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MRCP - Part 1 > Resp > Flashcards

Resp Flashcards

1
Q

Stepwise management of inhalers in adults

A
  1. low dose ICS
  2. Add LABA to low dose ICS
  3. Consider increasing ICS to medium dose or adding LTRA (if no response to LABA - consider stopping)
  4. refer for specialist care
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2
Q

Stepwise management of inhalers in children

A
  1. very low dose ICS (or LRTA if < 5 yrs)
  2. very low dose ICS plus
    a. LABA or LRTA if > 5 yrs old
    b. LRTA if < 5
  3. Increase ICS to low dose or in children > 5 add LRTA or LABA (if no response to LABA, consider stopping)
  4. refer for speclialist care
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3
Q

Features of life threatning asthma

A

Hypoxaemia (<92%)
PEFR <33% of predicted
Exhaustion
Bradycardia or arrythmia
Hypotension
Silent chest
Altered consciousness
Poor resp effort
Cyanosis
Normal or raised PCO2

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4
Q

What is Bronchiolitis Obliterans

A

The term used to describe the fibrous scarring of the small airways, seen in the following;
- inhalation of toxic fumes
- exposure to mineral dust
- viral infections
- mycoplasma infections
- legionella
- bone marrow, heart or lung transplant
- RA or SLE
- Penicillamine treatment

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5
Q

Presentation of bronchiolotiis obliterans

A

Dry cough
Dyspnoea

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6
Q

Signs of bronchiolitis obliterans

A

Unremarkable
Expiratory wheeze may be audible

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7
Q

CXR findings of bronchiolitis obliterans

A

Can vary
Normal
Reticular pattern
Reticulonodular pattern

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8
Q

Diagnosis of bronchiolitis obliterans

A

Lung biopsy

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9
Q

Prognosis of bronchiolitis obliterans

A

Poor
Rarely respond to steriods

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10
Q

Investigation specific to allergic bronchopulmonary aspergillosis

A

Early positive skin prick test for aspergillus fumigatus (antigen-specific IgE)

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11
Q

What does FEF reflect

A

Status of the small airways

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12
Q

What is sent away when a pleural aspiration is carried out

A

Cytology
Protein
LDH
pH
Gram stain
Culture
Sensitivity

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13
Q

Stepwise Tx of COPD

A

1 SABA or SAMA
2. Combined therapy
- a) no asthmatic or steriod responsive features; LABA + LAMA
- b) asthmatic or steriod responsive featutres; LABA + ICS
3. 3x therapy; add ICS to 2a or LAMA to 2b

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14
Q

What epworth sleepiness score is suggestive of OSA

A

11 or more
(can be up to 24)

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15
Q

What is an azygous lobe

A

Normal variant
Seen as reverse comma sign behind the medial end of the right clavicle
right upper zone

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16
Q

What is the only treatment proven to improve long term prognosis in patients with chronic hypoxaemia in COPD

A

Long term domicillary oxygen therapy

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17
Q

Presentation of histoplasmosis

A

Acute URTI
Substernal pain

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18
Q

Xray changes in histoplasmosis

A

Patchy pulmonary infiltrates
Mediastinal widening
10% arthralgia
5% have pleural effusions

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19
Q

Diagnosis of histoplasmosis

A

Culture of histoplasma capsultatum from urine, blood and bone marrow and sputum

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20
Q

Treatment of histoplasmosis

A

Amphotericin B - not required unless patients show signs of respiratory insufficiency

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21
Q

Causes of upper lobe fibrosis on CXR

A

Ankylosing spondylitis (apices)
TB
Sarcoidosis
Extrinsic allergic alveolitis
Silicosis
ABPA
Post Radiotherapy

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22
Q

Causes of lower lobe fibrosis

A

RA
Scleroderma
SLE
IPF

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23
Q

Criteria of allergic bronchopulmonary aspergillosis

A

Clinical deterioration in asthma symptoms
Raised IgE levels
Positive aspergillosis serology
Pulmonary infiltrates on CXR

