Respiratory Flashcards
(348 cards)
1
Q
Where are Anti-inflammatory steroids produced?
A
Adrenal Cortex
2
Q
What is an example of a mineralcorticoid and where are they produced?
A
Aldosterone
Zona Glomerulosa
3
Q
What is an example of a glucocorticoid and where are they produced?
A
Hydrocortisone
Zona fasiculata
4
Q
How do glucocorticoids work?
A
interfere with gene transcription (They have zinc fingers)
5
Q
How do mineralcorticoids work?
A
Metabolic changes and anti-inflammatory effect.
6
Q
What is a consequence of prolonged hydrocortisone usage?
A
Muscle wasting
osteoporosis
Increased risk of infection
7
Q
What is pulmonary vasculitis?
A
Inflammation of the pulmonary arterial wall
8
Q
What is the treatment for pulmonary vasculitis?
A
Immunosuppressants as it is AI mediated.
9
Q
What is whooping cough caused by?
A
Bordetella pertussis (Gram neg bacilli)
10
Q
What is bordetella pertussis cultured on?
A
Bordet gengou agar
11
Q
What are the symptoms of whooping cough?
A
- Chronic cough
2. Inspiratory whoop, posttusive vomiting
12
Q
What is the treatment of whooping cough?
A
Clarithromyocin
13
Q
What is the vaccination schedule for whooping cough?
A
8,12,16 weeks and at 3years 4 months with dTaP
14
Q
What is coup?
A
Acute larygnotracheobronchitis affecting the trachea, bronchi and larynx.
Most common in children
15
Q
What is the cause of coup?
A
Parainfluenza virus.
16
Q
Who is at risk of CMV?
A
Immunocompromised patients.
17
Q
Why is treatment of CMV difficult?
A
Long duration and potential toxicity
18
Q
What is the difference between palliative and radical radiotherapy?
A
Radical – Daily treatment for 4-6 weeks.
Palliative – patient attends the minimum number of visits to control symptoms
19
Q
What are some side effects of radiotherapy
A
Fatigue, anorexia, cough, oesophagitis and systemic symptoms.
20
Q
What is a positive and negative of adding chemotherapy to radiotherapy?
A
- Positive –> Survival advantage
- Negative –> increased risk of toxicity
21
Q
What are the side effects of chemotherapy?
A
Alopecia, nausea/vomiting, peripheral neuropathy and constipation/diarrhoea.
22
Q
What are the aims of palliative chemotherapy?
A
- Relieve symptoms
- Improve QOL
- Shrink tumours
23
Q
What does pleural fluid contain?
A
Albumin and globulin
24
Q
What produces pleural fluid and how much is found in a healthy cavity?
A
Produced –> Parietal pleura
15ml
25
What is the function of pleura?
Allows movement of the lung and lung expansion against the chest wall.
26
What diseases are associated with the pleura.
1. Pleural effusions
2. Pleural plaques
3. Pneumothorax
27
What are the viral and bacterial causes of pharyngitis?
- Viral usually e.g. rhinovirus and adenovirus
| - Bacteria e.g. Streptococcus pyogenes
28
What is the centor criteria?
Determines the likelihood that a sore throat is bacterial
1. Tonsillar exudate
2. Fever >38
3. Tender/enlarged anterior cervical lymph nodes
4. Absence of cough
29
What is neutropenia?
A disease characterised by having an abnormally low concentration of neutrophils in the blood.
30
What is the cause of neutropenia?
Iatrogenic e.g. Chemo
Examples of iatrogenic suppression
1. Corticosteroid use
2. Chemo
3. Immune suppression post organ transplant
4. Rituximab
31
Give 4 examples of non-specific supression
1. Malnutrition
2. Alcohol
3. Sepsis
4. Trauma
32
How can illness be prevented in the immunocompromised?
1. Hand hygiene
2. Education
3. Isolation
4. Screen for TB before anti TNF therapy
5. PCP prophylaxis of
33
What is the usual presentation of pulmonary infection in the immunocompromised?
1. Pyrexia
2. Lethargy
3. Cough
4. Breathlessness
5. Hypxoic
34
What is empyema?
Pockets of pus that have collected in the body cavity.
35
What are the signs and symptoms of Empyema?
- WBC/CRP doesn’t settle with Abx
- Pain on deep inspiration
- Pleural collection.
36
What is the management of empyema?
Drainage
37
What is Wegener's Granulomatosis?
Vasculitis of an unknown aetiology, commonly involves the upper airway and endobronchi
38
What are the symptoms of Wegener's Granulomatosis?
1. Rhionorrhea
2. Nasal mucosa ulceration
3. Cough
4. Haemoptysis
5. Pleuritic chest pain
39
What serum investigations would you order in Wegener's granulomatosis?
- C-ANCA and anti-PR3 positive
40
What is the treatment of Wegener's granulomatosis?
1. If severe – high dose steroids
| 2. If non-end organ threatening – moderate steroids
41
What should the PaO2 be to be suitable for home O2?
PaO2 <7.3kPa when breathing room air.
42
Describe the assessment process of home O2?
1. Blood gas measurements taken 3 weeks apart in a stable pt receiving bronchodilator therapy
2. Pt should stop smoking
3. Pt should have a PaO2<7.3kPa
43
What is Horners syndrome?
Results from apical lung cancer affecting the T1 nerve root.
44
What are the signs of Horner's syndrome?
1. Anhydrosis
2. Miosis --> pupil contraction
3. Ptosis
4. Loss of cilospinal reflex
5. Enophthalmos – backwards displace of the eyeball.
45
What is sarcoidosis?
Granulomatous disease that affects the organ system but typically lungs/lymph nodes.
Restrictive disease
46
What are the symptoms of Sarcoidosis?
- Cough
- SOB
- Wheeze
47
What is the effect on the following in sarcoidosis?
```
metabolic
neurological
bone
eyes
skin
```
Metabolic effect of sarcoidosis --> hypercalcaemia
Neurological effect --> inflammation of the meninges and seizures
Effect on bone --> arthralgia (pain in joints)
Effect on eyes --> Uveitis
Effect on skin --> erythema nodosum (red tender lumps)
48
What is the differential diagnosis of sarcoidosis?
Pulmonary TB and lymphoma
49
What is the treatment for sarcoidosis?
Steroids
50
What is a pneumothorax?
Air in the pleural space which leads to partial lung collapse.
51
What are the main types of pneumothorax?
