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FRACP Clinical > Resp > Flashcards

Resp Flashcards

1
Q

What are the clinical features of sarcoidosis?

A
  • fever, wt loss, anorexia
  • eye symptoms: uveitis
  • nasal congestion
  • facial nerve palsy
  • erythema nodosum, arthralgia
  • lupus pernio: nose swelling
  • lymphadenopathy
  • pulmonary fibrosis
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2
Q

Signs of sarcoidosis on CXR?

A
  • hilar lymphadenopathy
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3
Q

Investigations for sarcoidosis?

A
  • FBC: lymphocytopenia, eosinophilia
  • ESR
  • ACE level
  • CXR, CT chest
  • PFT, ABG
  • bronchoscopy and biopsy
  • LN biopsy
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4
Q

Treatment for sarcoidosis?

A
  • prednisone
  • if long term Rx needed: MTX, AZA
  • hydroxychloroquine for skin disease
  • infliximab
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5
Q

What are causes of clubbing?

A
  • resp: lung ca, bronchiectasis, CF, Idiopathic pulmonary fibrosis
  • cardiac: cyanotic congenital heart disease, IE
  • GI: cirrhosis, IBD, Coeliac
  • thyrotoxicosis
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6
Q

What is Lights criteria for exudate?

A

Pleural:serum Protein >0.5
Pleural:serum LDH >0.6
LDH > 2/3 upper limit of normal

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7
Q

What are causes of transudative pleural effusion?

A
  • heart failure
  • liver failure
  • nephrotic syndrome
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8
Q

What are causes of exudative pleural effusion?

A
  • infection: pneumonia, TB
  • malignancy
  • pulmonary infarction
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9
Q

What investigations on pleural fluid?

A
  • pH:
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10
Q

What us the differential for bilateral crackles?

A
  • pulmonary edema/cardiac failure
  • bronchiectasis
  • atelectasis
  • bilateral pneumonia
  • pulmonary fibrosis (fine crackles)
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11
Q

How many posterior ribs visible to say a CXR is hyperexpanded?

A

More than 9 posterior ribs, flattened diaphragm

Or >6 anterior ribs at diaphragm

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12
Q

What is the differential for a lung mass on imaging?

A
  • carcinoma - primary or metastatic
  • lung abscess
  • TB
  • pulmonary infarct
  • granuloma: I.e. Fungal
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13
Q

What are causes of cavitating lung lesion?

A
  • lung abscess: staph, klebsiella
  • carcinoma
  • TB
  • fungus
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14
Q

What are the signs of asthma severity?

A
  • symptoms throughout day
  • nightly symptoms >7x/week
  • SABA use several times a day
  • extreme interference with normal activity
  • FEV1
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15
Q

How to investigate asthma?

A
  • spirometry: obstructive, reversible 12%
  • bronchial challenge testing if normal spiro
  • PEF for monitoring
  • allergen skin testing
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16
Q

How would you manage asthma? (Maintenance Rx)

A 
Non pharm: 
- allergen avoidance, smoking cessation
- asthma action plan
Pharm:
- vaccinations
- SABA
- ICS alone
- ICS/LABA combination
- prednisone
- treat GORD, if present
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17
Q

What are causes of upper lobe lung fibrosis?

A

SCART

  • silicosis
  • coal worker pneumoconiosis
  • ank. spond
  • radiation
  • tuberculosis
18
Q

What are causes of lower lobe lung fibrosis?

A

RASIO

  • RA
  • asbestosis
  • scleroderma
  • idiopathic
  • other: drugs (MTX, bleomycin, amiodarone)
19
Q

What are symptoms of OSA?

A
  • snoring/apneas/waking gasping for air
  • excessive daytime sleepiness
  • decreased concentration
  • cognitive impairment
20
Q

What are complications of OSA?

A
  • HTN
  • pulmonary HTN
  • increased CAD and stroke
  • polycythemia
  • cognitive impairment
21
Q

How to diagnose sleep apnea?

A
  • sleep study: apnea-hypopnea index (severe >60)

- ABG

22
Q

What are some adjuvants for NSCLC lung cancer treatment?

A

VEGF: bevacizumab
EGFR: cetuximab, gefitinib, erlotonib (adenocarcinoma)

23
Q

What is treatment for SCLC?

