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Respiratory > MRCP > Flashcards

MRCP Flashcards

1
Q

What are the causes of lung fibrosis?

A 
Idiopathic
Drugs - Methotrexate, Nitrofurantoin
Connective Tissue Disease - SLE, Scleroderma
Asbestosis
Radiotherapy
Extrinsic allergic alveolitis - occupational exposures
Sarcoidosis
TB
Cryptogenic fibrosing alveolitis
RA
AS
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2
Q

Respiratory causes of clubbing?

A

Idiopathic Pulmonary Fibrosis
Bronchiectasis
Cystic Fibrosis
Lung Ca

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3
Q

What is the difference between an exudate and a transudate?

A

Exudate - high protein, local pathology, unilateral

Transudate - low protein, systemic pathology, bilateral

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4
Q

What are the causes of an exudative pleural effusion and transudative pleural effusion?

A

Exudate: Malignancy, TB, Pneumonia, PE
Transudate: Heart failure, nephrotic syndrome, Liver failure, Peritoneal dialysis

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5
Q

Differentials for a patient with a Lobectomy/Pneumonectomy scar?

A

Neoplasm - any kind of lung Ca - lobectomy or pneumonectomy
Bronchiectasis
COPD - volume reduction surgery
TB - Old treatment (pneumonectomy only)
Consider lung transplant, A1AT deficiency, empyema/abscess

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6
Q

Causes of bronchiectasis?

A 
Cystic Fibrosis
Post-TB, pneumonia
Primary ciliary dyskinesia
RA, IBD, GORD
Allergic broncho-pulmonary aspergillosis
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7
Q

Signs and symptoms of Sarcoidosis?

A

General - constitutional symptoms
Respiratory - dry cough, SOB, chest pain, reduced lung function
Arthralgia - polyarthralgia, dactylitis
Neurological - peripheral and cranial polyneuropathy
Urine - increased calcium - stones
Low hormones - pituitary dysfunction
Ophthalmological - Uveitis, keratoconjunctivitis
Myocardial - Restrictive cardiomyopathy
Abdominal - Hepatosplenomegaly
Skin - Lupus Pernio and Erythema Nodosum (both painful)

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8
Q

Investigations in Sarcoidosis?

A 
Raised Ca
Raised ESR
High Ig
Bilateral hilar lymphadenopathy on CXR
Restrictive spirometry
Tissue biopsy - non caseating granulomas (in contrast to TB)
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9
Q

X Ray findings in Idiopathic Pulmonary Fibrosis?

A

Small peripheral opacities in the lower zones

Honeycombing is a late feature in IPF

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10
Q

Spirometry findings in IPF?

A

Restrictive pattern (Reduced FEV1, reduced FVC and increased FEV1/FVC ratio)

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11
Q

Most commonly isolated causative organism in Bronchiectasis?

A

Haemophilus Influenzae
Pseudomonas Aeruginosa
Klebsiella
Strep Pneumoniae

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12
Q

Paraneoplastic syndromes associated with squamous cell lung cancer?

A

Parathyroid hormone related peptide secretion causing hypercalcemia (normal - low PTH level)
Hypertrophic pulmonary osteoarthritis
Ectopic TSH secretion leading to hyperthyroidism
Cavitating lung lesions

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13
Q

COPD inhaler escalation guidelines - no asthmatic features?

A
  1. SABA/SAMA
  2. LABA + LAMA
  3. LABA + LAMA + ICS
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14
Q

COPD inhaler escalation guidelines - asthmatic features?

A
  1. SABA/SAMA
  2. LABA + ICS
  3. LABA + LAMA + ICS
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15
Q

Indications for prophylactic antibiotics in COPD?

A

Non smokers
Continuing to have exacerbations despite maximal inhaler therapy
Standard inhaler therapy is optimised
Sputum culture to rule out atypicals
CT Chest to exclude bronchiectasis?
Before starting do an ECG to rule out long QT

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16
Q

Most common cause for extrinsic allergic alveolitis?

A

‘Farmers lung’, ‘bird fanciers’ lung’, ‘malt workers lung’, ‘mushroom workers lung’ - occupational exposures
Contaminated hay (farmers) - source of S. Rectivirgula
Type 3 hypersensitivity reaction - immune mediated tissue damage in the acute phase, then Type 4

17
Q

Asthma inhaler escalation guidelines?

A
  1. SABA
  2. ICS
  3. ICS + Leukotriene receptor antagonist
  4. ICS + LABA (+/- LTRA according to response)
  5. Add in varying combinations of MART
18
Q

Contraindications to lung transplant?

A

CF - colonisation with Burkholderia Cepacia (associated with low survival rate, rapid disease progression and recurrence after transplant)
Systemic sepsis

19
Q

Features of adenocarcinoma lung?

A

Non-smokers

20
Q

Causes of predominantly lower zone fibrosis?

A

Asbestosis
IPF
Connective tissue disorders
Drug induced (e.g. Amiodarone)

21
Q

Causes of predominantly upper zone fibrosis?

A 
Coal dust
TB
Crystalline silica dust
EAA
Sarcoidosis
22
Q

Causes of left shifted oxygen dissociation curve?

A 
This leads to lower oxygen delivery to tissues (more bound)
Alkalosis
Pyrexia
Carboxy/methaemoglobin
HbF
23
Q

Causes of right shifted oxygen dissociation curve?

A 
This leads to raised oxygen delivery to tissues (less bound)
Acidosis
Raised CO2
Pyrexia
Exercise
24
Q

Major criteria for diagnosis of Allergic Bronchopulmonary Aspergillosis?

A 
Features of asthma exacerbation
Proximal bronchiectasis on CXR
Eosinophilia
Immediate skin reactivity to Aspergillus
Increased serum IgE
25
Q

Most common bacterial organisms in COPD?

A

Haemophilius Influenzae
Moraxella
Strep Pneumoniae

Respiratory (1 decks)

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