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week 8 Flashcards

1
Q

what is the medical imaging definition for cardiomegaly

A

when the heart takes up greater than 50% of the thoracic cavity

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2
Q

what is evidence of pleural effusion on a CXR

A

blunted costophrenic angles

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3
Q

when you lose the right heart border due to pleural effusion on an CXR whcih lobe is affected

A

middle

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4
Q

when you lose the hemi-diaphragm due to pleural effusion on an CXR which right lobe is affected

A

lower lobe

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5
Q

what are air bronchograms indicative of

A

pulmonary oedema

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6
Q

how many phases of covid 19 and brief description of each

A

3
stage 1 = asymptomatic, innate immune response
stage 2 = severe symptoms uncontrolled immune response due to cytokine storm
stage 3 = post covid symptoms (long covid)

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7
Q

what are the primary targets of covid 19

A

epithelial cells of the resp tract, specifically binding to ACE2 receptors

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8
Q

two receptors taht covid 19 uses

A

ACE 2 receptor to attach to host cell
TMPRSS2 receptor to fuse into host cell

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9
Q

role of ACE 2 receptors

A

convert angiotensin 2 into its anti-inflammatory form ANG1-7

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10
Q

functions of ANG 1-7 5

A

decrease inflammation
decrease autophagy
decrease vasodilation
decrease insulin resistance
decrease oxidative stress

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11
Q

what cytokine activates the cytokine storm

A

PANoptosis

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12
Q

what does the cytokine storm mean?

A

Panoptosis triggers the formation of panaptosome complexes which trigger excessive cytokine release resulting in the cytokine storm which leads to end organ damage

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13
Q

symptoms of covid 7

A

fever
cough
fatigue
anosmia
dyspnoea
headache

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14
Q

what is anosmia

A

abrupt loss in someones ability to taste

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15
Q

what causes ARDS in covid

A

cytokine storm leading the destruction of type 2 pnuemocytes causing lack of surfactant causing alveolar collapse

build up of fluid in the lungs

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16
Q

how does ARDS lead to multi organ collapse 3

A

the two changes (cytokine storm=type 2 pneumoycte destruction=lack of surfactant + build up of fluid)

can causes respiratory failure, penuomothroax and barotrauma which leads to a lack of ventilation and perfusion

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17
Q

treatments for covid 3

A

analgesics
oxygen therapy
antivirals

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18
Q

pneumonia definition

A

acute infection of the lung parenchyma

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19
Q

aetiological classification of pneumonia 5

A

bacterial
viral
aspiration
atypical
opportunistic

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20
Q

what is the most common cause of pneumonia

A

streptococcus penumoniae

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21
Q

acquisition based classification of pneumonia

A

community acquired
healthcare acquired
ventilator acquired

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22
Q

presentation of pneumonia (symptoms) 5

A

productive cough
pleuritic chest pain
dyspnoea
fatigue
fever

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23
Q

phsyical examination symptoms of pneumonia 4

A

dullness on percussion
decreased breath sounds
bronchial breathing
coarse crackles

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24
Q

what is required for diagnosis of pneumonia? 1 +1 of 4

A

consolidation on CXR with one of the following symptoms:
fever >38
dyspnoea
pleuritic pain
productive cough

