infection exercise cold air dust damp pollen emotion tobacco beta blockers aspirin ```
27
what kind of hypersensitivity reaction is asthma?
type 3 / type 1
28
what cells/molecules are involved in asthma?
cytokines = IgE and mast cells mast cells release histamine, prostaglandins, leukotrienes and attract eosinophils
29
what happens in the late response of asthma?
immune mediators damage the epithelium
30
why is airflow reduced in asthma?
bronchoconstriction & mucus
31
is asthma reversible?
initially, yes over time inflammatory reactions mean the basement membrane becomes thicker and fibrosed, = permanently reduced diameter, then it is not reversible
32
what does an asthma attack look like?
``` trigger worsening SOB tachynoea using accessory muscles tachycardia ```
33
what is the wheeze like in asthma?
polyphonic bilateral widespread episodic
34
what does spirometry show in asthma?
FVC fairly normal FEV1 is low, less than 80% of expected FEV1/FVC ratio less than 0.7 improves with bronchodilators eg salbutamol - 12% increase in FEV1, 200ml increase in vol worsens with histamine/metacholine challenge, which causes hyperreactivity
35
what is FENO, how is it used?
fractional exhaled nitrogen oxide more than 40 is pos can be used in investigation of asthma
36
what is first line for asthma?
SABA eg salbutamol
37
what is second line for asthma?
inhaled corticosteroid eg beclamethosone
38
what are some third line options for asthma?
3. montelukast 4. laba eg salmeterol (need to be taking saba too) theophylline lama more steroid
39
what is montelukast?
a leukotriene antagonist
40
what is a problem with theophylline?
it has a very narrow TI
41
NICE treatment for severe asthma attack in hospital?
salbutamol (nebulised) ipratropium bromide nebulised oral predisolone or IV hydrocortisone
42
in asthma exacerbation what is the ABG like?
initially low pCO2, as trying to get enough oxygen in - alkalosis normal co2 means pt is getting tired of compensatory breathing, this is a bad sign
43
what are the two most common kinds of non small cell lung cancer?
``` squamous cell (central) adenocarcinoma (peripheral) - from mucus secreting cells ```
44
what cells is small cell lung cancer from?
``` kulchitsky cells (neuroendocrine) ```
45
which is generally worse, small cell or non small cell lung cancer?
small cell, as it tends to cause paraneoplastic syndromes
46
5 clinical presentations of lung cancer?
``` SOB cough haemoptysis clubbing recurrent infection lymphadenopathy - supraclavicular fever, weight loss, night sweats, lethargy pleuritic chest pain wheeze ```
47
what is the wheeze like in lung cancer?
fixed monophonic
48
a recurrent laryngeal nerve palsy could be caused by a ______ tumour and would result in __________
lung | hoarse voice
49
a phrenic nerve palsy caused by a lung tumour would cause ______ weakness and this would manifest as _______
diagphragm | SOB
50
what is pembertons sign?
bilateral arm elevation = facial oedema | shows the vena cava is being occluded by a lump in the neck, eg enlarged thyroid or lung cancer
51
what is Horners syndrome?
unilateral ptosis, anhydrosis, myosis | caused by pancoast tumour in the apex of the lung pressing on the sympathetic ganglion
52
what is lambert-eaton myasthenic syndrome?
the body produces antibodies against small cell cancer the antibodies also attack voltage gated calcium channels proximal weakness, diplopia, ptosis, dysphagia
53
what hormone does squamous cell lung cancer commonly release and what is the effect of this?
PTH hypercalcaemia osteomalacia
54
two molecules that small cell lung cancer commonly releases that cause paraneoplastic syndromes?
``` ADH = SIADH = hyponatraemia AcTH = cushings ```
55
what is an important cause of limbic encephalitis?
small cell lung cancer releases antibodies to the limbic system = memory loss, hallucinations and seizures anti Hu antibodies
56
3 features of lung cancer seen on a chest x ray?
hilar enlargement circular peripheral opacity unilateral pleural effusion lung collapse
57
how might you obtain a biopsy in lung cancer?
percutaneous | or with an ultrasound guide bronchoscopy
58
how can you scan the body to look for cancer?
