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MRCP 1 > Resp > Flashcards

Resp Flashcards

1
Q

What is Allergic bronchopulmonary aspergillosis

A

Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia.

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2
Q

What are the features of allergic bronchopulmonary aspergillosis

A

bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)

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3
Q

Investigation results in allergic bronchopulmonary aspergillosis

A

eosinophilia
flitting CXR changes
positive radioallergosorbent (RAST) test to Aspergillus
positive IgG precipitins (not as positive as in aspergilloma)
raised IgE

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4
Q

Management of allergic bronchopulmonary aspergillosis

A

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

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5
Q

Where do you normally see Klebsiella pneumonia

A

Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics

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6
Q

Features of Klebsiella pneumonia

A

more common in alcoholic and diabetics
may occur following aspiration
‘red-currant jelly’ sputum
often affects upper lobes

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7
Q

Churg-Strauss Features

A

asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%

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8
Q

Features of sarcoidosis

A

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
ocular: uveitis
skin: lupus pernio
hypercalcaemia

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9
Q

High risk characteristics for pneumothorax

A

haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax

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10
Q

Sarcoidosis stages by cxr signs

A

Stage 1 - bilateral hilar lymphadenopathy
Stage 2 - bhl & infiltrates
Stage 3 - infiltrates
Stage 4 - fibrosis

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11
Q

Fibrosis in lower zones causes

A

Idiopathic pulmonary fibrosis
Connective tissue disorders
Drugs - amiodarone, bleomycin & methotrexate
Asbestosis

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12
Q

Fibrosis in upper zones causes

A

Hypersensitivity pneumonitis
Coal workers pneumoconiosis
Silicosis
Sarcoidosis
Ankylosing spondylitis
TB
Radiation

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13
Q

Which drugs can precipitate Churg-Strauss

A

Montelukast

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14
Q

Bronchiectasis management

A

Physical training - inspiratory muscles
Postural drainage
Antibiotics for exacerbations - long term in severe cases
Bronchodilators for some
Immunisations
Surgery for some

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15
Q

Bronchiectasis most common organisms

A

Haemophilus influenza
Pseudomonas aeruginosa
Klebsiella
Strep pneumonia

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16
Q

Causes of raised transfer factor

A

Asthma
Pulmonary haemorrhage (goodpastures, granulomatosis with polyangitis)
Left to right shunts
Polycythaemia
Hyperkinetic states
Male
Exercise

17
Q

Causes of lower transfer factor

A

Pulmonary fibrosis
Pneumonia
PE
Pulmonary oedema
Emphysema
Anaemia
Low cardiac output

18
Q

What is transfer factor

A

The rate at which a gas will diffuse from alveoli to blood. Uses carbon monoxide to test.

19
Q

What is Lofgren’s syndrome

A

An acute sarcoidosis - bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia

Young females
Excellent prognosis

20
Q

Prevention of acute mountain sickness

A

Acetazolamide

21
Q

Mechanism of high altitude pulmonary oedema (HAPE)

A

Hyperbaric hypoxia -> uneven hypoxic pulmonary vasoconstriction-> uneven blood flow in lungs -> areas of lung with more blood experience raise in cap pressure -> more fluid leakage

Classical pulmonary oedema features

22
Q

Mechanism of high altitude cerebral oedema (HACE)

A

Hypoxia -> cerebral vasodilation -> elevated cerebral blood volume

Also - hypoxia = increase in permeability of blood brain barrier and capillaries in brain more leaky

SX - headache, ataxia & papilloedema

23
Q

Management of HACE

A

Descent
Dex

24
Q

Management of HAPE

A

descent
Nifedipine
Dex
Acetazolamide
O2

25
Q

How does varenicline work?

A

Nicotinic receptor partial agonist
Start one week before target stop date
12 week course
Side effect - nausea, headache, insomnia

26
Q

How does bupropion work?

A

Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist
1-2 week before target stop date
Small risk of seizure (1 in 1000)
Not in epilepsy, pregnancy, eating disorders

27
Q

Alpha 1 antitrypsin deficiency genetics

A

Chromosome 14
Autosomal recessive/co-dominant
Normal PiMM
Heterozygous PiMZ
Homo PiSS - 50% normal level
Homo PiZZ - 10% normal

28
Q

What is catamenial pneumothorax?

A

3-6% of spontaneous pneumothorax in menstruating women - thought to be due to endometriosis in the thorax

29
Q

What are the obstructive lung diseases

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

30
Q

What pulmonary function test results do you get with the obstructive lung diseases

A

FEV1 - significantly reduced
FVC - reduced or Normal
FEV1% - reduced

31
Q

What are the restrictive lung diseases?

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis
ARDS
Kyphoscoliosis
Obseity
Neuromuscular disorders

32
Q

Paraneoplastic features of small cell lung cancer

A

ADH- hyponatraemia
ACTH - Cushings - hypokalaemic alkalosis
Lambert-Eaton - myasthenic like syndrome

33
Q

Paraneoplastic of squamous cell lung cancer

A

PTH related peptide secretion
Clubbing
HPOA

34
Q

Lung carcinoid features

A

Age 40-50
Not smoking
Slow growing, long hx of symptoms.
Centrally located, not seen on cxr
Cherry red ball on bronch

35
Q

Features of ARDS

A

Dyspnoea
Bilateral lung crackles
Low oxygen

36
Q

Causes of bilateral hilar lymphadenopathy

A

Sarcoidosis
TB
Lymphoma
Pneumoconiosis - berylliosis
Fungi - histoplasmosis

37
Q

Diagnostic test for OSA

A

Polysomnography

38
Q

How long do you anticoagulate an unprovoked PE?

A

6 months

MRCP 1 (14 decks)

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