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25
curb 65 score def
score to assess the severity of community acquired pneumonia
26
curb 65 definition
c = confusion u = urea r = resp rate b = blood pressure 65 = greater than 65
27
how do clinical symptoms in TB vary to taht of pneumonia aka what are the clinical symptoms of TB 6
chronic cough night sweats weight loss persistent low grade fever persistent fatigue and malaise
28
general differentiation in symptoms of pneumonia to TB
pneumonia presentation and symtpoms more acute - TB commonly low grade persisting
29
diagnostic investigations in TB 2
lesions on CXR positive TB skin test
30
pathogenesis of pneumonia
1. aspiration 2. colonisation in nasopharynx 3. micro aspiration transmission to lung parenchyma 4. replication in lung parenchyma 5. cytokine release causing inflammation 6. systemic inflammation end organ damage
31
complictations of pneumonia 5
sepsis lung absces respiratory failure kidney failure neurological effects
32
key investigation in pneumonia
CXR
33
other investigations in pneumonia 6
CBE EUC viral swab Sputum MCS Pleural fluid aspirate+culture bronchoscopy
34
when would you do a bronchoscopy in pneumonia 4
- immunosupressed - severe pneumonia unresponsive to normal treatment - conern of endo-bronchial obstruction - concern of hyper sensitivity pneumonitis
35
pneumonia treatment (viral, bacterial, mild, severe)
viral = wait and watch bacterial = antibiotics mild = oral severe = intravenous
36
additional management therapies in pneumonia 4
oxygen if <92 IV fluids analgesia pulmonary rehabilitation
37
oral antibiotics in pneumonia 2
amoxicillin and doxycyclin
38
intravenous antibiotics in pneumonia
axzythromyosin
39
three things whcih need to be assessed prior to antibiotic treatment in pneumonia 3
CXR and tests to diagnose pneumonia and pathogen kidney tests to determine funciton and which antibiotic to use whether pneumonia is mild or severe to determine whether intravenous or oral antibiotics are used
40
what is the main cause of pulmonary tb
mycobacterium tuberculosis
41
what are two characteristics of TB which increase its virulence
slow growth which makes it hard to treat and prolongs infection waxy cell wall which is lipid rich protecting it from environmental stresses and host immune responses
42
pathogenesis of TB 4
myocbacterium TB enters upper airways attempted phagocytosis by alveolar macrophages migrates to lung parenchyma or to lymph nodes further cuases
43
what happens when TB enters the lung parenchyma 4
active infection inflammation granuloma development causes lung damage and dysfunction
44
what happens when TB enters the lymph nodes
activates B and T cells they will differentiate into epithelioid cells to form granulomas
45
advanced symptoms of TB 4
haemoptysis chest pain loss of appetite dyspnoea
46
clinical findings in TB 3
pallor wasted appearance clubbing
47
systemic manifestations of TB 5
haematuria headache backpain hoarseness abdominal discomfort
48
investigations in TB 5
CXR sputum microscopy and culture TB skin test TB blood test
48
Sputum microscopy use in TB 2
used to observe for acid fast bacilli of which mycobacterium TB is one its not specific, only confirms diagnosis
49
sputum culture in TB diagnosis
key diagnostic tool used to identify mycobacterium TB
50
what is used to detect latent TB 3 points
TB skin test TB blood test they cannot distinguish between active and latent
51
what can be present on CXR for TB
fibro-nodular changes and lesions not diagnostic though
52
complications of TB
pleural effusion haematogenous cardiac TB ocular TB hepatic TB GIT TB
53
what are the rules for good treatment in TB 3
combination drug therapy standardised good treatment adherance
54
what is the standard treatment for TB (overall duration, phase duration)
6 months divided into 2 phases 2 months: intensive phase w 4 drugs to kill multiplying baccili 4 months: continuation phase w 2 drugs killing semi-dormant
55
what is DOT in TB treatment
Directly observing therapy used to ensure strict adherence and assess any side effects from high drug load
56
what is the key drug used in the first phase of TB
isoniazid
57
what is the key drug used in the second phase of TB
Rifampicin
58
example of drug resistant TB strain
MDR-TB = multi drug resistant TB resistant to both isoniazid and rifampicin
59
definition of an acute chest infection
infection that lasts <3 weeks
60
definition of a chronic chest infection
infection that lasts >3 weeks often characterised by periods of stability and then exacerbations
61
physiological risk factors for chest infection development
impaired mucous removal reduced respiratory effort decreased cough reflex immunocomprimised patients
62
bronchiectasis definition
chronic inflammation of upper airways leading to: - mucous build up - scarring - abnormal widening of bronchi
63
Pathogenesis of bronchiectasis 6
impaired drainage obstruction due to structural abnormalities and mucuous accumulation inflammatory response transmural inflammation loss of elasticity in bronchial walls airway remodelling and dilatation
64
symptoms features of bronchiectasis 4
productive cough dyspnoea wheeze recurrent infections
65
clinical findings in bronchiectasis 2
clubbing coarse crackles
66
clincal investigations in bronchiectasis 5
sputum culture CXR lung function tests CBE blood test
67
treatments for bronchiectasis 4
mucolytics antibiotics physiotherapist pulmonary rehabilitation
68
genetic characteristics of CF 2
autosomal recessive most common genetic disease
69
6 classes of cystic fibrosis
these are based off of severity of gene mutation 1 = no protein produced 2 = no trafficking, cell degrades protein prior to docking 3 = no function 4 = reduced function 5 = less protein 6 = less stable
70
pathogenesis of CFTR protein
mutation in CFTR gene CFTR protein not produced properly Causes defective chlorine channel affects ion transportation More sodium retained in cells Liquid depletion in fluids leaves thickened mucous decreased mucociliary clearance inflammation and infection
71
what and why does CFTR impact so many organs 5
CFTR protein found on epithelial cells across the body, therefore affects multiple systems including: - lungs - pancreas - liver -glandular - reproductive organs
72
why is genotyping useful in CF management
determine the specific mutation and therefore direct management
73
groups of treatment pathways in CF 3
symptomatic therapy CFTR modulator drugs genetic therapies
74
symptomatic therapy treatments in CF 4
mucolytics pancreatic enzymes chest physio antibiotics
75
CFTR modulator drugs characteristics 4
only for certain mutations increase CFTR activity slow disease progression example is Trikafka
76
where is ground glass opacity common
interstitial lung disease
77
what are miliaries
multiple well defined nodules spread diffusely through the lungs
78
what includes correct procedure for inhaler usage 5
1. shaking puffer before use 2. if using spacer coating inside w one puff prior to use 3. exhale fully first 4. large inhale 5. rinse mouth after

M1 (13 decks)

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