PET-CT | higher uptake of glucose tracer where there is more cancer
59
treatment for non small cell lung cancer?
surgery can often be curative | adjuvant or palliative chemo/radio
60
treatment for small cell lung cancer?
generally not curative | platinum based chemo + radiotherapy
61
5 risk factors for pulmonary embolism?
``` immobility eg flight recent surgery pregnancy oestrogens malignancy polycythaemia thrombophilia eg antiphospholipid syndrome inflam conditions eg SLE ```
62
5 clinical manifestations of pulmonary embolism?
``` hypoxia -- cyanosis SOB haemoptysis tachycardiaa tachypnoea pleuritic chest pain hypotension pyrexial right parasternal heave syncope ```
63
investigations in ?PE?
CXR to exclude pneumothorax, pneumonia well's score - is PE likely? - yes -- do a CTPA - no -- do a d dimer -- if d dimer raised -- do a CTPA
64
if you want to do a CTPA for PE but it is contraindicated what can you do instead? when would CTPA be contraindicated?
ventilation-perfusion scan - shows good ventilation poor perfusion CTPA contraind if allergy to contrast or severe kidney failure
65
what would ABG show in PE?
low oxygen - as blood cannot get to the alveoli to pick up the oxygen resp alkalosis - as co2 is being blown off
66
management of PE? - 5
``` supportive - admission, analgaesia, oxygen enoxaparin alteplase - if PE is large surgical embelectomy vena cava filter ```
67
in pregnant patients at a high risk of PE, what is the best prophylaxis?/
heparin
68
where does lung cancer commonly metastasise to?
``` brain bone liver adrenals lymph ```
69
where does secondary lung cancer usually come from?
``` breast prostate colon bladder neuroblastoma ```
70
who is TB most common in?
people moving from outside of UK esp s asia, subsaharan africa immunocomp alcoholic homeless, ivdu
71
what is TB's waxy capsule made of?
mycolic acid
72
how does latent TB arise?
the immune system forms a granuloma around the bacteria | but the granuloma does not succeed in killing it and instead actually seals off the bacteria and protects it
73
what is it called when latent TB reactivates?
secondary TB
74
what is milliary TB?
Disseminated infection
75
what is a 'cold abscess'?
``` TB forms a colony in the lymph this is often what allows it to spread painless lump in lymph usually in the neck no surrounding inflammation ```
76
how does TB usually spread between people?
through inhaled drops oof infected saliva
77
5 presentations of pulmonary TB?
``` fatigue, night sweats, weight loss, fever cold abscess cough/haemoptysis dyspnoea clubbing crackles ```
78
how does the mantoux test work?
inject tuberculin if there is more than 5mm induration of skin after 72 hours it is pos the person has had TB and the imune system has generated a response against the ag
79
what alternative to mantoux test checks for immune response to TB?
IGRA - interferon gamma release assay looks to interferon alpha in response to tb antigen (quantiferon is an igra test)
80
tb on a chest x ray: - 3 features of primary TB? - 2 features of reactivated TB?
``` GHON COMPLEX Primary: pleural effusion patchy consolidation lymphadenopathy dense homogenous opacity ``` secondary: nodular consolidations cavitations at the top of the lung
81
what are TB on culture?
acid fast bacilli | red on ziehl-neilson stain
82
what is the usual management of TB and what are some side effects?
R - rifampicin - red tears/urine, cyp induction - 6 months I - isoniazid - lupus, peripheral neuropathy - 6 months P - pyrazinamide - gout, hepatitis - 2 months E - ethambutol - eye probs eg colour blind - 2 months steroids
83
is TB a notifiable disease?
yes
84
what is the most common cause of community acquired pneumonia?
strep pneumoniae
85
what is the second most common cause of community acquired pneumonia?
haemophilus influenzae
86
pseudomonas causes pneumonia in who?
cystic fibrosis | bronchiectasis
87
what syndrome can legionella pneumophilia cause, alongside pneumonia?
SIADH
88
what extra-respiratory syndromes does mycoplasma pneumoniae present with?
``` erythema multiformae (target rash) neuro symptoms ```
89
in exams a bird owner with a cough and infection is usually infected with
chlamydia psittaci
90
what is 'lung consolidation'?
lung is full o stuff (water, mucus) not air
91
what is aspiration pneumonia caused by?
foreign material in the lungs
92
'q fever' is most often seen in farmers, what is it caused by?
coxiella burnetti
93
5 symptoms of pneumonia?
