1
Q
Describe the Epidemiology of Asthma (2)
A
- Commonly presents in childhood/adolescence
- More common in developed countries
2
Q
What are the two types of Asthma
A
- Allergic/Eosinophillic
- Non-Allergic/Non Eosinophillic
3
Q
What are the 3 main characteristics of Asthma
A
- Airway hyper-responsiveness
- Airway obstruction
- Bronchial inflammation/fibrosis with smooth muscle hypertrophy, increased mucosal secretion and epithelial damage
4
Q
What are the risk factors for Asthma (5)
A
- Atopy
- Family History
- Premature birth
- Obesity
- Poor socioeconomic status
5
Q
What are the main precipitating factors for Asthma (6)
A
- Cold air
- Smoke (tobacco)
- Exercise
- Allergens
- Stress
- NSAIDs and Beta blockers
6
Q
How might someone with Asthma present (6)
A
- Intermittent dyspnoea
- Wheeze
- Frequent exacerbation due to an identifiable factor
- Cough
- Symptoms worse at night
- Often a younger patient
7
Q
What tests might you do in Asthma (4)
A
- RCP3
- Spirometry
- Obstructive pattern (FEV1/FVC <0.7) - PEFR diary with introduction of Salbutamol
- Skin prick test (for allergies)
8
Q
What medication might you prescribe in Asthma (3)
A
- Beta agonists
- SABA (salbutamol)
- LABA (Salmeterol) - Muscarinic Antagonists
- SAMA (Ipratropium)
- LAMA (Tiotropium) - Inhaled Corticosteroids
- Prednisolone
- May be given systemically if ineffective
9
Q
What is the medication Guideline regime in Asthma (4)
A
- SABA
- SABA and ICS
- SABA and LABA and ICS
- SABA and LABA and ICS plus 4th?
10
Q
How would a patient having an acute Asthma attack present (3)
A
- Tachycardia
- Resp. Rate > 24
- Unable to finish sentences due to severe
breathlessness
11
Q
How would you treat an acute Asthma attack (3)
A
- Oxygen (keep above 92%)
- Nebulised Salbutamol
- Prednisolone
12
Q
What is COPD
A
- A disease state with progressive airway obstruction that is not fully reversible
13
Q
What are the risk factors for COPD (3)
A
- Smoking
- Alpha 1 Antitrypsin defficiency
- Occupational factors (Coal dust, chemicals, etc.)
14
Q
What are the two diseases in COPD
A
- Chronic Bronchitis
- Emphysema
15
Q
Describe the pathophysiology of Chronic Bronchitis
A
- Airway narrowing and increased mucosal secretions in response to inhaled irritants
- Hypertrophy and Hyperplasia of mucus scereting glands of Bronchi
- Inflammation and fibrosis of Bronchial walls leading to airway narrowing
- Blue Bloaters
16
Q
Describe the pathophysiology of Emphysema
A
- Dilatation and destruction of lung tissue distal to bronchioles in reponse to inhaled irritants
- inflammation leads to decreased elastic recoil and dilatation of alveoli
- This leads to alveolar collapse and decreased compliance/ decreased gas exchange
- pink puffers
17
Q
How might someone with COPD present (6)
A
- Chronic productive (clear) cough
- Breathlessness
- Wheeze
- Frequent infections
- Symptoms worsened by cold/damp
- Usually older Smokers
18
Q
What is the treatment for COPD (4)
A
- Smoking cessation (most effective)
- B2 Agonists
- LABA (salmeterol)
- SABA (salbutamol) - Corticosteroids
- 2 week prednisolone trial
- beclametasone ICS if improves symptoms - Oxygen therapy
19
Q
What type of disease is Hypersensitivity Pneumonitis
A
- Autoimmune Interstitial Lung Disease (restrictive)
20
Q
What is the epidemiology of Hypersensitivity Pneumonitis (2)
A
- Usually in Adults
- Acute, Sub-Acute and Chronic Forms
21
Q
What are the causes/risk factors for hypersensitivity pneumonitis
A
- Farmers Lung (Mouldy Hay)
- Cheese Workers Lung (Mouldy Cheese)
- Pigeon Fanciers Lung (Proteins in droppings)
- Malt Worker (Mouldy Malt)
- Existing Lung Disease
22
Q
Describe the Pathophysiology of Hypersensitivity Pneumonitis
