RESPIRATORY SYSTEM Flashcards
(220 cards)
1
Q
what is the prevalence of acute asthma in children and young adults?
a) 5%
b) 15%
c) 25%
d) 35%
A
b) 15%
2
Q
is acute asthma more common in developed or developing countries?
A
developed
3
Q
what is the name for chronic inflammation of the large airways?
A
bronchospasm
4
Q
name one hypothesis for the development of asthma
A
hygeine
5
Q
what antibody mediates an asthma allergic reaction?
A
IgE
6
Q
name 5 cells which are recruited during an asthma attack
A
mast cells dendritic cells eosinophils lymphocytes T helpers
7
Q
what epithelial and basement re-modelling occurs in asthma?
A
loss of cilia
increase of mucus cells
thickened basement membrane
8
Q
what happens to smooth muscle in the airways in chronic asthma?
A
hyperplasia from chronic infection
9
Q
What are the four main symptoms of worsening asthma?
A
SOB at night
Wheeze at night
Cough
Chest tightness
10
Q
what would occur upon percussion of a patient with asthma?
A
hyper resonance
11
Q
is the airway obstruction of asthma reversible or irreversible?
A
reversible
12
Q
what 4 things cause bronchial inflammation in asthma?
A
infiltration of immune cells
muscle hypertrophy
mucus plugging
epithelial damage
13
Q
What are the signs of acute asthma attack?
A
PEFR <35%-50% RR= >25 HR=> 110pbm Can't speak full sentance Cyanotic
14
Q
What is the signs for fatal asthma attack?
A
PEFR <35%
Poor respiratory effort and silent chest sound
Pa02= <8
O2 sats= 92% on air
Unconsciousness and arrhythmia may be present
15
Q
What is the atopic triad commonly seen in medical/family history of a patient with asthma?
A
The patient or within the family they are suffering from
Eczema
Asthma
Hay fever
16
Q
give 4 examples of exacerbating factors for asthma
A
cold air exercise allergens pets existing atrophy acid reflux
17
Q
what is the difference between intrinsic and extrinsic asthma?
A
intrinsic = no known cause (chemical/exercise induced) extrinsic = allergen
18
Q
what two measurement test might you recommend for a patient with suspected asthma?
A
peak expiratory flow
spirometry
19
Q
what type of drug is salbutamol and terbutaline and how are they administered and how often?
A
beta agonist
inhaled
short acting up to 4x daily
20
Q
Give an example of an inhaled steroid for asthma or COPD
A
Corticosteriods such as beclometasone, fluticasone and budesonide
21
Q
why are inhaled steroids given for asthma and how often are they administered?
A
prevention
two times daily
22
Q
give 3 side effects of inhaled steroids
A
reduced bone mineral density
growth failure
adrenal suppression
oral candida
23
Q
What is the treatment for acute asthma attack?
A
O SHIT ME
Oxygen 15L non rebreathable mask
Salbutamol 5mg Nebulizer ( change oxygen to 6L/8L) = every 15-20 minutes
Hydrocortisone 200mg Iv or prednisolone 40mg oral
Ipratropium bromide Iv 0.5mg 4-6 hours
Theophylline
Magnesium Sulphate 2g Iv
Extra help
24
Q
how many people are affected by COPD in the UK?
a) 50
b) 50,000
c) 500,000
d) 1.5 million
A
d) 1.5 million
25
what 2 things is COPD a combination of?
emphysema (pink puffer) and chronic bronchitis (blue bloaters)
26
how does COPD lead to air collapse?
emphysema causes loss of elasticity and loss of alveoli
27
how can a patient with COPD get blocked airways?
increased goblet cells and mucus secretion
28
why does a COPD patient get lung hyperinflation and shortness of breath?
narrowing of small airways and trapping of air
29
what is the major cause of COPD?
smoking
30
give 2 minor causes of COPD
```
infections
a1-antitrypsin deficiency
Air pollution (motor vehicles)
Occupational pollution ( dust, chemicals)
```
31
why does a1-antitrypsin deficiency cause COPD?
Occurs in emphysema and a1 antitrypsin protects lungs from elastase enzyme. when there is a deficiency, the lungs are destroyed by elastase. Lower lobes are more severely affected
32
is COPD reversible or irreversible?
irreversible
33
What are the general symptoms of COPD?