``` SOB productive cough haemoptysis pleuritic chest pain delirium sepsis - fever tachycardia tachypnoea hypotension etc ```
94
5 signs of pneumonia?
``` fever, tachycardia, tachypnoea hypotension bronchial/harsh breath sounds equally loud on inspiration/expiration dullness to percuss crackles ```
95
what system is used to consider how risky a patients pneumonia will be? what does it consider? what score warrants admission?
``` CURB-65 C - confusion U - uraemia R - resp rate high B - bp less than 90/ or /60 over 65 ``` consider admit if score of 2 or more 3 or more -- intensive care
96
3 antibiotics commonly used in pneumonia?
co amoxiclav amoxicillin doxycycline clarithromycin - -mycin = macrolide. usually co amoxiclav + -mycin for hosp treatment ceftriaxone
97
what antibiotic works against MRSA?
Vancomycin
98
what is an empyma?
infected pulmonary effusion
99
3 complications of pneumonia?
``` ARDS sepsis lung abscess pleural effusion empyma death ```
100
where is the division between the upper and lower respiratory tract?
vocal chords
101
5 parts of the upper resp tract (that might get infected!)
``` nasal passages sinuses pharynx larynx, above vocal cords tonsils eustachian tube ```
102
is tonsilitis usually caused by a bacteria or virus?
virus
103
3 features that suggest a tonsilitis is bacterial, not viral?
fever tonsillar exudate no cough tender anterior cervical lymph nodes
104
some microbiology of strep pyogenes?
lancefield group a beta haemolytic catalase neg
105
presentation of tonsilitis?
``` usually associated with pharyngitis red inflamed sore tonsils sore throat pain on swallowing fever malaise headache ```
106
first line drug for bacterial tonsilitis?
penicillin V
107
what is otitis media?
inflammation of the 'middle ear' | commonly infection of the eustachian tube following urt inf
108
4 bacteria that cause most upper resp tract infections?
strep pneumoniae h influenzae moraxella catarrhalis staph aureus
109
5 presenting signs/symptoms of otitis media?
``` ear pain hearing loss loss of balance inflamed/perforated tympanic membrane middle ear effusion otorrhea (discharge) ```
110
1st and 2nd line treatments for otitis media and sinusitis?
1 - amoxicillin | 2 - co amoxiclav
111
what could you use instead of penicillin/amoxicillin if pt is allergic to penicillin?
clarithromycin
112
is sinusitis usually bacterial or viral?
viral | eg rhinovirus
113
presentation of sinusitis? 4
``` purulent rhinorrhoea face pain headache fever voice changes change in smell/taste cough ```
114
differences between copd and asthma?
copd: non reversible, interval symptoms
115
emphysema vs bronchitis presentation?
emphysema = pink puffer - pursed lips, bent over, skinny, | blue bloater = reactive pulmonary vasoconstriction, overweight, productive cough, hypertension
116
what is the most common interstitial lung disease?
idiopathic pulmonary fibrosis
117
what kind of spirometry does silicosis and aspestosis have?
restrictive
118
presentation of silicosis and asbestosis?
dry cough dyspnoea generally quiet, not crackly chest
119
what systems are affected by granulomatosis with polyangiitis?
``` ELK ENT - conjunctivitis, ear infections (ent involvement separates it from goodpastures) Lung - cough/dyspnoea/wheeze Kidney - haematuria general malaise, fever etc ```
120
what investigation for staging lung cancer?
CT chest, liver, adrenals
121
on CXR what is the difference between the consolidation inn tb and pneumonia?
TB - in the middle | pneumonia - at the bottom
122
what are the most common causes of hosp acquired pneumonia?
aerobic gram neg bacilli eg pseudomonas klebsiella e coli
123
first line imaging for ?lung cancer or ?TB?
chest x ray
124
in a non smoker what lung cancer is most common??
adenocarcinoma
125
What is the most common form of pulmonary fibrosis?
idiopathic
126
5 aetiologies of pulmonary fibrosis?