A
- Type 3 hypersensitivity reaction
- Cellular immune response and immune complex deposition in response to inhaled allergen
- This leads to granulatomous inflammation and hence progressive fibrosis of the lung parenchyma
23
Q
How might someone with acute Hypersensitivity Pneumonitis present (6)
A
- Fever, sweats, rigor
- Dyspnoea
- Dry cough
- Myalgia
- Crackling
- Tight chest
24
Q
How might someone with sub-acute Hypersensitivity Pneumonitis present (8)
A
- Similar to acute but less pronounced and slower onset
- May have a history of acute attacks
- Fever, sweats, rigor
- Dyspnoea
- Dry cough
- Myalgia
- Crackling
- Tight chest
25
How might someone with Chronic Hypersensitivity Pneumonitis present (5)
- Unlikely to have history of acute attack
- Progressive dyspnoea
- Weight loss
- Cyanosis
- Finger clubbing
26
What tests might you do on someone with Hypersensitivity Pneumonitis (3)
- Bloods
- Raised ESR/CRP
- Raised WCC
- Chest X-Ray
- Diffuse Nodular Shadowing
- Fibrotic Shadowing in upper zone
- Spirometry
- Reversible Restriction
27
How would you treat someone with Acute/ Subacute Hypersensitivity Pneumonitis (3)
- Remove Allergen
- Oxygen
- Prednisolone
28
How would you treat someone with Chronic Hypersensitivity Pneumonitis (2)
- Avoid exposure to allergen
| - Prednisolone
29
Describe the Epidemiology of Brochiectasis (3)
- More common in Females
- Often caused by infection
- Incidence increases with age
30
What are the causes of Bronchiectasis (3)
- Infection
- Pneumonia/TB
- Congenital
- Cystic Fibrosis/Primary Ciliary Dyskinesia
- Mechanical bronchial obstruction
- Tumour
31
Describe the Pathophysiology of Bronchiectasis
- Decreased Mucociliary clearance and impaired immune function lead to recurrent lung infections
- This results in constant bronchial wall inflammation and fibrosis
- In response to this the airways permanently dilate
32
How might someone with Bronchiectasis present (6)
- Chronic productive cough with green smelly sputum
- Dyspnoea
- Chest pain
- Recurrent infection
- Wheeze
- Finger clubbing
33
What tests might you run for Bronchiectasis (5)
- Chest X-Ray
- Dilated Airways
- Sputum Culture
- Look for bacterial colonisation
- Spirometry
- Restrictive pattern
- Test for Cystic Fibrosis
- Bronchoscopy
34
What is the treatment for Bronchiectasis (3)
- Mucus Drainage
- Antibiotics to treat infections
- Bronchodilator
- ICS
35
Describe the Epidemiology of Cystic Fibrosis (3)
- More common in Caucasians
- Multi-System mostly affects lungs and pancreas
- Autosomal recessive
36
Describe the pathophysiology of Cystic Fibrosis
- Mutation of Cystic Fibrosis gene on chromosome 7
- Codes for Cystic Fibrosis Transmembrane regulator
- CFTR tranports Cl which is followed by Na then water into mucus
- in CF this means that less water moves into mucus resulting in thicker secretions
- Leads to Obstruction/ Bronchiectasis and Pancreatic insufficiency
37
How might someone with Cystic Fibrosis present (9)
- Thicc mucus
- Cough
- Shortness of breath
- Anorexia/ Weight loss
- Bowel obstruction
- Wheeze
- Recurrent infection
- Diabetes
- Weight loss
38
What tests might you run for Cystic Fibrosis (3)
- Genetic screening
- Sweat test (Salt >60mmol/L)
- Clinical/Family History
39
What is the treatment for Cystic Fibrosis (7)
- Education
- Vaccination/Antibiotics
- Pancreatic replacement therapy
- ADEK vitmain suplements
- B2 agonists and ICS to relive symptoms
- Stop Smoking
- Amiloride (reduces Na transport)
40
Describe the Epidemiology of Sarcoidosis (4)
- Type of Interstitial lung disease
- Commonly affects adults 20-40
- More common in women
- Multi-system granulatomous disease mostly affects lungs and Lymph nodes