```
Recurrent infections
SOB
Fatigue
Productive cough
Fever
```
34
what chest abnormality might you see with a patient with COPD?
barrel chest
35
give 2 examples of behavioural abnormalities of a patient with COPD in an attempt to ease shortness of breath
pursed lip breathing
tripod positioning
use of accessory muscles
36
how long do symptoms have to be present for a diagnosis of COPD to be considered?
more than 3 months
37
What is the FEV1:FVC ratio in a patient with COPD?
Less than 0.7
38
name 2 things you might see on a chest X-ray of a patient with COPD
hyperinflation
| enlarged pulmonary vessels
39
name something which you might see on an ECG of a patient with COPD
right ventricular hypertrophy
40
in an ABG of a patient with COPD, the PaO2 would be ___ and the PaCO2 would be ____
PaO2 low
| PaCO2 high
41
what treatment might you recommend for mild COPD?
ipratropium inhaler (antimuscarinic)
or
Salbutamol ( Short acting B2 agonist)
42
what 3 things might you recommend for moderate COPD?
ipratropium
long acting b2 agonist ( salmeterol and formoterol)
steroid (fluticasone and budesonide
43
what is seretide a combination of?
salmeterol (B2 agonist)
| fluticasone (steroid)
44
what is symbicort a combination of?
formoterol (b2 agonist)
| budesonide (steroid)
45
what is combivent a combination of?
salmeterol (b2 agonist)
| ipratropium (antimuscarinic)
46
what 3 things would you recommend as combination therapy for severe COPD?
long acting beta 2 agonist (salmeterol)+
long acting antimuscarinics (tiotropium) +
Inhaled steroids
47
what drug might you prescribe to reduce inflammation and relax smooth muscle in severe COPD?
theophylline
48
how would you treat theophylline toxicity?
beta blockers
49
give 3 cardiac complications of COPD
right sided heart failure
oedema
hypertension
50
give an MSK complication of COPD
osteoporosis
51
give a metabolic complication of COPD
weight loss
52
what accounts for 95% of all primary lung tumours?
bronchial carcinoma
53
is bronchial carcinoma more likely in men or women?
men
54
what makes up 15-20% of bronchial carcinomas?
small cell calcer
55
SCC is a cancer of what cells?
Kulchitsky cells (endocrine)
56
what do kulchitsky cells do?
secrete polypeptide hormones
57
how do kulchitsky cells stimulate tumour growth?
secretion of polypeptide hormones
58
do SCCs metastasise early or late?
early
59
is the prognosis of SCCs good or bad?
bad - inoperable at presentation
60
what makes up 40% of NSCCs?
squamous/epidermoid= flat cells near the centre of the lungs presenting which cause bronchial blocking and infeciton
61
what makes up 42% of NSCCs?
adenocarcinomas= mucus gland cells in bronchial epithelium which invades lymph nodes and pleura
62
what makes up 10% of NSCCs?
large cell cancer
63
large cell carcinomas are _____ differentiated and metastasise _____
poorly
| early
64
What are the common symptoms of bronchial carcinoma?
```
Chest pain*
Haemoptysis*
Cough*
Dysponea and sob*
Weight loss and fatigue *
Malaise
Slow resolving infection/pneumonia
```
65
what is the main risk factor for the development of bronchial cancer?
smoking
66
give 2 other risk factors for the development of bronchial cancer
urban areas
| occupation
67
name 2 peripheral signs you might see relating to lung cancer
clubbing
| weight loss
68
what medical imaging technique might you suggest for diagnosis of bronchial cancer?
CT (MRI not useful)
69
if during a bronchoscopy you noticed that there was a loss of the sharp angle of the carina, what might you suspect?
mediastinal lymph node involvement
70
why might you perform a full blood count in suspected bronchial cancer?
anaemia of malignancy
71
why might you perform LFTs in suspected bronchial cancer?
liver metastases
72
is prognosis better for NSSCs or SCCs?
NSSCs
73
give 4 examples of where bronchial cancer can directly spread
```
pleura
ribs
brachial plexus
hilar region
phrenic nerve
oesophagus
pericardium
```
74
give 3 common metastatic sites for bronchial cancer
bone
brain
liver
adrenal gland
75
give 4 examples for benign tumour that can exist in the lung
```
pulmonary harmatoma
bronchial adenoma
chondroma
lipoma
mesothelioma
tracheal squamous papilloma
```
76
give 2 circulatory complications of bronchial cancer
superior vena cava obstruction
pericarditis
AF
77
which gender are more likely to get a pneumothorax?
males
78
Who commonly develops spontaneous pneumothorax?
