Respiratory Flashcards
(272 cards)
1
Q
What causes type 1 respiratory failure?
A
Lung fails to fill properly
2
Q
What are the blood gas values for T1 respiratory failure?
A
- O2 = low
- CO2 = low/ normal
3
Q
What mechanisms/ conditions can cause type 1 respiratory failures (3)?
A
- Low ambient O2 (e.g. high altitude)
- V/Q mismatch (e.g. PE)
- Diffusion problem (e.g. pneumonia, ARDS)
4
Q
How is type 1 respiratory failure often treated?
A
Oxygen alone
5
Q
What is type 2 respiratory failure?
A
Lung fails to remove CO2 properly
6
Q
What are the blood gas values for T2 respiratory failure?
A
- O2 = low
- CO2 = high
7
Q
What mechanisms/ conditions can cause type 2 respiratory failure (2)?
A
- Airway resistance (e.g. COPD, asthma)
- Decrease in gas exchange area (e.g. chronic bronchitis)
8
Q
How is type 2 respiratory failure often treated?
A
BiPAP (bi +ve airway pressure) + oxygen
9
Q
What is COPD?
A
Lung tissue damage causing an obstruction to airflow through the lungs, making them more difficult to ventilate
10
Q
What are the two types of COPD?
A
- Emphysema
- Chronic bronchitis
11
Q
What are some risk factors/ causes of COPD?
A
- Smoking
- Air pollution
- Alpha 1 antitrypsin deficiency (A1AT)
12
Q
What mechanisms cause chronic bronchitis?
A
- Hypertrophy/plasia mucous glands –> hypersecretion of mucous
- Chronic inflammatory cells (in bronchi/oles) –> luminal narrowing
13
Q
What defines chronic bronchitis?
A
Chronic productive cough for 3 months or more per year for 2 years
14
Q
What is the mechanism in which emphysema causes respiratory failure?
A
Destruction of elastin in respiratory bronchiole + alveolar walls –> walls collapse and trap air distal to blockage
15
Q
What is a large air sac that can form in the lungs as a result of emphysema called?
A
Bullae
16
Q
What are the three main types of emphysema?
A
- Centriacinar emphysema (resp bronchioles ONLY)
- Panacinar (resp bronchioles, alveoli sac BOTH)
- Distal acinar (alveoli sac ONLY)
17
Q
How is A1AT deficiency inherited?
A
Autosomal co-dominance
18
Q
How does A1AT deficiency cause pathology?
A
Alpha 1 antitrypsin degrades elastase in neutrophils (elastase degrades elastin), therefore A1AT deficiency = more elastin degradation
19
Q
What are the signs/ symptoms of COPD (4)?
A
- Chronic cough
- Shortness of breath
- Recurrent resp infections
- Lots of mucous production
20
Q
What are 2 presentations, one typical of emphysema one typical of chronic bronchitis?
A
- Chronic bronchitis = blue bloater
- Emphysema = pink puffer
21
Q
What scale can be used to measure the level of dyspnoea in those with COPD?
A
MRC dyspnoea scale:
* 1 = breathless with strenuous exercise …
* … 5 = can’t even leave the house
22
Q
What is not usually present in COPD (in terms of symptoms)?
A
Haemoptysis
23
Q
What investigations are done for COPD (5)?
A
- Pulmonary function test spirometry
- DLCO test
- High expired NO = lung damage
- Genetic testing
- ECG, ABG, Xray
24
Q
What would spirometry results show in COPD?
A
FEV1:FVC < 0.7 (= obstructive respiratory failure)
25
How is COPD and asthma differentiated between?
Give bronchodilator, if FEV1 increases by more than 12% then diagnosis is likely asthma
26
What is DLCO test?
Diffuse capacity of CO across the lung
27
How is COPD treated medically?
* 1st line = SAB2A (short acting beta 2 agonist) or SAM3A
* 2nd line = add LAB2A and LAM3A
* 3rd line = inhaled corticosteroids
28
What can be given to people with very severe COPD?
Long term oxygen therapy
29
What is given to patients with COPD to prevent infection?
Influenza + pneumococcal vaccine
30
What is a complication of COPD?
