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MRCP Part 1 > MRCP Resp > Flashcards

MRCP Resp Flashcards

1
Q

Outline management of TB

meningitis

non CNS

MDRTB

Disseminated

A

Meningitis:
12 months
R + I (P+E first 2 month only)
Prednisolone

Non CNS TB-
6 months
(incl spine)
R + I (P+E first 2 month only)

MDRTB:
5 drug: RIPE + streptomycin

Disseminated TB:
12 months
same as CNS TB

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2
Q

What is goodpasture syndrome?

A

HLADR2
Anti-GBM antibodies

  1. glomerulonephritis
  2. intrapulm haemorrhage

URTI -> haemoptysis -> intrapulmonary haemorrhage -> glomerulonephritis

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3
Q

Outline types of lung cancer

A

Small cell
- rapid aggressive smoking

Non small cell
- squamous -> isocyanate fume exposure

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4
Q

How would spirometry look in obstructive and restrictive?

A

Obstructive- FEV1/FVC<75%

Restrictive- FEV1/FVC >75%

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5
Q

What are the hallmarks of PJP?

A

dry cough

high LDH

CXR
- diffuse infiltrates
- perihilar changes

chest is clear on auscultation

desaturation on exercise

immunodeficiency

Mx: co-trimoxazole/pentamidine

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6
Q

What are the hallmarks of mycoplasma pnuemonia?

A

cold agglutinin
LDH elevated

headache/cough/fever

extrapulmonary- rash/haemolytic anaemia
erythema multiforme

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7
Q

What are the hallmark of klebsiella pneumonia?

A

immunocompromised

upper lobe cavitating lung lesion

ALCOHOLIC

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8
Q

what are the hallmarks of legionella?

A

deranged LFT
hyponatraemia
diarrhoea
air conditioning

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9
Q

Outline management for primary pneumothorax AND <50 yo

A

primary >2cm or breathless - aspirate

primary <2cm- discharge with conservative + rpt CXR in 2 weeks

Drain if failed aspiration/tension

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10
Q

Outline management for secondary pneumothorax OR >50 year old

A

small <1cm - observe in hospital

moderate 1-2cm - aspirate => fail then drain

large >2cm/breathless- drain, suction

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11
Q

Where do you aspirate pneumothorax?

A

MCL- 2/3rd ICS

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12
Q

Where do you insert chest drain?

A

MAL - 4/5th ICS

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13
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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14
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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15
Q

What lung condition has fine fixed end inspiratory crackles?

A

pulmonary fibrosis

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16
Q

What condition causes diffuse alveolar infiltrates on CXR?

A

Goodpasture’s

(due to pulmonary haemorrhage)

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17
Q

What is the investigation and management of goodpastures?

A

Renal biopsy

Medical:
- steroid
- cyclophosphamide
- dialysis
- plasma exchange

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18
Q

What is GPA?

GCSE

A

Granulomatosis with polyangitis

C-ANCA against PR3

sinusitis and renal disease

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19
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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20
Q

What is the transfer factor (Kco) and alveolar volume (Va) like in pulmonary fibrosis?

A

Low due to thickened alveoli

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21
Q

What is the definitive management of SVC compressions secondary to small cell lung ca?

A

stenting

Note:
chemo may be first line once SCC proven

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22
Q

Why is radiotherapy for SVCO not done before stenting?

A

radiotherapy induced fibrosis may make it difficult to stent

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23
Q

Decreased vocal resonance causes?

A

Pneumothorax
Pleural effusion

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24
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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25
Q

What is Mounier Kuhn syndrome?

A

bronchial cartilage deficiency -> recurrent LRTI

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26
Q

What should you monitor in GBS for respiratory muscle involvement?

A

FVC

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27
Q

What does honeycombing on CT suggest?

A

pulmonary fibrosis

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28
Q

What does ground glass shadowing with reticularnodular pattern suggest?

A

Hypersensitivity pneumonitis

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29
Q

What lung conditions cause clubbing?

A

Pulmonary fibrosis
Cystic fibrosis
Lung cancer

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30
Q

What is Mcleod syndrome?

A

Unilateral empysema following childhood brocnhiolitis

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31
Q

What conditions are associated with empysema?

A

COPD
Alpha-1-antitrypsin deficiency
Mcleod syndrome

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32
Q

What conditions are associated with bronchiectasis?