Tall thin white boys
79
what could cause a spontaneous pneumothorax?
rupture of subdural bulla
80
what is a major cause of pneumothorax?
chest trauma
81
give 3 rare, chronic respiratory causes of pneumothorax
asthma
COPD
CF
82
give 2 infective causes of pneumothorax
TB
| pneumonia
83
give a systemic, connective tissue, inflammatory cause of pneumothorax
sarcoidosis= production of granulomas in the body in response to inflammation
84
give 2 inherited causes of pneumothorax
marfan's
| ehlers-danlos
85
give a rare, more serious cause of pneumothorax
cancer
86
CVP line, pleural aspiration and biopsy are all examples of _____ causes of pneumothorax
iatrogenic
87
why does pneumothorax occur?
negative pressure in lungs is lost and the lungs partially deflate - air is sucked into cavity through valve causing lung compression
88
pneumothorax can be described as ____ onset ____ pain
sudden onset
| pleuritic pain
89
what would you hear on percussion and auscultation of the chest of a patient with a pneumothorax?
hyper-resonant and absent breath sounds
90
What is the presentation of tension pneumothorax?
Distended neck veins (raised JVP), deviated trachea and cardiac arrest
91
tension pneumothorax is a medical emergency, how would you treat it?
Needle thoracostomy ( 14/16g large bore needle into the 2nd intercostal space midclavicular line)
92
how would you treat a normal pneumothorax?
If symptoms are severe then do chest drain or needle aspiration
93
what is a unilateral pleural effusion?
fluid in pleural space
94
what is the difference between transudate and exudate?
```
transudate = low in protein
exudate = high in protein
```
95
give 4 causes of transudate pleural effusion
increased venous pressure
hypoproteinaemia
hypothyroidism
meig's syndrome
96
give 2 examples of what can cause increased venous pressure
heart failure
fluid overload
pericarditis
97
give 2 examples of what can cause hypoproteinaemia
```
malabsorption
liver disease (reduced albumin production)
nephrotic syndrome (albumin loss through leaky glomeruli)
```
98
what is Meig's syndrome?
unilateral pleural effusion and ovarian fibroma
99
give 6 causes of exudative pleural effusion
```
increased capillary leakage
infection (pneumonia, TB)
malignancy
rheumatoid arthritis
SLE
pulmonary infarction
```
100
what would you hear on percussion in a pleural effusion?
stony dullness
101
what other sign would be reduced during a respiratory examination on a patient with pleural effusion?
decreased vocal resonance/fremitus
102
what is light's criteria used to distinguish?
whether an effusion is exudative or transudative
103
What is the Lights criteria of exudate pleural effusion?
Pleural fluid protein:serum protein is >0.5
Pleural fluid LDH: Serum LDH >0.6
Fluid fluid LDH > 2/3 of the upper limit of the serum LDH
104
what might you see on a chest x-ray of someone with a pleural effusion?
blunting of costophrenic angles
105
what is pleurodesis?
treatment of pleural effusion and recurrent pneumothorax
| Adhesion of 2 pleural layers to remove pleural space
106
give 4 complications of pleural effusions
scarring
sepsis
empyema
pneumothorax
107
how common is pneumonia?a) 2/1000 a year
b) 10/1000 a year
c) 50/1000 a year
d) 100/1000 a year
a) 2/1000 a year
108
what is the mortality of pneumonia?
a) 1%
b) 5%
c) 10%
d) 20%
c) 10%
109
in what age group is pneumonia most dangerous?
elderly
110
what is pneumonia?
inflammation of lungs, consolidation fluid in alveoli
111
```
how can pneumonia be classified by area?
Describe
a) age of onset
b) gender
c) common causes
d) spread
e)
```
bronchial:, extreme of ages, common in both genders. Caused by strep/staph and h.influenz, spread around the brocnhial and not limited to one lobe. Bilateral in spread = secondary in sick
lobular= male 20-50, pneumococcus, entire lobe, uniltaeral = primary in healthy
112
how can pneumonia be classified by cause?
bacterial
fungal
viral
parasitic
113
how can pneumonia be classified by location of onset?
community acquired
| hospital acquired
114
name a type of pneumonia that can have iatrogenic causes
aspiration
115
what is the 3 most common causative organism for community acquired bacterial pneumonia?