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24
Q

Treatment of ABPA

A

Corticosteriods
Itraconazole

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25
Q

WHat genotype is most commonly assosiated with early onset a1at

A

PIZZ

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26
Q

Diagnosis of sarcoid

A

Skin biopsy - non ceasating granulomas

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27
Q

Which lung cancer can progress rapidly in under 3 months

A

small cell lung carcinoma

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28
Q

Xray findings of radiation pneumonitiis

A

Hazy consolidation demarcated by a sharp margin that corresponds to the limits of the irridation field

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29
Q

Treatment of idiopathic pulmonary fibrosis

A

Nintedanib (tyrosine protein kinase inhibitor)

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30
Q

Common features of sarcoidosis

A

Erythema nodosum
Bilateral hilar lymphadenopathy on CXR
Uveitis
Hypercalcaemia

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31
Q

What lung condition develops in people with a1at defieicny

A

Empysema

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32
Q

transfer factor in stable astham

A

unafffected

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33
Q

Which lung cancer is related to hyponatraemia and how

A

small cell lung cancer
syndrome of innapropriately secreated anti diuretic hormone (SIADH)

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34
Q

Which is the most aggressive lung cancer

A

Small cell lung cancer

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35
Q

Which lung cancer is most assosiated with smoking

A

squamous cell carcinma

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36
Q

Which lung cancer is often peripheral

A

adenocarcinoma

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37
Q

What is the most important thing to consider in the mangement of pneumothoraxes

A

Degree of clinical compromise, not the pneumothorax

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38
Q

Management of a patient < 50 with a primary spontaneous pneumothorax with no clinical distress which is < 2cm

A

No specific therapy
Supplemental o2 as required
F/u CXR to ensure lung expansion

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39
Q

Management of patient with primary spontaenus pneumothorax < 50 yrs old who is breathless or a large pneumothorax (>2cm)

A

Supplemental oxygen
Percutaneous needle aspiration (midclavicular line 2nd/3rd IC space)
If aspiration fails - insert a chest tube or a small bore catheter

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40
Q

Management of a secondary pneumothorax or patient > 50 yrs old if it is a small (<1cm) penumothorax and no SOB

A

Supplemental O2
Observe in hospital

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41
Q

Management of a secondary pneumothorax or a patient > 50 if it is moderate (1-2cm) pneumothorax and no SOB

A

Supplemental 02
Observe in hospital
Percutaneus needle aspiration
Chest drain
Suction

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42
Q

Hyponatraemia in small cell lung cancers

A

SiADH secretion
Dilutional
Low serum osmolality
High urine osmolality

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43
Q

Tx of hyponatraemia in small cell lung cancers

A

Fluid restriction

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44
Q

anti-GBM antibody is assosiated with what

A

Goodpastures syndrome

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45
Q

What antibody is assosiated with eosinophilic granulomatsosi with polyangitis

A

anti-myeloperoxidase antibody

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46
Q

Investigation of choice for eosinophilic granulomatosis with polyangitis

A

Skin biopsy
- small vessel ateriopathy
- granuloma formation

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47
Q

Treatment of eosinophilic granulomatosis with polyangitis

A

High dose methylpred
+/- cyclophosphamide

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48
Q

Example of a condition where the antibody anticardiolipin is found

A

antiphopsholipid syndrome
SLE

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49
Q

Examples of anaerobic pleuropulmonary infections

A

Aspiration pneumonia
Necrotising pneumonitis
Lung abscess
Empyema
Infection secondary to bronchiectasis and bronchial carcinoma

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50
Q

Example of pneumonia secondary to gram positive areobes

A

Strep
Staph

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51
Q

Example of presentation of allergic bronchopulmonary aspergillosis

A

Deteriorating asthma sx
Haemoptysis
General malaise
Headache

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52
Q

Investigations for ABPA

A

Peropheral blood eosinophilia
Increased serum IgE
Bilateral infiltrates on CXR
Increased aspergillus specific IgE or IgG

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53
Q

What is the main driver for LTOT prescription

A

02

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54
Q

Criteria for LTOT prescription

A

PO2 < 7.3
P02 > 7.3 but < 8 when stable, who also have
- Secondary polycythaemia
- peripheral oedema
- noctural hypoxaemia
- pulmonary HTN

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55
Q

What is indicated in the treatment of asthma when symptoms are still not controlled despite inhaled corticosteriods, LABA and LTRAs

A

Theophylline

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56
Q

Assosiations of OSA

A

Stroke
HTN
T2DM

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57
Q

Over 98% of men with cystic fibrosis have what

A

Bilateral Abscence of vas deferens

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58
Q

What sweat chloride value is diagnostic for CF?