``` idiopathic ra/sle/annkylosing spondylitis/other connective tissue diseases vasculitis eg goodpastures aspergillus/TB infection drugs eg amiodarone, methotrexate aspiration sarcoidosis ```
127
presentation of pulmonary fibrosis?
dry cough SOB fine bilateral crackles when you listen to chest ``` wheeze haemoptysis chest pain clubbing cor pulmonale ```
128
what kind of spirometry is seen in pulmonary fibrosis?
restrictive - so reduced fvc | because fibrosis prevents the lung from expanding
129
what investigation for pulmonary fibrosis?
chest CT is best but can do x ray if not available | ground glass appearance - irregular peripheral opacities
130
how is DCLO affected in pulmonary fibrosis?
reduced | as gas exchange is impaired
131
2 drugs for pulmonary fibrosis?
pirfenidone/nintendinab - anti fibrotic
132
what is the epidemiology of sarcoidosis?
female black and scandinavian young adults/60+
133
what is the pathophysiology of sarcoidosis? | & what type of hypersensitivity?
type 4 hypersensitivity unknown antigen granuloma pulmonary fibrosis and nodules
134
what cells make up the granulomas in sarcoidosis?
macrophage in the center | t cells on the edges
135
what is the most common location for the granulomas in sarcoidosis?
the hilar lymph node, where the bronchi meets the lung
136
symptoms of pulmonary sarcoidosis?
cough gradual onset progressive dyspnoea mediastinal lymphadenopathy
137
5 extrapulmonary effects of sarcoidosis?
``` systemic - fever, weight loss, fatigue skin - erythema nodosum, lupus pernio joints - polyarthralgia eye - uveitis, conjunctivitis heart - bundle branch block hypercalcaema liver - nodules, cirrhosis, cholestasis nervous system - diabetes insipidus, bells palsy ```
138
treatment for sarcoidosis?
generally resolves spontaneously 1st line = prednisolone 2nd line = methotrexate/azathiopurine
139
blood tests in sarcoidosis? - 3
raised serum ACE raised serum calcium raised serum soluble il2 receptor
140
what is gold standard investigation for sarcoidosis and what will you see?
ultrasound guided biopsy of mediastinal lymph nodes | non caseating granuloma with epitheloid cells
141
on a chest x ray in sarcoidosis what would you see?
hilar lymphadenopathy | bilateral lung exudate
142
what is lofgrens syndrome and what condition is it most commonly associated with?
sarcoidosis | triad of bilateral hilar lymphadenopathy, polyarthritis and erythema nodosum
143
what is bronchiectasis?
widening of the bronchioles and build up of mucus
144
5 aetiologies of bronchiectasis?
``` young syndrome cf infection eg tb, pneumonia, hiv, pertussis bronchial obstruction eg tumour rheumatoid arthritis/uc alpha 1 antitrypsin deficiency copd ```
145
why is there increased risk of infection in bronchiectasis?
because the cilia are damaged so cannot clear the mucus+infection as easily
146
is bronchiectasis an obstructive or restrictive disease?
obstructive, the main problem is that mucus obstructs the airways
147
why is there pulmonary hypertension in bronchiectasis?
in response to hypoxia the pulmonary vessels constrict in an attempt to divert flow to somewhere with better airflow
148
5 clinical presentations of bronchiectasis?
``` persistent productive cough purulous sputum which is foul smelling and dark green (usually has been sat around in the lung for a long time before it can be coughed up) intermittent haemoptysis SOB clubbing wheeze coarse inspiratory crepitations prone to respiratory infections ```
149
what does the chest x ray show in bronchiectasis?
cystic shadows | dilated and thickened bronchi and bronchioles
150
how to manage the mucus in bronchiectasis?
mucolytic eg carbocysteine | flutter valve for mucus drainage
151
what population is at greatest risk of cystic fibrosis?
caucasian
152
what is the mutation in cf and what is the effect of it?
mutation in CFTR protein = lack of cl- into mucus secretions = thick and sticky mucus
153
5 clinical presentations of CF?
``` Failure to thrive cough - haemoptysis/thick sputum wheeze recurrent resp inf bronchiectasis pancreatic insufficiency = steatorrhoea and diabetes gall stones, cholestasis male infertility nasal polyps cyanosis clubbing bilateral coarse crackles ```
154
what is the test for CF in newborns? how does it work?