1) pneumococcal pneumonia. (+VE)
2) h. infleunza (-VE)
3) atypical bacteria e.g mycoplasma pneumoniae
4) Staphylococcal aureus,
5) mycobacterium tuberculosis,
6) viruses.
116
what are 3 most common causative bacteria for hospital acquired pneumonia? 48 hours after admission
Pseudomonas aeruginosa (-ve)
Staphylococcal aureus
Enterobacteriaceae (especially Klebsiella, E. coli and Enterobacter spp.
HAP related to ventilation assoiciated pneumonia
117
what type of pain is present in pneumonia?
pleuritic chest pain
118
what sign may be present in the sputum of someone with pneumonia?
It can be dry or productive of green grey phlegm
| Severe cases cause haemoptysis
119
What are the common symptoms of pneumonia?
```
Chest pain worse by coughing
Tachycardia
Tachypnea
Hypotension
Dyspnea
Lost of appetite
Fever
Rigors
```
120
what are the 4 stages of pneumonia progression?
congestion
consolidation
grey hepatisation
resolution
121
what 3 things occur in the congestion phase of pneumonia?
fluid accumulation
pulmonary oedema
neutrophil accumulation
122
what occurs in the consolidation phase of pneumonia and where?
exudate forms of neutrophils, fibrin and RBCs in the alveoli
123
what occurs in the grey hepatisation stage of pneumonia?
only neutrophils and fibrin persist in exudate - paler colour
124
give 2 examples of how the exudate is removed in the resolution stage of pneumonia
digested by macrophages
| coughed up
125
what does CURB 65 stand for? (is a 5 point score)
confusion
urea >7
respiratory rate >30
blood pressure 65
126
On examination of the lungs what do you find in pneumonia?
Dull percussion
Basal Crackles on auscultation of the lung bases due to consolidation
Bronchial breathing
Increased tactile vocal fremitus
127
what would tactile vocal fremetus be like in a patient with pneumonia?
increased
128
what would happen to the blood markers WCC, CRP and ESR in a patient with pneumonia?
all increase
129
is there a vaccine available for pneumonia?
yes
130
a CURB score of 0 would recommend what antibiotic treatment for pneumonia?
oral amoxycillin OR clarithromycin
131
a CURB score of 1-2 would recommend what antibiotic treatment for pneumonia?
oral amoxycillin AND clarithromycin
132
a CURB score of >3 would recommend what antibiotic treatment for pneumonia?
co-amoxiclav &; clarithromycin IV
133
give 4 respiratory complications of pneumonia
respiratory failure
pulmonary effusion
empyema
lung abscess
134
give 4 cardiac complications of pneumonia
hypotension
AF
pericarditis
myocarditis
135
give a systemic complication of pneumonia
septicaemia
136
what percentage of pulmonary emboli are present undiagnosed in patients?
a) 10%
b) 30%
c) 60%
d) 80%
c) 60%
137
what percentage of PEs are fatal?
a) 1%
b) 10%
c) 50%
d) 100%
b) 10%
138
what is PE classically a complication of?
DVT
139
what is virchow's triad?
blood constituents
blood flow
vessel properties
140
a change in virchow's triad can cause what?
DVT or PE
141
how can bacterial endocarditis cause a pulmonary embolism?
septic emboli dislodges from RHS of heart and travels to lung
142
how can an MI lead to a pulmonary embolism?
right sided thrombus after MI
143
What are the symptoms of PE?
Sudden SOB and dysponea
Hypoxia
Sudden Pleuritic chest pain and also back pain
Coughing ( dry but can have mucus and blood)
Feeling light headness and dizzines
Fainting
Symptoms of DVT
144
when in a PE might you get haemoptysis?
if lung tissue is damaged
145
give 3 physiological risk factors for PE
age >60
obesity
pregnancy
146
give 3 pathological risk factors for PE
trauma
varicose veins
previous DVT/PE
147
give a blood-related risk factor for PE
hyper coagulability e.g. thrombophilia, factor V leiden, protein C/S deficiency, antithrombin def
148
give a lifestyle risk factor for PE
long air travel/immobility, diet and smoking
149
give 2 iatrogenic risk factors for PE
COCP
| HRT
150
if a patient with a PE has an ABG showing low PaO2 and normal PaCO2 what does this show?
type 1 respiratory failure
151
what might an echo show of a heart of a patient with a PE?
dilated right ventricle and increased contraction of LV
152
what part of the lung is affected in a small or medium pulmonary embolism? what affect does this have?
terminal vessels
| Causes coarse crackles, pleural rub and tachyponea.
