Top band topics Flashcards
(230 cards)
1
Q
Most common arteries to develop atherosclerosis
A
- Circumflex
- Left anterior descending
- Right coronary arteries
2
Q
7 risk factors for atherosclerosis
A
- Age
- Tobacco
- Cholesterol
- Obesity
- Diabetes
- Hypertension
- Family history
3
Q
Where are atherosclerotic plaques likely to form?
A
Peripheral and coronary arteries
4
Q
Structure of atherosclerotic plaque
A
- Lipid
- Necrotic core
- Connective tissue
- Fibrous cap
5
Q
Outcomes of atherosclerotic plaques
A
- Occlusion -> ischaemia
- Rupture -> thrombus
- Embolism
6
Q
What is the main inflammatory cytokine in atherosclerotic plaques?
A
IL-1
7
Q
What are the stages of atherosclerosis?
A
- Fatty streaks
- Intermediate lesions
- Fibrous plaques
- Plaque rupture
8
Q
When do fatty streaks start forming?
A
Age 10
9
Q
What are fatty streaks made of?
A
- Foam cells
2. T lymphocytes
10
Q
What are intermediate lesions made of?
A
- Foam cells
- Smooth muscle cells
- T lymphocytes
11
Q
Define angina.
A
Chest pain / discomfort as a result of reversible myocardial ischaemia
12
Q
What is stable angina?
A
Angina induced by effort and relieved by rest
13
Q
What is unstable angina?
A
- Recent onset (<24hrs)
- Deterioration of stable angina (symptoms at rest)
- Increasing frequency and severity
- Occurs on minimum exertion / at rest
14
Q
What can cause angina?
A
- Atheroma / stenosis of coronary arteries
- Valvular disease
- Aortic stenosis
- Arrhythmia
- Anaemia
15
Q
8 risk factors for angina
A
- Smoking
- Sedentary lifestyle
- Obesity
- Hypertension
- Diabetes mellitus
- Family history
- Age
- Hypercholesterolaemia
16
Q
Clinical presentation of angina?
A
- Central chest tightness
- Provoked by exertion, cold, anger, excitement, and large meals
- Relieved by rest or GTN
- Radiation to arms, neck, and jaw
- Dyspnoea
- Nausea
- Sweating
- Fainting
17
Q
Diagnosis of angina?
A
- 12 lead ECG
- Treadmill test
- CT scan calcium scoring
- SPECT
- Cardiac catheterisation
18
Q
What would an ECG of angina look like?
A
- Normal
- ST depression
- T wave inversion
19
Q
Treatment for angina?
A
- Aspirin (COX inhibitor - reduced platelet aggregation)
- Statins (reduces cholesterol)
- Beta-blockers
- GTN
- CCB
- Revascularisation
20
Q
How do beta-blockers help treat angina?
A
- Reduce force of contraction
- Reduce heart rate
- Reduce cardiac output
21
Q
Side effects of beta-blockers?
A
- Tiredness
- Nightmares
- Bradycardia
- Erectile dysfunction
- Cold hands
22
Q
How does GTN help treat angina?
A
- Dilates systemic veins
- Reduced venous return
- Reduces preload
- Reduces workload and O₂ demand
23
Q
Side effects of GTN?
A
Profuse headache immediately after use
24
Q
How do CCBs help treat angina?
A
- Dilates systemic arteries
- BP drop
- Reduces afterload
- Reduces workload
25
Purpose of revascularisation?
Restore patent coronary arteries and increase flow reserve
26
What are ACS?
1. STEMI
2. NSTEMI
3. Unstable angina
27
What is a STEMI?
Complete occlusion of MAJOR artery -> full thickness damage of heart muscle
28
What is an NSTEMI?
Complete occlusion of MINOR / partial occlusion of MAJOR coronary artery -> partial thickness damage of heart muscle
29
What is a type 1 MI?
Spontaneous MI with ischaemia due to primary coronary event
30
What is a type 2 MI?
MI secondary to ischaemia due to increase O₂ demand or decreased supply
31
Clinical presentation of UA?
1. Chest pain
2. Breathlessness
3. Pleuritic pain
4. Indigestion
5. New onset angina
6. Recent destabilisation of pre-existing angina
32
What is the clinical presentation of ACS?
1. Acute central chest pain >20mins - RADIATION
2. Sweating
3. Nausea and vomiting
4. Dyspnoea
5. Fatigue
6. SOB
7. Palpitations
8. Distress / anxiety
9. Pallor
10. No response to GTN
11. Hypotension
33
Diagnosis of MI?
1. 12 lead ECG
2. Bloods - cardiac enzymes
3. CXR
34
ECG of STEMI?
1. Persistent ST elevation
2. Tall T waves
3. New LBBB
4. Pathological Q waves (days later)
5. T wave inversion (days later)
35
ECG of NSTEMI or UA?
1. ST depression
2. Tall T waves
3. T wave inversion (days later)
36
What are the biochemical markers relevant to an MI?