Acute inflammation of lungs associated with infection
31
What can an acute exacerbation of COPD lead to?
High CO2 levels due to V/Q mismatch --> respiratory acidosis
32
What is an example of a SABA inhaler?
Salbutamol (albuterol)
33
Give an example of a SAMA inhaler?
Ipratropium
34
Give an example of a LABA + LAMA combined inhaler?
Anoro
35
Give an example of a LABA?
Salmeterol
36
Give an example of a LAMA?
Tiotropium
37
Give an example of a LABA + LAMA + ICS combination inhaler?
Trimbow (brand name don't need to know this actually)
38
How is an acute exacerbation of COPD treated?
Nebulised salbutamol + ipratropium
*O2 saturation target = 88-92%*
*With ICS*
39
What is asthma?
Chronic, but reversible obstruction/ constriction of the airways
40
What are the two types of asthma and their prevalence?
* Allergic (70%)
* Non-allergic (30%)
41
What are some common triggers for allergic asthma (3)?
* Pollen
* Dust
* Mould
42
When do allergic and non allergic asthma tend to present?
* Allergic = earlier in life
* Non-allergic = later in life
43
What has been associated with/ is thought may cause allergic and non-allergic asthma?
* Allergic = hygiene hypothesis, genetics
* Non-allergic = smoking
44
What are some general triggers for asthma (4)?
* Infection (esp. viral)
* Cold weather
* Exercise
* Drugs (Bb, aspirin)
45
What is the atopic triad?
* Asthma
* Atopic rhinitis (hay fever)
* Eczema
46
What 3 conditions/ symptoms have been associated in another triad linked to asthma?
Samters triad:
* Nasal polyps
* Asthma
* Aspirin sensitivity
47
What is the pathophysiology/ mechanism which causes bronchoconstriction/ inflammation in asthma?
1. Over-expression of T-helper 2 cells exposed to tigger
2. Cytokines release (esp IL 4,5)
3. IL4 --> IgE release --> mast cell degranulation --> histamine + leukotrienes
3. IL5 --> Eosinophil recruitment --> leukotrienes
4. Bronchial constriction + mucous hypersecretion
48
What happens to the airways when asthma repeatedly occurs?
Chronic remodelling
* Decreased lumen size (scarring)
* Increased mucous production
49
What are the symptoms of asthma?
Bilateral episodic wheeze/ cough worse at night
50
How is asthma investigated (2)?
* Mucous microscopy
* Spirometry
51
What can be seen in asthma mucous sample (2)?
* Curschmann spirals - spiral shaped mucous plugs (from gland ducts)
* Charcot-leyton crystals - proteins from eosinophils
52
What can be used to determine the severity of an asthma episode?
Peak expiratory flow (PEF)
*can be moderate, severe, life threatening, fatal*
53
How can spirometry be used to diagnose asthma?
* FEV1:FVC < 0.7
*and*
* Bronchodilator reversible > 12% FEV1 increase
54
The presence of what in the expired air can indicate inflammation?
High proportion NO
55
How is asthma treated?
1. SABA
2. + ICS
3. + LTRA
4. + LABA
5. Increase ICS
56
What is important to check the patient is doing correctly when treating asthma?
Inhaler technique + compliance
57
What is LTRA?
Leukotrene receptor antagonist
58
Give an example of a LTRA inhaler?
Montelukast
59
How is an exacerbation of asthma treated?
1. **O**2
2. **S**ABA nebulised
3. ICS (**h**ydrocortisone)
4. **I**V **M**gSO4 (bronchodilator)
5. IV **t**heophylline (bronchodilator)
6. **E**scalate
**OSHITME
60
What can also be given to people with an exacerbation of asthma?
* BIPAP
* Antibiotics (if infection)
61
What are the 3 classes of lung cancer?
* Mesothelioma
* Small cell lung cancer
* Non-small cell lung cancer
62
What are 4 types of non-small cell lung cancer?
* Adenocarcinoma = most common
* Squamous
* Carcinoid
* Large cell
63
What is the main risk factor for mesothelioma?
Asbestos exposure
64
Who is most commonly affected by mesotheliomas?