A

Aspergillosis
Hypogammaglobinulinaemia
Bronchial adenoma
IBD
Rheumatoid arthritis
Infection
Congenital (CF, Kartagener’s syndrome- primary ciliary dyskinesia)

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33
Q

What is the most common pathogens causing IECOPD?

A

HSM

Haemophilus
Strep pneumonia
Moraxella catarrhalis

Mx: clarithromycin

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34
Q

What is the management of radiation pnuemonitis?

A

Steroids

for 3-4 weeks

then taper and stop

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35
Q

What is the criteria for NIV?

A

pH 7.35, not improved with nebs and controlled oxygen therapy, and CONSCIOUS

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36
Q

What is the criteria for ITU in T2RF?

A

suitable for ITU
failed NIV, unconscious or pH <7.25

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37
Q

Why is gas transfer elevated in idiopathic pulmonary haemosiderosis?

A

As blood is already in the alveolar space

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38
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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39
Q

What is Q fever?

A

Coxiella burnetii

Cattle/sheep/goat spread airborne

Hepatitis (transaminitis)
Atypical pneumonia
endocarditis

Treat with doxycycline

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40
Q

CURB-65

A

confusion
urea >7
rr>30
bp<90/60

1- amox
2- amox+clari
3- co-amox + clari IV

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41
Q

Why is there hypercalcaemia in sarcoidosis?

A

ectopic vitamin D activation from granuloma causing hypercalcaemia

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42
Q

What does bihilar lymphadenopathy suggest?

A

Sarcoidosis
TB
Lung cancer

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43
Q

What is multidrug resistant TB?

A

Resistant to R+I

Treat with 5 or more drugs

Treat until sputum -ve
24 months

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44
Q

What is the the chance of being carrier of CF gene in same family?

A

Auto recessive

sibling of affected person has 3 in 4 chance being carrier

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45
Q

What is chance of being carrier of CF gene?

A

1 in 25 in white people

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46
Q

How to diagnose OSA?

A

polysomnographic studies (sleep)

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47
Q

Causes of cavitating lung lesion?

A

klebsiella pneumonia (upper lobe)
staph pneumonia
aspergilloma
TB

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48
Q

What are the symptoms of CF?

A

bronchiectasis
pancreatic insufficiency

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49
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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50
Q

Which lung cancer is associated with asbestos?

A

Mesothelioma (thickening)

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51
Q

What exposure causes silicosis fibrosis?

A

brick/stone dust

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52
Q

Which part of lung function test is monitored in COPD for mortality?

A

FEV1

PEFR

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53
Q

What supports the diagnosis of empyema in parapneumonic effusion?

A

Pleural pH <7.2

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54
Q

Presentation of GPA

A

Haemoptysis
Sinusitis
Nasal bridge collapse
Glomerulonephritis

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55
Q

What is the gold standard imaging choice for bronchiectasis?

A

HRCT

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56
Q

Pleural effusion criteria

A

Transudative (failure)
- protein <25

Exudative
(cancer/infection/PE/inflammatory SLE/pancreatitis)
- extra protein in fluid (>35)

Note:
use light criteria if 25-35
- pleural/serum protein >0.5
- pleural/serum LDH >0.6
- pleural LDH is >2/3 of ULN serum LDH

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57
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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58
Q

What disease causes cannon ball mets, haematuria, bulky LN on CXR?

A

Pulmonary mets

RCC

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59
Q

How do you treat cough variant asthma, normal lung function test?

A

Trial of high dose inhaled steroid

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60
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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61
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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62
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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63
Q

What is the pathophysiology of CF?

A

CFTR - chloride channel defect

DELTA F508 gene on CHR 7

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64
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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65
Q

How do you treat eosinophilic pneumonia?

A

Steroids

  • asthma
  • parasite
  • vasculitis
  • drug
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66
Q

What is eosinophilic GPA?

A

pANCA - anti - myeloperoxidase

4 of the following:
- raised eosinophil >!0%
- asthma
- neuropathy
- pulmonary infiltrate
- sinus polyps
- skin lesions- petechiae/livedo reticularis

small vessel vasculitis

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67
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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68
Q

What is the hallmark of sarcoidosis?

A

Non caseating granuloma
- macrophage and giant cells
- centre contain schaumann body (Cal phosp)

skin/lung/eye/heart/kidney/liver

NO clubbing

Mx: steroids

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69
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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70
Q

Why is there increased residual volume in acute asthma?