A

> 60

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59
Q

If a sweat chloride test is 30 - 60, what should be done next

A

CFTR gene analysis

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60
Q

WHat is an auscultation finding of consolidation

A

Whisphering pectoriloquy

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61
Q

What picture do you get with silicosis

A

Mixed obstructive / restrictive picture

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62
Q

Investigation of legionella

A

Urinary antigen test

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63
Q

Presentation of legionella

A

Cough
SOB
Wheeze
Pleurtic pain
Fevers
Neurological / confusion
GI Sx / diarrhea / deranged LFTs
AKI
Hyponatraemia

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64
Q

What is GPA assosiated with

A

Midline sinusitis
Pulmonary haemorrhage
Retinal vasculitis

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65
Q

What is the syndrome called when you aspirate stomach contents and what pathology does this cause

A

Mendelson syndrome
bronchospasm

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66
Q

WHat bacteria commonly causes LRTIs in people with herbes libialis

A

strep pneumonia

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67
Q

An obstructive spirometry with raised lung volumes may indicate what

A

asthma
COPD

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68
Q

Transfer factor in asthma

A

normal

69
Q

Beside test to assess lung function in a patient with GBS

A

forced vital capacity (FVC)

70
Q

Indications for draingage of pleural effusion

A

Infected fluid
ph < 7.2
gram stain showing the prescence of organisms
fluid is frankly purulent
clinical improvement slow despite antibiotic therapy

71
Q

WHat does oeosinophilia in a pleural cavity suggest and what does it make the diagnosis LEAST likely

A

suggests air in the pleural cavity
malignancy and TB less likely

72
Q

Causes of low gluocse levels in pleural aspirate

A

RA
TB
Empyema
Malignancy

73
Q

What do high levels of salivary amylase indicate

A

Oesophageal rupture

74
Q

The prescence of anti-nuclear factor in a pleural aspirate is virtually diagnostic of what?

A

SLE

75
Q

What is cricoartenyoid arhtisi related to

A

RA

76
Q

Presentation of cricoartenyoid arthritis and what can exacerbate symptoms

A

Sore throat
hoarse voice
stridor
asymptomatic

post op period can rapidly worsen symptoms

77
Q

Investigations of cricoartyeniod arthriits

A

spirometry with flow volume loop
Direct laryngoscopy and CT of larynx

78
Q

CXR findings in pneumocystitis jirovecci

A

diffuse pulmonary infiltrates extending from perihilar region

79
Q

Treatment of narcolepsy and how does it work

A

Modafinil
CNS stimulant

80
Q

WHat are the strongest predictors of survival in COPD

A

Age
Baseline FEV1

81
Q

Predisopsing factors for recurrent PE

A

Antithrombin III deficiency
Protein C defieincy
Factor V Leiden mutation

82
Q

WHat is suggestive of EAA (EXTRINSIC ALLERGIC ALVEOLITIS)

A

Circulating IgG precipitans

83
Q

Types of pleural effusions

A

Exudate
Transudate

84
Q

WHat are exudates high in

A

proteins

85
Q

Causes of exudative pleural effusion

A

Infections
Malignancy
PE
Connective tissue disorders
Pancreatitis, subphrenic abscess
Trauma

86
Q

causes od transudative pleural effusion

A

LVF
Liver cirrhosis
Nephrotic syndrome
Other causes of hypoproteinaemia
PE
sarcoid
peritoneal dialysis
myoexema

87
Q

Protein in transudative effusions

A

low

88
Q

Antibodies of eosinophilic granulomatosis with polyangitis

A

pANCA

89
Q

Presentation of esoinophilic granulomatosis with polyangitis

A

Asthma
Mononeuritis multiplex / peripheral nerve impariemnt
Atopy
recurrent nasal polyps
Renal impariement
raised esoinophil count

