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MRCP Part II > Resp > Flashcards

Resp Flashcards

1
Q

ABG - normal pH

A

7.35 - 7.45

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2
Q

ABG - normal pCO2

A

4.5 - 6.0 kPa

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3
Q

ABG - normal pO2

A

10 - 14 kPa

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4
Q

Indications for NIV - in COPD

A

COPD with respiratory acidosis pH 7.25 - 7.35 (after starting nebs + steroids)

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5
Q

Initial settings for BiPAP in COPD - EPAP

A

4 - 5 cm H2O

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6
Q

Initial settings for BiPAP in COPD - IPAP

A

10 cm H2O

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7
Q

Initial settings for BiPAP in COPD - back up rate

A

15 breaths/min

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8
Q

Initial settings for BiPAP in COPD - back up insp:expiration ratio

A

1:3

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9
Q

Primary pneumothorax - rim < 2cm - not short of breath

A

Consider discharge

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10
Q

Primary pneumothorax - rim > 2cm or short of breath

A

Aspiration

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11
Q

Primary pneumothorax - rim still >2cm or still short of breath after attempting aspiration

A

Insert chest drain

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12
Q

Secondary pneumothorax - rim > 2cm and/or > 50 years old

A

Insert chest drain

Admit for 24+ hours

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13
Q

Secondary pneumothorax - patient < 50 years old, rim 1 - 2 cm

A

Attempt aspiration

Admit for 24+ hours

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14
Q

Secondary pneumothorax - rim still > 1 cm after attempting aspiration

A

Insert chest drain

Admit for 24+ hours

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15
Q

Secondary pneumothorax - patient < 50 years old, rim < 1 cm

A

Give oxygen

Admit for 24+ hours

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16
Q

Diving after secondary pneumothorax

A

Avoid permanently, unless had bilateral pleurectomy + normal lung Fx + CT post-operatively

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17
Q

Features of Lefgren’s syndrome (acute form of sarcoidosis)

A

BHL

Erythema nodosum

Fever

Polyarthralgia

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18
Q

Paraneoplastic ADH associated with which lung cancer

A

Small cell

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19
Q

Paraneoplastic ACTH associated with which lung cancer

A

Small cell

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20
Q

Lamber-Eaton paraneoplastic syndrome associated with which lung cancer

A

Small cell

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21
Q

Paraneoplastic PTH-rp associated with which lung cancer

A

Squamous cell

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22
Q

Paraneoplastic HPOA associated with which lung cancer

A

Squamous cell,

Adenocarcinoma

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23
Q

Paraneoplastic TSH associated with which lung cancer

A

Squamous cell

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24
Q

Paraneoplastic syndromes - Clubbing is associated with which lung cancer

A

Squamous cell

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25
Q

Paraneoplastic syndromes - Gynaecomastia is associated with which lung cancer

A

Adenocarcinoma

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26
Q

Causes of bronchiectasis

A 
Post-infective
Bronchial obstruction
Cystic fibrosis, ciliary dyskinesias
Immune deficiency
ABPA
Yellow nail syndrome
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27
Q

Post-infective causes of bronchiectasis

A

TB
Measles
Pertussis
Pneumonia

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28
Q

Immune deficiency causes of bronchiectasis

A

Selective IgA deficiency

Hypogammaglobulinaemia

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29
Q

Medication licensed for idiopathic pulmonary fibrosis

A

Pirfenidone,

Nintedanib

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30
Q

Pirfenidone MOA

A

Anti-fibrotic agent

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31
Q

Features of ABPA

A

Bronchoconstriction
Bronchiectasis
Eosinophilia

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32
Q

Life threatening asthma - PEFR

A

PEFR <33% best or predicted

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33
Q

Life threatening asthma - Oxygen sats

A

sats < 92%

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34
Q

Life threatening asthma - pCO2

A

‘Normal’ pCO2 (4.6 - 6.0 kPa)

