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BPT Written > Respiratory > Flashcards

Respiratory Flashcards

1
Q

In what form is the majority of carbon dioxide in the blood carried?

A

bicarbonate ions

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2
Q

REM sleep behaviour disorder has which gender predominance?

A

Massive male predominance

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3
Q

To what drug does REM sleep behaviour disorder respond?

A

Clonazepam

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4
Q

Vital capacity is the sum of…

A

TV + inspiratory reserve vol + expiratory reserve vol

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5
Q

What 2 mutations are present in majority of cases of inherited PAH?

A

mutations in receptors of the transforming growth factor-beta family (BMPR2) and activin like kinase type 1 (ALK1)

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6
Q

A-a gradient equation

A

(150 - pCO2/0.8) - PaO2

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7
Q

HLA allele in Narcolepsy

A

HLA DQB1*0602

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8
Q

Reduced levels of … are seen in the … of people with narcolepsy

A

Hypocretin (wakefulness assoc. neurotransmitter), CSF

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9
Q

Acid Base disturbance of salicylate poisoning

A

primary respiratory alkalosis from salicylate induced hyperventilation; metabolic acidosis due to salicylate interference w. intermediary metabolism -> overproduction of organic acids

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10
Q

Lung volume changes in pregnancy

A

RV and ERV gradually reduce; FRC decreases and IC increases by same amount so TLC stable

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11
Q

At which lung volume is PVR lowest?

A

FRC, because inward elastic forces of lung are in equilibrium with outward elastic forces of chest wall

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12
Q

Feature of a lung nodule that is highly predictive of malignancy

A

High Houndsfield density (>20 HU)

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13
Q

Major side effect of Nintedanib

A

Diarrhoea- in >60%

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14
Q

Does Pirfenidone improve dyspnoea scores?

A

No

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15
Q

Gas trapping increases what spirometry measurement?

A

RV and FRC

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16
Q

Normal A-a gradient

A

(Age/4) + 4; typically <15mmHg

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17
Q

Causes of a raised KCO

A

obesity, asthma, haemorrhage, polycythaemia, L to R shunt

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18
Q

O2 dissociation curve shift to the right

A

acidosis, rise in DPG, rise in temp

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19
Q

What causes a large decrease in VC with lying down?

A

diaphragmatic palsy

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20
Q

Slow VC > FVC suggests

A

dynamic airway collapse

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21
Q

3 congenital causes of bronchiectasis

A

Marfan’s, ciliary dysfunction, alpha-1 AT

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22
Q

Condition with highest sputum mucin concentration

A

Primary ciliary dyskinesia

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23
Q

SE of hypertonic saline

A

bronchspasm

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24
Q

when to initiate hypertonic saline in bronchiectasis?

A

> 3 exac/yr

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25
Q

Abs for. mdr-Pseud

A

beta-lactam + aminoglycoside

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26
Q

drugs w/o evidence in bronchiectasis?

A

PO steroid, tiotropium

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27
Q

Rx duration for M abscessus

A

12 months

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28
Q

CF GI Manifestations:

A

DIOS, fibrosing colonopathy


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29
Q

CF most common mutation

A

F508deletion

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30
Q

CF F508deletion mechanism

A

Defective trafficking and opening

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31
Q

CF F508deletion rx

A

Homozygotes with: Ivacaftor + tezacaftor + exelacaftor


Hetero: Iva and teza alone


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32
Q

Ivacaftor MOA

A

potentiator, opens channel (good for G551D)

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33
Q

tezacaftor + exelacaftor
 + lumacaftor MOA

A

traffickers

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34
Q

tezacaftor + exelacaftor
 effect

A

Increase FEV1 by: 5-15%

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35
Q

Diagnose CF by one of 4:

A

mec ileus, heelprick immunoreactive trypsinogen, sweat test >60mmol, gene test


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36
Q

CF Transplant indications


A

FEV1 <35%
PaO2 <60
PaCO2>55
Infections: Resistance or increasing exac QoL


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37
Q

In asthma, what is a Positive methacholine challenge?

A

drop >20% FEV1

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38
Q

In asthma, what is a Positive mannitol challenge?

A

drop >15%

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39
Q

Gold standard for exercise-induced asthma

A

Eucapnic voluntary hyperventilation >10% fall


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40
Q

In asthma, what does FENo: >50ppb mean?