A

due to gas trapping and increase in TLC

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71
Q

What are the criteria for life threatening asthma?

A

Signs:
low GCS
exhaustion
arrhythmia
hypotension
cyanosis
silent chest
poor resp effort

Measurement:
PEFR <33% (best/predicted)
O2 <92%
PO2 <8
normal PCO2 (or high)

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72
Q

Outline NICE guidelines for asthma

A

Escalation therapy if:
symptomatic 4 times week
requiring SABA 4 times week
waking at night 1 or more times week

First step: low dose ICS and formoterol - LABA PRN

Second step: low dose MART (REGULAR of above)

Third step: moderate dose MART

Fifth step:
If high FENO/Eosinophilia
- refer to specialist

If normal FENO/Eosinophil
- Add Leukotriene receptor antagonist/LAMA
- trial swapping LTR and LAMA if not working

Exampled: seretide (ICS+LABA)

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73
Q

Cause of upper lobe fibrosis

A

SCARTEx

Sarcoidosis/silicosis
COAL
ANK SPOND
RADIATION
TB
EAA

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74
Q

Cause of lower lob fibrosis

A

ACID

CTD (RA/scleroderma)
ASBESTOS
IPF
Drugs (nitrofurantoin/amiodarone/methotrexate/bleomycin)

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75
Q

What is galactomannan test for?

A

Invasive aspergillosis

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76
Q

Which medication cause bronchospasm in asthmatics?

A

BB

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77
Q

What causes neutrophil infiltrates in transbronchial biopsy and no granuloma?

A

polyarteritis nodosa.

medium artery vasculitis

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78
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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79
Q

What drugs are associated with pulmonary hypertension?

A

amphetamine
cocaine
anorect drugs- appetite suppressant

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80
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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81
Q

How do you give mag sulf for acute asthma

A

single dose 1.2-2g IV over 20min

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82
Q

What is lofgren syndrome?

A

sarcoidosis

erythema nodosum (HALLMARK)

hilar adenopathy
migratory polyarthralgia
fever

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83
Q

What is low glucose in pleural fluid (<1.6) associated with?

A

rheumatoid arthritis related effusion

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84
Q

Indications for chest drain in infected pleural effusion:

A
  1. frank purulent turbid/cloudy fluid
  2. gram stain/culture +ve
  3. fluid pH <7.2 in suspected infection
  4. lack of response to abx treatment
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85
Q

What is ABPA?

A

asthmatic vigorous IgE response to aspergillus

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86
Q

What is Loffler syndrome?

A

Löffler’s syndrome is a rare, benign lung disease that occurs when eosinophils build up in the lungs.

It can be caused by parasitic infections or an allergic reaction to certain drug

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87
Q

Lung cancer types:

A

Small cell:
- worse prognosis
- smoker

Non small cell:
adenocarcinoma - most common
- non smokers
- peripheral lesion

squamous
- cavitating lesion
- central lesion
- smoking

Large cell
- smoking
- peripheral lesion

bronchial adenoma
- metastatic carcinoid

mesothelioma
- asbestos

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88
Q

What is primary pneumothorax caused by?

A

rupture of apical pleural blebs

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89
Q

What 4 drugs should be given in initial empirical TB

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol or streptomycin

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90
Q

Outline management of COPD

A

Initial:
- SABA or SAMA PRN

Combined therapy:
asthmatic feature/steroid responsive
- ICS + LABA regular

no asthma/not steroid responsive
- LABA + LAMA regular

Triple therapy:
(SABA PRN) + (ICS +LABA+LAMA regular)

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91
Q

What is aspergillus precipitins?

A

IgG ab to aspergillus

(CHRONIC ABPA +/- aspergilloma)

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92
Q

What is Brucellosis?

A

Zoonotic bacterial infection

FLAW symptoms + arthralgia + GI + neuropsych symptoms

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93
Q

What is Wunchereria bancrofti?

A

South asian tropical pulmonary eosinophilia

associated with microfilaria

cough/wheeze/fever/weight loss/LL swelling due to lymphatic obstruction

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94
Q

What medical management can you give for SIADH if fluid restriction fails?

A

demeclocycline

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95
Q

What XR changes are seen in PJP?

A

Diffuse bilateral infiltrates

96
Q

What is histoplasmosis?

A

Systemic mycosis (fungal)

UTRI/sternal pain/arthalgia

Mediastinal widening CXR

Culture: Histoplasma capsulatum

Mx: amphotericin B if unwell

97
Q

What is the most common occupational asthma trigger?