Males (40-70)
65
What are the general signs/ symptoms of mesothelioma (3)?
* Weight loss
* Night sweats/ pain
* TATT
66
What are the lung signs/ symptoms of mesothelioma (5)?
* SoB
* Cough
* Pleuritic chest pain
* Haemoptysis
* Hoarse voice
67
How is mesothelioma investigated (3) - (clue = something weird)?
* Xray + CT
* CA-125 antigen (general tumour marker)
* Biopsy = diagnostic
68
How is mesothelioma treated?
Mostly palliative care as VERY aggressive
69
Where do small and non-small cell lung cancers form in?
Parenchyma lung
70
What are some risk factors for lung cancer (not including mesotheliomas), (5)?
* **Asbestos**
* **Smoking**
* Coal
* Radiation
* Other lung conditions
71
What are some symptoms of lung cancer (9)?
* SoB
* Weight loss
* Hoarse voice
* Haemoptysis
* Cough
* Chest pain
* TATT
* Night sweats/ pain
* Finger clubbing
72
What usually causes finger clubbing?
Chronically low blood oxygen levels
73
What are two extra pulmonary manifestations of lung tumours caused by them pressing on structures?
* Horners syndrome
* Superior vena cava obstruction
74
What is horners syndrome and what causes it (3 things)?
Tumour pressing on sympathetic ganglion --> ptosis, miosis (pupil constriction), anhidrosis (no sweat)
75
How does a SVC obstruction present and what is this sign called?
Pemberton's sign - swollen congested face
76
What percentage of lung cancers (not mesothelioma) are SCLCs?
15%
77
What is a paraneoplastic syndrome?
A syndrome that is the consequence of a tumour in the body
78
What are some paraneoplastic syndromes caused by an SCLC (3)?
* SIADH
* Cushings
* Lambert-eaton syndrome (nmj autoimmune disorder)
79
Where do SCLCs originate from?
Neuroendocrine cells in lung
80
Where do squamous NSCLCs originate from?
Lung epithelium
81
What do squamous NSCLCs sometimes secrete?
PTH
82
Where do adenocarcinoma NSCLCs originate from?
Mucous secreting glandular epithelial cells
83
Where do carcinoid lung tumours originate from?
Neuroendocrine cells (like SCLC) - sometimes secrete serotonin
84
What gene mutations are carcinoid tumours associated with (2)?
* MEN 1 mutation
* Neurofibromatosis 1
85
Where do carcinoid tumours also form?
GIT
86
How are lung cancers investigated (3)?
* CT/ xray
* Bronchoscopy + biopsy
* MRI (for staging - TNM)
87
How are lung cancers treated?
* Surgery (for less aggressive NSCLC)
* Chemo/radio therapy
88
What is a monoclonal antibody therapy used for lung cancers called that is anti epidermal growth factor called?
Cetuximab
89
What are 2 risk factors for pulmonary embolism?
* Anything affecting virchows triad
* Family history
90
How does a PE affect alveolar-arterial gradient?
Increases gradient as more oxygen in alveoli compared to arteries
91
How is V/Q of the lungs affected in a PE?
Ventilation with no perfusion = dead space
*Perfusion without ventilation = shunt*
92
How do the lungs respond to the VQ mismatch found in PEs?
Bronchoconstriction to the areas of dead space
93
What are 2 typical presentations for a PE?
* Female uni student on contraception pill returns from Japan
* Older man had surgery 6 weeks ago and hasn't been able to move
94
What are the signs/ symptoms of a PE (7)?
* Tachypnoea + dyspnoea
* Haemoptysis
* High JVP
* Tachycardia
* Evidence of DVT
* Pleuritic chest pain
* Cough
95
What score is used to asses the likelihood of a PE?
Wells score
96
How should a PE be investigated (3)?
* D-dimer test
* CT PA
* V/Q scan (if really impaired)
97
When should each of these tests be carried out for a PE?
* If wells score < 4 --> d-dimer
* If wells score > 4 or d-dimer +ve --> CTPA or V/Q scan
98
What ECG signs are seen in those with PE (5)?
