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MRCP 2 > Resp > Flashcards

Resp Flashcards

1
Q

Initial NIV settings

A

IPAP 10

EPAP 4

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2
Q

Aerospace engineer gets cough, night sweats fatigue

Reticular cxr changes

A

Berylliosis

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3
Q

What test can be performed to assess if the effusion is an empyema?

A

If visibly pus, then that’s diagnostic

If unsure, centrifuge

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4
Q

Chronic productive cough, dextracardia

A

primary ciliary dyskinesia.. a type of bronchiectasis

Diagnose with ciliary function tests - can they taste saccharin 20m after placed in nose?!

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5
Q

worsening SOB in a middle-aged pt
clear lung fields
diastolic murmur
CXR: enlarged proximal pulmonary arteries

A

Pulmonary arterial hypertension

Murmur is pulmonary regurgitation

Diagnosis R heart cath

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6
Q

Management of new pulmonary nodule

A

=> 8mm urgent CT pet

5-6mm or low risk then CT at 1 year, if 6 or 7 then in three months

Nodule <5mm, or clear benign features, or unsuitable for treatment: discharged

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7
Q

ARDS, history of exposure to bats and their droppings in Mississippi

A

Histoplasmosis

Tx Amphotericin or itraconazole

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8
Q

Pneumothorax, after drain inserted when would you involve surgeons

A

persistent air leak or failure of the lung to re-expand, an early (3-5 days) thoracic surgical opinion should be sought

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9
Q

Secondary pneumothorax,1.3cm, breathless, mx

A

Any secondary pneumo with SOB: Chest drain

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10
Q

Which lung cancer is assx w gynaecomastia

A

Adenocarcinoma

Also assx w hypertrophic pulmonary osteoarthropathy (HPOA)

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11
Q

most common type of lung cancer in non-smokers

A

Adenocarcinoma, although the majority of patients who develop lung adenocarcinoma are still smokers

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12
Q

Upper Vs lower zone fibrosis

A

ACID causes lower, the rest upper

Asbestosis
Connective tissue disorders (except ank spond)
Idiopathic pulmonary fibrosis
Drugs…… (Amiodarone, bleomycin, methotrexate).

Upper:
C -Coal worker's pneumoconiosis
H -Histiocytosis/hypersensitivity pneumonitis
A -Ankylosing spondylitis
R - Radiation
T -Tuberculosis
S -Silicosis/sarcoidosis
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13
Q

How long can’t you fly for after pneumothorax

A

1/52 after clear CXR if simple pneumothoraces

Or two weeks after traumatic

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14
Q

LTOT w NIV

A

If develop a respiratory acidosis and/or a rise in PaCO2 of >1 kPa (7.5 mmHg) during an LTOT assessment on two repeated occasions, while apparently clinically stable, should only have LTOT w NIV

(Also need PaO2 is < 7.3 kPa)

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15
Q

Scoring system for PE 30d mortality and long term morbidity

A

PESI score

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16
Q

Indications for thrombolysis in PE

A

systolic <90 or drop off more than 40 for longer than 15 mins
New onset RHF….. Raised JVP/loud P2/ECG abnorm

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17
Q

Pathogenesis of TRALI

A

Thought to be due to anti - HLA or anti-neutrophil antibodies

Usually within 6hr of transfusion

More common in patients who are multiparous women, or receiving donors from multipara women

If you’ve previously had TRALI, you can have male donors in future (1-5% antibodies compared to 20% in women)

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18
Q

CXR changes with aspergilloma

A

CXR showing round opacity in upper zone with surrounding halo of air

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19
Q

CXR showing round opacity in upper zone with surrounding halo of air

History of tb

A

Aspergilloma

Usually asymp but can be large haemoptysis
Manage surgically

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20
Q

ECG changes in PE

A

S waves in v1 , q waves and inverted t in v3
S1Q3T3
But only in 20%

RBBB, tachy

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21
Q

What measure do you use to judge severity of copd

A

Fev1

80% Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients
50-79% Stage 2 - Moderate
30-49% Stage 3 - Severe
< 30% Stage 4 - Very severe

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22
Q

Young non smoking female presents with spontaneous pneumothorax on the BG of gradual reduction of exercise tolerance. .