41
How might someone with Sacrcoidosis present (6)
- Fever, Fatigue, Weight loss
- Erythema Nodosum (red lumps on skin)
- Cough
- Progressive dyspnoea
- Lymphadenopathy
- Chest pain
- plus so many others i cba fucking learning
42
What tests might you run for Sarcoidosis (3)
- Chest X-Ray
- Bilateral Hilar Lymphadenopathy
- Lung infiltrates/fibrosis
- Biopsy
- Non Caseating Granulomas (DIAGNOSTIC)
- Bronchoscopy
43
How would you treat Sarcoidosis (2)
- Acute attack
- Bed rest and NSAIDs
- Steroids
- Prednisolone (IV Methylprednisolone if severe)
44
Describe the epidemiology of Idiopathic pulmonary fibrosis (IPF) (3)
- More common in Males, Inc. with age
- Most common cause of interstitial lung disease
- Progressive lung fibrosis of unknown cause
45
Describe the pathophysiology of IPF
- Progressive fibrosis of lung parenchyma
| - Leads to decreased lung compliance and impaired gas exchange due to thicker alveolar membrane
46
What are the risk factors for IPF (5)
- Smoking
- Infectious agents
- GORD
- Occupational exposure
- Drugs
47
How might someone with IPF present (6)
- Dry cough
- Progressive dyspnoea
- Crackle
- Malaise/Arthralgia
- Weight loss
- Cyanosis/Finger clubbing
48
What tests might you run for IPF (4)
- Chest X-Ray
- High Resolution CT
- Spirometry
- Restriction
- Biopsy
49
How do you treat IPF (4)
- Oxygen
- Opiates
- Treat cough/GORD
- Anti fibrotic
- Perfenidone (if eligible)
50
Define Pulmonary Hypertension
- Mean pulmonary arterial pressure >25 mmHg with secondary right heart failure
51
Describe the epidemiology of Pulmonary Hypertension
- May be caused by any disease that causes increased resistance to pulmonary flow or increased blood flow from RV
52
Describe the Pathophysiology of Pulmonary Hypertension
- Raised MAP leads to arterial wall damage causing release of vasoconstrictors
- Vasoconstriction caused increased afterload leading to RV hypertrophy, dilatation and faliure
53
How might someone with Pulmonary Hypertension present (5)
- Exertertional dyspnoea
- Chest pain
- Fatigue/lethargy
- Oedema
- Syncope
54
What tests would you run for Pulmonary Hypertension (3)
- Chest X-Ray
- PA dilated proximally then taper distally
- RV hypertrophy
- ECG
- RV hypertrophy
- Right heart catherterisation
- Mean Pulmonary arterial pressure >25
55
How do you treat Pulmonary Hypertension (4)
- Treat underlying cause
- CCB
- Verapamil (pulmonary vasodilators)
- Warfarin
- Diuretics for Oedema
56
Define Pleural Effusion
- An excess accumulation of fluid in the pleural cavity
57
Describe the epidemiology of pleural effusion (2)
- Transudates and Exudates
| - More common in adults
58
Describe the pathophysiology of pleural effusion
- Transudates Protein <20
- Leakage of fluid into pleural cavity due to
decreased blood oncotic pressure
- Exudates Protein >20
- Leakage of fluid into pleural cavity due to
increased capillary/pleural permeability due to
infection/inflammation/malignancy
59
How might someone with pleural effusion present (5)
- Dyspnoea
- Cough
- Pleuritic chest pain
- Decreased chest expansion on side of effusion
- Dull percussion/diminished breath sounds
60
What tests would you do for pleural effusion (2)
- CXR
- Water shadowing
- Pleural tap
- Needle aspiration
- Sample sent to lab
61
How might you treat pleural effusion
- Transudates treat underlying cause
| - Exudates drainge
62
Describe the epidemiology of pneumothorax (2)
- Spontaeous or secondary to trauma
| - More common in males
63
What are the risk factors for pneumothorax (4)
- Smoking
- Male
- Tall and thin
- Mechanical Ventilation
64
Describe the pathophysiology of pneumothorax
