Respiratory Flashcards
In what form is the majority of carbon dioxide in the blood carried?
bicarbonate ions
REM sleep behaviour disorder has which gender predominance?
Massive male predominance
To what drug does REM sleep behaviour disorder respond?
Clonazepam
Vital capacity is the sum of…
TV + inspiratory reserve vol + expiratory reserve vol
What 2 mutations are present in majority of cases of inherited PAH?
mutations in receptors of the transforming growth factor-beta family (BMPR2) and activin like kinase type 1 (ALK1)
A-a gradient equation
(150 - pCO2/0.8) - PaO2
HLA allele in Narcolepsy
HLA DQB1*0602
Reduced levels of … are seen in the … of people with narcolepsy
Hypocretin (wakefulness assoc. neurotransmitter), CSF
Acid Base disturbance of salicylate poisoning
primary respiratory alkalosis from salicylate induced hyperventilation; metabolic acidosis due to salicylate interference w. intermediary metabolism -> overproduction of organic acids
Lung volume changes in pregnancy
RV and ERV gradually reduce; FRC decreases and IC increases by same amount so TLC stable
At which lung volume is PVR lowest?
FRC, because inward elastic forces of lung are in equilibrium with outward elastic forces of chest wall
Feature of a lung nodule that is highly predictive of malignancy
High Houndsfield density (>20 HU)
Major side effect of Nintedanib
Diarrhoea- in >60%
Does Pirfenidone improve dyspnoea scores?
No
Gas trapping increases what spirometry measurement?
RV and FRC
Normal A-a gradient
(Age/4) + 4; typically <15mmHg
Causes of a raised KCO
obesity, asthma, haemorrhage, polycythaemia, L to R shunt
O2 dissociation curve shift to the right
acidosis, rise in DPG, rise in temp
What causes a large decrease in VC with lying down?
diaphragmatic palsy
Slow VC > FVC suggests
dynamic airway collapse
3 congenital causes of bronchiectasis
Marfan’s, ciliary dysfunction, alpha-1 AT
Condition with highest sputum mucin concentration
Primary ciliary dyskinesia
SE of hypertonic saline
bronchspasm
when to initiate hypertonic saline in bronchiectasis?
> 3 exac/yr
Abs for. mdr-Pseud
beta-lactam + aminoglycoside
drugs w/o evidence in bronchiectasis?
PO steroid, tiotropium
Rx duration for M abscessus
12 months
CF GI Manifestations:
DIOS, fibrosing colonopathy
CF most common mutation
F508deletion
CF F508deletion mechanism
Defective trafficking and opening
CF F508deletion rx
Homozygotes with: Ivacaftor + tezacaftor + exelacaftor
Hetero: Iva and teza alone
Ivacaftor MOA
potentiator, opens channel (good for G551D)
tezacaftor + exelacaftor + lumacaftor MOA
traffickers
tezacaftor + exelacaftor effect
Increase FEV1 by: 5-15%
Diagnose CF by one of 4:
mec ileus, heelprick immunoreactive trypsinogen, sweat test >60mmol, gene test
CF Transplant indications
FEV1 <35%
PaO2 <60
PaCO2>55
Infections: Resistance or increasing exac QoL
In asthma, what is a Positive methacholine challenge?
drop >20% FEV1
In asthma, what is a Positive mannitol challenge?
drop >15%
Gold standard for exercise-induced asthma
Eucapnic voluntary hyperventilation >10% fall
In asthma, what does FENo: >50ppb mean?
likely steroid responsive; not if <25ppb
Mepoliziumab MOA
Anti-IL5
Benralizumab MOA
Anti-IL5R
Omalizumab MOA
Anti-IgE, but not effective if IgE >1300 (too much to bind)
ABPA clinical findings
Asthma, bronchiectasis, fleeting infiltrates
ABPA lab
IgE >1000, Eo >0.5, Aspergillus IgG precipitans
ABPA rx
Steroids and itraconazole
COPD x3 indications for Abx
Fever, sputum vol increase, change in sputum colour
BODE predicts:
respiratory death in COPD
BODE is made up of
BMI; FEV1; dyspnoea scale; 6MWT distance;
LTOT indications
Pa O2 <55 or PaO2 55-59 with pulmon HTN or polycythaemia
ICS candidates in COPD
FEV1 <50%, 2 or more moderate exac/year, eosinophilia, asthma concurrent