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MRCP Part 1 > MRCP Resp > Flashcards

MRCP Resp Flashcards

1
Q

What Epworth score and above is OSA and the management including DVLA advice

A

10 or more

DVLA- lorry driver cannot drive until treated

Mx:
All: weight loss
First line: CPAP at night
Second: Mandibular advancement if CPAP not tolerated or mild OSA

Modafanil for day time sleepiness

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2
Q

Outline lung function test for obstructive and restrictive with examples

A

Obstructive:
FEV1/FVC <75%
- asthma (normal transfer factor)
- COPD (reduced transfer factor)
- bronchiectasis
- early CF

Restrictive:
FEV1/FVC >75%
- pulmonary fibrosis
- severe obesity
- scoliosis
- sarcoidosis
- asbestosis
- neuromuscular disease

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3
Q

What is the investigation and management of goodpastures?

A

Renal biopsy

Medical:
- steroid
- cyclophosphamide
- dialysis
- plasma exchange

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4
Q

What is paradoxical hemidiaphragm movement?

A

With unilateral paralysis of diaphragm, during sniff test in fluoroscopy- normal side descends forcefully -> increasing intraabdo pressure-> pushing the paralysed side up

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5
Q

What is hypogammaglobuninaemia ataxia telangiectasia?

A

Auto recessive

Deficiency in humoural immunity -> recurrent infection and tumour risk

Progressive ataxia and multiple telangiectasia (bleed)

Risk of bronchiectasis

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6
Q

What should you monitor in GBS for respiratory muscle involvement?

A

FVC

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7
Q

What is the management of radiation pnuemonitis?

A

Steroids

for 3-4 weeks

then taper and stop

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8
Q

What is another name for Lyme disease

A

Borreliosis due to Borellia Burgdoferi

Tick bite

Headache/malaise/fever/facial paralysis/arthritis/erythema migrans

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9
Q

What is hepatopulmonary syndrome

A

liver failure-> NO release-> cause vasodilation of lung vasculature esp in bases (most oxygen exchange occur here) -> increased perfusion due to AV shunt -> less gaseous exchange as too quick -> hypoxaemia -> desaturation (on standing)

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10
Q

Presentation of GPA

A

Haemoptysis
Sinusitis
Nasal bridge collapse
Glomerulonephritis

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11
Q

What is the gold standard imaging choice for bronchiectasis?

A

HRCT

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12
Q

What test should be done pre op in patients with severe RA?

A

Spirometry - due to cricoarytenoid arthritis can cause stridor post op

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13
Q

Why do you repeat CXR with consolidative pneumonia after 4-6 weeks?

A

To ensure resolution- if not need to rule out bronchial carcinoma

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14
Q

What is the minimum number of hrs LTOT should be used per day?

A

15 hours, ideally 18 to maintain pO2 >8

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15
Q

What is the criteria for LTOT?

A

pO2 <7.3, normal/high pCO2

pO2 7.3-8, with cor pulmonale/peripheral oedema/nocturnal hypoxaemia

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16
Q

What is CREST syndrome and how does it manifest?

A

Calcinosis
Raynaud
Esophageal dysmotility
Sclerdactyly
Telangiectasis

Scleroderma => interstitial lung disease

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17
Q

What causes FVC to drop from 88% to 55% on lying down?

A

Diaphragmatic palsy

Note: obesity should not cause a huge drop

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18
Q

What is the BTS guideline for imaging pleural effusion after tap?

A
  1. CT thorax for architecture of effusion and cause and possible drain placement
  2. Bronchoscopy if CT and pleural biopsy non diagnostic
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19
Q

What causes neutrophil infiltrates in transbronchial biopsy and no granuloma?

A

polyarteritis nodosa.

medium artery vasculitis

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20
Q

What is Histiocytosis X, also known as Langerhans cell histiocytosis?

A

XS histiocytes - langerhan cells in bronchiolar (immune cell)

forms eosinophilic granuloma- seen as widepread nodules in lungs

CXR- bilateral symmetrical reticulonodular upper/middle zone

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21
Q

When is immunotherapy indicated for anaphylaxis

A

Latex exposure unavoidable

12 month treatment

slowly injecting allergen with increasing dose

protect for 3-5 years

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22
Q

How do you give mag sulf for acute asthma

A

single dose 1.2-2g IV over 20min

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23
Q

What is aspergillus precipitins?

A

IgG ab to aspergillus

(CHRONIC ABPA +/- aspergilloma)

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24
Q

What is Brucellosis?