1. Traumatic e.g. stab wound
2. Spontaneous --> can be primary (PSP) or secondary (SSP)
3. Iatrogenic
52
What is the treatment for traumatic pneumothorax?
Drainage ASAP
Chest drainage site --> bound by pect major, latissimus dorsi and the nipple in men or the 5th ICS in women.
53
What is a tension pneumothorax?
Pleural tear creates 1 way valve through which air passes in inspiration
Increased intra-pleural pressure --> Resp distress, cardiac arrest and shock.
54
What is the treatment for a tension pneumothorax?
Needle decompression.
55
What is pneumoconiosis?
A group of lung disorders that that reflects inhaled dust/toxins
e.g. Coal workers pneumoconiosis, silicosis, asbestos exposure and extrinsic allergic alveolitis
56
What is silicosis and what does those affected have a higher risk of?
reflects silica structure and may occur in grinding related occupations and mining practices
TB and cancer
57
What are the consequences of asbestos exposure?
1. Lung cancer
2. Persistent Pleural effusion
3. Diffuse pleural fibrosis
4. Diffuse interstitial lung fibrosis
58
What is the histological pattern in those in RA with lung disease.
Paralleling usual interstitial pneumonia (UIP)
59
How does Anti IgE therapy work in asthma?
- Works as Ab binds to and neutralises free IgE, preventing IgE binding
- results in decreased mast cell sensitisation --> allergens can’t activate mast cells.
60
Why are inhaled medicines better in asthma?
They are more likely to reach the target sites.
61
What is an epidemic?
More cases in a region/country
62
What is a pandemic?
Epidemics that span international boundaries.
63
What are the consequences of pandemics?
1. High morbidity
2. Excess mortality
3. Social disruption
4. Economic disruption
64
What factors suggest a pandemic will be likely?
- More travel
- Increasing world population
- Rise in intensive farming
65
What factors suggest pandemics will not be likely?
1. Healthier populations due to medical advances
2. Better healthcare
3. Vaccination
4. Antivirals
66
What is interstitial lung disease?
Diseases of the alveolar/capillary interaction. Increased scarring around the alveoli so an increased diffusion pathway for gaseous exchange
67
What are the 5 major categories of Interstitial Lung diseases?
1. Associated with systemic disease e.g. rheumatological
2. Environmental aetiology
3. Granulomatous disease e.g. sarcoidosis
4. Idiopathic e.g. IPF
5. Other
68
What are the signs and symptoms of interstitial lung disease?
1. Cough
2. Breathlessness
3. Finger clubbing
4. Evidence of systemic disease
69
What investigation would you order in interstitial lung disease?
- CXR
- Blood tests
- Pulmonary function tests
- Bronchoscopy with biopsy
70
Is interstitial lung disease restrictive or obstructive?
Restrictive
Fibrosis causes decreased gas transfer and decreased PaO2
71
What is the treatment for interstitial lung disease?
- Remove the exposure
| - Steroids
72
What are 3 examples of chronic interstitial lung disease?
Interstitial pneumonia
Sarcoidosis
Rheumatoid arthritis
73
What is the pathology of chronic interstitial lung disease?
Increasing fibrous tissue within lung parenchyma resulting in increased stiffness and decreased expansion
74
What is the effect of chronic interstitial lung disease on lung volumes?
1. Reduced TCO, VC and FEV1
| 2. FEV1/FVC ratio and PEFR normal.
75
What is the treatment for chronic interstitial lung disease?
Steroids and immunosupressive agents.
Lung transplant
Drugs can cause issues as they can generate free radicals.
76
What are the signs and symptoms of Idiopathic pulmonary fibrosis?
1. Dyspnoea on exertion
2. Dry cough
3. Elderly effected
Progressive fibrosis in the alveoli that limits a patients ability to respire
77
What is IPF?
A disease characterised by chronic inflammation and permanent scarring in the alveoli. Respiratory ability is affected, chest infection + hypoxic damage likely.
78
What investigations would you order in IPF?
1. Pulmonary function tests
2. CXR
3. Bloods --> Neutrophil count up
79
What risk factors is associated with IPF?
- Dust inhalation
- Smoking
- Exposure to infectious agents
- Long term antidepressant use
80
What is the treatment for IPF?
Lung transplant and supportive care --> only treatment to increase survival
Broad spectrum Abx if patient has acute exacerbation
81
What 3 things would you look for on pulmonary tests for IPF?
- Reduced TLCO
- Restrictive spirometry, Low FEV1 and FVC but normal ratio
- Low/normal PaO2
82
Eicosanoid pathway - What does phospholipase A2 do?
Converts phospholipid to arachidonic acid
83
Eicosanoid pathway - 5 Lipoxygenase do?
Converts arachidonic acid to leukotrienes
84
Eicosanoid pathway - What does COX do?
Converts archidonic acid to prostaglandins
85
What inhibits phospholipase A2 and why is this good in asthma treatment?
Archidonic acid not converted so less inflammation and reduced TXA2.
86
Describe the eicosanoid pathway briefly.
Phospholipid is converted into arachidonic acid, it can then be converted to prostaglandins by COX or leukotrienes by 5 lipoxygenase.
87
What is bronchiolitis and who is it common in?
airway obstruction caused by inflammation of the bronchioles and increased mucus secretion
Children.
88
What is the cause of bronchiolitis?
RSV infection.
89
What is the difference between bronchiolitis and bronchitis?
Bronchitis = inflammation of bronchi epithelium due to irritants or chemicals
Bronchiolitis = Inflammation of bronchioles and increased mucus secretion due to RSV infection
90
What investigations would you use to diagnose bronchiolitis?
1. CXR
| 2. Viral and bacterial swabs
91
What is the management of bronchiolitis?
- Supplemental O2
- Fluids, nutrition
- Airway support
92
What is the pathophysiology of chronic bronchitis?
Exposure to irritants and chemicals e.g. smoke --> as and hyperplasia of mucus secreting glands --> increased mucus --> airway obstruction. Neutrophil + macrophage involvement --> bronchi inflamed.
93
What is the usual cause of infective bronchitis?
Viral, acute bronchitis caused by adenovirus
94
What is the investigations in infective bronchitis?
CXR
| Viral and bacterial swabs
95
What is the cause of chronic bronchitis?
Often tobacco smoking induced and can be aggravated by pollution and infections.
reversible!
96
How do you diagnose chronic bronchitis?
a persistent cough and sputum for >3months in 2 consecutive years.
97
What is the effect of chronic bronchitis on lung function?