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35
Q

Life threatening asthma - Examination

A

Silent chest,
Cyanosis,
Poor respiratory effort
Exhaustion, confusion, coma

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36
Q

Severe asthma - PEFR

A

PEFR 33 - 50% best or predicted

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37
Q

Severe asthma - Examination

A

Can’t complete sentences

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38
Q

Severe asthma - RR

A

RR >25/min

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39
Q

Severe asthma - HR

A

HR > 110 bpm

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40
Q

Life threatening asthma - Obs

A

Bradycardia
Dysrhythmia
Hypotension

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41
Q

Moderate asthma - PEFR

A

PEFR 50 - 75% best or predicted

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42
Q

Moderate asthma - Examination

A

Speech normal

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43
Q

Moderate asthma - RR

A

RR < 25/min

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44
Q

Moderate asthma - HR

A

HR < 110 bpm

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45
Q

COPD exaverbation - NIV unavailable/inappropriate

A

Doxapram

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46
Q

Doxapram MOA

A

Respiratory stimulant

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47
Q

COPD - still breathless on SABA/SAMA and LABA + ICS

A

Add LAMA

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48
Q

COPD - 1st line

A

SABA/SAMA prn

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49
Q

COPD - Still breathless on SABA/SAMA without asthmatic features/steroid responsiveness

A

SABA prn

LABA + LAMA regular

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50
Q

COPD - Still breathless on SABA/SAMA + asthmatic features/steroid responsiveness

A

SABA/SAMA prn

LABA + ICS regular

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51
Q

COPD -
SABA prn
LABA + LAMA regular
Still breathless

A

SABA prn

LABA + LAMA + ICS regular

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52
Q

COPD
SABA/SAMA prn
LABA + ICS regular
Still breathless

A

SABA prn

LABA + LAMA + ICS regular

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53
Q

Features of EGPA (Churg-Strauss)

A 
Lung disease (late onset/worsening 'asthma')
Renal disease (AKI)
Eosinophilia
pANCA
Mononeuritis multiplex
NO SINUSITIS (in exams)
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54
Q

Pulmonary hypertension group 1

A

I - Pulmonary arterial hypertension (PAH)

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55
Q

Pulmonary hypertension group 2

A

II - Pulmonary hypertension secondary to left heart disease

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56
Q

Pulmonary hypertension group 3

A

III - Pulmonary hypertension secondary to lung disease

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57
Q

Pulmonary hypertension group 4

A

IV - Pulmonary hypertension secondary to chronic thromboembolic disease

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58
Q

Pulmonary hypertension group 5

A

V - Pulmonary hypertension with unclear cause

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59
Q

Sarcoidosis - indications for steroids

A

Stage 2 or 3 disease + symptomatic

Hypercalcaemia

Eye/heart/neuro involvement

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60
Q

Restrictive spirometry - FEV1/FVC ratio

A

FEV1/FVC > 0.7

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61
Q

Obstructive spirometry - FEV1/FVC ratio

A

FEV1/FVC < 0.7

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62
Q

Cavitating upper lobe pneumonia in diabetic/alcoholic

A

Klebsiella

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63
Q

Lung fibrosis in aerospace worker

A

Berylliosis

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64
Q

Management of acute eosinophilic pneumonia

A

Oral steroids

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65
Q

COPD not controlled on triple inhaled therapy

A

Roflumilast

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66
Q

Roflumilast MOA

A

Long-acting phosphodiesterase inhibitor

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67
Q

NSCLC stage I or II - management

A

Surgical resection

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68
Q

Contraindications to surgical resection in NSCLC

A 
Stage IIIb/IV
FEV <1.5
Malignant effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction
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69
Q

Features of Hypersensitivity Pneumonitis / Extrinsic allergic alveolitis

A 
Episodic SOB and cough
Environmental trigger
Acute: fever
Chronic: weight loss
No eosinophilia
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70
Q

Silicosis - fibrosis affects which zone

A

Upper zone fibrosis

71
Q

Coal worker’s pneumoconiosis - fibrosis affects which zone

A

Upper zone fibrosis

72
Q

Histoplasmosis (fungus Histoplasma capsulatum) - typical features

A

Recent travel
URTI and retrosternal pain
Nodular shadowing

73
Q

Pathogen commonly associated with bronchiectasis

A

Pseudomonas

74
Q

Features of microscopic polyangiitis

A 
Glomerulonephritis
Systemic features
Palpable purpura
Cough, dyspnoea, haemoptysis
Mononeuritis multiplex
ANCA +ve
75
Q