1. Troponin I / T
2. CK-MB
3. Myoglobin
37
Describe the levels of troponin following an MI
1. Rise within 3-12 hours
2. Peak at 24-48 hours
3. Return to normal over 5-14 days
38
Why is CK-MB useful in MI treatment?
Determines re-infarction as levels drop back within 36-72 hours
39
Immediate treatment for an MI
MONA
1. Morphine IV
2. Oxygen
3. Nitrates (GTN)
4. Anti-emetic
40
What anti-platelets are used following an MI?
1. Aspirin (COX inhibitor)
| 2. Clopidigrel (P2Y12 inhibitor)
41
Treatment for an MI?
1. Anti-platelets
2. Beta-blockers (atenolol)
3. Statins (simvastatin)
4. ACEi (ramipril)
5. Coronary revascularisation
5. Risk factor modification
42
When should you do a PCI for STEMIs and what if you can't do it?
1. PCI within 120 minutes
| 2. If not possible, fibrinolysis with alteplase
43
Complications of MIs
1. Sudden death
2. Arrhythmias
3. Persistent pain (due to necrosis)
4. Heart failure
5. Mitral incompetence
6. Cardiac rupture
7. Pericarditis
8. Ventricular aneurysm
44
Define cardiac failure
Inability of the heart to deliver blood, thus O₂, at a rate that is commensurate with the requirement of metabolising tissue
45
Main causes of cardiac failure?
1. IHD
2. Cardiomyopathy
3. Valvular heart disease
4. Cor pulmonate
5. Hypertension
6. Alcohol excess
46
Name the compensatory mechanisms in cardiac failure
1. Venous return (preload)
2. Outflow resistance (afterload)
3. Sympathetic system activation
4. RAAS
47
Describe the venous return compensatory mechanism in CF
1. Reduced SV
2. Increased blood after systole
3. Stretched myocardial fibres
4. Increased force of contraction (STARLING'S LAW)
5. DECOMPENSATION - increased CO cannot be maintained
48
Describe the outflow resistance compensatory mechanism in CF
1. Increased after load
2. Increased EDV & decreased SV
3. Decreased CO
4. COMPENSATORY CHANGE - dilatation of LV
49
Describe the sympathetic system activation compensatory mechanism in CF
1. Baroreceptors detect BP drop
2. Increased FoC
3. Increased SV & HR
4. Increased CO
5. COMPENSATORY CHANGE - chronic sympathetic activation
6. Sympathetic system acts on baroreceptors to make them less receptive to BP drop
7. CO stops increasing in response to sympathetic activation
50
Describe the RAAS compensatory mechanism in CF
1. Reduced CO
2. Reduced renal perfusion
3. Activation of RAAS
4. Increased Na+ absorption & ADH secretion
5. Increased water retention
6. Increased BP
7. Increased preload
8. Stretched myocardial fibres (STARLING'S LAW)
9. Increased CO
10. DECOMPENSATORY CHANGE - not enough O₂ to keep up this increased workload
51
What is systolic heart failure?
Inability of the ventricle to contract normally -> decreased CO
- IHD, cardiomyopathy
52
What is diastolic heart failure?
Inability of the ventricles to relax and fill fully -> decreased SV and CO
- Ventricular hypertrophy, aortic stenosis
53
What are the cardinal symptoms of heart failure?
1. SOB
2. Fatigue
3. Peripheral oedema
54
Clinical presentation of HF
1. CARDINAL SYMPTOMS
2. Dyspnoea
3. Orthopnoea
4. Cold peripheries
5. Raised JVP
6. Murmurs
7. Displaced apex beat
8. Cyanosis
9. Hypotension
10. Peripheral and pulmonary oedema (back flow from decreased CO)
11. Tachycardia
12. 3rd and 4th heart soudns
13. Ascites
14. Bi-basal crackles
55
Describe the NYHA classification of HF
Class I - no limitation
Class II - slight limitation (comfortable at rest, normal activity causes fatigue, dyspnoea, and palpitations - FDP)
Class III - marked limitation (gentle activity = FDP)
Class IV - inability to carry out any physical activity (FDP at rest)
56
Diagnosis of HF?
1. Blood tests (increased BNP)
2. CXR
3. ECG
4. Echo
57
What would you see on a CXR of someone with HF?
1. Alveolar oedema
2. Cardiomegaly
3. Dilated upper lobe vessels of lung
4. Pleural effusions
58
What is the treatment for HF?
1. Lifestyle changes
2. Diuretics (furosemide, bendroflumethiazide)
3. ACEi (ramipril)
4. Beta-blockers (bisoprolol)
5. Digoxin
6. Inotropes
7. Revascularisation
8. Surgery (to repair valve defects)
9. Cardiac resynchronisation
59
Define stage 1 hypertension
Clinic BP > 140/90mmHg
| 24hr ABPM / HBPM > 135/85mmHg
60
Define stage 2 hypertension
Clinic BP > 160/100mmHg
| 24hr ABPM / HBPM > 150/95mmHg
61
Define severe hypertension
Clinic systolic BP > 180mmHg
Clinic diastolic BP > 110mmHg
IMMEDIATE ANTI-HYPERTENSIVE DRUGS
62
What is essential hypertension?