A

Most common Isocyanates (LAB)

  1. Flour/grain
98
Q

What treatment in COPD has mortality benefit ?

99
Q

What is EAA?

A

Hypersensitivity reaction triggered by e.g birds/moulds allergen -> leading to fibrosis

100
Q

What respiratory complications is RA associated with?

A

Bronchiolitis obliterans- inflamm and scarring of bronchioles-> irreversible obstructive lung

Methotrexate induced fibrosis (lower)

101
Q

What is caplan syndrome?

A

RA + pneumoconiosis

102
Q

Lambert eaton syndrome vs Myaesthenia gravis

A

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.

103
Q

Describe the 4 stages of sarcoidosis on CXR

A
  1. Hilar adenopathy alone
  2. adenopathy and parenchymal disease
  3. parenchymal disease alone
  4. fibrosis
104
Q

Pathophysiology of TB

A

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

105
Q

4 Types of hypersensitivity

A

ACID

Anaphylaxis - IgE
Cytotoxic (activated by antibodies)
Immune complex
Delayed type T cell

106
Q

Where does aspiration pneumonia commonly affect?

A

Right upper and middle lobe

107
Q

Which bacteria causes pneumonia following influenza and common in IVDU

A

staphylococcal pneumonia

108
Q

What medication would you give for liver capsule pain?

A

Dexamethasone

109
Q

Which occupational lung disease predisposes to TB?

A

Silicosis - toxin to macrophage hence immunocompromises

110
Q

Which pathogen is associated with increased mortality and is contraindication to lung transplant in CF?

A

Burkholderia cenocepacia

111
Q

What test should you perform to rule out occupational asthma?

A

serial peak flow at home and at work

112
Q

Which medication should you give in pen allergic CAP?

A

Doxy/clarithromycin

Note:
Cefalexin cross cover with penicillin

113
Q

What test should you do with lung cancer with stridor?

A

Medical emergency- ENT
Airway obstruction
Flow-volume loop test

Give steroid, chemo, radio, stent

114
Q

What are the 4 subtypes of aspergillosis?

A
  1. aspergilloma - no sx, mild haemoptysis
  2. invasive- fever/cough/pleuritic chest pain
  3. ABPA- cough/wheeze/SOB
  4. Chronic BPA- cough/SOB
115
Q

What does halo sign on HRCT indicate?

A

Aspergilloma

116
Q

What additional test should you perform in patients that present with invasive fungal disease/PJP

117
Q

Which organism that causes CAP is associated with herpes labialis (cold sore)

A

Strep pneumonia

118
Q

How does bronchial carcinoid present?

A

recurrent haemoptysis
lung collapse

119
Q

What is the difference between bronchial carcinoid and carcinoid syndrome

A

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.

120
Q

Which scan should be done to assess the nodes prior to further treatment in lung cancer?

121
Q

Gold standard test for CO poisoning and treatment?

A

ABG

High levels of oxygen to displace CO

122
Q

Outline investigation for APBA bronchiectasis

A

MOST SPECIFIC:
positive (RAST) test to Aspergillus (skin prick)

eosinophilia

CXR- proximal bronchiec

positive IgG precipitins (not as positive as in aspergilloma)

raised IgE

123
Q

What is contraindication for pneumonectomy in bronchial carcinoma?

A

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

124
Q

3 hallmarks to suggest ITU review needed in acute asthma

A

unable to speak in full sentences
peak flow <33%
normocapnia

124
Q

Describe 3 categories of coal worker pneumoconiosis

A

1- few opacities and normal lung markings

2- number of opacities but able to see lung markings

3- most severe, obscure lung markings

124
Q

What occupational fibrosis show eggshell calcification and hilar adenopathy?

A

Silicosis

silly eggs

125
Q

What is the abx choice for chlamydia pneumonia/atypical pneumonia in pregnancy?

A

Erythromycin

126
Q

What is the screening test for TB (previously not had BCG or TB)

A

Mantoux

> 15mm ACTIVE
6-15- possible

127
Q

What is the management of latent TB (asymptomatic, normal CXR, matoux +ve)

A

6 months isoniazid alone

OR

3 months isoniazid + rifampicin

128
Q

What is whispering pectorioquy

A

Vocal resonance

Increased in solid:
Consolidation/cancer

129
Q

What does decreased breath sounds indicate?