153
what occurs to the lung in a massive PE?
sudden lung collapse due to pulmonary obstruction
154
what occurs systemically and peripherally in a massive PE?
shock
| peripheral shutdown
155
What are the circulatory signs of massive PE?
Tachycardia
Tachypnea
Hypotension
Raised JVP
156
where might you feel a heave in a patient with a massive or multiple recurrent PE?
right ventricle
157
what might occur to the second heart sound in a patient with a massive or multiple recurrent PE?
split
158
What are the symptoms of multiple recurrent PE?
Increased shortness of breath over a few weeks
Syncope, weakness and angina
Pulmonary hypertension and RV overload signs
RV heaves and loud 2nd heart sound
159
what 3 immediate suppurative treatments would you give to a patient with a PE?
high flow oxygen
IV fluids
analgesia
160
give an example of a thrombolytic that you could give in a pulmonary embolism
streptokinase IV for 30 mins
161
give 2 methods you would use to prevent a further pulmonary embolism occurring in the future?
LMWH ( tinzaparin) initially and then warfarin following on or rivaroxaban
162
What are the symptoms of pulmonary fibrosis?
```
SOB on exertion
Lose of apeptite
Rapid Weight loss
Fatigue and tired
Clubbing
Chest discomfort
Chronic dry hacking cough
```
163
What therapy treatment can you have at home for pulmonary fibrosis?
Oxygen therapy
| Pulmonary rehabilitation
164
What are the life style advice for a patient with pulmonary fibrosis?
Stop smoking
Exercise
Healthy diet
165
what is pulmonary fibrosis?
scarring of the lungs
166
pulmonary fibrosis is excess accumulation of what?
fibrous connective tissue
167
pulmonary fibrosis results in ____ of alveolar walls and ____ gaseous exchange
thickening
| reduced
168
give an example of a cause of idiopathic pulmonary fibrosis
genetic mutation of a surfactant protein
FHx
GORD
Smocking
169
give 3 examples of diseases for which pulmonary fibrosis can be a secondary effect
TB
bacterial lung infection
viral lung infection
autoimmune diseases (e.g. sarcoidosis, granulomatosis)
170
give a lifestyle cause of pulmonary fibrosis
smoking
171
give a immune mediated cause of pulmonary fibrosis
hypersensitivity
172
give examples of 4 drugs which can cause pulmonary fibrosis
amoidarone
methotrexate
nitrofurantoin
apomorphine
173
which of these would NOT be reduced in a spirometry reading for pulmonary fibrosis
a) FEV1
b) FEV2
c) FVC
b) FEV2
174
is the scarring of pulmonary fibrosis permanent or temporary?
permenant
175
give 2 types of drugs that pulmonary fibrosis may respond to
steroids
| immunosuppressents
176
give an example of an anti-fibrinic drug that can be used in treatment of pulmonary fibrosis
pirfenidone
| nintedanib
177
what is end stage treatment of pulmonary fibrosis?
lung transplant
178
give 3 complications of pulmonary fibrosis
Hypoxia leading to pulmonary hypertension then heart failure
Pulmonary embolism
Chest infection
179
What is chronic bronchitis?
It is inflammation of the bronchioles causing production of mucus. Causing the patient to be cyanosed but not breathless
180
What is emphysema?
It is destruction, dilation and distention of the alveolar sacs. Which leads to being breathless but not cyanosed
181
What is the affect of
a) chronic bronchitis
b) emphysema
on alveolar ventilation?
a) decreased
| b) increased
182
What can COPD be exacerbated by?
Infection
Exercise
Bad weather
Pollution
183
What heart condition can chronic bronchitis cause?
Cor pulmonale
184
What is cor pulmonale?
It's right heart failure secondary to lung disease
| Caused by pulmonary hypertension consequence of hypoxia
185
What is the treatment for exacerbation of COPD?
Abx and Steroids (prednisolone) for 7 days
186
What are pre medical treatment for COPD?
Stop smoking, nutrition and exercise
187
For acute asthma attack what is the 2 drugs plus oxygen you give immediately?