Primary cause is unknown
63
What can cause secondary hypertension?
1. Renal (CKD)
2. Endocrine (Cushing's, Conn's, Pheochromocytoma)
3. Coarctation of aorta
4. Drugs (corticosteroids, cyclosporin)
64
What is malignant hypertension?
Raised diastolic blood pressure over 120mmHg
65
What is involved in the diagnosis of hypertension?
Looking for end-organ damage
66
What is the treatment for hypertension?
GOAL - 140/90mmHg
1. Lifestyle changes
2. ACEi (ramipril) or ARB (candesartan)
3. CCB (amlodipine)
4. Diuretics (furosemide)
67
What is the hypertension treatment for <55yos?
1. Ramipril / candesartan
2. Nifedipine
3. Bendroflumethiazide
4. Furosemide
68
What is the treatment for hypertension in >55yos / black people?
1. Ramipril / candesartan
2. Nifedipine
3. Bendroflumethiazide
4. Furosemide
69
Causes of mitral stenosis?
1. Rheumatic fever
2. Group A beta-haem strep
3. IE
4. Calcification
70
Pathophysiology of mitral stenosis
LA pressure increase -> LA hypertrophy / dilatation -> pulmonary venous / pulmonary arterial / right heart pressure increase -> pulmonary capillary pressure increase -> pulmonary oedema -> reactive pulmonary hypertension -> RV hypertrophy / dilatation -> RV failure
71
Clinical presentation of mitral stenosis?
1. Progressive dyspnoea
2. Haemoptysis
3. RHF
4. AF
5. Systemic emboli
6. Prominent 'a' wave in JV pulsations
7. Mitral facies (bilateral, cyanotic, or dusky pink discolouration on upper cheeks due to vasoconstriction)
72
What are the heart sounds in mitral stenosis?
1. Diastolic murmur
| 2. Loud opening S1 snap
73
Diagnosis of valve disease?
1. CXR
2. ECG
3. Echo
74
Treatment for mitral stenosis?
1. Beta-blockers for rate control to improve diastolic filling
2. Diuretics for fluid overload
3. Percutaneous mitral balloon valvotomy
4. Valve replacement
75
Clinical presentation of mitral regurgitation?
1. Exertional dyspnoea
2. Pulmonary venous hypertension
3. Fatigue
4. Lethargy
5. Palpitations (increased SV)
6. RHF symptoms
76
Heart sounds for mitral regurgitation?
1. Soft S1
2. Pansystolic murmur
3. Prominent S3
77
Treatment for mitral regurgitation?
1. ACEi (vasodilator)
2. Beta-blockers (rate control)
3. Anti-coagulation (AF)
4. Diuretics (fluid overload)
78
Causes of aortic stenosis
1. Calcific aortic valvular disease
2. Congenital bicuspid valve
3. Rheumatic heart disease
79
Clinical presentation of aortic stenosis?
1. TRIAD = syncope, angina, heart failure, dyspnoea on exertion
2. Sudden death
3. Slow rising carotid pulse
4. Decreased pulse amplitude
80
Heart sounds in aortic stenosis?
1. Soft S2
2. Prominent S4
3. Ejection systolic murmur
81
Treatment for aortic stenosis?
1. Dental hygiene
2. IE prophylaxis
3. Valve replacement
4. TAVI
82
Clinical presentation of aortic regurgitation?
1. Exertional dyspnoea
2. Palpitations
3. Angina
4. Syncope
5. Wide pulse pressure
6. Quincke's sign
7. de Musset's sign
8. Pistol shot femoral
9. Collapsing water hammer pulse
83
Heart sounds in aortic regurgitation?
1. Diastolic blowing murmur
| 2. Systolic ejection murmur
84
Treatment for aortic regurgitation?
1. IE prophylaxis
2. ACEi (vasodilator)
3. Serial echos
4. Valve replacement
85
Clinical symptoms of anaemia?
1. Fatigue
2. Headaches
3. Faintness
4. Dyspnoea / SOB
5. Angina
6. Anorexia
7. Intermittent claudication
8. Palpitatinos
86
Signs of anaemia?
1. Pallor
2. Tachycardia
3. Systolic flow murmur
4. CF
87
Causes of microcytic anaemia?
1. Iron deficiency
2. Anaemia of chronic disease
3. Thalassaemia
88
Clinical presentation specific to iron deficiency anaemia?
1. Brittle hair and nails
2. Koilonychia
3. Atrophic glossitis
4. Angular stomatitis
89
Diagnosis of iron deficiency anaemia?