1. Reduced FEV1/FVC ratio
2. Reduced PEFR
3. Increased TLCO
98
What are the signs of chronic bronchitis?
- Chronic productive cough
- Wheeze and crackles
- Hypoxic + hypercapnic
- Cyanosis
- Vasoconstriction --> pulmonary hypertension cor pulmonale
99
How can chronic bronchitis cause cor pulmonale?
- Pulmonary vasoconstriction in lungs in an attempt to shunt blood to better ventilated alveoli
- Pulmonary hypertension --> RHF --> Cor Pulmonale
100
What is airway obstruction as defined by spirometry?
1. FEV1 <80% predicted
| 2. FEV1/FVC <0.7
101
What is the pathophysiology of emphysema?
Irritants and chemicals trigger inflammatory mediators to release matrix destructive enzyme --> elastin destruction and enlargement of alveolar air spaces --> air trapping
102
What is the cause of emphysema?
- Tobacco smoke induced
- Associated with alpha-1-antitrypsin deficiency (protease inhibitor) – tobacco smoke inhibits
- Coal dust exposure
103
What are the signs of emphysema?
1. Pursed lip breathing
2. SOB
3. Barrel chest
4. Weight loss
5. CO2 retention
104
What happens in chronic emphysema?
- Patient may be hypercapnic, hypoxic and have progressive R side HF (Cor pulmonae).
- This is due to pulmonary vasoconstriction --> fibrosis and tissue destruction
105
What is a pleural fibroma?
Fibrous tumour of the pleura
106
What is a consequence of a pleural fibroma?
can grow to massive size and compress on lung tissue. Occasionally they secrete insulin related factors so produce hypoglycaemic symptoms
107
What is bronchiecstasis?
Irreversible and abnormal dilation of the bronchi with chronic inflammatory and fibrotic changes. Leads to a build-up of excess mucus and predisposes the person to chest infections.
108
What is the pathophysiology of bronchiecstasis?
1. Failed mucocillary clearance and impaired immune function --> prone to infection
2. Leads to inflammation and therefore progressive lung damage
Bronchitis --> bronchiectasis --> fibrosis
109
What is the cause of bronchiecstasis?
- Often post-infective e.g. previous pneumonia
- Congenital causes e.g. primary ciliary dyskinesia.
- 50% idiopathic
110
What bacteria cause bronchiecstasis?
- Haemophilus influenzae
- Pseudomonas aeruginosa
- Staph aureus
111
What are the symptoms of bronchiecstasis?
1. Chronic productive cough
2. Recurrent chest infection
3. Dyspnoea and wheeze
4. Recurrent exacerbations
5. Chest pain
6. Haemoptysis
112
What are the investigations necessary in bronchiecstasis?
1. CT
2. Spirometry --> obstructive
3. Sputum culture
4. CXR
113
What is the treatment for bronchiecstasis?
1. Education
2. Smoking cessation
3. Annual influenzas + pneumococcal vaccinations
4. Anti-inflammatories
5. Bronchodilators
6. Improved mucus Clearance
7. Abx
114
What is inspiratory reserve volume?
Additional vol of air that can be forcible inhaled after a tidal volume inspiration.
115
What is expiratory reserve volume?
additional vol of air that can be forcibly exhaled after a tidal volume expiration
116
What is forced vital capacity?
The max volume of air that can be forcibly exhaled after maximal inhalation
117
What is total lung capacity?
the vital capacity + residual volume. Maximum amount the lungs can hold
118
What is residual volume?
Volume of air remaining in the lungs after a maximal inhalation
119
What is functional residual capacity?
Volume of air remaining in the lungs after a tidal volume exhalation
120
What is the definition of tidal volume?
volume of air moved in and out of the lungs during a normal breath
121
What is FEV1?
Volume of air that can be forcibly exhaled in 1 sec
122
What is peak expiratory flow?
greatest rate of airflow that can be obtained during forced expiration. Age sex and height can all affect PEF.
123
What is TLCO?
The extent to which O2 passes from the alveoli into the blood.
124
What two equations can work out TLC?
1. TLC = VC+RV
| 2. TLC = TV + FRC + IRV
125
What is the normal tidal volume?
500ml
126
What is an equation for FRC?
ERV+RV
127
What is the transfer coefficient?
Ability of O2 To difuse across the alveolar membrane
128
How can you test the transfer coefficient?
Low dose CO is inspired, pt asked to hold breath for 10sec and the amount of gas transfer is measured
129
What diseases can cause a low transfer coefficient?
1. Emphysema
2. Anaemia
3. Fibrosing alveolitis
130
What disease can cause a high transfer coefficient?
Pulmonary haemorrhage
131
How can you test respiratory function?
A 6 minute walk
132
What is a consolidation on a CXR?
Regions of the lung filled w/ liquid e.g. pulmonary oedema --> Areas appear white and dense.
133
What are 2 causes of breathlessness?
Heart disease, anaemia
134
What are 3 signs of an infection?
1. Temperature
2. Increased neutrophils
3. Increased CRP
135
What is ANCA?
Anti-neutrophil cytoplasmic antibody (AI disorder)
136
What is the mechanism for ANCA?
1. Activates neutrophils and monocytes, neutrophils adhere to endothelial cells
2. Degranulation and free radicals are released
3. Free radicals damage the endothelium, further neutrophil recruitment =+ve feedback
4. This can cause vasculitis as it inflames the vessel wall.
ANCA associated vasculitis is caused by it.
137
What are the common effects of RA on the lung?
- Pleural effusion
- Fibrosing alveolitis
- Airway disorders e.g. bronchiolitis and bronchiectasis
138
What is Guillian Barre syndrome?
Demyelinating polyneuropathy - can present 6 weeks post flu/cmv
139
What 3 factors can affect TLCO?
- Alveoli/capillary interaction
- Hb concentration
- Cardiac output
140
What are occupational lung disorders?
Lung disorders due to a response or inhaling something at work e.g. dust, gas fumes, aerosol
141
What is the damage mechanisms of occupational lung disorders?
1. Direct injury
2. Infection
3. Allergy e.g. EAA
4. Chronic inflammation
5. Destruction of lung tissue
6. Lung fibrosis
7. Carcinogenesis
142
How can you prevent occupational lung disorders?
1. Risk assessment
2. Legal requirement under COSHH
3. Prevent and mimise exposure to harmful substances
4. Monitor workers health so problems are identified early
143
What is an example of occupational asthma?
Bakers asthma --> caused by flour.
144
How can you diagnose occupational asthma?
