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MRCP Master > Resp General > Flashcards

Resp General Flashcards

1
Q

Vital capacity/forced vital capacity

A

Volume that can be exhaledafter maximum inspiration
(ie. maximum inspiration to maximum expiration)
IRV + TV + ERV = VC
=4.5L

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2
Q

What does Spirometer measure

A

FCV,
FEV1
Flow vol loop
PEFR

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3
Q

What ratio is used to distinguish between obstructive and restrictive

A
  • FEV1/FVC
    < 0.7 = obstructive
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4
Q

If FEV1/FVC decrease what do you look at next
and what do conclude if that measure is
- Normal
- Low

A

FVC
Normal = Obstructive
Low = Mix
(usually reduced to a lesser extent in obstructive )

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5
Q

If FEV1/FVC in normal or High
you at the FVC again and if
- normal/ High
- Low

What does it indicate

A

FCV Low= restrictive
FCV normal high = normal lung mechanics

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6
Q

In obstructive disease and change of what in FEV1 pre & post bronchodilator is significant ?

A

12-15%

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7
Q

What does this indicate

A

Mild and severe obstruction

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8
Q

What can spirometry not measure and thus can give us TLC ?

A

Residual volumes

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9
Q

What does a pt have if they have a low TLC but normal/high FEV1/FVC?

A

Restrictive disease

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9
Q

If residual volume increased and TLC Increased

A

Obstructive

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10
Q

What does a pt have if they have a low TLC AND low FEV1/FVC?

A

mix restrictive & obstructive

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10
Q

Reduction of all lung volumes

A

restrictive disease

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10
Q

What test are needed to IX asthma in adults

A
  1. spirometry with a bronchodilator reversibility (BDR) test
  2. FeNO test
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11
Q

Decrease DLco (4)

A
  1. Decrease membrane surface area
    (emphysema)
  2. Increase membrane membrane thickness.
  3. PHTN
  4. Anemia
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12
Q

Increase in DLCO

A
  1. Exercise
  2. Asthma
  3. Pul. Hemorrhage
  4. Polycythemia
  5. Mile left HF
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13
Q

Describe moderate Asthma

PEFR
Speech
RR
Pulse

A

PEFR 50-75% best or predicted

Speech normal

RR < 25 / min

Pulse < 110 bpm

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14
Q

Describe Severe Asthma

PEFR
Speech
RR
Pulse

A

PEFR 33 - 50% best or predicted

Can’t complete sentences

RR > 25/min

Pulse > 110 bpm

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14
Q

Life-threatening Asthma

A

PEFR < 33% best or predicted

O2 < 92%

Silent chest, cyanosis or feeble respiratory effort

Bradycardia, dysrhythmia or hypotension

Exhaustion, confusion or coma

‘Normal’ pC02 (4.6-6.0 kPa)

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15
Q

Near-fatal asthma

A

raised pC02
and/or requiring mechanical ventilation with raised inflation pressure

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16
Q

What do SABA’s end in

A
  • buterol
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17
Q

COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features

A

add a LABA + LAMA

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18
Q

what is after SABA, low ICS Step 3

A

SABA (ending -ol)
+ low-dose ICS
+ leukotriene receptor antagonist (LTRA) (-kast)
Nb. Caution with LTRA in pregnancy

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19
Q

What medication are used in the Step 4 of asthma

A

SABA
+ low-dose ICS
+ long-acting beta agonist (LABA) (ending in -metrol)

Continue LTRA depending on patient’s response to LTRA

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20
Q

name some long-acting beta agonist

A

relax smooth muscle work on B2
Arformoterol.
Bambuterol.
Clenbuterol.
Formoterol.
Salmeterol.
Protokylol.

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21
Q

Name some LAMA’s & Moa

A

Inhibits binding of ACh to M3 muscarinic receptors; blocks the bronchoconstrictor effects of acetylcholine, leading to bronchodilation.

aclidinium (Genuair)
glycopyrronium (Breezhaler)
tiotropium (HandiHaler, Respimat)
umeclidinium (Ellipta)

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22
Q

COPD Indication for LTOT O2

A
  • PaO2 < 7.3

**PaO2 < 8 **if also have:
- polycythemia,
-peripheral oedema
-nocturnal hypoxaemia or
- Pul HTN

23
Q

1st step in rx of COPD without asthma

A

Saba
LABA + LAMA

24
Q

1st step in rx of COPD with Asthma

A

SABA OR Sama
LABA + ICS

25
Q

2nd step of Rx COPD

A

SABA
LABA + ICS +LAMA

26
Q

Asthma rx step 5

A

SABA +/- LTRA

Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS

27
Q

Asthma rx step 6

A

SABA +/- LTRA + medium-dose ICS MART

OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA

28
Q

Asthma rx step 6

A

SABA +/- LTRA + one of the following options:

  • increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART)
  • a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline)
  • seeking advice from a healthcare professional with expertise in asthma
29
Q

What is Maintenance and reliever therapy (MART) ?