A

Zoonotic bacterial infection

FLAW symptoms + arthralgia + GI + neuropsych symptoms

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25
What is Wunchereria bancrofti?
South asian tropical pulmonary eosinophilia associated with microfilaria cough/wheeze/fever/weight loss/LL swelling due to lymphatic obstruction
26
What medical management can you give for SIADH if fluid restriction fails?
demeclocycline
27
What treatment in COPD has mortality benefit ?
LTOT
28
What respiratory complications is RA associated with?
Bronchiolitis obliterans- inflamm and scarring of bronchioles-> irreversible obstructive lung Methotrexate induced fibrosis (lower)
29
What is caplan syndrome?
RA + pneumoconiosis
30
Lambert eaton syndrome vs Myaesthenia gravis
Both autoimmune disorders affecting the neuromuscular junction LEMS: antibodies attacking calcium channels, leading to muscle weakness that improves with use, often starting in the legs, and is associated with small cell lung cancer, mainly in older men with a smoking history. MG, caused by antibodies attacking muscle cell receptors, results in muscle weakness worsening with use, often beginning in the eyes with drooping eyelids and double vision, and is linked to thymoma, affecting younger women and older men.
31
Pathophysiology of TB
macrophage migrate to LN LN and lung lesion = > ghon complex form granuloma with histiocyte centre of caseous necrosis calcified ipsilateral hilar node is Rhanke's complex
32
4 Types of hypersensitivity
ACID Anaphylaxis - IgE Cytotoxic (activated by antibodies) Immune complex Delayed type T cell
33
Where does aspiration pneumonia commonly affect?
Right upper and middle lobe
34
What medication would you give for liver capsule pain?
Dexamethasone
35
Which occupational lung disease predisposes to TB?
Silicosis - toxin to macrophage hence immunocompromises
36
Which pathogen is associated with increased mortality and is contraindication to lung transplant in CF?
Burkholderia cenocepacia
37
Which medication should you give in pen allergic CAP?
Doxy/clarithromycin Note: Cefalexin cross cover with penicillin
38
What are the 4 subtypes of aspergillosis?
1. aspergilloma - no sx, mild haemoptysis 2. invasive- fever/cough/pleuritic chest pain 3. ABPA- cough/wheeze/SOB 4. Chronic BPA- cough/SOB
39
What does halo sign on HRCT indicate?
Aspergilloma
40
What additional test should you perform in patients that present with invasive fungal disease/PCP
HIV
41
What is the difference between bronchial carcinoid and carcinoid syndrome
Bronchial carcinoid are slow-growing neuroendocrine tumors that originate in the bronchi of the lungs symptoms like coughing, wheezing, and chest pain due to airway obstruction. Carcinoid syndrome is a group of symptoms including flushing, diarrhea, and rapid heart rate that occur when a carcinoid tumor secretes serotonin hormones into the bloodstream.
42
Which scan should be done to assess the nodes prior to further treatment in lung cancer?
PET
43
Gold standard test for CO poisoning and treatment?
ABG High levels of oxygen to displace CO
44
Outline investigation for APBA bronchiectasis
MOST SPECIFIC: positive (RAST) test to Aspergillus (skin prick) eosinophilia CXR- proximal bronchiec positive IgG precipitins (not as positive as in aspergilloma) raised IgE
45
What is contraindication for pneumonectomy in bronchial carcinoma?
FEV1 drop >50% FEV1 <1.6L Metastatic lung cancer/distant lymph nodes SVC obstruction Malignant pleural effusion Recurrent laryngeal nerve palsy Note: mediastinal LN does not confirm malignant spread
46
3 hallmarks to suggest ITU review needed in acute asthma
unable to speak in full sentences peak flow <33% normocapnia
46
What is the abx choice for chlamydia pneumonia/atypical pneumonia in pregnancy?
Erythromycin
46
What is the screening test for TB (previously not had BCG or TB)
Mantoux >15mm ACTIVE 6-15- possible
47
What conditions are associated with T2RF with CO2 rising due to hypoventilation?
Obesity End stage NMD Kyophoscoliosis Ank sponk (fibrosis) Drug overdose
48
Give examples of gram negative and positive aerobes and anaerobe that cause pneumonia
Positive aerobe - staph and strep Negative aerobe - klebsiella Anaerobe - aspiration
49
Radiation induced pneumonitis vs chemotherapy induced pneumonitis
Radiation= localised Chemo= diffuse
50
What is the function of alpha 1 antitrypsin
prevent neutrophil elastase hence alveolar destruction
51
What are the respiratory manifestation of CREST syndrome (scl70)
Pulmonary HTN Pulmonary fibrosis
52
Which chromosome containing tumour suppressor gene is defective in mesothelioma?
Chr 22
53
When would you perform CT scan in TB?
When mediastinal nodes are causing upper airway obstruction- stridor