1. PEFR at their place of work and a history to see if it worsens at work
2. Serum immunology --> IgE to specific workplace allergen.
145
What are consequences of occupational lung disease?
- Loss of income
| - Increased morbidity and mortality
146
What is a complication of bronchoscopy?
Pneumothorax and pneumonia
147
What is the cause of sinusitis?
Viral
148
What is the function of the medulla?
Detects h+ conc of the CSF
149
What is the function of the carotid and aortic bodies?
Chemoreceptors respond to an increased CO2 and decreased O2
150
What are the radiological indications for bronchoscopy?
1. Lobar collapse
2. Presence of a mass
3. Persistent consolidation
151
What are the non-radiological indications for bronchoscopy?
1. Hemoptysis
2. Cough
3. Wheeze
4. Stridor
152
What is atopy?
A tendency to develop IgE mediated responses to common aeroallergens.
153
What is the function of inositol triphosphate?
1. IP3 increases free cystolic Ca2+ by releasing it from IC components
2. Ca2+ activates MLC kinase = bronchial smooth muscle contraction
154
What is asbestosis?
Phagocytes are frustrated --> chronic inflammation and permanent scarring --> asbestosis.
155
What is a common cause of acute airway obstruction?
Can be caused by a tumour or foreign bodies with distal collapse of the lung
156
What does the activation of M3 receptor cause?
- Bronchoconstriction
- Vasodilation
- Glandular secretions
157
Where do pulmonary emboli arise from?
dislodged DVT --> usually iliofemoral veins.
158
What are the symptoms of small peripheral PE's?
1. Breathlessness
2. Pleuritic Chest pain
Consequence --> Infarction, ventilation but no perfusion – dead space.
159
What are the symptoms of large central PEs?
1. Severe central chest pain
2. Pale and sweaty
Consequence of a large central PE --> Ischaemia, resistance to flow that can result in RHF
160
What are the investigations in Pulmonary embolism?
- CXR, ECG, D-Dimer
- V/Q lung scan --> shows ventilated areas w/ perfusion defects.
- CTPA --> Detects emboli
161
What is a D-dimer?
protein fragment found when a blood clot has been degraded by fibrinolysis.
162
What is the well's scoring system?
1. Clinical signs and symptoms of DVT
2. Tachycardic
3. Recent immobilisation
4. Previous DVT
5. Haemoptysis
6. Malignancy
If score is above 4 it is likely.
163
What is the treatment for PE?
1. Thrombolysis for large PE
2. LMWH and oral warfarin
3. NOAC
4. Analgesia
164
What is the differential diagnosis of PE?
asthma, COPD, Pneumonia, MI
165
What are the signs of large PE?
1. Shocked
2. Central cyanosis
3. Raised JVP
4. Accentuation of second heart sound
166
What are the risk factors for PE?
Obesity, Recent surgery, Malignancy, Immobility and OCP/HRT
167
How is pulmonary hypertension defined?
mPAP <25mmHg and Secondary RV failure
168
What are the causes of pulmonary hypertension?
1. Heredity
2. Idiopathic
3. Drug use
4. HIV
5. Secondary to left heart disease (valvular systolic/diastolic dysfunction)
Increase caused by --> Increased resistance to flow and increased flow rate.
169
What are the symptoms of Pulmonary hypertension?
1. Dyspnoea on exertion
2. Lethargy/fatigue
3. Syncope
Symptoms as RV failure develops --> pulmonary oedema, abdo pain
170
What are the signs of pulmonary hypertension?
1. RV hypertrophy
2. Loud pulmonary second sound
3. Right parasternal heave
4. Enlarged proximal pulmonary arteries
5. In advanced there is signs of RHF --> Elevated JVP, Hepatomegaly and pleural effusion
171
What investigations would you order in pulmonary hypertension?
1. ECG --> RV hypertrophy
2. Spirometry
3. CXR --> Enlarged proximal pulmonary arteries
4. Echocardiography
172
What is the treatment of Pulmonary hypertension?
1. Initial treatment is O2
2. Warfarin --> risk of thrombosis
3. Diuretics for oedema
4. Ca2+ blockers as pulmonary vasodilators
173
How does pulmonary hypertension cause peripheral oedema?
Blood accumulates in PA, RV experiences greater afterload and works harder to get it out of the ventricle into the artery.
This is due to RV hypertrophy + right heart failure = peripheral oedema.
174
What are the potential causes of Pleural effusion?
1. Heart/renal failure (transudate)
2. Hypoalbuminaemia (transudate)
3. Malignancy (exudate)
4. Infection (exudate)
5. Inflammation (exudate)
175
How can you diagnose pleural effusion?
1. Taking a good history
2. Imaging
3. Thoracentesis --> can tell you transudates vs exudates
176
What are the investigations of pleural effusion?
1. CXR
| 2. Ultrasound
177
What is the treatment of pleural effusion?
Treatment of pleural effusion with transudate cause e.g. H/RF --> Treat underlying cause
Treatment of pleural effusion with exudate cause e.g. inflammation --> Drainage
178
What are the features of restrictive lung disease?
- FVC reduced
- FEV1/FVC ratio normal
- TLC is also reduced
179
What is a giveaway for restrictive lung disease?
If a patient doesn't have chronic wheeze it is likely to be restrictive lung disease.
180
What are the features of obstructive lung disease?
- FEV is <80% predicted
- FVC is normal
- FEV1/FVC ratio <0.7
- TLC is increased
181
What is an example of reversible obstructive lung disease?
Asthma
182
What is the giveaway for obstructive lung disease?
If a patient has a chronic wheeze it is likely to be obstructive lung disease.
183
Describe respiratory innate immunity
1. Mucous, mucouscillary escalator, macrophages and neutrophils are all involved.
2. Cough reflex and epiglottis closing off trachea on swallowing.
184
Describe respiratory adaptive immunity
1. B cells produce mainly IgG and IgA antibodies
2. T cells – CD4, CD8 and regulatory.
Neutrophils can destroy bacteria --> ROS, proteases and NETs
185
What is the cough reflex affected by?
- Pain
- Sedation
- Opiates
186
What is cillia function affected by?
- Infection
| - Primary dyskinesia
187
What are the 3 types of Immunosuppression?
1. Granulocyte defect – associated with chemo
2. B cell defect – associated with rituximab and haematological malignancy.
3. T cell defect – associated with immunosuppression/HIV
188
Describe the IgE binding and activating mast cell process.
- IgE binds to high affinity receptors on the mast cell surface.