90
Q

How does a 1 antitrypsin limit emphysema

A

Elastase inhibitor

91
Q

What is meigs syndrome

A

In the prescence of an ovarian fibroma / tumour
Ascites
Pleural effusion

92
Q

Treatment of meigs sydnrome

A

Removal of fibroma / tumour causes resolution of ascites / effusion

93
Q

Features of yellow nail syndrome

A

Abnormality of lymphatic drainge
Recurrent bronchiectasis
Small bilateral pleural effusions
Lymphodema
Grossly thickened, yellow nails

94
Q

Assosiated lung condition of RA

A

Bronchiectasis

95
Q

On auscultation what would you hear with bronchiectasis

A

Coarse creps

96
Q

On auscultation what would you hear with lung fibrosis

A

Fine fixed end inspiratry crackles

97
Q

Who is at risk of getting mycoplasma

A

Those in institutions

98
Q

Who is langerhans cells histocytosis seen in

A

younger
ex or current smokers

99
Q

radiological findings of langerhans cells histocytosis

A

bilateral symmetrical reticlulonodular pattern
affecting upper and mid zones
later diseases may lead to cyst formation

100
Q

What is cryptogenic organising pneumonia

A

non specific inflammatory pulmonary process with buds of granulation tissue forming in the distal air spaces

101
Q

Treatment of COOP

A

Steriods

102
Q

Lymphocyte predominant pleural fluid suggests what

A

Lymphoma
Cancer
TB

103
Q

CXR findings in PJP

A

diffuse ground glass opacities
nodular opacities
lobar consolidations
normal film

104
Q

What is polyarteritis nodosa

A

affects medium sized arteries
infiltrate composed of neutrophils
absent granulomas

105
Q

How often does polyarteritis nodosa affect the lungs?

A

rarely

106
Q

Treatment of TB that is fully sensitive

A

4 drugs (rifampicin, isonizaid, ethambutol, pyrazinamide) for 2 months
then 2 drugs (rifampicin and isonizaid) for 4 months

107
Q

How is unilateral paralysis of the diaphragm diagnosed

A

flurosccopy

108
Q

Investigation for OSA

A

Polysomnography

109
Q

What should be checked before TB treatment is started

A

LFTs

110
Q

Drug assosiations of PHTN

A

Anorectics (flenfuramine, dexfenfluramine)
Amphetamines
Cocaine

111
Q

What is horner syndrome caused by

A

Pancoast (apical) tumour
Leads to damage to spinal nerve roots at levels C8 and T1

112
Q

Presentation of horner syndrome

A

Pupil constriction
Ptosis
Facial anhidrosis

113
Q

When does a staph pneumonia occur

A

after a proceeding viral illness

114
Q

What are common in staph pneumonias

A

pneumothorax
pleural effusion
empyema

115
Q

What is commonly seen 1-2 weeks after infection with mycoplasma pnuemonia in young adults

A

acute cold autoimmune haemolytic anaemia

116
Q

treatment of mycoplasma pneumonia

A

erythromycin

117
Q

Which lung cancer is assosiate dwith increased skin pigmentation

A

Small cell carcinoma

118
Q

What is a positive tuberculin test in a patient with chronic sarcoid suggestive of

A

active TB

119
Q

What is the mainstay of treatment of bronchiectasis

A

Postural drainage by physios

120
Q

What is the best way to ascertain the effects of an extrathoracic tracheal compression

A

flow volume loop

121
Q

What is the thing that prolongs a COPD patients life

A

LTOT

122
Q

What is the PEFR a sensitive measure of

A

airflow obstruction

123
Q

Which vaccine is contraindicated in patients taking high dose steriods

A

Yellow fever vaccination

124
Q

Examples of live vaccines

A

Influenza
Yellow fever
MMR

125
Q

Which type of TB needs 12 month therapy

A

TB meningitis

126
Q

Is asbestos related pleural plaque disease assosiated with abnormal lung function

A

no

127
Q

What is loeffer syndrome

A

transisent respiratory illness with blood eosinophilia and pulmonary infiltrates
Self limiting and lasts under a month

128
Q

Where is the gene defect in cystic fibrosis

A

chromosome 7

129
Q

What is the significant pathogen in CF that is a contraindication to lung transplant