* Deep S waves (lead 1)
* Deep Q waves (lead 3)
* Inverted T wave (lead 3)
**S1Q3T3**
* RBBB
* Tachycardia
99
What is a massive PE?
Systolic BP < 90mmHg
100
How is a haemodynamically stable PE treated (2)?
* DOACs = 1st line (rivaroxiban, apixaban); (LMWH if contraindicated)
* Warfarin = 2nd line
101
How is a haemodynamically unstable PE treated (2)?
* Thrombolysis (alteplase)
* Catheter embolectomy
102
What is pneumonia?
Inflammation and fluid exudation into lung parenchyma, due to infection
103
How is pneumonia classified in terms of where it develops (2)?
* Community acquired pneumonia
* Hospital acquired pneumonia
104
What defines hospital acquired pneumonia?
Developed > 48 hours after hospital admission
105
What are the two most common bacterial causes of pneumonia?
* S. pneumoniae (most common)
* H. influenzae
106
What is atypical pneumonia?
Pneumonia that cannot be cultured in the normal way or detected using gram staining
107
Give 2 examples of atypical pneumonia?
* Mycoplasma pneumoniae
* Legionella pneumoniae
108
How are atypical pneumonias usually treated?
Clarithomycin (as penicillin resistant)
109
Where is legionella pneumoniae frequently associated with?
Spain
110
What viruses commonly cause pneumonia (2)?
* Influenza A virus
* CMV
111
What fungi sometimes causes pneumonia?
P. jiroveci (pneumocystis pneumonia)
112
What is fungal pneumonia often suggestive of?
AIDS/ HIV
113
Which bacteria are more common in HAP (4)?
* P. aeruginosa
* E. coli
* Klebsiella
* MRSA
114
What are two ways pneumonia is commonly developed?
* Inhaling pathogen
* Aspiration pneumonia
115
What are risk factors for pneumonia (4)?
* IVDU (staph aureus)
* Very old/ young
* Pre existing lung disease
* Immunocompromised
116
What is the difference in presentation between atypical and typical pneumonia?
* Atypical = unproductive cough (exudate forms in interstitium)
* Typical = productive cough (exudate forms in alveoli)
117
What are the signs/ symptoms of pneumonia (8)?
* Pyrexia
* Productive cough
* Pleuritic chest pain
* Tachypnoea
* Tachycardia + hypotension
* Hypoxia
* Haemoptysis
* Crackling lungs on auscultation
118
How is pneumonia investigated (2)?
* Xray chest
* Sputum culture
119
What is seen on an Xray positive for pneumonia?
Consolidation (fluid filled alveoli highlight air filled bronchi)
120
How is the severity of pneumonia assessed?
CURB 65 score
121
What is assessed in CURB-65?
* **C**onfusion
* **U**rea > 7
* **R**espiratory rate > 30
* **B**lood pressure (<90 systolic or <60 diastolic)
* **65** years <
*1 point for each*
122
How does CURB-65 score guide management?
* 0/1 = outpatient treatment (3% mortality)
* 2 = hospital admission (3-15% mortality)
* 3+ = ICU admission (15% + mortality)
123
How is pneumonia treated?
* Maintain O2 sats (94-98%)
* Antibiotics
* Analgesia
* Fluids
124
What antibiotics are used for CURB-65 score 1/0 patients?
Amoxicillin
125
What antibiotics are used for CURB-65 score 2+ patients?
Amoxicillin + clarithomycin
126
Which bacteria are the exceptions to these antibiotic treatments?
Atypical pneumonia = clarithomycin strait away
127
What is tuberculosis?
Caseating granulomatous disease, caused by mycobacterium
128
Give an example of a non TB causing mycobacterium?
M. leprae
129
What are the two most common mycobacterium causing TB?
* Mycobacterium tuberculosis
* Mycobacterium bovis
130
Where is TB more prevalent in the world (2)?
* South asia
* Sub-saharan africa
131
How many people have TB globally?
About 2 million (mostly latent)
132
How is TB spread?
Airborne
133
What are some risk factors for TB (4)?
* Travel/ migrant
* Immunocompromised
* Crowded living space
* Older age
134
What is the waxy capsule found around TB mycobacterium made of?