- There is cross-linking and biochemical cascades
- The mast cells are sensitised and there is degranulation
189
What does mast cell degranulation release?
1. Pre-formed histamine
2. Newly synthesised eicosanoids e.g. cysteinyl leukotrienes (cys LTs) and prostaglandin D2
3. Cytokines e.g. IL-3,4,5
190
What is the function of
IL-3
IL-4
IL-5
IL-3 is responsible for increasing the number of mast cells
IL-4 is responsible for IgE synthesis
IL-5 is responsible for pro-inflammatory and eosinophil survival
191
Mast cell mediators - What are Cys-LT, histamine and cytokines responsible for?
Inflammation
192
Mast cell mediators - What are Cys-LT, Cytokines and enzymes responsible for?
Responsible for airway remodelling
193
Mast cell mediators - What are Cys-LT and histamines responsible for?
Lung mast cell mediators responsible for bronchoconstriction.
194
What is the mechanism behind chronic infection?
- Infection wont clear, chronic neutrophil recruitment and persistent cellular activation
- Pro-inflam mediators are released = tissue damage
195
What are the 5 types of tissue mediated damage?
1. Tissue damage in chronic infection
2. Excessive immune response
3. Failure to control the immune response
4. On target immune response
5. Off target immune response e.g. AAV and goodpastures syndrome
196
What it the cause of excessive immune response in ARDS and COPD?
Tissue damage due to chronic infection.
197
What are 2 common URT infections and their cause?
1. Common cold --> Rhinovirus
| 2. Sore throat --> adenoviruses. EBV
198
What virus can cause pneumonia?
- Adenoviruses, Influenza A+B, Measles, VZV
199
What are the main antigens on Influenza A?
1. Hemagglutinin (H) --> Grappling hook, grabs onto cells
| 2. Neuraminidase (N) --> cuts newly formed virus loose from infected cells
200
What type of influenza is commonly behind severe and extensive outbreaks?
A - due to lots of mutations and it replicates alot.
201
What is antigenic drift?
When there are small mutations and minor antigenic variation --> seasonal epidemics
202
What is antigenic shift?
When there are large mutations and major antigenic variation --> pandemics
203
How do mast cell mediators affect airways and blood vessels?
results in bronchoconstriction + vasodilation
204
Describe allergen challenge
30 mins after --> bronchoconstriction and reduced FEV1
3 hours after --> Vasodilation = increased Vasc permeability = inflammation and reduced bronchoconstriction and upregulated adhesion molecules
6 hours after --> worsening inflammation, eosinophil involvement and 2nd wave bronchoconstriction
205
What is the treatment for influenza?
Supportive care.
Antivirals can be given to reduce the risk of transmission.
206
What is reproduction number?
avg number of secondary cases generated from a primary case.
Measles has a high productive number.
207
How is the flu transmitted?
- Aerosol – coughing and sneezing --> inhale particles
| - Droplet – hand to hand
208
What is cystic fibrosis?
AR disease resulting in abnormal exocrine gland function. (1 in 25 are carriers)
209
What is the pathogenesis of Cystic fibrosis?
Defect in chromosome 7 coding CFTR protein. Cl- transport is affected and there is a production of thickened mucus secretions.
210
What are the signs of Cystic fibrosis?
- SOB/Wheeze
- Poor growth and weight
- Persistent coughing, sometimes with phlegm --> frequent lung infections inc pneumonia.
- Frequent bulky, greasy stools and difficulty with BM.
211
What are the complications of cystic fibrosis?
- Malnutrition due to malabsorption, delayed puberty, weight loss + growth retardation
- Nasal polyps
- Resp failure + cor pulmonale
- DM
- Breathlessness
- Finger clubbing, frequent resp infections.
212
What is the management of Cystic fibrosis?
1. Prevention of lung disease e.g. Vaccination
2. Supporting therapies --> good diet
3. Surveliance --> monitor FEV1
4. Antibiotic therapy
5. Hypertonic saline --> mucus thinner and Ivacaftor --> reduces mucus
6. Bronchodilators
7. Steroids
213
What does CF do to the mucus and how?
CF increases the viscosity and tenacity of bronchial mucus
- Failure to excrete Cl- leads to Na+ retention
- This then leads to H2O retention
214
What codes for the CFTR and what ions does it transport?
Chloride, thiocyanate.
215
What cells are responsible for inflammation in asthma?
Mast cells and eosinophils are responsible for inflammation in asthma
216
Give 3 reasons why the airways are hyperreactive in asthmatics
1. Inflammatory ifiltrate
2. Eosinophils
3. Epithelium destruction gives easier access to bronchoconstriction
217
What is the mechanism behind hypersensitivity (neurogenic inflammation)
Sensory nerve activation initiates impulses that stimulate CGRP
This is pro inflame and activates mast + goblet cells.
218
What are the main functions of CGRP?
1. Pro inflammatory
2. Mast cell activation --> mediator release
3. Innervation of goblet cells --> mucus release
219
What makes LABA long acting?
Increased lipophilicity
220
Where would you find B1, B2,B3 adrenergic receptors?
Beta 1 adrenergic receptors are found in the heart
Beta 2 adrenergic receptors are found in the lungs
Beta 3 adrenergic receptors are found in the adipose tissue
221
How is PKA synthesised from beta 2 receptor activation?
1. Beta 2 interacts with Gs activating adenylate cyclase
| 2. Adenylate cyclase converts ATP to cAMP this leads to PKA synthesis = bronchodilation
222
What are the functions of cAMP?
1. Stabilisation of mast cells, inhibits mast cell mediator release
2. Relaxes airway smooth muscle
223
What happens after M3 receptor activation?
- M3 interacts with Gq. Phospholipase C activated
| - Leads to DAG and IP3 production which further leads to Ca2+ and PKC production
224
How do muscarinic antagonists work?
Muscarinic antagonists work by preventing M3 Receptor activation so reduction in Ca2+ activation
- Means less MLC kinase is produced, and you have less muscle contraction.
225
How do Methylxanthines work?
- Increase cAMP and therefore PKA production
| - PKA Inhibits MLC kinase so you have less muscle contraction.
226
What does MLC kinase do?
Phosphorylation MLC which causes muscle contraction
227
What inhibits and activates MLC kinase?
- Inhibited by PKA (which is produced by cAMP)
| - Activated by Calmodium (produced from Ca2+)
228
How do beta agonists and methylxanthines reduce symptoms?