Guthrie detects raised trypsinogen trypsinogen raised in response to pancreatic damage
155
what is the gold standard CF test?
sweat test inject pilocarpine to stimulate sweat production salty sweat = cf, sweat glands are opposite so cl- cannot be absorbed from the sweat
156
two methods of genetic testing for CF during pregnancy?
amniocentesis | chorionic villus sampling
157
management for CF?
chest physio antibiotics - acute or prophylactic mucolytics eg dornase alpha bronchodilators eg salbutamol fat soluble vitamin supplement ursodeoxycholic acid to improve bile flow ivacaftor or lunacaftor depending on mutation
158
what is a pleural effusion?
fluid in the pleural cavity
159
exudative vs transudative effusion?
``` transudative = low protein, less than 3 exudative = high protein, more than 3 ```
160
3 aetiology of transudative pleural effusion?
transudative is caused by movement of fluid eg congestive heart failure low albumin hypothyroid peritoneal dialysis
161
3 aetiologies of exudative pleural effusion?
exudative caused by inflammation, which means both fluid and proteins can move ``` lung cancer pneumonia tb RA SLE and other autoimmune pulmonary embolism ```
162
clinical presentation of pleural effusion?
``` SOB cough pleuritic chest pain stony dull to percussion reduced chest expansion superior raspy breathing tracheal and mediastinal deviation, if severe ```
163
investigation for pleural effusion?
chest drain/pleural effusion, test the fluid for culture, protein/LDH, appearance, cell count chest xray
164
what does the chest x ray in pleural effusion show?
blunting of the costophrenic angle fluid in the lung fissures meniscus at the bottom tracheal and mediastinal deviation
165
management of pulmonary effusion?
antibiotics diuretics pleural aspiration or chest drain small may spontaneously resolve
166
2 complications of pulmonary effusion?
empyema | trapped lung
167
in exams what is a common epidemiology/type of patient for pneumothorax?
a tall young male with sudden onset shortness of breath while playing sport
168
what conditions is spontaneous pneumothorax more likely in?
marfans rheumatoid arthritis etc
169
some causes of iatrogenic pneumothorax?
central line insertion mechanical ventillation lung biopsy
170
presentation of pneumothorax?
``` sudden onset SOB / pain / cough cyanosis tachycardia tachypnoea reduced breath sounds hyper resonance pleuritic chest pain ```
171
first line investigation for pneumothorax?
erect chest x ray - see a visible rim with no lung markings
172
gold standard investigation for pneumothorax?
ct thorax | allows you to see smaller pneumothorax and measure them more effectively than a cxr
173
when would a pneumothorax not need management?
less than 2cm with no SOB
174
management of pneumothorax? 3
high flow oxygen insert a chest drain at 5th intercostal space on the mid axillary line aspiration
175
what can you do for recurrent pneumothorax?
surgery to remove the pleura or stick the visceral and parietal layers together
176
where is the air in pneumothorax?
in the pleural space (between visceral and parietal pleura)
177
what is a tension pneumothorax caused by?
trauma | one way valve
178
clinical presentation of tension pneumothorax?
``` decreased air entry unequal lung expansion tachycardia hypotension trachial deviation hyperresonance ```
179
management of tension pneumothorax?
large bore canula 2nd intercostal space mid clavicular line
180
at what pressure is pulmonary hypertension diagnosed?
25mmHg
181
what are the 5 groups of aetiology of pulmonary hypertension?
1. primary - eg SLE 2. left sided heart failure - eg MI, systemic hypertension 3. chronic lung disease - eg COPD - reactive vasoconstriction 4. pulmonary vascular disease eg PE 5. miscellaneous eg sarcoidosis, vasculitis
182
what is the effect on the lungs of hypertension?
thickening of alveolar and capillary membranes | = reduced gas exchange
183
what is cor pulmonale?
``` increased pressure in the lung vessels backs up into right ventricle = rv hypertrophy = backpressure into veins = systemic oedema ```
184
clinical presentation of pulmonary hypertension?
``` SOB worse when flat / on excercise - orthopnoea syncope tachycardia raised jvp hepatomegaly peripheral oedema chest pain heart murmur ```
185
what does an ECG show in pulmonary hypertension?
large R waves on the right V1-V3 large S waves on left V4-V6 right axis deviation right bundle branch block
186
a blood test that would show heart pathology in pulmonary hypertension?