A

Effusion
Pneumothorax
Collapse

130
Q

What causes inspiratory crackles?

A

Fibrosis
Pulmonary oedema
Consolidation

131
Q

Bug associated with Pigeon keeper presenting with pneumonia

A

Chlamydia psittaci

Mx: Erythromycin

132
Q

What drug is used to treat IPF?

A

Nintedanib

133
Q

What conditions are associated with T2RF with CO2 rising due to hypoventilation?

A

Obesity
End stage NMD
Kyophoscoliosis
Ank sponk (fibrosis)
Drug overdose

134
Q

What type of infection is Non tuberculous mycobacterium infection

A

Opportunistic in existing cavitation/lung conditions i.e bronchiectasis

This is not TB

135
Q

Give exampled of gram negative and positive aerobes and anaerobe that cause pneumonia

A

Positive aerobe
- staph and strep

Negative aerobe
- klebsiella

Anaerobe
- aspiration

136
Q

What is ARDS

A

acute non cardiac pulmonary oedema

  • increased recoil
  • reduced wedge pressure
137
Q

Radiation induced pneumonitis vs chemotherapy induced pneumonitis

A

Radiation= localised

Chemo= diffuse

138
Q

What is the function of alpha 1 antitrypsin

A

prevent neutrophil elastase hence alveolar destruction

139
Q

What are the respiratory manifestation of CREST syndrome (scl70)

A

Pulmonary HTN
Pulmonary fibrosis

140
Q

Which chromosome containing tumour suppressor gene is defective in mesothelioma?

141
Q

When would you perform CT scan in TB?

A

When mediastinal nodes are causing upper airway obstruction- stridor

142
Q

How should you biopsy a lung lesion too small and near mediastinum

A

Endobronchial ultrasound biopsy

Note: CT guided may not reach

143
Q

Polymyositis vs dermatomyositis

A

Muscle
Skin

Proximal myopathy
Small finger joint and nail pathology

Pulmonary fibrosis risk

144
Q

What is the most common typical bacteria causing CAP?

A

Strep pneumoniae

145
Q

What is the most common bacteria causing IECOPD?

A

H.influenzae

146
Q

Which blood test should be checked and monitored for TB treatment with RIPE?

A

LFT

Hepatotoxic

147
Q

Which occupational fibrosis show mixed restrictive/obstructive pattern on LFT?

148
Q

Why does elastic recoil increase with restrictive lung disease?

A

Tightly stretched rubber band snaps back quick and forcefully.

Fibrotic stiff lungs recoil back more on expiration

149
Q

Which thrombophilias predispose to recurrent PE/DVT?

A

antithrombin 3 deficiency
protein c deficiency
factor V leiden mutation

150
Q

What is the firstline medication for newly diagnosed asthma, including pregnancy?

A

low dose ICS and formoterol

151
Q

Provoked PE management

A

3 months anticoag
3-6 months if active cancer

152
Q

When is lifelong anticoag recommended

A

history or recurrent DVT/PE

153
Q

Unprovoked PE management

A

3-6 months
6 months if increased risk of recurrence
6 months if active cancer

154
Q

Outline genotype of alpha 1 antitrypsin deficiency

A

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

155
Q

What is the most common malignant tumour found in the lung?

A

metastatic carcinoma
(colon)

156
Q

How should you manage patient with metastatic lung cancer (to brain) with oedema

A

dexamethasone

CT head with contrast

157
Q

What is pulmonary arteriovenous malformation?

A

right to left shunt

reduced Tlco (diffusing) => hypoxaemia

similar to hepatopulmonary syndrome

158
Q

What would you see in lung function test for bronchiolitis obliterans (inflammatory fibrosis)

A

mixed obstructive/restrictive

aka cryptogenic organising pneumonia

159
Q

What does fluffy shadows on CXR represent?

A

Oedema
Fibrosis
Vasculitic lung
Pulmonary haemorrhage

160
Q

Which innate immune cell is antigen presenting cell?

A

Dendritic cell (KEY) => to t cell

also macrophage

161
Q

Why is statin stopped during clarithromycin therapy?

A

CYP3A4 inhibitory effect of abx

162
Q

Features of chronic PE?

A

Pulmonary hypertension
V/Q mismatch
Loud P2
Decreased transfer factor
widening alveolar-arterial gradient

163
Q

What is Gilbert’s syndrome?