1. Hypochromic microcytic anaemia
2. Poikilocytosis
3. Anisocytosis
4. Low serum ferritin
5. Low serum iron
6. Raised TIBC
7. Raised transferrin receptors
8. Low reticulocyte count
90
Treatment of iron deficiency anaemia?
Ferrous sulphate
S/E: nausea, diarrhoea
91
Causes of normocytic anaemia?
1. Acute blood loss
2. Anaemia of chronic disease
3. Hypopituitarism
4. Renal failure
5. Pregnancy
92
Categories of macrocytic anaemia?
1. Megaloblastic (presence of erythroblasts with delayed nuclear maturation due to delayed DNA synthesis)
2. Non-megaloblastic / normoblastic
93
Causes of macrocytic anaemia?
1. Vitamin B12 / folate deficiency (megaloblastic)
2. Alcohol
3. Liver disease
4. Haemolysis
5. Aplastic anaemia
6. Bone marrow infiltration
7. Myeloma
94
Clinical presentation of pernicious anaemia?
1. Insidious onset
2. Lemon-yellow skin colour (body tries to remove defective large blood cells)
3. Glossitis
4. Angular stomatitis
5. Symmetrical paraesthesia
6. Loss of proprioception / vibration sense
7. Weakness and ataxia
8. Paraplegia
9. Dementia
95
Diagnosis of pernicious anaemia?
1. Megaloblastic anaemia
2. Macrocytic
3. Raised bilirubin
4. Low serum B12
5. Low Hb
6. Low reticulocytes
7. Intrinsic factor antibodies
96
Treatment of pernicious anaemia?
Malabsorption = injections
Dietary = oral B12
Replenish B12 = IM hydroxycobalamin
97
Treatment for arterial thrombosis?
1. Aspirin (COX inhibitor) - PREVENTION
2. Clopidogrel (P2Y12 inhibitor) - PREVENTION
3. Streptokinase (thrombolysis)
4. Tissue plasminogen activator (stroke / MI)
98
Diagnosis of venous thrombosis?
1. Plasma D-dimer
| 2. Compression ultrasound
99
Treatment of venous thrombosis?
1. LMWH (SC enoxaparin) - 5+ days
2. Oral warfarin - 6 months
3. DOAC
4. Compression stockings
5. IVC filters
100
Clinical presentation of ALL?
1. Marrow failure - anaemia, neutropenia, thrombocytopenia
2. Bone pain (marrow infiltration)
3. Hepatosplenomegaly
4. Lymphadenopathy
5. Headaches and cranial nerve palsy
6. Mediastinal masses w/ SVC obstruction
101
Diagnosis of ALL?
1. FBC - raised WCC
2. Blood film - blast cells
3. CXR / CT - lymph/mediastinaladenopathy
4. Lumbar puncture
102
Treatment for ALL and AML?
1. Blood and platelet transfusions
2. Prophylactic antimicrobials
3. Allopurinol (prevent tumour lysis syndrome)
4. IV fluids through Hickman line
5. Chemotherapy
6. Marrow transplant
103
Clinical presentation of CML?
1. Anaemia
2. Splenomegaly
3. Weight loss
4. Tiredness
5. Pallor
6. Fever and sweats
7. Gout
8. Bleeding
104
80% of CML patients have what?
PHILADELPHIA CHROMOSOME
105
Diagnosis of CML?
1. High WCC
2. Low Hb
3. Hypercellular aspirate
106
Treatment for CML?
1. Oral imatinib
| 2. Stem cell transplant
107
Clinical presentation of CLL?
1. Anaemia
2. Weight loss
3. Sweats
4. Anorexia
5. Hepatosplenomegaly
6. Lymphadenopathy
108
Diagnosis of CLL?
1. High WCC
| 2. VERY HIGH LYMPHOCYTES
109
Treatment of CLL?
1. Blood transfusion
2. Human IV immunoglobulins
3. Chemo/radiotherapy
110
What is the difference between Hodgkin's and non-Hodgkin's lymphoma?
Hodgkin's = Reed-Sternberg cells
111
Causes of lymphoma?
1. Primary immunodeficiency
2. Secondary immunodeficiency (e.g. HIV)
3. Infection (e.g. EBV)
4. Autoimmune (e.g. SLE)
112
Clinical presentation of Hodgkin's lymphoma?
1. Painless cervical lymphadenopathy
2. Cough (mediastinal lymphadenopathy)
3. General B symptoms (weight loss, fever, night sweats)
4. Infections
113
Diagnosis of Hodgkin's lymphoma?
1. CT/MRI for staging
2. Lymph node excision
3. Bone marrow biopsy
4. Bloods
5. Immunophenotyping
6. Cytogenetics
114
What will you see on the bloods from someone with Hodgkin's lymphoma?
1. High ESR
2. Low Hb
3. High serum lactate dehydrogenase
115
Staging of Hodgkin's lymphoma?
ANN-ARBOUR CLASSIFICATION
116
Treatment for Hodgkin's?