Mycolic acid
135
What is TB resistant to in the immune system?
Phagolysosome (enzymes in lysosomes) killing
136
What is the pathophysiology/ mechanism of TB infection?
1. TB phagocytosed, but resists killing --> granuloma forms
2. T cells recruited, central part of granuloma undergoes caseating necrosis --> **primary ghon focus**
3. TB spreads to nearby lymph nodes --> **ghon complex**
4. TB systemic spread = **miliary** TB
137
Where in the lungs does TB typically affect and why?
Upper lobes as TB is aerobic and there is higher perfusion in upper lobes
138
What is the difference between symptomatic and latent TB?
Latent = asymptomatic
139
What are the signs/ symptoms of TB (5)?
* Fever + night sweats
* Cough
* Weight loss
* Chest pain
* Lymphadenopathy
140
How is TB investigated (4)?
* Mantoux skin test
* Sputum culture
* Chest X-ray
* Biopsy
141
What would sputum analysis show for TB (2)?
* Acid fast bacilli
* Ziehl Neelson = bright red
142
How does the Mantoux skin test work?
Tuberculin injected into skin, if lump (induration) certain size = positive result
143
How is active TB treated?
* **R**ifampicin (6 months)
* **I**soniazid (6 months)
* **P**yrazinamide (2 months)
* **E**thambutol (2 months)
**RIPE**
144
How is latent TB sometimes treated?
R+I (from ripe) for 3 months
145
What is a side effect of rifampicin?
Discolouration of urine (orange/ yellow)
*riff am piss ing*
146
What is a side effect of isoniazid?
Peripheral neuropathy
147
What is a side effect of pyrazinamide?
Gout (hyperuricaemia)
148
What is a side effect of ethambutol?
Eye problems (colour blindness)
149
What are all RIPE drugs associated with?
Hepatotoxicity
150
What is pulmonary fibrosis?
Replacement of normal elastic lung tissue with scar tissue that does not function properly
151
What are the different types of pulmonary fibrosis (3)?
* Idiopathic
* Drug induced
* Secondary (to another condition)
152
Which drugs can induce pulmonary fibrosis (3)?
* Amiodarone
* Methotrixate
* Nitrofurantoin
153
What conditions can cause pulmonary fibrosis (3)?
* SLE
* RA
* A1AD
154
What is the most common interstitial lung disease?
Idiopathic pulmonary fibrosis
155
What are risk factors for idiopathic pulmonary fibrosis (4)?
* Smoking
* Older age
* Occupation (e.g. dust)
* Viruses (e.g. EBV, CMV)
156
What type of respiratory failure does pulmonary fibrosis cause?
Type 1 (problem with filling lungs, not gas exchange)
157
What are the signs/ symptoms of pulmonary fibrosis (3)?
* Slow onset dyspnoea
* Dry cough
* Finger clubbing
158
How is pulmonary fibrosis investigated (2)?
* Spirometry
* CT chest
159
What would spirometry results be for someone with pulmonary fibrosis (2)?
* FEV1 : FVC > 0.7 (= normal)
* But FVC < 0.8 predicted
160
What type of lung disease does pulmonary fibrosis represent?
Restrictive
161
What does a CT for pulmonary fibrosis show (2)?
* Ground glass lung (white streaks of fibrous tissue)
* Traction brochiectasis
162
What medication is used to treat pulmonary fibrosis (2)?
* Pirfenidone
* Nintedanib
163
What else can be done to treat pulmonary fibrosis?
Lung transplant
164
What term is used to describe interstitial lung disease caused by the inhalation of dust?
Pneumoconiosis
165
What 3 inhaled materials cause pneumoconiosis the most?
* Silicosis (crystalline silica)
* Asbestosis (asbestos)
* Coal miners lung (coal) - *coaliosis if you will...*
166
What findings can sometimes be found on X-ray of silicosis and coal miners lung?
Egg shell calcification
167
What is sarcoidosis?
Idiopathic granulomatous disease that tends to affect the lungs
168
What are 3 risk factors for sarcoidosis?
* Bimodal distribution (younger adulthood, 60+)
* Female
* Black
169
How are the lungs affected by sarcoidosis - what does it cause in the lungs (3)?