A

Elevated Bilirubin
Normal liver enzymes

164
Q

When does transfer coefficiency Kco increase?

A

greater blood flow
haemorrhage
polycythaemia

165
Q

Which blood markers indicates poor prognosis with pneumonia?

A

WCC >20
WCC <4
Urea >7

CURB 65

Coexisting illness

Acidosis
T1RF/T2RF

166
Q

Which vitamins are fat soluble?

167
Q

What widens A-a gradient

A
  • defect in ventilation- fibrosis/oedema/Cap
  • defect in vasculature - shunt/PE
168
Q

What is diagnostic of EAA?

A

IgG precipitins

169
Q

When do you treat sarcoidosis?

A
  1. PERSISTENT hypercalcaemia
  2. extrapulmonary- eye, heart, neuro
  3. sx and CXR changes
170
Q

What is the treatment for invasive aspergilosis

A

Amphotericin B

171
Q

What are the risk factors for MDRTB?

A

Poor compliance
Previous TB treatment
HIV
contact with drug resistant TB

172
Q

What is the most common symptoms of non small cell lung cancer?

A

cough > SOB

173
Q

What is the best predictor of OSA?

A

Neck size >43cm

174
Q

What vaccine is contraindicated whilst on high dose steroid?

A

Live attenuated vaccine

  • yellow fever
  • MMR
175
Q

What would indicate mixed metabolic and respiratory acidosis?

A

Low bicarb
high co2
acidosis

176
Q

What is mendelson syndrome?

A

Acute pneumonia from regurgitation of stomach content and aspiration of gastric juice => severe bronchospasm

177
Q

Movement in pleural drain for pneumothorax and pleural effusion:

A

pneumothorax- bubbling
- if no bubbling on coughing => reinflated

pleural effusion- swinging

Note:
if drain is not swinging or bubbling then it is blocked OR kinked hence not working

178
Q

What is the management for TB contact screening:

A

close contacts need to be screened for active TB but not latent TB

179
Q

What is the gold standard test for active TB?

A

Sputum culture

180
Q

What is the test for latent TB?

181
Q

What is the standard combination therapy for GPA?

A

steroid and cyclophosphamide

182
Q

What is the management for NSCLC with stage 2 and 3?

A

Radical surgery + adjuvant chemotherapy

183
Q

What is atelectasis and causes?

A

Lung collapse preventing oxygen absorption

  • mucus plugging
  • tumour
  • foreign body
  • chest injury
  • prolonged general anaesthetic
184
Q

Physical signs of familial primary pulmonary hypertension

A

Elevated JVP
Left parasternal heave
Pansystolic murmur from TR
S4 (stiff heart)
Peripheral oedema

185
Q

What imaging should be ordered for suspected lung cancer?

A

CT chest => then bronchoscopy

186
Q

Which rare genetic condition is associated with pneumothorax and lung cysts

A

Birt Hogg Dube

AD- mutated folliculin gene

PTx, lung cyst, renal cancer, skin fibrofolliculoma

Ix: genetic testing

187
Q

COPD target sats:

A

88-92% in acute IECOPD

ABG not showing chronic CO2 retention
- then target sats >94% if patient not admitted for acute respiratory condition

188
Q

What is the mainstay treatment for bronchiectasis to reduce exacerbations?

A

postural drainage (physio)

189
Q

What are the 3 pathophysiology of asthma?

A
  1. reversible airway limitation
  2. hyper sensitive airways to external stimuli
  3. eosinophilic inflammation causing mucus plug -> smooth muscle hypertrophy -> damage
190
Q

What is a consequence of inhaled ICS and how can you prevent it?

A

oral candidiasis

rinse mouth each time inhaled using spacer

191
Q

What drug treats narcolepsy

A

modafinil - stimulant

192
Q

Which childhood infection is a well known risk factor for bronchiectasis?

A

Whooping cough

193
Q

Acute asthma management:

A

O SHIT ME
oxygen
salbutamol
hydrocort
ipratropium
theophylline (amino- if not tachy)
mag sulf

194
Q

What are the 4 CXR stages of sarcoidosis

A

0 clear
1 BHL
2 BHL and pulmonary infiltrate
3 diffuse pulmonary infiltrate
4 pulmonary fibrosis

195
Q

Describe the 2 types of systemic sclerosis

A

Limited cutaneous
- anti- centromere
- a/w pulmonary hypertension and reduced gas transfer

Diffuse cutaneous systemic sclerosis
- anti-Scl 70

196
Q

What does eosinophilia in pleural fluid indicate?