1. Combination chemo (ABVD)
2. Stage I-A to II-A = short course + radiotherapy
3. Stage II-A to IV-B = long course ABVD
117
What is ABVD?
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
118
Clinical presentation of non-Hodgkin's lymphoma?
1. Superficial lymphadenopathy
2. Systemic B symptoms (night sweats, fever, weight loss)
3. Pancocytopenia
119
What is low grade non-Hodgkin's?
1. Slow growing
2. Advanced at presentatino
3. Incurable
4. 9-11yrs survival
120
What is high grade non-Hodgkin's lymphoma?
1. Rapid growing
2. Curable
3. Nodal presentation
121
Diagnosis of non-Hodgkin's lymphoma?
1. Raised lactose dehydrogenase
2. Marrow biopsy
3. Node biopsy
4. CT/MRI for staging
5. Immunophenotyping
6. Cytogenetics
122
Treatment for non-Hodgkin's lymphoma?
R-CHOP chemo
Rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone
123
Treatment for low grade NHL?
1. None
| 2. Radiotherapy
124
Treatment for high grade NHL?
```
Early = 3 months R-CHOP + radiotherapy
Late = 6 months R-CHOP + radiotherapy
```
125
What is myeloma?
Cancer of plasma cells which accumulate in bone marrow and lead to progressive marrow failure
126
Clinical presentation of myeloma?
OLD CRAB
```
Old age
Calcium elevated
Renal failure
Anaemia
Bone pain
```
127
Diagnosis of myeloma?
1. Blood
2. U&Es
3. Plain X-ray - lytic lesions
4. Serum and urine electrophoresis - B2-microglobulin present
128
What will bloods and U&Es show in someone with myeloma?
1. Anaemia
2. Raised ESR
3. Rouleaux formation
4. High calcium
5. High alkaline phosphatase
129
Treatment for myeloma?
1. Analgesia (bone pain)
2. Bisphosphonates (fractures)
3. RBC transfusion (anaemia)
4. 3L/day fluid (prevent renal damage)
5. Renal dialysis
6. Chemo (CTD or VAD)
7. Stem cell transplant
130
How is sickle cell anaemia inherited?
Autosomal recessive
131
What is the clinical presentation of homozygous sickle cell anaemia?
1. Vaso-occlusive crises
2. Acute chest syndrome
3. Pulmonary hypertension
4. Anaemia -> splenic sequestration
132
Long term problems of sickle cell?
1. Growth and development
2. Avascular necrosis of bones
3. Osteomyelitis
4. Cardiomegaly, arrhythmias, MI
5. TIA, fits, stroke, coma
6. Liver dysfunction
7. Chronic tubulointerstitial nephritis
8. Retinopathy, vitreous haemorrhage
9. Spontaneous abortion
133
Treatment of sickle cell?
1. Avoid precipitating factors
2. Folic acid
3. Blood transfusions (for anaemia)
4. Oral hydroxycarbamide (increased HbF conc)
5. Stem cell transplant
134
Treatment for acute painful attacks in sickle cell?
1. IV fluids
2. Analgesia
3. Oxygen
4. Antibiotics
135
Definition of chronic bronchitis
Cough with sputum for 3 months for 2 or more years
136
Definition of emphysema
Enlarged airspaces distal to terminal bronchioles, with destruction of alveolar walls
137
Describe the airflow limitation in COPD
1. Progressive
| 2. Caused by abnormal inflammatory response to noxious particles or gases
138
Pathophysiology of chronic bronchitis?
1. Hypertrophy & hyperplasia of mucus secreting goblet cells
2. Bronchial wall inflammation
3. Mucosal oedema
139
What is the metaplasia present in chronic bronchitis?
Columnar to squamous
140
What is the pathophysiology of emphysema?
Dilatation and destruction of tissue distal to terminal bronchioles -> loss of elastic recoil -> airways close during expiration -> airflow limitation and air trapping
141
Classifications of emphysema?
1. Centri-acinar emphysema (around resp bronchioles, distal alveolar ducts and alveoli are preserved)
2. Pan-acinar emphysema (distension and damage of whole acinus) -> collection of bullae
3. Irregular emphysema
142
What is the short term effect of COPD?
V/Q mismatch -> hypoxia -> increased work -> alveolar hyperventilation
Increased PaCO2 = increased respiration
143
What are the long term effects of COPD?
Patients are desensitised to CO2 so rely on hypoxia to drive respiration
1. Less SOB
2. Renal hypoxia -> fluid retention and EPO release -> polycythaemia and cyanosis
144
Clinical presentation of COPD?
1. Productive cough
2. Wheeze
3. SOB at rest
4. Prolonged respiration
5. Poor chest expansion
6. Barrel chest
7. Pursed lips on expiration
8. High pack year
9. Frequent chest colds
10. Symptoms worsened by damp/cold weather
11. Hypertension
12. Osteoporosis
13. Depression
14. Weight loss
15. Later stages = type 2 resp failure
16. Advanced disease = pulmonary hypertension
145
Diagnosis of COPD?