A

likely steroid responsive; not if <25ppb

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41
Q

Mepoliziumab MOA

A

Anti-IL5

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42
Q

Benralizumab MOA

A

Anti-IL5R

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43
Q

Omalizumab MOA

A

Anti-IgE, but not effective if IgE >1300 (too much to bind)

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44
Q

ABPA clinical findings

A

Asthma, bronchiectasis, fleeting infiltrates

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45
Q

ABPA lab

A

IgE >1000, Eo >0.5, Aspergillus IgG precipitans

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46
Q

ABPA rx

A

Steroids and itraconazole

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47
Q

COPD x3 indications for Abx

A

Fever, sputum vol increase, change in sputum colour

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48
Q

BODE predicts:

A

respiratory death in COPD

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49
Q

BODE is made up of

A

BMI; FEV1; dyspnoea scale; 6MWT distance;

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50
Q

LTOT indications

A

Pa O2 <55 or PaO2 55-59 with pulmon HTN or polycythaemia

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51
Q

ICS candidates in COPD

A

FEV1 <50%, 2 or more moderate exac/year, eosinophilia, asthma concurrent

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52
Q

Who not to give ICS in COPD

A

repeated pneumonia, low eos, myobacterial infection

53
Q

DECAF score for worse outcomes in exacs of COPD

A

Dyspnoea scale; eosinopaenia; consolidation on CXR; acidaemia pH <7.30,; afib

54
Q

SpO2 measurement in CO poisoning

A

Pulse oximeter will be normal, PaO2 will be normal

55
Q

O2 sats vs gas measurement in MetHb

A

Pulse Ox will read low, PaO2 will be normal

56
Q

Lemiere’s disease is due to which organism…

A

Fusobacterium

57
Q

ARDS key ventilation targets

A

TV 6-8ml/kg; peak plateau pressure <30cmH2o

58
Q

When to consider ECMO in ARDS

A

When PF <80

PF is PaO2/FiO2

59
Q

Level of MIP/SNIP that predicts T2RF in MDN

60
Q

Normal MIP/MEP F or M

A

F: 90
M: 140

61
Q

Apnoea definition

A

cessation of airflow >10s

62
Q

Definition of hypopnoea

A

> 30% reduction in airflow for >10s with EEG arousal OR sats drop 4%

63
Q

Respiratory disturbance Index (RDI) equation

A

AHI + RERA (resp effort related arousal)

64
Q

AHI normal/moderate/severe

A

Mild5-15, mod 15-30, severe >30

65
Q

OSA definition

A

AHI >5 with symptoms; or AHI >15

66
Q

OHV triad

A

BMI >30, awake PaCO2 >45, sleep disordered breathing

67
Q

CPAP adherence definition

A

> 4 hours/ night

68
Q

Type 1 Narcolepsy definition

A

> 3/12 EDS + cataplexy + positive MSLT OR low CSF hypocretin

69
Q

Type 2 Narcolepsy definition

A

> 3/12 EDS + positive MSLT + normal hypocretin

70
Q

Positive MSLT

A

sleep within 8 mins x2 on test

71
Q

Rx of excessive daytime sleepiness

A

Dexamphetamine or modafinil

72
Q

Rx of cataplexy

73
Q

Lofgren syndrome

A

Sarcoidosis: Arthritis + EN + bilateral hilar LN

74
Q

Key aspect of Lofgren’s for Ix and Rx

A

No further Ix needed if textbook; Mgmt NSAIDs

75
Q

Sarcoid stages

A

1: Hilar/mediastinal LN; 2: LA and parenchymal infiltrates; 3: parenchymal infiltrates; 4: fibrosis

76
Q

Sarcoid stages mgmt

A

1: 95% resolve spont; 2: steroids; 3: steroids

77
Q

Radiographic predictors of malignancy

A

nodule >3cm, poorly marginated or spiculated, UL location

78
Q

PET is not good for:

A

<0.7cm, carcinoid, bronchoalveolar adenoCa

79
Q

Three key pathways for pulmonary HTN

A

endothelin, nitric oxide, prostacyclin

80
Q

Triad for definition of pHTN

A

mPAP >25, PVR >3, PAW <15

81
Q

pulmonary HTN positive vasodilator challenge

A

10-40 reduction mmHg, stable or rise in CO

82
Q

Adverse reaction to vasodilators that occurs with PVOD

A

pulmonary oedema

83
Q

2 main RHC prognostic markers

A

Cardiac Index, RAP

84
Q

Group most likely to respond to vasodilators in pHTN

A

idiopathic pulmonary arterial HTN, anorexigen

85
Q

Specific medical rx for CTEPH

86
Q

Gene assoc. w. familial PAH

87
Q

Contraindications to bronchoscopy

A

platelets <50, INR <1.5

88
Q

Mgmt of lung nodule <6mm, solid and low risk

89
Q

Mgmt of lung nodule <6mm, solid and high risk

A

optional CT at 12 months

90
Q

Mgmt of 6-8mm nodule, solid, low or high risk

A

CT 6-12 months

91
Q

Mgmt of nodule >8mm, solid

A

CT at 3 months, PET or tissue sampling

92
Q

Crazy paving is

A

GGO, interlobular thickening, intralobular reticulation

93
Q

PTx mgmt primary, <2cm and Asymptomatic

94
Q

PTx mgmt if primary >2cm or dyspnoea

95
Q

PTx mgmt if secondary, <2cm and asymptomatic

A

aspirate and admit

96
Q

PTx mgmt if secondary, >2cm or Sx

97
Q

When to check diff between protein levels in serum and pleural fluid? (SPPG)

A

If think fluid it transudative but appears exudative

98
Q

SPPG suggesting exudate

99
Q

How to calculate SPPG

A

serum protein - pleural protein

100
Q

If SPPG consistent with exudate, check:

A

check serum:pleural albumin gradient (SPAG)

101
Q

SPAG consistent with exudate

102
Q

ADA is produced by

A

cell mediated immune response

103
Q

ADA value suggesting TB?

104
Q

ADA value suggesting lymphoma or empyema?

105
Q

Predominant cell type in TB pleural fluid

A

Lymphocytic

106
Q

Differential diagnosis if pleural fluid >10% eosinophils (4 diagnoses)

A

Drugs, fungus, parasites, BAPE (benign asbestos pleural effusion)

107
Q

Characteristic pleural fluid findings for peritoneal dialysis related effusion?

A

Glucose 2x serum

Low protein

108
Q

Characteristics pleural fluid findings for urinothorax

A

Creatinine 5x serum

109
Q

Pleural fluid findings in duropleural shunt

A

Beta-2-transferrin level elevated

110
Q

Characteristic pleural fluid findings in ventriculopleural shunt

111
Q

Characteristic pleural fluid findings in trapped lung?

A

Pleural elastase >14.5

112
Q

Antibiotics for CAP-associated empyema

A

Benpen+metro OR cef/metro
Then Augmentin OR amox+metro
Total 3-4 weeks

113
Q

Antibiotics for HAP associated empyema

114
Q

Classical findings for UIP

A

Subpleural reticulation, honeycombing, traction bronchiectasis, apical-basal gradient

115
Q

4 features of NSIP

A

Ground glass opacities
Subpleural sparing
Apical-basal gradient
Traction bronchiectasis

116
Q

What is significant fall in FVC or DLCO?

A

FVC 10%

DLCO 15%

117
Q

What DLCO cut-off is used to say lung biopsy ++ risky?

118
Q

Hyaline membranes on lung biopsy suggests:

A

Acute interstitial pneumonia

119
Q

Mechanism of pirfenidone and side effects

A

Reduces production of pro-fibrotic cytokines- TGF-b, IL1b, fibroblast growth factors
AEs - GI, ALT/AST elevation, photosensitive rash

120
Q

Nintedanib mechanism and S/E

A

Multi-target TKI (PDGF, VEGF, FGF)

Diarrhoea, CV risk, bleeding

121
Q

Average FVC loss per year in IPF

122
Q

PBS criteria for IPF anti-fibrotics?

A

FEV1 > 50%

DLCO > 30%

123
Q

Pathogenesis of hypersensitivity pneumonitis

A

Type 3 hypersensitivity, mediated by IgG immune complexes

124
Q

AIP biopsy histology

A

Hyaline membranes in the alveoli from diffuse alveolar damage

125
Q

UIP/ IPF histology

A

Numerous fibroblastic foci

126
Q

Causes of extra thoracic obstruction

A

Vocal cord paralysis, extra-thoracic goitre, laryngeal tumour

127
Q

Causes of intrathoracic obstruction

A

Tracheomalacia of intrathoracic airways, bronchogenic cysts, tracheal lesions

128
Q

Cause of fixed airway obstruction

A

Tracheal stenosis

BPT Written (21 decks)

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