Features of GPA (Wegeners)

A 
Lung disease 
SINUS DISEASE
Renal disease
No eosinophilia
ANCA positive (usually c, but may be p)
76
Q

Adult with asthma - not controlled on SABA alone

A

SABA + low-dose ICS

77
Q

Adult with new diagnosis of asthma with symptoms <3/week and no night-time awakening

A

SABA

78
Q

Adult with new diagnosis of asthma with symptoms >3/week or night-time awakening

A

SABA + low-dose ICS

79
Q

Adult with asthma - not controlled on SABA + low-dose ICS

A

SABA + low-dose ICS + LTRA

80
Q

Adult with asthma - not controlled on SABA + low-dose ICS + LTRA

A

SABA + low-dose ICS + LABA

+/- continure LTRA

81
Q

Adult with asthma - not controlled on SABA + low-dose ICS + LABA

A

SABA + MART (LABA + low-dose ICS)

+/- LTRA

82
Q

Features of theophylline poisoning

A

Hypokalamia
Hyperglycaemia
Tachycardia + increased myocardial contractility

83
Q

DLCO/TLCO

A

Diffusion capacity of lung for CO

84
Q

KCO

A

Transfer coefficient

=DLCO corrected for lung volume/transfer per ‘bit’ of lung

85
Q

Causes of a low DLCO (low transfer co-efficient)

A
  • Pulmonary fibrosis
  • Pneumonia
  • PE
  • Pulmonary oedema
  • Emphysema
  • Anaemia
  • Low cardiac output
86
Q

Causes of a raised DLCO

A 
Asthma
Pulmonary haemorrhage
Left-to-right heart shunt
Polycythaemia
Hyperkinetic state
Male, exercise
87
Q

CURB-65 score - C

A

Confusion (AMTS <=8/10)

88
Q

CURB-65 score - R

A

RR >= 30

89
Q

CURB-65 score - U

A

Urea > 7

90
Q

CURB-65 score - B

A

Systolic <= 90 ,or,

Diastolic <= 60

91
Q

CURB score of >=3

A

Consider ITU

92
Q

Stable COPD - ABG shows pO2 <7.3

A

Offer LTOT

93
Q

Stable COPD - ABG shows pO2 7.3 - 8

A

Offer LTOT if any of:

  • secondary polycythaemia
  • peripheral oedema
  • pulmonary hypertension
94
Q

LTOT assessment - patient develops respiratory acidosis

A

Medical optimisation + re-assess 4 weeks

95
Q

LTOT assessment - PaCO2 rise of >1 kPa

A

Medical optimisation + re-assess 4 weeks

96
Q

Two difficult to control organisms in CF

A

Pseudomonas aeruginosa

Burkholderia

97
Q

Caplan syndrome

A

Patient with RA + occupational dust exposure - > severe pneumoconiosis

98
Q

Solitary lung nodule <5mm

A

Can be discharged

99
Q

Solitary lung nodule >= 8 mm + high risk features

A

CT-PET, and biopsy if high uptake

100
Q

Solitary lung nodule > 6 mm + low risk

A

CT surveillance (3 months)

101
Q

Solitary lung nodule 5 -6 mm

A

CT surveillance (12 months)

102
Q

ARDS diagnostic criteria

A

Acute onset
Oedema on CXR
Non-cardiogenic
pO2/FiO2 < 40kPa (200 mmHg)

103
Q

CRB-65 score 0 - risk of death

A

< 1%

104
Q

CRB-65 score 1 or 2 - risk of death

A

1 - 10%

105
Q

CRB-65 score 3 or 4 - risk of death

A

> 10%

106
Q

Small cell lung cancer with extensive disease

A

Consider chemotherapy

107
Q

Treatment for MAC (mycobacterium avium complex)

A

Rifampicin + clarithromycin + ethambutol

108
Q

Treatment for M.kansii NTM (Mycobacterium kansasii)

A

Rifampicin, isoniazid + ethambutol

109
Q

Prognostic test in IPF

A

Carbon monoxide transfer factor

110
Q

Hypersensitivity pneumonitis/EEA - bronchoalveolar lavage findings

A

Lymphocytosis

111
Q

Hypersensitivity pneumonitis (Extrinsic allergic alveolitis) - CXR/CT findings

A

Upper/mid-zone fibrosis

112
Q

Hypersensitivity pneumonitis (Extrinsic allergic alveolitis)- blood investigations