* Mediastinal lymphadenopathy
* Pulmonary fibrosis
* Pulmonary nodules
170
What are the signs/ symptoms of sarcoidosis (6)?
* Fever
* Weight loss
* Dry cough
* Dyspnoea
* Uveitis
* Skin lesions (erythema nodosum, lupus pernio - purple lumps)
171
What is lofgren's syndrome?
Presentation of sarcoidosis characterised by:
* Erythema nodosum
* Bilateral hilar lymphadenopathy
* Polyarthritis
172
How is sarcoidosis investigated (3)?
* Bloods
* Xray/ CT/ (MRI fro CNS involvement)
* Biopsy
173
What blood results are suggestive of sarcoidosis (2)?
* High ACE
* Hypercalcaemia
174
What would a chest Xray show in sarcoidosis?
* Bilateral hilar lympadenopathy
* Pulmonary infiltrates
175
What is a pulmonary infiltrate?
Substance denser than air, seen on Xray
176
What would a sarcoidosis biopsy show?
Non-caseating granuloma
177
How is sarcoidosis treated (3)?
Often self resolving, if more severe...
* Coricosteroids
* DMARDs
* lung transplant
178
What is hypersensitivity pneumitis?
Inflammation of the lung due to exposure to an allergen
179
What type of hypersensitivity is hypersensitivity pneumitis?
Type 3 (antigen antibody complex deposition)
180
What are some common causes of hypersensitivity pneumitis (4)?
* Pidgeon fanciers lung!!! - bird droppings
* Farmers lung - mouldy hay
* Mushroom workers lung
* Cheese workers lung
181
How is hypersensitivity pneumitis diagnosed?
Bronchoalveolar lavage - raised lymphocytes + mast cells
182
How is hypersensitivity pneumitis treated?
Steroids (prednisolone)
183
What type hypersensitivity is goodpasture's syndrome?
Type 2 hypersensitivity
184
What is the pathophysiology/ mechanism of Goodpastures syndrome?
1. Anti - glomerular basement membrane (anti-GBM) antibody production
2. Attack basement membrane in the lungs + kidneys --> pulmonary fibrosis + glomerulonephritis
185
How is Goodpasture's syndrome investigated (2)?
* Lung + kidney biopsy = Ig deposition
* Serology = anti-GBM antibodies
186
How is Goodpasture's syndrome treated (3)?
* Steroids + DMARDs
* Plasmapheresis + plasma exchange
187
What is Wegeners vasculitis (granulomatosis with polyangitis)?
Autoimmune medium/ small vessel vasculitis
188
What antibodies are associated with granulomatosis with polyangitis?
c-ANCA
189
What are the symptoms of granulomatosis with polyangitis (3)?
* **E**NT = saddle shape nose + ear infection
* **L**ungs = haemoptysis
* **K**idneys = glomerulonephritis (haematuria)
**ELK**
190
How is granulomatosis with polyangitis diagnosed?
c-ANCA +ve antibodies
191
How is granulomatosis with polyangitis treated (2)?
* Corticosteroids
* DMARDs
192
What is bronchiectasis?
Permanent bronchial dilation due to irreversible damage to the bronchial wall
193
What are some risk factors/ causes of bronchiectasis (2)?
* Post infection
* Pulmonary disease (e.g. CF, COPD)
194
What are the symptoms of bronchiectasis (3)?
* Productive cough
* Dyspnoea
* Haemoptysis
195
What is the pathophysiology of bronchiectasis?
1. Infection --> dilation of bronchi + loss of cilia + mucous hyper secretion
2. Factors prevent bronchodilator from reversing --> irreversible bronchodilation
196
Which lobes are usually affected by bronchiectasis?
Lower (maybe as this is where infection is more likely)
197
How is bronchiectasis investigated (4)?
* Xray - exclude other stuff
* High resolution CT
* Spirometry
* Sputum culture
198
What would CT show in bronchiectasis?
Dilated thickened bronchi (signet ring sign
199
What is a typical spirometry result for bronchiectasis?
Obstructive (FEV1:FVC < 0.7)
200
How is bronchiectasis treated?
