HLB - MTT Combined set

what are three examples of DPLD

pulmonary fibrosis, sarcoidosis, pneumoconiosis

what are the lung parenchyma

the alveoli and interstitium

what are five examples of pleural disease

pleural effusion, pneumothorax, haemothorax, pleural thickening, mesothelioma

what are four examples of chest wall disease

neuromuscular disease, diaphragmatic palsy, kyphosis, scoliosis

what disease is pulmonary fibrosis associated with

collagen vascular disease

how is pulmonary fibrosis treated

by antifobrotic treatment

what can sarcoidosis progress into

pulmonary fibrosis

what is the primary site of injury for fibrosis of the lungs

the interstitium

in DPLD what occurs to JVP

it is increased

what is JVP

jugular venous pressure

what does DPLD stand for

diffuse parenchymal lung disease

is peripheral oedema a sign off DPLD

yes

what is meant by loud P2 heart sound

loud pulmonary valve closure sound

what would a CT show for idiopathic pulmonary fibrosis

traction bronchial dilation and honeycombing

what two diseases are NSIP associated with

autoimmune disease and collagen vascular disease

what has a better prognosis and response to anti-inflammatory drugs, IPF or NSIP

NSIP

what does NSIP stand for

non-specific interstitial pneumonia

what does a CXR show for NSIP

small lungs with reticulo nodular changes

what does a CT show for NSIP

ground glass changes

what are ground glass changes

hazy grey and increased density areas in the lungs

what is sarcoidosis

a multi-system granulomatous disease

what is sarcoidosis characterised by

non-caseating granulomas

what can inhaled beryllium dust result in

pulmonary granulomas

what are the three ways in which sarcoidosis can present

acute, chronic or asymptomatic

what symptoms are common to both acute and chronic sarcoidosis

breathlessness, reduced appetite, weight loss

what is a common skin lesion symptom for acute and chronic sarcoidosis

erythema nodosum

what is loefgren’s syndrome

a classic acute presentation of sarcoidosis

what does loefgren’s syndrome consist of

erythema nodosum, bilateral hilar lymphadenopathy, and acute arthritis

is anterior uveitis a symptom of acute sarcoidosis

yes

what is anterior uveitis

eye inflammation

is lymphadenopathy a common symptom for acute sarcoidosis

yes

what is lymphadenopathy

swollen lymph nodes

how is acute sarcoidosis treated

by oral prednisolone

which two skin liesons are symptoms of chronic sarcoidosis

lupus pernio, erythema nodosum

are renal stones and bone pain symptoms of acute or chronic sarcoidosis

chronic

how many radiological stages are there for sarcoidosis

five

what does the radiological stage zero show for sarcoidosis

normal chest x-ray

what does the radiological stage one show for sarcoidosis

bilateral hilar lymphadenopathy

what does the radiological stage two show for sarcoidosis

node and upper zone parenchymal disease

what does the radiological stage three show for sarcoidosis

parenchyma disease

what does the radiological stage four show for sarcoidosis

pulmonary fibrosis

what is the differential diagnosis for stage I and II in radiological staging for sarcoidosis

TB

what is the differential diagnosis for stage III and IV in radiological staging for sarcoidosis

other DPLDs

what does a CT often show due to pleural disease

calcified pleural plaques

what is a common cause for calcified pleural plaques

asbestos exposure

what is pleural effusion

fluid in the pleural space

what is thoraconcentesis

pleural aspiration

biochemically, how can pleural effusion be determined

when there is an increase in protein and lactate dehydrogenase

what is transudate a sign of

low protein

Out of transudate and exudate, which one is linked to unhealthy pleura

exudate

out of transudate and educate, which one is linked to low protein

transudate

out of transudate and exudate, which one is linked to reduced optic pressure

transudate

what is transudate caused by

congestive cardiac failure, or low albumin

what is low albumin caused by

nephrotic syndrome/ kidney failure

what is exudate caused by

malignancy, autoimmune disease, or chest infection

what is the edudate chylothorax due to

blocked lymphatics

what is the most reliable clinical finding for pleural effusion

dullness on percussion

is reduced chest wall movement and reduced air entry a clinical sign of pleural effusion

yes

what is pneumothorax

air in the pleural space

how is pneumothorax managed

with aspiration of air using a needle or local anaesthetic

Except for underlying lung disease, how is pneumothorax caused

by rupture of alveol near pleural space

what is haemothorax

blood in the pleural space

What is mesothelioma

cancer of the mesothelium

what can chest wall disease result in

difficulty expanding the lungs

what is an obstructive lung disease

when air can enter the lungs but has difficulty leaving due to narrowed or collapsed airways

what is a restrictive lung disease

when the lungs cannot expand properly, resulting in reduced lung volumes

is COPD obstructive or restrictive

obstructive

is DPLD obstructive or restrictive

restrictive

is asthma obstructive or retrieve

obstructive

is bronchiectasis obstructive or restrictive

obstructive

Is pulmonary fibrosis obstructive or restrictive

restrictive

is sarcoidosis obstructive or restrictive

restrictive

what is hypersensitivity

an immune disorder caused by inappropriate response to antigens that are not necessarily pathogens

how many categories of hypersensitivity are there

4

what is an allergy

a damaging immune response by the body to an allergen to which it has become hypersensitive to

what does an allergic response trigger an increase in

vascular permeability and inflammation

what is meant by a local allergic response

when symptoms are restricted to the site where the antigen interacts with the body

what is meant by anaphylaxis

a system wide allergic response

what is type I hypersensitivity

allergy and atopy/ immediate hypersensitivity

what is atopy

a genetic disposition to develop an allergic reaction

which antibody is type I hypersensitivity driven by

igE

what do individuals without allergies generally only produce IgE antibodies in response to

parasitic infections

what processes, apart from the action of IgE, are involved in type I hypersensitivity

degranulation of mast cells, basophils, and eosinophils

in type I hypersensitivity, what receptor do mast cells, basophils and eosinophils express

Fc3RI

what does FcεRI act as

a main mediator of allergy symptoms

what can FcεRI be cross linked via

igE complexes

what does the cross linkage of FcεRI initiate

a signalling cascade, resulting in mast cell and basophil degranulation, with the release of inflammatory mediators

when does the degranulation and secretion of molecules occur in type 1 hypersensitivity

after Fc3RI binds to IgE and triggers the signalling cascade

what lipid mediators are released in type 1 hypersensitivity

prostaglandins and leukotrienes

what do prostaglandins and leukotrienes cause

vasodilation and smooth muscle contraction

what is responsible for inflammation in type 1 hypersensitivity

cytokines

what does exocytosis of the granule cause in type 1 hypersensitivity

vasoactive amines and proteases

what are vasoactive amines responsible for

vascular dilation and smooth muscle contraction

what are proteases responsible for

tissue damage

how does the gradient differ between the immediate reaction and the late phase reaction

the immediate reaction has a higher peak

in the asthmatic response, what does histamine initially cause

the contraction of the bronchial and tracheal smooth muscles

what does histamine bind to

the H1 receptor

in the asthmatic response, what occurs when histamine binds to the H1 receptor

there is an increase in vascular permeability and mucus secretion

asthma is an example of what type of hypersensitivity

type I

what releases phospholipase in the asthmatic response

degranulation