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MRCP 1 > Resp > Flashcards

Resp Flashcards

1
Q

Cells producing surfactant?

A

Type 2 alveolar epithelial cells

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2
Q

FEV1

A

Volume of gas expired in first second of forced expiration

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3
Q

FVC

A

Total volume of gas expired on forced expiration

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4
Q

Normal FEV1:FVC?

A

70-80%

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5
Q

Obstructive vs restrictive FEV1/FVC pattern?

A

Obstructive is a preserved FVC with a reduced FEV1:FVC - obstruction limits the amount in 1 second but the capacity is not restricted

Restrictive is a preserved FEV1:FVC but with a reduced FVC - they can blow lots of air out but the total capacity is limited

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6
Q

Obstructive vs restrictive airway diseases

A

Obstructive - asthma/COPD

Restrictive - PF/obesity/neuromuscular/pleural disease

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7
Q

Diffusion impairment in hypoxaemia?

A

Pulmonary oedema or ILD

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8
Q

Dissociation curve to the right?

A

High temperature
Acidosis
Hypercapnia
Increased 2,3-GPD - encourages offloading of oxygen to tissues
Altitude

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9
Q

Dissociation curve to the left?

A

Alkalosis
Low temperature
Hypocapnia
Carboxyhaemoglobin
Foetal haemoglobin

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10
Q

Variable and reversible airflow obstruction?

A

Asthma

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11
Q

Exhaled nitric oxide concentration in asthma?

A

Increased, >40 parts per billion
Do this in all suspected asthmas over 17 years
In children only do it if the spirometry is normal/not as expected

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12
Q

Common Ig response in asthmatics?

A

IgE

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13
Q

Testing for specific IgE responses?

A

RAST

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14
Q

Monoclonal antibody sometimes used in severe allergic asthma? What does it bind to?

A

Omalizumab
IgE

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15
Q

Asthma not controlled on SABA?

A

Add low dose ICS

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16
Q

ASthma not controlled on SABA + ICS?

A

Add LTRA

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17
Q

Asthma not controlled on SABA + ICS + LTRA?

A

SABA + ICS + LABA +/- LTRA

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18
Q

Asthma not controlled on SABA + ICS + LABA +/- LTRA?

A

SABA + MART +/- LRTA

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19
Q

Life-threatening asthma features?

A

Hypoxaemia
PEFR<33%
Exhaustion
Bradycardia/arrhythmia
Hypotension
Silent chest
Altered consciousness
Poor respiratory effort
Cyanosis

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20
Q

ITU referral in asthma?

A

Deteriorating PEFR despite Rx
Persistent or worsening hypoxia
Rising CO2
Acidosis
Altered consciousness/exhaustion
Resp arrest

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21
Q

FEV1:FVC in COPD?

A

<70

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22
Q

FEV1 in COPD?

A

Classically <80% predicted

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23
Q

Most common exaccerbating organisms in COPD?

A

H flu - most common
Strep pneumoniae
Less common - staph, moraxella

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24
Q

Score for objective measure of COPR prognosis?

A

BODE

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25
Q

COPD grades of airflow obstruction (FEV1)

A

Mild - at least 80%
Mod - 50-79% predicted
Severe - 30-49% predicted
Very severe - <30% predicted

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26
Q

COPD causes

A

Smoking
A-1 antitrypsin
Coal
Cotton
Cement
Cadmium
Grain

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27
Q

“Asthmatic/steroid responsive” features in COPD

A

Any previous, secure diagnosis of asthma or of atopy
Higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up
Substantial variation in FEV1 over time (at least 400 ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)

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28
Q

Treatment for COPD WITHOUT “Asthmatic/steroid responsive” features”

A

LABA + LAMA + SABA for bronchodilation

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29
Q

Treatment for COPD WITH “Asthmatic/steroid responsive” features”

A

LABA + ICS

You can add LAMA

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30
Q

Transplant basic criteria in COPD?

A

Under 65
FEV1 and DCLO <20%, history of severe hospitalisaton
+/- cor pulmonale despite O2 therapy

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31
Q

Transplant basic criteria in COPD?

A

Under 65
FEV1 and DCLO <20%, history of severe hospitalisation
+/- cor pulmonale despite O2 therapy

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32
Q

Normal alpha 1 AT genotype?

A

PiMM

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33
Q

Abnormal alpha 1 AT genotypes?

A

PiMZ - carrier - may pass on to children but low risk of lung disease in non-smoker

PiSS - 50% A1AT levels
PiZZ - most severe deficiency and most likely to manifest disease - 10% A1AT levels

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34
Q

What is alpha 1 AT?

A

Protease inhibitor

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35
Q

Effects of A1AT deficiency?

A

Emphysema, mostly lower lobes
Liver: cirrhosis and HHC in adults, cholestasis in children

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36
Q

LTOT criteria?

A

pO2 <7.3 on at least two separate occasions
OR
<8.0 with evidence of PHTN, polycythemia, peripheral oedema or nocturnal hypoxaemia

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37
Q

Gram +ve cocci in COPD?

A

Moraxella

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38
Q

Most common organism in central line infections?

A

Staph epidermidis

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39
Q

Markers of poor prognosis in CAP beyond CURB?

A

Hypoxaemia despite O2 therapy
Multilobar involvement
WCC <4 or >20
Low albumin
Bacteraemia

40
Q

Herpetic cold sores with pneumonia?

A

Strep pneumoniae

41
Q

Capsular polysaccharide detected in pneumonia?