Salbutamol 5g Nebulizer
| Hydrocortisone/Prednisolone
188
Why do you do a ECG when administrating continuous doses of salbutamol for acute asthma attack?
To identify any arrhythmias
189
What additional treatment do you give if acute asthma become severe?
Increase frequency of salbutamol
Ipratropium 0.5mg nebulizer
Magnesium sulphate over 15-20 minutes
190
Differential diagnosis of asthma for adults?
```
Chronic obstructive pulmonary disease
Bronchiectasis
Inhaled foreign body
Lung cancer
Sarcoidosis
```
191
Differential diagnosis of asthma for children?
```
Inhaled foreign body.
Viral-associated wheeze of infancy, bronchiolitis, pneumonia, croup, bronchitis, pertussis.
Sinusitis.
Post-nasal drip.
Bronchiectasis.
```
192
What are the usual clinical presentation of primary spontaneous pneumothorax?
Pleuritic chest pain with mild or moderate dyspnea
193
What are the usual clinical presentation of secondary spontaneous pneumothorax?
Pleuritic chest pain often absent but laboured dyspnea
194
What is the pathology of tension pneumothorax?
A tear in the lung causing a one way valve that leads air into the pleural space.
Causing collapse of the lungs and positive mass effect (shifting )of the mediastinum and heart.
195
How does tension pneumothorax cause cardiac arrest and potentially death?
Impaired venous return leads to reduced preload that leads to tachycardia
Over time this leads to reduced diastole period that means lead blood to the heart
Over time causes death of the heart
196
What is the treatment if you get recurrent pneumothorax?
Pleurodesis
197
Differential diagnosis of pneumothorax?
Pleural effusion
| Pulmonary embolism
198
What is a life style risk factor for pneumothorax?
smocking
199
What lung conditions can occur in a patient with bronchial carcinoma?
Collapse
Pleural effusion
Slow resolving pneumonia
200
What are the 5 common causes of bone mets?
```
Lungs
Prostate
Kidney
Thyroid
Breast
```
201
What system is used to assess the staging of bronchial carcinoma?
TNM system
202
In what age group do you get confusion with pneumonia?
Elderly
203
What type of pneumonia is CURB 65 used for?
CAP
204
What is the treatment for HAP?
Gentamicin and ticarcillin
205
What types of surgery increase the likelihood of PE?
Surgery of the abdomen and pelvic area
| Knee and hip replacement
206
What scan would you do if their was a positive D dimer test for PE?
CTPA
207
Is D Dimer test definitive for DVT and PE?
If -ve then yes
| However if +ve then need to do other test to confirm
208
What would a ECG show of a PE?
Tachycardia and RV strain
209
What is the triad of symptom for PE?
Sudden onset of
Hypoxia
SOB
Pleuritic chest pain
210
What criteria is used for the development of potential PE?
WELLs score
211
What is the wells score for PE?
```
No other possible diagnosis
HR= >100
Previous DVT or PE
Active malignancy
Haemoptysis
DVT symptoms and signs
Immobilisation for 3 days or surgery in past 4 weeks
```
Score of 4 or more =likely it is PE
212
What scan do you do if it is not possible to do a CTPA for a patient with potential PE?
VQ scan
213
What are differential diagnosis of PE?
```
Pneumonia
Pneumothorax
ACS
GORD
MSK pain
```
214
What are the signs and symptoms of pleural effusion?
```
Usually asymptomatic
However
Dyspnea and pleuritic chest pain can be present
Reduced chest expansion and chest sound
Stony Dull percussion
Reduce vocal resonance and fremitus
Bronchial breathing over the effusion
```
215
What is empyema?
It is collection of pus in the pleural space and a complication of pneumonia and pleural effusion
216
What does dull percussion indicate?
Consolidation, tumour or lung collapse
217
What would a increase in vocal resonance and dull percussion indicate ?
Consolidation, tumour or lung collapse
218
When is the criteria for a patient to be prescribed prophylaxis steroid inhaler for asthma?
If they are using their reliever inhaler more than 3 times a week or
Asthma is disturbing their sleep at least once a week or
They have had a asthma attack in the last 2 years that needed systemic steroids
219
What are the 7 most common primary tumours to cause mets in the lung?
kidney, prostate, breast, bone, gastrointestinal tract, cervix and ovary.
220
Which bronchial carcinoma is most commonly linked to asbestos and occurs in non smokers?
Adenocarcinoma