1. Lung function test - OBSTRUCTIVE
2. Bloods - polycythaemia
3. PEFR - non-variable
146
Treatment for COPD?
1. SMOKING CESSATION
2. Bronchodilators (tiotropium bromide (LAMA) + SABA)
3. + LABA
4. Corticosteroids (to assess reversibility)
5. Vaccines
6. Oxygen therapy
7. Anti-mucolytics
8. Diuretics (oedema)
9. Pulmonary rehabilitation
147
What should you do if you see improvement in lung function in a COPD patient following oral prednisolone for 2 weeks?
Move to an ICS beclometasone twice a day
148
What are the three characteristics of asthma?
1. Airflow limitation (reversible)
2. Airway hyper-responsiveness
3. Bronchial inflammation
149
What are the two types of asthma?
1. Allergic / eosinophilic asthma (70%)
| 2. Non-allergic / non-eosinophilic asthma (30%)
150
What triggers non-allergic asthma?
1. Cold
2. Exercise
3. Stress
151
What are the classifications of allergic asthma?
1. Extrinsic (atopic)
| 2. Intrinsic
152
What is atopy?
Ready development of IgE against common environmental antigens, such as house-dust mites, grass pollen, and fungal spores
153
What gene is thought to be linked to airway hyper responsiveness and tissue remodelling?
ADAM33
154
6 risk factors for asthma?
1. Personal history of atopy
2. Family history of asthma or atopy
3. Obesity
4. Inner-city environment
5. Premature birth
6. Socio-economic deprivation
155
Name some precipitating factors of asthma
1. Occupational sensitisers (e.g. wood dust, bleach, dyes)
2. Cold air
3. Exercise
4. Emotion
5. Drugs (particularly NSAIDs)
5. Allergens
156
Define asthma.
Narrowing of the airway, due to smooth muscle contraction, thickening of the airway wall by cellular infiltrate and inflammation and the presence of secretions within the lumen
157
Describe the role of mast cells in asthma
1. Increased in epithelium, smooth muscle, and mucous glands
2. Sensitised when bound to IgE
3. Release histamine, tryptase, prostaglandin 2 Cys-LTs, and cytokines
158
What do histamine and cysteine leukotrienes cause in asthma?
Bronchoconstriction and inflammation
159
What is the role of IL-3, IL-4, and IL-5 in asthma?
```
IL-3 = increases mast cell numbers
IL-4 = IgE synthesis
IL-5 = essential for eosinophil survival
```
160
What decreases numbers / activation of eosinophils?
CORTICOSTEROIDS!
161
Describe the response 30 minutes after an allergen challenge
Bronchoconstriction
162
Describe the response 3 hours after an allergen challenge
1. Bronchoconstriction DECREASES
2. Inflammation due to vasodilation
3. Increased vascular permeability
4. Adhesion molecules
163
Describe the response 6 hours after an allergen challenge
1. Worsening inflammation (eosinophils)
| 2. Second wave of bronchoconstriction
164
What happens in remodelling in asthma?
1. Smooth muscle hypertrophy and hyperplasia -> larger fraction of wall is muscle
2. Deposition of repair collagens in basement membrane
3. Expansion of submucosa due to deposition of matrix proteins, swelling, and cellular infiltrate
4. Reduced retractile forces -> airways close more easily
5. Metaplasia -> more goblet cells
165
Describe the clinical presentation of asthma
1. Intermittent dyspnoea
2. Wheeze
3. Cough
4. Sputum
5. Worse at night
6. Episodic SOB
166
What happens during an asthma attack?
1. Reduced chest expansion
2. Prolonged expiratory time
3. Bilateral expiratory polyphonic wheezes
4. Tachypnoea
167
Describe uncontrolled asthma
1. PEFR <50%
2. Resp rate < 25
3. Pulse < 110
4. Normal speech
168
What happens during a severe asthma attack?
1. Inability to complete sentences
2. Pulse > 110
3. Resp rate > 25
169
What happens during a life threatening asthma attack ?
1. Silent chest
2. Confusion
3. Exhaustion
4. Cyanosis
5. Bradycardia
6. PEFR <33%
170
What is the immediate management of a life threatening asthma attack?
1. Oxygen
2. Nebulised 5mg salbutamol (± ipratropium)
3. Prednisolone
4. ABGs
5. CXR (if doesn't respond to treatment)
6. PEFR every 15-30 mins
7. Oximetry
171
What are the RCP3 questions?
1. Recent nocturnal waking?
2. Usual asthma symptoms in the day?
3. Interference with ADLs?
172
What is the diagnosis for asthma?
1. PEFR
2. Spirometry
3. CO test
4. Exercise tests
5. Trial of corticosteroids + SABA
6. Exhaled nitric oxide
7. Blood and sputum tests
8. Skin prick tests
9. History
173
What is the result of the PEFR in asthmatics?