A

NO eosinophilia

Serology for specific IgG antibodies (precipitins for bird/fungus)

113
Q

Hypersensitivity pneumonitis/EEA - examples

A

Bird fancier’s lung
Farmer’s lung
Malt worker’s lung
Mushroom worker’s lung

114
Q

Psuedomonas eradication in CF

A

2 weeks IV anti-pseudomonal antibiotic + inhaled aminoglycaside

or

6 weeks PO ciprofloxacin

115
Q

Management of theophyllin poisoning

A

Gastric lavage if <1hr
Activated charcoal
Charcoal haemoperfusion

116
Q

Features of sarcoidosis

A

Lung fibrosis/BHL
Renal failure
Non-caseating granulomas

117
Q

Sarcoidosis CXR features

A

BHL

Apical fibrosis

118
Q

Sarcoidosis - blood findings

A 
Lymphocytosis
Increased CD4:CD8 ratio
Raised ESR
ACE (in 70%)
Hypercalcaemia (10%)
119
Q

Sarcoidosis - CXR stage 0

A

Normal

120
Q

Sarcoidosis - CXR stage 1

A

Bilateral hilar lymphadenopathy

121
Q

Sarcoidosis - CXR stage 2

A

BHL + interstitial infiltrates

122
Q

Sarcoidosis - CXR stage 3

A

Diffuse interstitial infiltrates only

123
Q

Sarcoidosis - CXR stage 4

A

Diffuse fibrosis

124
Q

Commonest lung cancer in adolescents

A

Bronchial carcinoid

125
Q

1st line management of psuedomonas in bronchiectasis

A

PO ciprofloxacin 14 days

126
Q

2nd line management of psuedomonas in bronchiectasis

A

IV tazocin, ceftazidime, aztreonam or meropenem

127
Q

Small cell lung cancer - Limited disease (T1-4, N0-3, M0)

A

Consider surgery
or
4 cycles cisplatin-based chemotherapy +/- radiotherapy

128
Q

Small cell lung cancer - Early stage (T1-2a, N0, M0)

A

Consider surgery

Or chemo + radiotherapy

129
Q

Small cell lung cancer - Extensive disease (T1-4, N0-3, M1a/b)

A

6 cycles cisplatin-based chemotherapy + radiotherapy if good response

130
Q

1st line management of moderate/severe disease in granulomatosis with polyangiitis

A

Cyclophosphamide and corticosteroids

131
Q

COPD patient develops respiratory acidosis/>1kPa rise in PaCO2 during LTOT on two repeated occasions (and apparently clinically stable)

A

Offer domiciliary oxygen only in conjunction with nocturnal ventilator support

132
Q

MPO antibodies

A

pANCA

133
Q

PR3 antibodies

A

cANCA

134
Q

Causes of mononeuritis multiplex

A 
Vasculitis 
Diabetes
AIDS
Amyloidosis
RA
135
Q

Microscopic polyangiitis - ANCA findings

A

pANCA in 50-70%

cANCA in 40%

136
Q

Pulmonary causes of eosinophilia

A
  • Asthma
  • ABPA
  • EGPA
  • Eosinophilic pneumonia
  • Hypereosinophilic syndrome
  • Loffler’s syndrome
  • Tropical pulmonary eosinophilia
137
Q