- Result in increased cAMP and therefore PKA. MLC kinase is inhibited so less contraction
- Results in bronchodilation
229
How do muscarinic receptors alleviate symptoms?
- Block M3 Receptor activation so less Ca2+ production
| - Less MLC is activated so less contraction --> bronchodilation
230
What is the cause and epidemiology of Pneumocystitis pneumonia?
Caused by Pneumocystis jirovecii. Seen in people with a weak immune system.
231
What are the signs and symptoms of pneumocystitis pneumonia?
- Hypoxia
- Progressive breathlessness and dry cough
- Lymphopenia typical (CD4<200)
232
What investigations would you order in suspected pneumocystitis pneumonia?
- CXR
- Biopsy
- Sputum Sample
233
What is the treatment for pneumocystitis pneumonia?
- High dose co-trimoxazole
| - Consider secondary prophylaxis
234
What is hypersensitivity pneumonitis?
Lung inflammation due to hypersensitivity reaction to an allergen.
235
What is the pathophysiology of hypersensitivity pneumonitis?
Inhalation of organic dusts that lead to a T3 hypersensitivity reaction --> inflammatory response in alveoli and small airways.
236
What is the cause of hypersensitivity pneumonitis?
- Bird fanciers lung --> proteins presence in birds faeces
| - Farmers lung --> Due to mouldy hay and aspergillus spores
237
What are the typical symptoms of hypersensitivity pneumonitis?
If farmers lung is persistent, fibrosis can occur, may be signs of dyspnoea, weight loss and a cough
238
What are the symptoms of hypersensitivity pneumonitis?
1. Fever
2. Malaise
3. Cough
239
What investigations would you order in hypersensitivity pneumonitis?
- CXR
- Nonspecific CRP/ESR
- Neutrophilia – WBC/FBC
- History
240
What is the treatment for hypersensitivity pneumonitis?
- Remove the cause!
| - Prednisone
241
What is mesothelioma?
A high grade malignancy of the pleura that spreads around the pleural spaces. Lung becomes encased by tumour. It’s strongly associated with asbestos exposure.
242
What is the cause of mesothelioma?
occupational – asbestos exposure
243
What are the signs of mesothelioma?
1. Breathlessness
2. Chest pain
3. Weight loss
4. Sweating
5. Abdo pain
244
What are the consequences of asbestos exposure?
plaques, effusion, asbestosis, mesothelioma and bronchial carcinoma.
245
What investigations would you order in mesothelioma?
1. CXR
2. CT scan
3. Pleural biopsy
246
What is the treatment for mesothelioma?
1. Symptom control
2. Palliative chemo or radiotherapy
3. Radical surgery (removal of tumour blood supply)
Local – surgery and radiotherapy
Systemic – chemotherapy
247
Why is the treatment for mesothelioma difficult?
Treatment is difficult as it is incurable and resistant to surgery, chemo and radiotherapy. The average time from diagnosis to death is about 8 months.
248
Who is at risk of pneumonia?
Elderly, children, people with COPD, Immunocompromised people and nursing home
residents.
249
Describe the pathogenesis of pneumonia
1. Bacteria translocate to normally sterile distal airway
2. Resident host defence is overwhelmed
3. Macrophages, chemokines and neutrophils produce an inflammatory response
Pneumonia can be severe as --> excessive inflammation, lung injury and resolution failure.
250
How is pneumonia resolved?
- Bacteria are cleared and inflammatory cells are removed by apoptosis
251
What intrinsic factors cause pneumonia?
cold temperatures, infection, stress, exercise and various pollutants
252
What are 3 protective features of the resp tract?
- Teeth
- Commensal bacteria
- Swallowing reflex
- Epiglottis closes resp tract
- Mucocillary escalator
- Coughing and sneezing
253
What are the symptoms of pneumonia?
1. Productive cough
2. Sweats and fever
3. Breathlessness
4. Pleuritic chest pain
5. Myalgia, headache, arthralgia suggests atypical pneumonia.
254
What are the signs of pneumonia?
1. Fever
2. Lung consolidation --> bronchial breath sounds and dull to percuss.
3. Pleural effusion
4. Crackles and wheeze
5. Abnormal vital signs
255
What investigations could you order in pneumonia?
1. CXR --> air bronchogram in consolidated area
2. FBC --> WBC
3. U+E
4. LFT
5. CRP
6. Microbiology --> sputum culture, blood culture and serology
256
How can you prevent pneumonia?
1. Children are given PCV
2. Smoking cessation is encouraged
3. Influenza vaccines are given to the children or elderly.
257
What is CURB65?
CURB65 – way of assessing the severity of community acquired pneumona --> effects mortality.
- Confusion
- Urea >7mmol
- RR>30/min
- BP reduced 90/60
- >65.
258
Give two common bacteria that cause pneumonia
- Streptococcus pneumoniae - gram positive cocci stain, alpha haemolytic and optochin sensitive.
- Haemophilus influenzae --> treat with co-amoxiclav or doxycycline (GRAM NEG)
259
Groups of people who are at risk of developing klebisella pneumonia (gram neg bacilli)
- Homeless people
- Alcoholics
- People in hospital
260
What people are at risk of hospital acquired pneumonia?
1. Elderly
2. Ventilator associated
3. Post-operative patients
261
What are some less typical pathogens that can cause pneumonia?
1. Mycoplasma pneumoniae
2. Chlamydia Psittaci/pneumoniae
3. Coxiella burnetti
4. Legionella pneumophila
Hard to grow so serology and antigen tests are used.
Antibiotics used --> macrolides like clarithromycin as they are often resistant to beta lactams.
262
Describe the treatment for mild pneumonia (CURB65 0-1)
PO amoxicillin in the community
263
Describe the treatment for moderate pneumonia (CURB65 2)
PO Amoxicillin and clarithromycin in hospital
264
Describe the treatment for severe pneumonia (CURB65 3)
IV co-amoxiclav and clarithromycin in hospital
265
Describe the treatment for severe pneumonia (CURB65 of 4)
Treat in hospital, consider admission to critical care.
266
What is COPD subdivided into?
1. Chronic bronchitis
| 2. Emphysema
267
What is likely to exacerbate COPD?
Viral infection e.g. RSV, influenza, rhino and coronavirus
268
What is the effect of COPD on RV/TLC?
Both raised
269
What are the main causes of COPD?
Smoking, genetics, socio-economic factors, occupation and the environment all contribute to COPD.
270
What cells are involved in COPD?
CD8+ is involved and Neutrophils and macrophages
271
What are the symptoms of COPD?