A

combined ICS and fast acting LABA treatment in one inhaler
This is used as both reliver and maintenance
Symbicort®(Budesonide/formoterol ),
DuoResp Spiromax® (Budesonide/formoterol )

30
Q

What is Apha 1 Antitrypsin deficiency

A

protein is a protease inhibitor from the liver that is secreted to inactivate Neutrophils Elastase (which breaks down elastin of bacteria). However, when there is a deficiency Elastase continues to break down the wall of the alveolus = enlargement of the air spaces =
1. pan acinar emphysema
(Esp at the bases)
2. Chronic bronchitis
3. Bronchieltasis
4. Cirrhosis

31
Q

Sx of Apha 1 Antitrypsin deficiency

A

COPD: pan acinar emphysema
(Esp at the bases), Chronic bronchitis,
Bronchieltasis
Cirrhosis - phtn, coagulation deficiency –> hepatocellular carcinoma

32
Q

Apha 1 Antitrypsin deficiency: * heterozygous: PiMZ

A

o however, if non-smoker low risk of developing emphsema but may pass on A1AT gene to children

33
Q

Apha 1 Antitrypsin deficiency:PiSS

A

50% normal A1AT levels

34
Q

PiZZ:

A

10% normal A1AT levels

35
Q

Rx Apha 1 Antitrypsin deficiency

A
  • no smoking
  • supportive: bronchodilators, physiotherapy
  • intravenous alpha1-antitrypsin protein concentrates
  • surgery: lung volume reduction surgery, lung transplantation
36
Q

triangle of safety for chest drain

A

base of the axilla,
lateral edge pectoralis major,
5th intercostal space
anterior border of latissimus dorsi

37
Q

common complication of plasma exchange

A

is hypocalcaemia

38
Q

Indications for placing a chest tube in pleural infection:

A
  1. frankly purulent or turbid/cloudy pleural fluid on sampling
  2. organisms identified on G&S and/or culture from a non-purulent pleural fluid sample (indicates that pleural infection is established)
  3. Pleural fluid pH < 7.2
39
Q

What causes exudative pleural effusions

A

exudative pleural effusions
-inflammation of the pulmonary capillaries which makes them much more leaky.

40
Q

What causes transudative pleural effusions

A

transudative
when too much fluid starts to leave the capillaries either because of increased hydrostatic pressure or decreased oncotic pressure in the blood vessels.

41
Q

Examples transudative pleural effusions (3)

A

Transudative
1LVF
2Cirrhosis
3Nephrotic syndrome
Other cause of hypoproteinemia
Uncommon: myoedema, sarcoid, peritoneal dialysis

42
Q

Examples Exudative pleural effusions(6)

A

Exudative
1. Infections: TB
2. Malignancy
3. PE
4. Connective tissue disorders
5. Sub diaphragmatic: (pancreatitis, sub phrenic abscess )
6Trauma

43
Q

Effusion with protein level < 25 g/L

A

Transudative

44
Q

Effusion with protein level >35 g/L

A

Exudative

45
Q

When do you need Lights criteria ?

A

When proteins levels are between 25-35 g/L

46
Q

What is Lights criteria

A

Exudate is likely if one :
fluid/serum

  1. pleural fluid protein divided by serum protein >0.5
  2. pleural fluid LDH divided by serum LDH >0.6
  3. pleural fluid LDH more than 2/3 the upper limits of normal serum LDH
47
Q

Characteristic pleural fluid findings:
low glucose:

A

RA & TB

48
Q

Characteristic pleural fluid findings:
raised amylase:

A

pancreatitis, oesophageal perforation

49
Q

Characteristic pleural fluid findings:
heavy blood staining:

A

mesothelioma, pulmonary embolism, tuberculosis

50
Q

RX Primary pneumothorax

A
  1. Rim of air is < 2cm and pt NOT SOB = discharge
  2. Otherwise, aspiration should be attempted
  3. if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
51
Q

Rx 2ndary pneumothorax (underlying lung ds)

A

All patients should be admitted for at least 24 hours

  • pt is > 50 y.o & rim > 2cm &/or the pt is SOB = chest drain should be inserted.
  • Otherwise aspiration should be attempted if rim is between 1-2cm.
    -If aspiration fails (i.e. pneumothorax >1cm) a chest drain should be inserted.

if <1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

52
Q

Upper zone fibrosis

A

CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidos

53
Q

Fibrosis predominately affecting the lower zones

A
  1. Idiopathic pulmonary fibrosis
  2. Most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
  3. Drug-induced: amiodarone, bleomycin, methotrexate, asbestosis
54
Q

Explain the flow volume loop

A
55
Q

What is happening when the flow volume loop shift to the right

A

Restrictive
(Restrictive =right)

56
Q

Respiratory alkalosis with decreased O2

A

PE

57
Q

Oxygen dissociation curve shift left

A

Oxygen dissociation curve
shifts Left
- Lower oxygen delivery
- Lower acidity, temp, 2-3 DPG - also HbF,
carboxy/methaemoglobin

58
Q

Oxygen dissociation curve what caused shift Right

A

shifts Right
- Raised oxygen delivery
- Raised acidity, temp, 2-3 DPG

59
Q

Oxygen dissociation curve shift to the left means

A

decreased oxygen delivery to tissues

60
Q

Oxygen dissociation curve shift to the Right means

A

enhanced oxygen delivery to tissues

MRCP Master (47 decks)

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