>15% improvement after bronchodilator
174
What are the aims of treating asthma?
1. Abolish symptoms
2. Restore best possible lung function
3. Reduce risk of severe attacks
4. Enable normal growth in children
5. Minimise absence from school / employment
6. Lowest effective dose possible to minimise S/Es
175
What is the treatment of asthma?
1. SABA (salbutamol) + LABA (salmeterol)
2. Muscarinic antagonist (ipratropium)
3. Methylxanthines (theophylline)
4. ICS (prednisolone)
176
Name 6 risk factors of bronchial cancer
1. Smoking
2. Asbestos
3. Radon exposure
4. Radiation
5. Pre-existing lung disease
6. Genetics
7. Iron oxide
177
Describe small cell lung cancer
1. STRONG ASSOCIATION WITH SMOKING
2. Metastasis by presentation
3. Central bronchus
4. From neuroendocrine cells
5. Secretes polypeptide hormones
6. Chemotherapy
7. Poor prognosis
178
Describe squamous cell carcinoma
1. MOST STRONGLY ASSOCIATED WITH SMOKING
2. Central location
3. Cavitation with central necrosis
4. From epithelial cells
5. Secrete keratin
6. Cause obstruction
7. Local spread
8. Surgical ablation
179
Describe adenocarcinoma
1. Most common
2. Most common in non-smokers
3. Central or peripheral
4. Single lesions or multifocal pattern
5. From mucus secreting glandular cells
6. Metastasis to pleura, lymph nodes, brain, bones, and adrenals
7. Associated with asbestos
180
Where do bronchial cancers metastasis to?
1. Liver
2. Bone
3. Adrenals
4. Brain
181
Which tumours metastasis TO the lungs?
1. Breast
2. Bowel
3. Kidney
4. Bladder
182
Clinical presentation of bronchial cancer
1. Cough
2. Breathlessness
3. Haemoptysis
4. Chest pain
5. Wheeze
6. Infections
7. Clubbing
183
What classification system is used for lung cancer?
TNM
184
How do you diagnose lung cancer?
1. CXR
2. CT
3. Bronchoscopy
4. Cytology
5. Bloods
185
What would you see on a CXR of lung cancer?
1. Round shadow
2. Hilar enlargement
3. Consolidation
4. Lung collapse
5. Pleural effusion
186
Treatment for NSCLC?
1. Surgical excision (if no metastasis)
2. Curative radiotherapy
3. Chemotherapy ± radiotherapy
187
Treatment for SCLC?
1. Chemo ± radio (if no metastasis)
2. Chemotherapy (if metastasis)
3. Palliation
4. SVC stent + radiotherapy + dexamethasone (for SVC obstruction)
5. Endobronchial therapy
6. Pleural drainage
188
Risk factors of PE?
1. Change in blood flow (immobility, obesity, pregnancy)
2. Change in blood vessel (smoking, hypertension)
3. Change in blood constituents (dehydration, malignancy, COCP)
189
Clinical presentation of a PE?
1. May be asymptomatic (small emboli)
2. Sudden onset dyspnoea
3. Pleuritic chest pain / haemoptysis (infarction)
4. Dizziness
5. Past history of thromboembolism
6. Pyrexia
7. Cyanosis
8. Tachypnoea
9. Tachycardia
10. Hypotension
11. Raised JVP
12. Pleural rub
13. Pleural effusion
190
How do you diagnose a PE?
1. Plasma D-dimer
2. Compression ultrasound
3. CT pulmonary angiography - GOLD STANDARD
191
Treatment of a PE?
1. High flow oxygen
2. LMWH (oral enoxaparin)
3. IV fluids + inotropic agents
4. Thrombolysis (alteplase) for massive PE
5. Surgical embolectomy
6. Vena cava filter
192
Prevention of further PE?
1. Warfarin
2. Mobilisation
3. Compression stockings
193
Management of massive PE?
1. Oxygen
2. Morphine
3. Anti-emetic
4. Immediate thrombolysis
5. IV heparin
194
Name three emergency upper respiratory tract infections
1. Severe acute respiratory distress (coronavirus, from China)
2. Middle East Respiratory Syndrome novel Coronavirus
3. Avian influenza
195
Bacterial cause of pharyngitis / tonsillitis?
Lancefield Group A beta-haemolytic strep - S.PYOGENES
196
Bacterial cause of sinusitis?
1. S.pneumoniae
| 2. H.influenzae
197
Clinical presentation of sinusitis?
1. Frontal headache
2. Purulent rhinorrhoea
3. Unilateral pain
4. Fever
5. Facial pain
198
Treatment for sinusitis?
1. Nasal decongestant (xylometazoline)
| 2. Broad spectrum antibiotics (co-amoxiclav)
199
Treatment for acute epiglottis?
IV ceftazidime
200
Causes of whooping cough?