A

Strep pneumoniae

42
Q

Nasty complications of mycoplasma pneumonia?

A

Peri/myocarditis
SJS
Erythema multiforme/nodosum
DIC
Meningitis
Hepatitis/pancreatitis

43
Q

Pneumonia in an alcoholic?

A

Klebsiella

44
Q

Bacterial pneumonia which may follow a recent viral illness?

45
Q

Cavitating lung organisms?

A

S aureus
Klebsiella
Legionella
Anaerobes
Pseudomonas
TB

46
Q

Ghon focus?

A

Area of primary TB infection in the lung, classically the stage at which infection is halted in immunocompetent hosts

47
Q

Symptoms of primary TB infection?

A

Usually asymptomatic but occasionally pleurisy secondary to pulmonary oedema/lymphadenopathy

48
Q

Crescent/halo sign in upper lobe cavity?

A

Aspergilloma

49
Q

Ghon focus?

A

Small lung lesion in TB in the mid-lower zone. Primary TB infection is usually halted at this point

50
Q

Reactivation of TB?

A

Immuosuppressants - incl. steroids, MTX, anti-TNF alpha
HIV
Malignancy
Malnutrition

51
Q

Choroidal tubercles on fundoscopy?

A

Miliary TB

52
Q

AAFB stain?

A

Ziehl-Neelsen
Auramine

53
Q

Asymptomatic but positive Mantoux and then positive interferon Y test?

A

Give prophylaxis:

Either
Isoniazid for 6 months
OR
Rifampicin and isoniazid for 3 months

54
Q

TB treatment?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

55
Q

Eye disease on TB treatment?

A

Ethambutol

56
Q

Hepatitis on TB treatment?

A

Rifampicin
Isoniazid
Pyrazinamide

57
Q

Peripheral neuropathy on TB treatment? Treatment?

A

Isoniazid
Rx with pyridoxine

58
Q

Addition to TB treatment in tuberculous meningitis?

59
Q

Vaccines contraindicated in HIV patients?

A

Live vaccines

BCG
Yellow fever
Oral polio
Nasal flu
Varicella
MMR

60
Q

Most severe pattern of bronchiectasis?

61
Q

Causes of bronchiectasis?

A

Post infective
Alpha 1 AT
Cystic fibrosis
Congenital - Marfan, Williams-Campbell
Immunocompromise
Aspergillosis
Sarcoid/pulm fibrosis
Chemicals
Ciliary dyskinesis

62
Q

Most common sputum isolate in bronchiectasis?

63
Q

PFTs in bronchiectasis

A

Generally obstructive

64
Q

Thickening of bronchial walls, ring shadows, fluid levels on CXR?

A

Bronchiectasis

65
Q

Diagnostic test for bronchiectasis?

66
Q

Bronchiectasis associations?

A

RA (30%)
Malignancy
Sjogren
IBD
Ank spon

67
Q

Treatment for bronchiectasis with underlying immune deficiency?

A

IV I-gamma-G

68
Q

CF chromosome?

69
Q

Most common CF mutation?

70
Q

Diagnosis of CF?

A

Sweat test (chloride)
Genetic analysis

71
Q

PFTs in CF? Why?

A

Obstructive
It’s bronchiectasis

72
Q

Neonatal presentation of CF?

A

Meconium ileus

73
Q

Adult GI manifestation of CF?

A

Distal intestinal obstruction syndrome
Malabsorption

74
Q

Fertility in CF?

A

Most males are infertile
Females slightly less fertile

75
Q

Chronic colonisation in CF?

A

Pseudomonas

76
Q

Group of organisms colonised in some CF patients which carries a poor prognosis?

A

Burkholderia

77
Q

Nebulised Abx in CF?

A

Colistin or tobramycin

78
Q

Drug given in CF sometimes and in stubborn empyema?

79
Q

NIV in bronchiectasis?

A

Rarely benefitial

80
Q

New therapy licensed for some CF patients which targets CFTR?

A

Ivacaftor/Lumacaftor

81
Q

CF birth rate?

82
Q

CF inheritance?

83
Q

CF-specific contraindication to lung transplant?

A

Burkholderia cepacia colonisation

84
Q

A history of bronchiectasis and eosinophilia - think?

85
Q

Treatment of ABPA (x2)

A

Prednisolone
Itraconazole sometimes

86
Q

Rounded opacity on CXR in someone with previous TB?

A

Aspergilloma

87
Q

Aspergilloma most common fungal organism?

A

A. fumigatus

88
Q

Non-invasive diagnostic test for aspergilloma?

A

Serology for aspergillus precipitins

89
Q

Gradual development of wheeze, haemoptysis, well demarcated lung lesion, no weight loss?

A

Carcinoid?

90
Q

Pneumonia in asolescent/young adule, headache/malaise/cough, pharyngitis/myringitis, cold agglutinins, muscle tenderness, dramatic CXR?

A

Mycoplasma pneumonia

91
Q

Drugs which increase theophylline levels?

A

Cipro
Clari
COCP

92
Q

Pneumothorax, fibrofolliculomas, renal Ca?

A

Brit-Hogg Dube syndrome

93
Q

Exotic travel history, blood eosinophilia, mention of filaria?

A

Tropical pulmonary eosinophillia assoc with Wuchereira bancrofti

94
Q

First line treatment for legionella?

95
Q

Most common pathogens in CF - early years and adulthood

A

Early years - staph aureus
Adulthood - pseudomonas

MRCP 1 (24 decks)

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