A

Lymphangioleiomyomatosis (LAM) affects non smoker premenopausal women causing proliferation of atypical smooth muscle cells in the lungs, lymphatics and uterus, most likely caused by oestrogens.. reticulonodular interstitial pattern

Exclude atypical Langerhans cell histiocytosis… Presents in smokers Which also has spontaneous pneumothorax, reduced ET. Can have cranial diabetes insipidus

23
Q

Purpose of seldinger chest drain Vs surgical chest drain

A

Surgical is larger, so if just blood aspirated or trauma

If bloodstained fluid then the smaller seldinger is ok

24
Q

CT chest showing widespread tram-track and signet ring signs

A

bronchiectasis

25
Q

Flu like symp dry cough erythema multiforme

A

Mycoplasma pneumoniae

second most common cause of erythema multiforme after HSV

26
Q

What resp parameter do you monitor in GBS for ? invasive ventilator support

A

FVC <15ml/kg

27
Q

Estimate if appropriate PaO2

A

2/3 of inspired O2

So 15L is 90% , therefore 60 kPa

28
Q

Microorganism in CF sputum which has worst prognosis

A

Burkholderia cepacia has worse prog… can get Capacia Syndrome with necrotising pneumonia
Also a contraindication to lung transplantation

Pseudomonad also v difficult to eradicate

29
Q

Important microorganism contraindication to lung transplantation in CF

A

Burkholderia cepacia

30
Q

Pharmacological therapy for idiopathic pulmonary fibrosis

A

Pirfenidone

Only other option is lung transplantation

31
Q

Chest drain inserted for empyema. 5 days later it’s bubbling

A

Bronchopleural fistula

Possibly iatrogenic pneumothorax, but the drain would have bubbles throughout then

32
Q

Diagnosis of whooping cough

A

In first two weeks nasopharyngeal swab culture
After that serology
Too late for abx by then though

33
Q

Indication for LTOT on ABG

A

Indicated if:
pO2 is <7.3, on two separate ABGs 3 weeks apart

Or pO2 7.3-8 with secondary polycythaemia, peripheral oedema, nocturnal hypoxaemia or pulmonary hypertension

34
Q

Features of TB meningitis

A 
Risk factor like homeless
6th nerve palsies
Siadh 
Cxr may show upper lobe fibrosis
Nodular enhancing lesion on MRI
Lymphocytic CSF with low glucose
35
Q

management of bronchiectasis

A

daily postural drainage and abx for exacerbations

36
Q

CXR features of coal workers pneumonoconiosis

A

Simple CWP is multiple small round opacities 1-10mm, mostly upper

complicated will have much larger opacities in upper zones, with fibrosis

37
Q

19y old with sob, Pharyngitis, wheeze rash, muscle tenderness. Cxr lower zone fibrosis which seems worse than OE. diagnosis

A

Mycoplasma

Often affects young
Clari

38
Q

Management for SVC obstruction

A

Stent insertion

39
Q

Most specific ECG changes in PE

A

Simultaneous T wave inversions in the inferior (II, III, aVF) and right precordial leads (V1-4)

40
Q

Distinguish between ACS and PE

A

simultaneous T wave inversion in III and V1 are diagnostically significant for PE
(only 1% of ACS, 88% w Acute PE)
- LITFL

ACS rarely tachy

41
Q

cryptogenic organising pneumonia features

A

assx w autoimmune / inflammatory conditions like RA,
Can mimic bacterial pneumonia on CXR and crackles OE
Raised ESR

Rheumatoid lung disease tends to be bilat basal opacification CXR - honeycomb/reticulonod on HRCT

42
Q

cryptogenic organising pneumonia management

A

corticosteroids (it’s non-infectious)

43
Q

non-small cell bronchial carcinoma (T2a, N1, M0, stage IIB management

A

if FEV1 >60% and good baseline then pneumonectomy is best (35% 5yr)

44
Q

pneumonia w hyponatraemia

A

legionella

45
Q

pt w diagnosis of asthma, started on monteleukast and gets signif worse. why?

A

Leukotriene receptor antagonists can precipitate Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

46
Q

Ascaris lumbricoides (giant roundworm) on serology, respiratory compromise

A

pulmonary eosinophilia where the nematode migrate to lung causing Loffler’s syndrome

can also be due to Strongyloides

47
Q

Mx of aspergilloma

A

surgical resection

48
Q

Investigation to diagnose methothelioma

A

Thoracoscopy pleural biopsy

49
Q

PE with haemodynamic instability

A

IV fluids to increase RV filling pressure

First line: Thrombolysis if not improving after 15-30 minutes

50
Q

management of PCP

A

co-trimoxazole w pred

if intolerant then
Clindamycin and Primaquine w pred
or IV Pentamidine w pred

51
Q

management for cystic fibrosis F508

A

Lumacaftor/Ivacaftor (Orkambi)

52
Q

patient presents w sats 90% on 10L, but ABG on RA P02 10.8. Young person, taking ilicit drugs. Cause and management?

A

Methaemoglobin
(Methaemoglobin MetHb levels usually <1.5%)

IV methylthioninium chloride (methylene blue) if acquired

drugs: sulphonamides, nitrates (including recreational nitrates e.g. ‘poppers’), dapsone, sodium nitroprusside, primaquine
chemicals: aniline dyes

53
Q

CT Thorax findings in Anti-glomerular basement membrane (GBM) disease (Goodpasture’s syndrome)
and
Granulomatosis with polyangiitis (Wegener’s granulomatosis)

A

both cause pulmonary-renal syndrome

GBM GroundGlass changes

Granulomatosis multiple cavitating lesions - usually apical

MRCP 2 (13 decks)

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