54
How should you biopsy a lung lesion too small and near mediastinum
Endobronchial ultrasound biopsy Note: CT guided may not reach
55
Polymyositis vs dermatomyositis
Muscle Skin Proximal myopathy Small finger joint and nail pathology Pulmonary fibrosis risk
56
Which occupational fibrosis show mixed restrictive/obstructive pattern on LFT?
Silicosis
57
Why does elastic recoil increase with restrictive lung disease?
Tightly stretched rubber band snaps back quick and forcefully. Fibrotic stiff lungs recoil back more on expiration
58
What is the firstline medication for newly diagnosed asthma, including pregnancy?
low dose ICS and formoterol
59
Outline genotype of alpha 1 antitrypsin deficiency
PiMM = normal PiMZ = associated with smoking PiSS = 60% normal enzyme, asx PiSZ = associated with smoking PiZZ = 10% normal enzyme (CIRRHOSIS + early onset) Note: heterozygous= risk with smoking homozygous= early presentation
60
What is the most common malignant tumour found in the lung?
metastatic carcinoma (colon)
61
How should you manage patient with metastatic lung cancer (to brain) with oedema
dexamethasone CT head with contrast
62
Which innate immune cell is antigen presenting cell?
Dendritic cell (KEY) => to t cell also macrophage
63
Why is statin stopped during clarithromycin therapy?
CYP3A4 inhibitory effect of abx
64
What is Gilbert's syndrome?
Elevated Bilirubin Normal liver enzymes
65
Which vitamins are fat soluble?
DAKE
66
What are the risk factors for MDRTB?
Poor compliance Previous TB treatment HIV contact with drug resistant TB
67
What is the best predictor of OSA?
Neck size >43cm
68
What vaccine is contraindicated whilst on high dose steroid?
Live attenuated vaccine - yellow fever - MMR
69
What would indicate mixed metabolic and respiratory acidosis?
Low bicarb high co2 acidosis
70
What imaging should be ordered for suspected lung cancer?
CT chest => then bronchoscopy
71
COPD target sats:
88-92% in acute IECOPD ABG not showing chronic CO2 retention - then target sats >94% if patient not admitted for acute respiratory condition
72
What is the mainstay treatment for bronchiectasis to reduce exacerbations?
postural drainage (physio)
73
What are the 3 pathophysiology of asthma?
1. reversible airway limitation 2. hyper sensitive airways to external stimuli 3. eosinophilic inflammation causing mucus plug -> smooth muscle hypertrophy -> damage
74
What is a consequence of inhaled ICS and how can you prevent it?
oral candidiasis rinse mouth each time inhaled using spacer
75
What drug treats narcolepsy
modafinil - stimulant
76
Describe the 2 types of systemic sclerosis
Limited cutaneous - anti- centromere - a/w pulmonary hypertension and reduced gas transfer Diffuse cutaneous systemic sclerosis - anti-Scl 70
77
What blood test should be tested for bronchiectasis?
Serum immunoglobulin (IgE, IgA and IgG)
78
In a post mortum respiratory epithelium of CF patient, what cell type would you see?
Neutrophil infiltration
79
What is the definitive investigation in assessing inhalation of hot smoke?
Bronchoscopy for upper airway oedema/ulcer
80
What feature is acute exacerbation of bronchiectasis?
haemoptysis, purulent sputum, fever
81
What are the commonest form of hypersensitivity pneumonitis?
Farmer's lung Bird fancier's lung Fibrosis without clubbing
82
What is the complication of hyponatraemia?
cerebral oedema
83
What is the histology of bronchial carcinoma?
eosinophilic granular staining of cytoplasm
84
What is the histology of squamous cell carcinoma?
intercellular bridging
85
What is the histology of SMALL cell lung carcinoma?
granular salt and pepper nuclear
86
What is the most common cause of haemoptysis in the UK
Acute infection | PE TB Cancer ## Footnote Rare: Good pasture, PAN, trauma
87
What is horner's syndrome and why is this relevant in lung cancer?
Ptosis Miosis Anhydrosis | Pancost tumour
88
What CSF findings do you see in TB meningitis?
Lymphocytosis Low glucose High protein
89
What is the normal dead space?
150ml
90
What does reduced transfer capacity of CO but normal CO transfer coefficient suggest?
Extrathoracic restriction i.e obesity
91
What is the risk of lung cancer with smoking and asbestos exposure?
asbestos x5 smoking x10 both together: x50
92
How can obesity and OSA lead to secondary pulmonary hypertension?
Chronic hypoxia => pulmonary arterial vasoconstriction => pulmonary HTN => RHF
93
What is an option for drowsy patient requiring NIV?
Intubation | Provided patient is for resus
94
What is diagnostic of sarcoidosis?
HRCT | Serum ACE may be negatvie
95
What abx choice for atypical pneumonia and CRUB3 and pen allergic
Levofloxacin (fluoroquinolone)

MRCP Part 1 (14 decks)

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