A

Air in pleural cavity

197
Q

What blood test should be tested for bronchiectasis?

A

Serum immunoglobulin (IgE, IgA and IgG)

198
Q

In a post mortum respiratory epithelium of CF patient, what cell type would you see?

A

Neutrophil infiltration

199
Q

What is hypertrophic pulmponary arthropathy ?

A

painful symmetrical arthropathy wrist, ankel knee

NON SMALL CELL LUNG CANCER

200
Q

What is the definitive investigation in assessing inhalation of hot smoke?

A

Bronchoscopy for upper airway oedema/ulcer

201
Q

What feature is acute exacerbation of bronchiectasis?

A

haemoptysis, purulent sputum, fever

202
Q

What are the commonest form of hypersensitivity pneumonitis?

A

Farmer’s lung
Bird fancier’s lung

Fibrosis without clubbing

203
Q

What is the complication of hyponatraemia?

A

cerebral oedema

204
Q

What is the histology of bronchial carcinoma?

A

eosinophilic granular staining of cytoplasm

205
Q

What is the histology of squamous cell carcinoma?

A

intercellular bridging

206
Q

What is the histology of SMALL cell lung carcinoma?

A

granular salt and pepper nuclear

207
Q

What is the most common cause of haemoptysis in the UK

A

Acute infection

PE
TB
Cancer

Rare: Good pasture, PAN, trauma

208
Q

What is horner’s syndrome and why is this relevant in lung cancer?

A

Ptosis
Miosis
Anhydrosis

Pancost tumour

209
Q

What CSF findings do you see in TB meningitis?

A

Lymphocytosis
Low glucose
High protein

210
Q

Which gender group is at higher risk of OSA?

211
Q

What is the normal dead space?

212
Q

When should you seek cardiothoracic opinion in someone with a chest drain?

A

Still swining and bubbling after 48 hrs of insertion

213
Q

What would pleural fluid show in empyema?

A

pH <7.2
low glucose
high LDH >1000

214
Q

What lung condition is not associated with clubbing?

215
Q

What does reduced transfer capacity of CO but normal CO transfer coefficient suggest?

A

Extrathoracic restriction i.e obesity

216
Q

What is the risk of lung cancer with smoking and asbestos exposure?

A

asbestos x5
smoking x10

both together: x50

217
Q

What does lymphoncytosis on pleural fluid indicate?

A

lymphoma
cancer
TB

218
Q

What does low glucose on pleural fluid indicate?

A

Infection
Cancer
Rheumatoid

219
Q

What should be avoided after pnuemothorax?

A

Scuba diving

220
Q

How can obesity and OSA lead to secondary pulmonary hypertension?

A

Chronic hypoxia => pulmonary arterial vasoconstriction => pulmonary HTN => RHF

221
Q

When can someone fly on a plane after pneumothorax?

222
Q

Which pathogen causes frequent exacerbations in CF?

A

Pseudomonas

Staph aureus in young patients

223
Q

What is found in sweat test in CF?

A

Chloride >60

if 30-60 perform CFTR analysis

224
Q

What is meig’s syndrome

A

Ovarian fibroma, ascites and pleural effusion

225
Q

Asbestosis vs mesothelioma on CXR

A

Pleural plaques
Pleural thickening

226
Q

What is an option for drowsy patient requiring NIV?

A

Intubation

Provided patient is for resus

227
Q

What is diagnostic of sarcoidosis?

A

HRCT

Serum ACE may be negatvie

228
Q

What is yellow nail syndrome?

A

abnormal lymphatic drainage (lymphoedema)

associated with bronchiectasis

229
Q

What is miliary TB and what does the CXR look like?

A

Dissemination of TB in the blood

CXR- widespread nodular consolidation

230
Q

How does venturi work?

A

Air entrainment (sucking in)

231
Q

What feature must be present for it to be lofgrens syndrome

A

Erythema nodosum

Bihilar lymphadenopathy
Polyarthralgia

232
Q

What abx choice for atypical pneumonia and CRUB3 and pen allergic

A

Levofloxacin (fluoroquinolone)

233
Q

What is loeffler syndrome?

A

eosinophils build up in the lungs due to drug/parasite

234
Q

What doese forced expiratory flow rate 25-75% of FVC indicate?

A

small airway disease

MRCP Part 1 (17 decks)

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