Bordatellla pertussis (G-ve rod)
201
Treatment of whooping cough?
Clarithromycin
202
Causes of CAP?
1. S.pneumoniae - MOST COMMON
2. S.aureus
3. Legionella
203
Definition of HAP?
New onset of cough with purulent sputum, along with a compatible CXR demonstrating consolidation, in patients who are beyond 48hrs of initial admission to hospital
204
Who is at risk of HAP?
1. Elderly
2. Ventilator assisted
3. Post-operative patients
205
Most common causes of HAP?
1. Pseudomonas Aeruginosa
2. E.coli
3. Klebsiella pneumoniae
4. MRSA
206
How is pneumonia spread?
Respiratory droplets
207
Clinical presentation of pneumonia
1. Fever
2. Night sweats
3. Raised resp rate
4. Productive cough
5. NO URTI SYMPTOMS
6. Rigors
7. Malaise
8. Anorexia
9. Dyspnoea
10. SOB
11. Dry or productive cough
12. Purulent sputum (S.pneumoniae)
13. Pleuritic chest pain
14. Cyanosis
15. Confusion
208
Signs of pneumonia?
1. Dull to percussion
2. Decreased air entry
3. Bronchial breath sounds
209
Diagnosis of pneumonia?
1. CXR
2. Blood tests (FBC, ESR, biochem)
3. Pulse oximetry / ABG
4. Sputum culture
5. Blood culture
6. Serology
210
Describe the CXR results for each type of causative microorganism in pneumonia
Multi-lobar = S.pneumoniae, S.aureus, Legionella
Multiple abscesses = S.aureus
Upper lobe cavity = Klebsiella pneumoniae
211
What does CURB65 stand for?
```
Confusion
Urea > 7mmol/L
Respiratory rate > 30/min
BP < 90mmHg sys / 60mmHg dias
Age > 65
```
212
Describe the treatment for 0-1/mild pneumonia
1. Treat at home
2. Amoxicillin 5-7 days
3. Oxygen
4. Analgesia (for pleuritic pain)
213
Describe the treatment for 2/moderate pneumonia
1. Admit to hospital
2. PO co-amoxiclav
3. Oxygen
4. Analgesia
214
Describe the treatment for 3/severe pneumonia
1. Hospitalisation and close monitoring
| 2. IV co-amoxiclav or clarithromycin
215
How do you treat pneumonia caused by legionella?
Fluroquinolone
216
How do you treat necrotising pneumonia?
1. IV linezolid
2. IV clindamycin
3. IV rifampicin
217
How do you treat pneumonia caused by pseudomonas aeruginosa?
1. IV ceftazidime
| 2. IV gentamicin
218
Name 4 complications of pneumonia
1. Respiratory failure
2. Hypotension
3. Parapneumonic effusion and empyema
4. Lung abscesses
219
Describe mycobacterium
1. Aerobic
2. Non-motile
3. Non-sporing
4. Slight curved bacilli
5. Thick waxy capsule
6. Acid-fast bacilli
7. Slow growing
8. Resistant to phagolysosomal killing
9. Can remain dormant
220
Name 6 risk factors of tuberculosis
1. Origination from high-incidence country
2. HIV
3. Immunosuppression
4. Diabetes mellitus
5. IVDU
6. Ageing
7. Malnutrition
8. Prisons
9. Homeless
10. Smoking
11. Alcohol
221
Describe the pathophysiology of primary tuberculosis
1. Inhalation of bacteria
2. Ingestion by macrophages
3. Proliferation inside macrophages
4. Inflammatory response in lungs
5. Macrophages present antigen to T cells
6. Hypersensitivity reaction -> necrosis and granulomas
7. Fibrosis
222
Where can TB affect?
1. GI
2. Bone and spine
3. Miliary (systemic)
4. CNS
5. Pericardium
6. Skin
223
Describe the clinical presentation of TB
1. Weight loss
2. Low grade fever
3. Anorexia
4. Night sweats
5. Malaise
6. Productive cough >3w
7. Haemoptysis
8. Chest pain
9. Breathlessness
224
What are the signs of TB in the lungs
1. Consolidation
2. Pleural effusion
3. Pulmonary collapse
225
How can you diagnose TB?
1. CXR
2. Sputum culture
3. Broncoscopy
4. Histology
5. Culture
6. Nucleic acid amplification
7. Lumbar puncture
8. Tuberculin skin test - Mantoux
226
What is the treatment for TB?
1. Rifampicin - 6 months
2. Isoniazid - 6 months
3. Pyrazinamide - 2 months
4. Ethambutol - 2 months
227
S/E of rifampicin
1. Red urine
2. Hepatitis
3. Drug interactions
228
S/E of isoniazid
1. Hepatitis
| 2. Neuropathy
229
S/E of pyrazinamide
1. Hepatitis
2. Arthralgia
3. Rash
230
S/E of ethambutol
1. Optic neuropathy