Treatment of ABPA

A

Oral steroids +/- itraconazole

138
Q

Treatment of aspergilloma

A

Oral itraconazole +/- surgical resection

139
Q

Delta-F508 mutation seen in

A

Cystic fibrosis

140
Q

ESR in anti-GBM disease

A

Normal

141
Q

Adult asthma step 1

A

SABA

142
Q

Adult asthma step 2

not controlled on 1 or new diagnosis with symptoms >3/week or nocturnal

A

SABA + low-dose ICS

143
Q

Adult asthma step 3

A

SABA + low-dose ICS + LTRA

144
Q

Adult asthma step 4

A

SABA + low-dose ICS + LABA

+/- LTRA depending on response before

145
Q

Adult asthma step 5

A

Switch to MART:
-SABA
-MART (LABA + low-dose ICS)
+/- LTRA

146
Q

Adult asthma step 6

A
  • SABA
    -MART (LABA + medium-dose ICS)
    +/- LTRA
147
Q

Adult asthma step 7

A

-SABA
-High dose ICS
- LABA
+/- LTRA
- trial LAMA/theophylline
-expert help

148
Q

How to distinguish transudate vs exudate

A

Protein level <30g/L = Transudate
Protein level >30g/L = Exudate
If protein level 25-35g/L use Light’s criteria

149
Q

Light’s criteria

A

Exudate likely if at least one of:
Fluid protein/serum protein >0.5
Fluid LDH/serum LDH >0.6
Fluid LDH more than 2/3 upper limits normal serum LDH

150
Q

PEFR demonstrating severe acute asthma

A

33-50% of best/predicted

151
Q

PEFR demonstrating life-threatening acute asthma

A

<33% best/predicted

152
Q

Acute asthma - RR demonstrating severe

A

RR >25

153
Q

Acute asthma - Pulse rate demonstrating severe (or life-threatening)

A

HR > 110

154
Q

Acute asthma - signs demonstrating severe

A

Can’t complete sentences

155
Q

Acute asthma - signs demonstrating life-threatening

A 
Silent chest
Cyanosis
Poor respiratory effort
Confusion
Exhaustion, coma
156
Q

Acute asthma - Obs demonstrating life-threatening

A

Oxygen sats <92%
Bradycardia
Hypotension
Dysrhythmia

157
Q

In which patients is Hypertrophic Pulmonary Osteoarthropathy seen?

A

Patients with Bronchial Carcinoma

158
Q

What is the characteristic of Hypertrophic Pulmonary Osteoarthropathy?

A

Finger clubbing and long bone pain

159
Q

What is the most sensitive Ix for Hypertrophic Pulmonary Osteoarthropathy?

A

Isotope Bone Scan

Findings: uptake in long bones, around periarticular surfaces and sometimes also the mandible and scapulae

160
Q

Treatment of Burkholderia Cepacia

A

IV regimes with two or more Abx:

  • Ceftazidime + aminoglycoside
  • Ceftazidime + Chloramphenicol
  • Chloramphenicol + Minocyclne
161
Q

Sensitive way to diagnose active TB?

A

Pleural Biopsy:

Obtain sample so PCR for TB can be carried out rapidly

162
Q

How severe is airflow obstruction in COPD if FEV1 30-49%

A

Severe

163
Q

How severe is airflow obstruction in COPD if FEV1 50-79%

A

Moderate

164
Q

How severe is airflow obstruction in COPD if FEV1 > 80%

A

Mild

165
Q

How severe is airflow obstruction in COPD if FEV1 <30%

A

Very severe

166
Q

What is the threshold for ventilatory support in patients with GBS?

A

20ml/kg

167
Q

What criteria makes a patient with emphysema unsuitable for lung volume reduction surgery?

A

1) Non-upper lobe emphysema with high exercise capacity
2) FEV1 < 20%
3) Carbon Monoxide diffusing capacity <20%

168
Q

The presence of what physical feature is associated with reaction to NSAIDs in asthmatics?

A

Nasal Polyps

169
Q

Causes of Lower Zone Fibrosis?

A

MAID:
Most connective tissue disease (Rheumatoid)
Asbestosis
Idiopathic Pulmonary Fibrosis, Infection
Drugs (Amiodarone, Methotrexate, Bleomycin)

170
Q

Nintednib MoA?

A

Small tyrosine kinase inhibitor including: PDGF, FGFR, VEGFR

171
Q

Features of Psittacosis?

A

Fever, Low WCC, Splenomegaly, epistaxis

172
Q

What is thunderstorm asthma?

A

Pressure changes in a thunderstorm causes release of pollen and spores which trigger asthma exacerbation

173
Q

Time frame for development of pleural plaques, asbestosis and mesothelioma following exposure of asbestos?

A

> 10 years: pleural plaques
20 years: asbestosis
30 years: mesothelioma

MRCP Part II (15 decks)

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