- Normally pressure in pleural cavity is negative but when a tear in pleura occurs it becomes the same as the lung
- This causes partial collapse of the lung due to its elastic recoil
65
How might someone with a pneumothorax present (4)
- Sudden onset dyspnoea and pleuritic chest pain
- Hyper-resonant to percussion and diminished breath sounds
- Reduced chest expansion
- Pallor and tachycardia as it progresses
66
What tests might you run for pneumothorax (1)
- CXR
- Areas devoid of lung markings
- Blurred lines (i know you want it)
67
What is the treatment for pneumothorax (3)
- Needle aspiration then chest drain
- Oxygen
- Surgery if reccurent
68
Describe the epidemiology of Bronchial Carcinoma (4)
- Most common metastatic tumour
- Secondary more common than primary
- 3rd biggest killer in UK
- More common in men
69
What are the risk Factors for Bronchial carcinoma (4)
- Smoking
- Occupational exposure eg. Asbestos/coal
- Radiation
- Previous/current lung disorder
70
What are the two categories of Bronchial carcinoma
- Small cell carcinoma
| - Non small cell carcinoma
71
Describe small cell carcinoma (4)
- Associated with smoking
- Early metastases
- Arises from endocrine cells
- Poor prognosis
72
Describe Non small cell carcinoma
- Squamous cell carcinoma
- most strongly associated with smoking
- Adenocarcinoma
- Most common overall
- Fairly metastatic
73
Where might Bronchial Carcinoma spread (5)
- Bones
- Lymph nodes
- Brain
- Adrenal glands
- Liver
74
Where can secondary bronchial carcinoma arise from (4)
- Bladder
- Kidney
- Breast
- Bowel
75
How might someone with bronchial carcinoma present (6)
- Weight loss/ malaise
- Cough/ Wheeze
- Haemoptysis
- Chest pain
- Reccurent infection
- Shortness of breath
76
What tests might you do for bronchial carcinoma (3)
- CXR
- Round shadowing
- CT for staging- TNM
- Bronchoscopy and biopsy
77
How might you treat bronchial cell carcinoma (3)
- Surgical excision
- Chemo/Radiotherapy
- Palliative
- Bronchodilators
- Analgesia
- Steroids
- Anti Emetics
78
Describe the Epidemiology of Mesothelioma (3)
- More common in males
- 40-70
- Strong association with asbestos exposure
79
Describe the pathophysiology of mesothelioma
- High grade malignancy that starts as nodular and spreads to encompass the entire pleural surface
80
How might someone with Mesothelioma present (4)
- Weight loss/malaise
- Shortness of breath
- Chest pain
- Recurrent pleural effusion
81
What tests might you run for mesothelioma (2)
- CXR
- Pleural effusion and thickening
- Biopsy
82
Describe the treatment for mesothelioma
- 'youre fucked mate'
- Generally resistant to surgery, Chemo and Radiotherapy
- Diagnosis- Death = 8 months
83
How might someone with Pharyngitis/Tonsilitis present (5)
- Inflamed tonsils
- Sore throat
- Tender neck glands
- Tender cervical lymph nodes
- High temperature
84
How do you treat Pharyngitis/Tonsilitis
- No treatment required
- If persistent Penoxylmethylpenicillin (swear big pharma just try to piss of med students because they couldn't get into med school)
85
How might someone with sinusitis present (4)
- Frontal headache
- Tender face pain
- Rhinorrhea
- Fever
86
How do you treat Sinusitis (2)
- Nasal decongestants
| - Co-amoxiclav
87
How might someone with acute epiglottitis present (4)
- High fever
- Airflow obstruction
- Sore throat and pain on swallowing
- Sits up straight and inspiratory wheeze
88
How do you treat acute epiglottitis (2)
- Urgent endotracheal intubation
| - IV ceftazidime
89
How might someone with whooping cough present (4)
- Chronic cough
- Vomiting during/ after attacks
- Fever
- Inspiratory whoop
90
How do you treat whooping cough (2)
- Clarithromycin
