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MRCP Part 1 > Resp > Flashcards

Resp Flashcards

1
Q

spirometry pattern in ILD

A

normal/reduced FEV1
reduced FVC
increased FEV1/FVC

restrictive pattern

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2
Q

Leukotriene receptor antagonist example

A

montelukast

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3
Q

management of obstructive sleep apnoea

A
  1. weight loss
  2. CPAP
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4
Q

preventing acute mountain sickness

A

Acetazolamide (a carbonic anhydrase inhibitor)

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5
Q

COPD criteria for LTOT

A

on 2 separate occasions, 3 weeks apart

Offer LTOT to patients with a pO2 of < 7.3 kPa

OR to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

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6
Q

most common organism causing infective exacerbations of COPD is

A

Haemophilus influenzae

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7
Q

chronic infection with what organism is an important CF-specific contraindication to lung transplantation

A

Burkholderia cepacia

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8
Q

Vital capacity in male vs woman?

A

4,500ml in males, 3,500 mls in females

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9
Q

Pulmonary arterial hypertension is defined

A

as an elevated pulmonary arterial pressure of greater than 25mmHg at rest or 30mmHg after exercise

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10
Q

Causes of bilateral hilar lymphadenopathy

A

Infection: tuberculosis

Inflammation:
- sarcoidosis
pneumoconiosis e.g. berylliosis
fungi e.g. histoplasmosis, coccidioidomycosis

Malignancy:
lymphoma/other malignancy

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11
Q

what is a Catamenial pneumothorax?

A

is the cause of 3-6% of spontaneous pneumothoraces occurring in menstruating women. It is thought to be caused by endometriosis within the thorax.

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12
Q

Eosinophilic granulomatosis with polyangiitis (EGPA) is now the preferred term for Churg-Strauss syndrome

Key features

A

asthma

blood eosinophilia (e.g. > 10%)

paranasal sinusitis

mononeuritis multiplex - nerve issue

pANCA positive in 60%

Leukotriene receptor antagonists (eg. monteleukast) may precipitate the disease.

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13
Q

HLA associations

A

HLA-DR1: bronchiectasis

HLA-DR2: systemic lupus erythematous (SLE)

HLA-DR3: autoimmune hepatitis, primary Sjogren syndrome, type 1 diabetes Mellitus, SLE

HLA-DR4: rheumatoid arthritis, type 1 diabetes Mellitus

HLA-B27: ankylosing spondylitis, postgonococcal arthritis, acute anterior uveitis

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14
Q

Lung cancer: paraneoplastic features

A

Small cell:
ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

Squamous cell:
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

Adenocarcinoma:
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

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15
Q

upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes

A

silicosis

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16
Q

what is - Light’s criteria

A
    • exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
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17
Q

cavitating pneumonia

A

s.aureus

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18
Q

‘cherry red ball’ often seen on bronchoscopy

A

lung carcinoid tumour

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19
Q

which pneumonia is most associated with cold sores?

A

Streptococcus pneumoniae

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20
Q

Resp physiology: chloride vs Bohr vs Haldane effects

A

Chloride shift
CO2 diffuses into RBCs
CO2 + H20 —- carbonic anhydrase -→ HCO3- + H+
H+ combines with Hb
HCO3- diffuses out of cell,- Cl- replaces it

Bohr effect
increasing acidity (or pCO2) means O2 binds less well to Hb

Haldane effect
increase pO2 means CO2 binds less well to Hb

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21
Q

Contraindications to lung cancer surgery include

A

SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

22
Q

Management
Allergic bronchopulmonary aspergillosis

A

oral glucocorticoids
itraconazole is sometimes introduced as a second-line agent

23
Q

A chest-x-ray demonstrates bilateral consolidation with superimposed areas of lucency

A

cavitating lesions
s.aureus
klebsiella (alcoholics)
tb

24
Q

Mycoplasma diagnostic test

A

serology

25
Q

Acute epiglottitis organism

A

is caused by Haemophilus influenzae type B

26
Q

deciding between transudate vs exudate

A

exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L

if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

27
Q

the most common cause of occupational asthma

A

Isocyanates

28
Q

what is the haldane effect?