NT - pro - BNP
187
3 drugs for primary pulmonary hypertension?
IV prostanoid eg epoprostenol endothelin receptor antagonist eg macitenan pde-5 inhibitor eg sildenafil
188
3 complications of pulmonary hypertension?
resp failure heart failure arrythmia
189
how many points do you need on the well's score for pe to be likely?
if wells is more than 4 PE could be likely
190
gold standard test for pulmonary hypertension?
right heart catheterisation | this is a way of measuring the pulmonary BP
191
Bird fanciers lung, farmers lung and malt workers lung are all examples of
hypersensitivity pneumonitis
192
what type of hypersensitivity reaction is hypersensitivity pneumonitis?
type 3 | over time -- type 4
193
what happens to the lung in hypersensitivity pneumonitis?
fibrosis -- impaired gas exchange, loss of elasticity | non caseating granulomas
194
what part of the lung is most affected in hypersensitivity pneumonitis?
top
195
presentation of acute hypersensitivity pneumonitis?
fever, rigors cough dyspnoea headache
196
presentation of chronic hypersensitivity pneumonitis?
``` progressive cough progressive dyspnoea fatigue cyanosis resp failure weight loss clubbing ```
197
what do you see on biopsy with hypersensitivity pneumonitis?
non caseating granuloma
198
management of hypersensitivity pneumonitis?
steroids | remove trigger
199
what do you see on imaging in hypersensitivity pneumonitis?
diffuse infiltrate ground glass (fibrosis) bronchiectasis
200
what are the antibodies to in goodpastures?
type 4 collagen | which is in glomerular basement membranes
201
presentation of goodpastures? - 5
``` cough SOB haemoptysis haematuria proteinuria oliguria ``` ``` hypertension anorexia myalgia/arthralgia lethargy fever ```
202
best investigation for goodpastures, what do you see?
kidney biopsy immunoflorescence - iGg associated with glomerulus crescents inflammation
203
what is DCLO in goodpastures?
high
204
management of goodpastures?
plasmaphoresis steroids cyclophosphamide
205
what is the most common ANCA vasculitis?
granulomatosis with polyangiitis
206
which ANCA antibody is usually associated with granulomatosis with polyangiitis?
cANCA
207
what do you see on chest imaging of granulomatosis with polyangiitis?
nodules fluffy alveolar haemorrhage cavitating lesions consolidation
208
mesothelioma is associated with
asbestos!
209
what is mesothelium?
epithelium that forms lining ie pleura, peritoneum, pericardium etc
210
what molecule does mesothelioma express?
calretinin
211
presentation of mesothelioma?
``` history to suggest clubbing sob pleuritic chest pain harmoptysis fever, weight loss etc ```
212
which part of the lung is fibrosed in mesothelioma?
lower
213
polo mint sign on CT is associated with what condition?
PE
214
bronchus sign on CT indicates what lung pathology?
bronchogenic cancer
215
tree in bud sign on CT indicates what lung pathology?
pneumonitis, bronchiolitis
216
split pleura sign on CT indicates what lung pathology?
exudative, malignant or infected pleural effusion
217
signet ring sign on CT indicates what lung pathology?
bronchiectasis
218
what is the most common type of lung cancer?
squamous
219
what is the most common lung cancer in non smokers?
adenocarcinoma
220
complications of bronchiectasis?
empyema respirator failure repeated inf = worsening lung function pneumothorax from repeated coughing
221
what is the microbiology of h influenzae?
small gram neg cocco-bacillus
222
risk factors for pneumothorax?
smoking trauma previous pneumothorax mechanical ventilation
223
how long after admission is it called hospital acquired pneumonia?
48hrs
224
what type of hypersensitivity is goodpastures?
type 2
225
what is gold standard for TB diagnosis?
sputum culture
226
what is the most common cause of pneumonia in bronchiectasis?
h influenzae
227
which sinus is most prone to infection and what are the symptoms of that?
maxillary, because it drains from the top forehead and cheek tenderness worse when leaning forward
228
is cystic fibrosis restrictive or obstructive?
obstructive
229
3 Indicators of good asthma control?
``` no night time symptoms inhaler used no more than 3x per week no breathing difficulties, cough or wheeze on most days able to exercise without symptoms normal lung function test ```

phase 2a (10 decks)

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