Bronchodilators (+ antibiotics if infection)
201
How is cystic fibrosis inherited?
Autosomal recessive
202
What gene and which chromosome are mutated in CF?
Cystic fibrosis transmembrane conductance regulatory gene on chromosome 7
203
What is the most common mutation on the cystic fibrosis transmembrane conductance regulatory gene?
Delta-F508 mutation
204
What is the prevalence of CF?
1/25 carry gene (1/2500 affected - [25 X 25 X 4])
205
What ethnicity is most affected by CF?
Caucasians
206
What is the pathophysiology of CF (how does it thicken secretions)?
CFTR is a chlorine channel which moves chlorine into secretions --> H2O is drawn in by the Cl- --> thinner watery secretions
*Mucous thicker due to lack of Cl- secretion*
207
What effects does thicker mucous have on the lungs (2)?
* Mucociliary dysfunction = high infection risk
* Higher risk of bronchiectasia
208
What are some signs/ symptoms of CF (7)?
* Chronic cough
* Thick sputum
* Recurrent respiratory infections
* Abdominal pain
* Bowel obstruction
* Finger clubbing
* Failure to thrive
209
What is often the first sign a baby has CF?
Meconium ileus = thick sticky stool --> bowel obstruction
210
How is CF investigated (4)?
* Newborn blood spot test
* Sweat test (gold standard)
* Genetic testing
* Faecal testing
211
What is diagnostic of CF in sweat test?
Cl- >60 mmol/L
212
Why is Cl- high in sweat in CF?
Cl- cannot be reabsorbed through channels in the skin
213
What is suggestive of CF in faecal testing?
Low amounts of pancreatic enzymes (as blockage in duct system
214
How is CF treated medically (3)?
* Bronchodilators
* Mucolytics
* Pancreatic enzyme supplementation
215
What bacteria commonly colonise CF patients (3)?
* H. influenzae
* S. aureus
* P. aeruginosa
216
What bacteria is particularly problematic for CF patients and why?
P. aeruginosa due to antibiotic resistance
217
What should people with CF be advised to do?
CF patients should not have contact with each other
218
What is pleural effusion?
Excess fluid accumulation between the visceral and parietal pleura
219
What are the two types of pleural effusion?
* Trasudative
* Exudative
220
What is transudative pleural effusion?
Movement of interstitial fluid into the pleural space (due to high hydrostatic/ low oncotic pressures)
221
What is exudative pleural effusion?
Leaky capillaries --> high vascular permeability --> proteins leak out into pleural space --> H2O follows
222
What are the defining protein contents of transudative and exudative fluid?
* Transudative < 25 g/L (transparent)
* Exudative > 35 g/L (cloudy)
*25-35 g/L = ambiguous*
223
What causes transudative pleural effusion (3)?
* Herat failure
* Liver cirrhosis
* NephrOtic syndromes
224
What causes exudative pleural effusions (3)?
* Cancer
* TB
* Pneumonia
225
What are the symptoms of a pleural effusion (5)?
* Dyspnoea
* Dullness when purcussed
* Reduced breath sounds
* Chest pain
* Cough
226
How is pulmonary effusion investigated (2)?
* Chest X-ray
* Thoracocentesis (aspiration of pleural fluid)
227
What would a chest x-ray show in pleural effusion (3)?
* Costophrenic angles decreased
* White fluid visible
* Tracheal deviation
228
How is pleural effusion treated (2)?
* Chest drain
* Surgical fusion of pleura (if recurrent)
229
What is an infected pleural effusion known as?
Empyema
230
What is a pneumothorax?
Excess air accumulation in the pleural space
231
What are some risk factors for a pneumothorax (4)?
* Tall + thin
* Family history
* Connective tissue disorders
* Smoking
232
What are the 3 types of pneumothorax?
* Primary spontaneous (in absence of known lung disease)
* Secondary spontaneous (in presence of lung disease)
* Traumatic
233
What life threatening condition can each type of pneumothorax develop into?
Tension pneumothorax
234
What are the signs/ symptoms of pneumothorax (5)?