1. Breathlessness
2. Wheeze
3. Chronic cough
4. Sputum
272
How can you diagnose COPD?
1. Progressive airflow obstruction
2. FEV1/FVC ratio <0.7
3. Lack of reversibility
273
What is the treatment for COPD?
1. Smoking Cessation
2. Pulmonary rehabilitation
3. SABA/LABA for symptom relief
4. ICS
5. Lung volume reduction surgery
274
Give an advantage and disadvantage of Inhaled corticosteroids (ICS)
Advantage --> Improve QOL, improve Lung function and reduce the likelihood of exacerbations
Disadvantages --> increased risk of pneumonia
275
What are the consequences of COPD exacerbation?
1. Worsened symptoms
2. Decreased lung function
3. Negative impact on QOL
4. Increased mortality
5. Huge economic costs
276
How can you treat COPD exacerbations?
1. Oxygen
2. Bronchodilators
3. Systemic steroids
4. Abx if breathlessness or sputum production
277
How can you prevent future exacerbations?
1. Smoking cessation
2. Vaccination
3. LABA/LAMA/ICS
278
How is T1 respiratory failure defined as?
- Hypoxia --> decreased PaO2
| - PaCO2 is normal or slightly low due to hyperventilation
279
What is the cause of T1 respiratory failure?
- Airway obstruction
- Failure of O2 to diffuse into the blood
- V/Q mismatch
- Alveolar hypoventilation
280
How is T2 Respiratory failure defined as?
- Hypoxia and hypercapnia --> Decreased PaO2 and increased PaCO2
- Alveolar hypoventilation
281
What is the cause of T2 respiratory failure?
Alveolar hypoventilation
282
What are the signs of Hypercapnia?
1. Bounding pulse
2. Flapping tremor
3. Confusion
283
What diseases can obstruct the airway and cause T1 resp failure?
- COPD
- Obstructive sleep apnoea
- Asthma
284
What 5 conditions can lead to alveolar hypoventilation and cause T1+T2 resp failure?
- Opiates
- Emphysema
- Obesity
- Neuromuscular weakness
- Chest wall deformity
285
What can cause a failure of O2 to diffuse properly causing T1 resp failure?
- Emphysema
| - ILD e.g. IPF, sarcoidosis
286
What are examples of diseases that can cause v/q mismatch and cause T1 resp failure?
- Cardiac failure
- PE (dead, V/Q mismatch)
- Shunt (V/Q =0)
- Pulmonary hypertension
287
What are the treatments for V/Q mismatch?
Ventilation support - CPAP and BIPAP
288
What is CPAP?
Ventilation support often given to people with Obstructive Sleep apnoea. It improves gaseous exchange by providing a continuous positive airway pressure.
289
What is BIPAP?
- Ventilation support given for people with acute exacerbations of COPD
Causes pressure to decrease when you breathe out and increase when you breathe in --> improving ventilation to perfused alveoli
290
What are some differential diagnoses of Dyspnoea?
- Heart failure
- PE
- Pneumonia
- Lung cancer
291
What is the MRC dyspnoea scale to assess breathlessness?
5 statements that describe the entire range of resp disability from none to almost compete incapacity
292
Shortness of breath can lead to excercise limitation, what is 3 consequences of this?
1. Muscle wasting
2. Depression and anxiety
3. Disability
293
SSC are derived from neuroendocrine cells, why is this significant?
can secrete peptide hormones such as ACTH, PTHrP, ADH and HCG.
294
What is the 5 year survival rate of lung cancer?
8-10%
295
How does a PET scan work?
- FDG is taken up rapidly by dividing cells, tumours appear hot on the scan
- PET scans are functional rather than anatomical.
296
Describe the TNM classification
1. Tumour (T1-T4)
2. N – Nodal involvement (N0-3)
3. M – Metastases (M0-1)
Increased staging = decreased survival.
297
Where are 5 places that lung cancer commonly metastasies too?
Bone, brain, liver, lymph nodes and adrenal glands.
298
What is a paraneoplastic syndrome and what is an example?
Paraneoplastic syndromes disorders triggered by immune response to a neoplasm
Examples of paraneoplastic syndromes --> Finger clubbing, anorexia, weight loss, hypercalcaemia and hypernatremia
299
What hormone changes would you expect to result in paraneoplastic changes?
PTH and increased ADH in SIADH.
300
What tests would you do on someone with lung cancer to see if they're fit for operation?
1. ECG
2. Lung function tests
3. Determine performance status
301
What cancers may spread to the lung?
Breast, prostate, Kidney, melanoma and lymphoma
302
What is the likely presentation of someone with a carcinoid tumour?
1. Younger age
2. Characteristic neuroendocrine secreting cells
3. Low rates of invasion and growth
Early symptoms – Change in cough, wheeze and hemoptysis
Late symptoms – weight loss and lethargy
303
What is the difference between a carcinoid tumour and a small cell cancer?
Small Cell cancers often metastasise and so prognosis is poor
Carcinoid tumours are malignant but have low rates of invasion and growth.
304
What are 3 causes of lung cancer?
1. Smoking
2. Asbestos exposure --> occupational
3. Radon exposure
4. Coal tar exposure
5. Chromium exposure
305
What are 6 symptoms of local lung cancer?
1. Chest pain
2. Wheeze
3. Breathlessness
4. Cough
5. Haemoptysis
6. Recurrent chest infections
306
What are 6 symptoms of metastised lung cancer?
1. Bone pain --> waking up in the night from pain
2. Headache
3. Seizures
4. Neurological deficit
5. Hepatic and or abdo pain
6. Weight loss
307
What investigations would you order in suspected lung cancer?
- CXR
- CT scan
- Bronchoscopy
- Surgical and percutaneous biopsy
- Bloods
308
What are 3 main cell types that make up NSCLC?
- Squamous cell (20%) --> Most common in smokers
- Adenocarcinoma (40%)
- Large cell
309
How can malignant bronchial tumours be divided?
Malignant bronchial tumours are divided into Non-small cell and small cell cancer.
- Non-small cell fits into TNM staging
- Small cell cancer has a worse prognosis
310
What are 3 features of Asthma?
- Causes a reduction in TLCO
- 10% due to occupation
- PEF is variable
311
What are 3 characteristics of Asthma?