A

Local: combined chemo (etoposide + cisplatin) + RTx
Advanced: combined chemo
Prophylactic cranial irradiation

24
Q

What are paraneoplastic manifestations of SCLC?

A
  • eaton-lambert
  • SIADH
  • ectopic ACTH
  • carcinoid
25
Q

What is the PAP for dx of pulmonary HTN?

A

> 25 at rest
Or
30 with exercise

26
Q

What investigations for pulmonary HTN?

A
  • CXR
  • PFT
  • ECG
  • ABG
  • CTPA or VQ
  • HRCT
  • TTE
  • R heart cath
  • 6min walk test (
27
Q

What are the types/classes of pulm HTN?

A
  1. Pulmonary arterial HTN
  2. From L heart disease
  3. Due to lung disease
  4. Due to chronic PE
  5. Unclear multifactorial mechanisms
28
Q

How to determine pharmacological treatment in pulm HTN?

A 
If reversibility: calcium channel blockers
Otherwise,
- endothelin receptor antag: bosentan
- PDE5i: sildafenil
- prostacyclins: iloprost, epoprostenol
29
Q

What are some symptoms/presentations of sarcoidosis?

A 
Systemic: fever, wt loss
Pulmonary: cough, sob, abnormal CXR
Eye: uveitis
Skin: erythema nodosum
Nerve: neuropathy/palsied
Cardiac: arrhythmia
30
Q

How to manage sarcoidosis?

A

Treat if:

  • increasing symptoms or worsening lung function
  • Neuro/renal/cardiac complications
  • major eye disease

Use:

  • prednisone 1mg/kg, 1 year taper
  • steroid sparing: MTX, AZA
  • hydroxychloroquine for skin disease
  • infliximab: 3rd line
31
Q

What investigations for sarcoidosis?

A
  • Bloods: FBC, ESR
  • ACE level
  • calcium level (hyperCa)
  • Imaging: CXR, CT, PET
  • biopsy: granulomas
32
Q

What gene and chromosome involved with CF?

A

Autosomal recessive CFTR gene mutation
(Most common is delta F508)
Chromosome 7
1:25 carrier rate

33
Q

What are the various manifestations of CF?

A
  • GI baby: meconium ileum, failure to thrive
  • Resp: cough, haemoptysis, wheeze, SOB
  • Cardiac: cor pulmonale
  • Gastro: diarrhea, steatorrhea, pancreatic insufficiency, intestinal obstruction, ADEK deficiency
  • Liver: cirrhosis/fibrosis, cholelithiasis
  • DM
  • infertility: CBAVD
34
Q

What organisms associated with CF?

A
  1. Staph and h. influenzae
  2. Nosocomial e.coli and proteus
  3. Pseudomonas***
  4. Burkholderia = poor prognosis
35
Q

What investigations for CF?

A
  • sputum MCS
  • bloods: FBC (anaemia, infection), LFT/alb, coags
  • CXR
  • CT chest
  • PFT
36
Q

What is your management of pulmonary CF?

A
  • neb. Antibiotics (tobramycin)
  • bronchodilators
  • mucolytics: neb NS, DNase
  • mutation specific drugs: ivacaftor(G551D), lumacaftor-ivacaftor(DF508)
    Non Pharm:
  • postural drainage, chest Physio
  • medical devices: oscillating devices
  • exercise
37
Q

What is indication for lung transplant in CF?

A
  • FEV1
38
Q

How would you manage gastro manifestations of CF?

A
  • high protein/fat diet
  • nutritional supplements
  • pancreatic enzyme replacement
39
Q

How do you manage pregnancy with CF?

A
  • acknowledge fertility issues; in women, mainly due to malnutrition
  • if FEV1 > 60%, should be OK
  • pulmonary HTN is contraindication to pregnancy
  • genetic counselling
  • screen for GDM
  • increased prematurity
40
Q

How would you approach pre transplant work up?

A

Lungs: PFT, imaging, 6MWT
Heart: TTE, ECG, angio, R heart cath
Infection status: CMV, EBV, HIV, Hep, sputum
Vaccinations
Malignancy: 5yrs cancer free
Social/mental: psych review, social supports, living, finance, compliance
Education

FRACP Clinical (11 decks)

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