* Dyspnoea
* Pleuritis chest pain (unilateral)
* Tachycardia/ hypotensive
* Decreased breath sounds
* Hyperresonant percussion
235
What is the pathophysiology of a tension pneumothorax, why is it a medical emergency?
Air can enter the pleura, but cant leave - this effectively squashes lung!!!
236
How is a pneumothorax diagnosed?
Chest xray
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What can be seen on a pneumothorax chest xray (2)?
* Air appears black
* Tracheal deviation
238
How is a pneumothorax treated (3)?
* Small = do nothing
* Large = needle aspiration/ chest drain
* Recurrent = pleurodesis (surgical) - stick lung to chest wall
239
How is a tension pneumothorax treated?
Insertion of bore cannula into 2nd intercostal space at mid-clavicular line
240
What is cor pulmonale (value)?
Mean pulmonary arterial pressure > 25 mmHg
241
How is mean arterial pressure measured?
Right heart catheterisation with pressure probe
242
How are the causes of pulmonary hypertension classified (4)?
* **Pre capillary** - PE
* **Capillary/ lung** - asthma, COPD
* **Post capillary** - LV failure, mitral regurgitation
* **Chronic hypoxaemia** - COPD, altitude
243
How does cor pulomale cause RHS heart failure?
High BP --> High resistance --> RS hypertrophy --> heart failure
244
What are the symptoms of right ventricular failure (4)?
* Exertional dyspnoea
* Tachycardia
* High JVP
* Peripheral oedema
245
How is cor pulmonale diagnosed?
* X-ray
* ECG
* Echo
* Right heart catheter probe
246
What is suggestive of cor pulmonale on X-ray and echo (2)?
RV hypertrophy + enlarged proximal pulmonary artery
247
What ECG features are associated with cor pulmonale (4)?
* P. pulmonale (peaked p waves)
* Right axis deviation
* ST depression + T inversion (v1-3)
* RBBB
248
How is pulmonary hypertension treated (4)?
* Phosphdiesterase-5 inhibitors (sildenafil) = viagra
* Endothelin-1 antagonists
* CCBs (amlodipine)
* Diuretics
249
What is pharyngitis?
Inflammation of the parynx
250
What are 2 common causes of viral pharyngitis?
* EBV
* Adenoviruses
251
What are bacteria commonly causes pharyngitis?
* S. pyogenes (group A beta haemolytic strep)
252
What are the signs/ symptoms of pharyngitis (3)?
* Sore throat
* Fever
* Cough
253
What is important to rule out after bacterial infections causes pharyngitis?
Rheumatic fever
254
What is sinusitis?
Inflammation of the lining of the sinuses + nasal cavity
255
What group of pathogens most commonly cause sinusitis?
Viral
256
Which 2 bacteria most commonly cause sinusitis?
* S. pneumoniae
* H. influenzae
257
What is otitis media?
Inflammation of the middle ear
258
How is otitis media diagnosed?
Otoscopy = inflamed erythematous tympanic membrane
259
What is important to be weary of with otitis media?
Meningitis
260
What is epiglottitis?
Inflammation of the epiglottis
261
What is a dangerous complication of epiglottitis?
Obstruction of the airway
262
What bacteria most commonly causes epiglottitis?
H. influenzae
263
What are the symptoms of epiglottitis (5)?
* Dyspnoea
* Sore throat
*Tripoding (to get more air in):*
* Lean forward
* Stick tongue out
* Open mout wide
264
What causes whooping cough?
Bordella pertussis (gram -ve bacteria)
265
What is often heard in those with whooping cough?
Characteristic whoop at end of cough
266
How does bordella pertussis cause disease + inflammation?
Produce toxins that damage epithelium + macrophages
267
What is croup?
Larygobronchitits
268
What are the symptoms of croup (4)?
* Hoarse voice
* Cough
* Stridor
* Sore throat
269
What commonly causes croup?
Parainfluenza infections
270
What is a treatment for severe croup?
Dexamethasone (single dose)
271
What is used to measure the extent of dyspnoea?
MRC dyspnoea scale
272
What are the 5 grades of dyspnoea?
1. No dyspnoea
2. When walking uphill
3. Walks slowly
4. With a few minutes of walking
5. Getting dressed