1. Airflow obstruction
2. Hyperresponsiveness to a range of stimuli
3. Bronchial inflammation
312
Describe the airway remodelling seen in Asthma
1. Hypertrophy and hyperplasia of smooth muscle cells that narrow the airway lumen
2. Deposition of collagen below the BM thickens the airway wall.
3. Eosinophils also play a role in remodelling.
The airways are hyper-reactive which leads to inflammation
313
What happens when IgE binds to mast cells?
release of vasoactive substances causing bronchoconstriction, oedema, bronchial inflammation and mucus hyper-secretion.
314
What occupations are linked to asthma?
paint sprayers, animal breeders, bakers, laundry workers
315
How can reversibility be tested in asthma?
When given a beta agonist --> 400ml increase in FEV1 or 20% increase in PEFR
316
How can the RCP3 be used to assess the severity of asthma?
1. Recurrent nocturnal waking
2. Usual asthma symptoms during the day
3. Interefence with ADL’s?
317
What is the first line treatment in asthma?
- Nebulised salbutamol with oxygen
| - IV corticosteroids and abx if evidence of infection.
318
How can aspirin induce asthma?
- Aspirin inhibits COX --> Increase in arachidonic acid
| - This is shunted to increased leukotriene production = inflammation.
319
What is Asthma?
An inflammatory disease characterised by hyper responsive airways. Airway obstruction is reversible, inappropriate smooth muscle contraction.
320
What factors exacerbate asthma?
Allergens, Stress, Viral infections, Drugs e.g. aspirin, Cold weather, Exertion, Fumes, Often worse at night
321
What are the signs of asthma?
1. Secretions
2. Obstructive spirometry
3. Variable PEFR
4. Reversibility when given a B2 antagonist FEV1 >20%
5. Diurnal variation.
322
What are the symptoms of asthma?
1. Breathlessness
2. Diurnal variation – often worse in the morning
3. Cough
4. Episodic wheeze
5. Chest tightness
323
What investigations would you order in asthma?
1. PEFR
2. Spirometry should be in an obstructive pattern FEV1<80%, FEV1/FVC <0.7, PEFR is variable
3. Test for atopy – RAST, skin prick test
4. CXR
5. Eosinophil count
6. O2 saturation
324
What are the histopathological changes seen in Asthma?
1. BM thickening
2. Epithelium metaplasia, increase no. of goblet cells that leads to mucus hypersecretion.
3. Increase in inflammatory gene expression on many cell types.
325
How can you diagnose acute severe asthma?
- RR over 25
- Tachycardic – 110
- PEFR --> 35-50% predicted
- Unable to complete a sentence in one breath.
326
Describe the management of Asthma
1. Improve control and avoid triggers
2. Smoking cessation
3. Beta agonists provide symptomatic relief
4. ICS are anti-inflammatory
5. Sometimes a short course of systemic steroids
327
What are side effects of systemic steroids?
skin thinning, oral candida, hypertension, osteoporosis, DM
328
What are the principles of asthma treatment?
1. Alleviate symptoms – bronchodilators (beta agonists, muscarinic antagonists, methylxanthines)
2. Target inflammation – steroids
329
Describe allergic asthma.
When an innocuous allergen triggers an IgE mediated response. The immune recognition processes are faulty so there is increased IgE, IL3,4 and 5 production.
330
Describe non allergic asthma
Airway obstruction induced by exercise, cold air and stress.
331
What is 3 features of Mycobacterium TB?
1. Acid fast bacilli
2. Waxy cuticle
3. Grows slowly hard to culture
4. Phagolysosomal killing resulting in granulomatous disease
332
What is the cause of
Primary TB
Abdo TB
Primary tb --> caused by a Ghon complex (lesion)
Abdo TB --> Mycobacterium Bovis (can be found in unpasteurised milk)
333
What are some risk factors for TB?
Live in a high prevalence area, IVDU, Homelessness, alcoholism, HIV+
334
How is TB transmitted?
Aerosol transmission --> inhaled and enter the lung
335
Describe the pulmonary infection in TB
- Bacilli settle in lung apex.
| - Macrophages and lymphocytes mount an effective immune response that encapsulates and contains the organism forever.
336
Describe the pathogenesis of Pulmonary TB
1. Bacili and macrophages form primary focus
2. Mediastinal lymph nodes enlarge
3. Primary focus and enlarged lymph nodes = primary complex
4. Granuloma develops into a cavity
5. The cavity fills with TB bacilli --> expelled when the patient coughs
Granuloma cavity more likely to develop in the apex of the lung as there is more air and less blood supply/immune cells.
337
Where can TB spread too?
1. Bone and joints --> pain and swelling
2. Lymph nodes --> swelling and discharge
3. CNS – TB meningitis
4. Military TB --> Disseminated
5. Abdo TB --> Ascites, malabsorption
6. GU TB --> Sterile, pyuria, WBC in GU tract.
338
How can you diagnose Latent TB?
diagnosed with Mantoux test --> T4 hypersensitivity
339
What are the side effects of
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Side effects of rifampicin = red urine, hepatitis, drug interactions (enzyme inducer)
Side effects of isoniazid = hepatitis, neuropathy
Side effects of pyrazinamide = Hep, Gout, Rash
Side effects of ethambutol = Optic Neuritis
340
What factors increase the risk of TB drug resistance?
1. If patient has had previous treatment
2. If they live in a high risk area
3. Contact with a resistant TB
4. Poor response to therapy
341
What are issues associated with TB drug resistance?
- TB difficult to treat
- Medication course >20 months
- Increased risk of side effects
- Increased relapse rate
342
How can you prevent TB?
1. Active case finding
2. Detect and treat latent tb
3. Vaccination – BCG
343
How can TB cause hypercalcaemia?
- Granulomatous disease --> Increased vit D production so increased bone resorption
- Increased absorption from the gut and increased reabsorption from the kidney
- Also seen in sarcoidosis
344
What is the special culture used to grow TB and how does it work?
Lowenstein Jensen slope --> Special culture medium to grow TB
1. Contains growth factors that promote mycobacterial growth
2. Contains small amounts of penicillin that prevents pyogenic bacteria growth.
345
How does TB typically present?
1. Weight loss
2. Night sweats
3. Anorexia
4. Malaise
346
How does pulmonary TB present?
1. Cough
2. Chest pain
3. Breathlessness
4. Haemoptysis
347
What would you expect to see in a CXR of a patient with TB?
- Consolidation
- Collapse
- Pleural effusion
348
What is the treatment of TB?
1. Rifampicin (6 months)
2. Isoniazid (6 months)
3. Pyrazinamide (2 months)
4. Ethambutol (2 months)