A

This is known as the Haldane effect, which describes how oxygenation of haemoglobin (Hb) in the lungs promotes the dissociation of carbon dioxide (CO2) from Hb. When the partial pressure of oxygen (pO2) increases, it lessens the affinity of Hb for CO2, causing it to be released and exhaled through the lungs.

29
Q

A fall in the partial pressure of oxygen in the blood leads to vasoconstriction of the pulmonary arteries. This allows blood to be diverted to better aerated areas of the lung and improves the efficiency of gaseous exchange

A
30
Q

Contraindications to lung cancer surgery

A

include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis, stage IIIb or IV (i.e. metastases present)

31
Q

investigation of choice for upper airway compression

A

Flow volume loop

32
Q

Which type of secondary messenger system does nitric oxide stimulate?

A

cyclic GMP

(remember, adrenoreceptors work via cyclic AMP

insulin and growth hormone via tyrosine kinase)

33
Q

Drugs causing lung fibrosis

A

amiodarone

cytotoxic agents: busulphan, bleomycin

anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin

ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

34
Q

classifying severity of COPD

A

1) confirm post bronchodilator FEV1/FVC is <0.7

2) The severity of COPD is categorised using the FEV1 (of predicted)

> 80% is stage 1 mild
50-79% is stage 2 moderate
30-49% is stage 3 severe
<30 is stage 4 very severe

35
Q

diagnosing asthma tests

A

both a FeNO test (high NO indicates high inflammation) and spirometry with reversibility (positive if 12%increase)

36
Q

The treatment for aspergilloma, especially in those with significant haemoptysis, is?

A

surgical resection

37
Q

Pneumocystis jiroveci pneumonia common complication

A
  • pneumothorax
38
Q

salbutamol drug class

A

beta 2 agonist

39
Q

treatment latent TB

A

3 months of isoniazid with pyridoxine and rifampicin
OR
6 months of isoniazid with pyridoxine

40
Q

meningeal tuberculosis mx

A

RIPE (at least 12 months) with the addition of steroids

41
Q

the most useful marker for monitoring the progression of patients with chronic obstructive pulmonary disease (COPD).

A

Forced expiratory volume in one second (FEV1)

42
Q

superior vena cava (SVC). What is the most likely cause

A

primary malignancy

43
Q

SOB after chest drain for pneumothorax

A

re-expansion pulmonary oedema (RPE)

likely due to rapid drainage of pleural fluid/air

44
Q

BIPAP initial settings

A

IPAP = 10 cm H2O;
EPAP = 5 cm H2O

45
Q

Zanamivir (Relenza) is an antiviral medication used to treat and prevent influenza. It works by inhibiting the neuraminidase enzyme, thus preventing the release of new virus particles from infected cells. However, it can cause bronchospasm in patients with underlying respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD). UK guidelines recommend caution when prescribing zanamivir in patients with these conditions due to the risk of exacerbation of their symptoms.

A
46
Q

Pneumocystis jirovecii pneumonia treatment

A

co-trimox
or IV pentamidine
Steroids are also given if there is severe hypoxaemia

47
Q

Determining if a pleural aspirate is transudate or exudate

A

exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L

if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

48
Q

what kind of pleural effusion is caused by Dressler’s syndrome

A

exudative

49
Q

what kind of pleural effusion is caused by Meigs’ syndrome

A

transudative

50
Q

CURB score meaning

A

total CURB-65 score is 2. This score is related to a 30-day mortality risk around 9% and it is advised that management should be hospital admission. A score of 3 or more would suggest a higher level of care may be required. A score of 0 or 1 would suggest that admission is not likely to be required (unless for social reasons or unstable comorbid illness) and that oral antibiotics can be used. I

MRCP Part 1 (21 decks)

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