| - Vaccination
91
Describe the epidemiology of Pneumonia (4)
- Hospital aquired Pneumonia
- Community aquired Pneumonia
- Aspiration Pneumonia
- Immunocompromised
92
What are the risk factors for Pneumonia (5)
- <16
- >65
- Immunocompromised
- Smoking
- IV drug use
93
Describe the pathophysiology of Pneumonia
- Spread by respiratory droplets
- Bacteria invade normally sterile distal airways
- Alveolar macrophages overwhelmed do recruit neutrophils
- Neutrophils produce inflammatory exudate (pus)
- In non-severe this is then cleared by apoptosis
- In severe there is
- Non resolution
- Excess inflammation
- Lung injury
94
How might someone with Pneumonia present (5)
- Fever, sweats, rigors
- Productive cough
- Pleuritic chest pain
- Dull to percussion/decreased breath sounds
- Breathlessness
95
What tests might you run for Pneumonia (3)
- CXR
- Shadowing (diffuse)
- Sputum culture
- Bloods
- Raised ESR, CRP, WCC
96
What are the common bacterial causes of pneumonia (5)
- Haemophilus Influenzae (CAP)
- Streptococcus Pneumoniae (CAP)
- Kelbsiela Pneumoniae (CAP and HAP)
- E. Coli (CAP and HAP)
- Staphylococcus Areus (HAP)
97
How do you Assess the severity of pneumonia
```
- CURB65 1 point for each
Confusion?
Urea (6mmol/L)
Resp. rate >30
Blood pressure <90/60
65 >65
- 0/1= mild 1/2= moderate (Hospital) 3/4= severe (Hospital) 5= ITU admission
```
98
How do you treat Pneumonia (4)
- Oxygen
- Analgesia
- Mild - clarithromycin
- Severe - iv Co-amoxiclav and clarithromycin
99
What are potential complications of pneumonia (3)
- Resp. failure
- Parapneumonic effusion
- Hypotension
100
Describe the epidemiology of Tuberculosis (3)
- 1/3 of population infected
- 9 million cases 2 million deaths each year
- Main cause of death in HIV
101
What are the four main causes of TB (bacteria)
- Mycobacterium tuberculosis
- Mycobacterium bovis
- Mycobacterium africanum
- Mycobacterium microti
102
What are the risk factors for TB (6)
- HIV/immunosupression
- Homeless/prison
- Malnutrition
- Diabetes
- IV drug use
- Inc. age
103
How might someone with TB present (5)
- Weight loss/anorexia
- Productive cough
- Chest pain
- Shortness of breath
- Fever/malaise/sweats
104
What tests might you do in TB (3)
- CXR
- Nodular shadowing
- Diffuse consolidation
- Sputum sample
- Bronchoscopy (if cannot get sputum)
105
How do you treat TB (2)
- Notify public health england (and their mum)
- RIPE
Rifampicin (6 months)
Isoniazid (6 months)
Pyrazinamide (2 months)
Ethambutol (2 months)
106
What are the risk factors for pulmonary embolism (2)
- DVT (surgery, fracture, plane)
| - Polycythaemia
107
How might PE present (5)
- Sudden onset dyspnoea (most common)
- Pleuritic chest pain
- Haemoptysis
- Raised resp. rate
- Hypotension/tachycardia
108
How do you diagnose PE (3)
- Plasma D-dimer
- CT pulmonary angiography
- CXR- small effusion
109
How do you treat PE (5)
- Oxygen
- Morphine
- LMW heparin (enoxaparin)
- Thrombolysis
- Surgery
110
What is the epidemiology of occupational asthma (4)
- 15% of all adult onset asthma
- 90% due to allergen exposure at work
- 10% due to lung injury with exposure to irritant
- 1500-3000 cases per year
111
What are the features of occupational asthma (5)
- Latent period
- Deterioration
- Gradual improvement
- Often causes depression
- Associated with flour, wood, metal and paint spray
112
What happens to patients post occupational asthma diagnosis (4)
- Unemployment
- Compensation
- Chronic resp. disorder
- Depression
113
How can you prevent occupational asthma (5)
- Risk assessment
- Elimination
- Substitution
- Masks/ventilators
- Ventilation
Phase 2
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