A

Burkholderia cenocepacia

130
Q

Features of scleroderma

A

Raynauds
Peripheral calcinosis
Oesopheageal symptoms
Sclerodactyly
Telangiectasia
Evidence of pulmonary fibrosis

131
Q

Haemopytsis after exposure to aspergillus environments would indicate what

A

Chronic aspergillosis rather thanABPA

132
Q

How does a venturi mask deliver a certain percentage of oxygen

A

Air entrainment

133
Q

Is a pancoast tumour a contranindication to surgery

A

yes

134
Q

Presentation of idiopathic pulmonary haemsiderosis

A

Occurs in young people
Pallor
Weakness
Lethargy
Dry cough
Occassional haemoptysis
No abnormal immunological features
Gas transfer elevated

135
Q

What can develop in an old lung cavity where a patient has had previous TB?

A

Aspergilloma

136
Q

What is a well known determinant of progression in cystic fibrosis

A

Neutrophils

137
Q

Drug interactions of theophylline

A

Clarithyrmycin
Cipro
Cimetidine
Oral contraceptives
Allopurinol

138
Q

What is the most common organism found in childrens sputum with CF

A

Staph A

139
Q

What is most common organism found in adults in sputum with CF

A

Psueodmonas aueringosa

140
Q

What is an aspergilloma assosiated with (blood test)

A

Aspegillus precipitans

141
Q

WHat is the key antigen presenting cell during sensitisation

A

Dendritic cells

142
Q

Example of a LRTA

A

Montelukast

143
Q

What is macleod syndrome

A

Unliateral emphysema following childhood bronchiolitis

144
Q

Treatment of an extrinsic cause of SVC obstruction

A

Stenting

145
Q

Inheritance of CF

A

AR

146
Q

Risk factors for multi drug resistant TB

A

Poor compliance
Previous anti-TB treatment
HIV infection
Contact with drug resistant TB

147
Q

What kind of lung tumour would be most common in a patient who is a lifelong no smoker and a peripheral nature

A

adenocarcinoma

148
Q

Guideliens for a health care worker with a positive tuberculin test after exposure to TB

A

Combination of isonizaid and rifampicin for 3 months or isonizaid alone for 6 months
Means latent TB - no need to stay off work

149
Q

What lung test correlates most with mortality in COPD

A

FEV1

150
Q

Which lung cancer is most assosiated with hypercalcaemia

A

Squamous cell carcinoma

151
Q

What can non resolving pneumonia be a sign of

A

Carcinoma

152
Q

What is the usual tracer in PET imaging used for lung cancer

A

Flurodeoxyglucose

153
Q

Genetics of mesothelioma

A

Loss of material on chromosome 22

154
Q

Who tends to get klebsiella pneumonia

A

Alcoholics

155
Q

Typical picture of klebsiella pneumonia

A

Cavitating lesions
Predominantely affecting upper lobes (can affect lower)

156
Q

Blood tests of a legionella pneumonia

A

Hyponatraemia
Deranged LFTs

157
Q

Normal anatomical dead space

A

150ml

158
Q

Pulmonary function test of a large compression lung cancer

A

flow volume loop

159
Q

Causes of an increased transfer coefficient

A

Increase in RBCs in the lungs due to greater blood flow
Pulmonary haemorrhage
Polycythaemia

160
Q

What is the most common malignant tumour of the lung

A

Metastatic carcinoma

161
Q

Limited cutaenous sclerosis antibodies

A

anti-centromere AbS

162
Q

Antibodies of diffuse cutaneous sclerosis

A

Anti-Scl-70

163
Q

WHats occupational asthma most triggered by

A

Isocycanates

164
Q

Pleural fluid analysis of empyema

A

Presence of macroscopic pus
ph < 7.2
Glucose < 3.3
LDH >1000

165
Q

Which anti-TB agent is responsible for increasing hydrocortisone requirements

A

Rifampicin

166
Q

Which test is the most reliable measure of asthma control

A

FEV1

167
Q

What does nicoteine primarily bind to

A

Acetylcholine receptor

168
Q

Which cell type is increased most in inflammation related to cystic fibrosis

A

Neutrophils

169
Q
A

MRCP - Part 1 (19 decks)

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