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Respiratory Flashcards

1
Q

What is the most common organism causing exacerbations of COPD?

A

Infective: s.pneumoniae

Non-infective: h.influenzae

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2
Q

What are the symptoms of A1AT?

A

Panacinar/lower lobe emphysema

Cirrhosis and HCC adults, cholestasis children

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3
Q

What is the criteria for LTOT?

A

Blood gases on 2 occasions at least 3 weeks apart:
pO2<7.3kPa
pO2 7.3-8 AND secondary polycythaemia, peripheral oedema, or pulmonary hypertension

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4
Q

What are the indications for lung transplant in cystic fibrosis?

A

Life threatening exacerbation requiring ICU admission, pulmonary hypertension, FEV1<30% predicted, recurrent exacerbations requiring antibiotic therapy, recurrent/refractory pneumothorax
Recurrent haemoptysis not controlled by emobolisation

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5
Q

What is a contraindication to lung transplant in CF?

A

Colonisation with burkholderia cepacia

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6
Q

What is Orkambi?

A

Lumacaftor/Ivacaftor
For CF pts who are homozygous for delta F508 mutation
Lumacaftor increases the number of CFTR proteins that are transported to the cell surface

Ivacaftor is a potentiator of CFTR is already at the cell surface, increases the probability that the defective channel will be open and allow chloride ions to pass through the channel pore

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7
Q

What is pulmonary hypertension?

A

Sustained elevation in mean pulmonary arterial pressure >25mmHg at rest

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8
Q

What are the causes of Group 1 PAH?

A

Idiopathic
Familial
Associated with HIV, drugs, vascular disease, congenital heart disease with systemic to pulmonary shunts
Persistent PHTN of the newborn

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9
Q

What is group 2 pulmonary hypertension?

A

Related to left heart disease

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10
Q

What is group 3 pulmonary hypertension?

A

Secondary to lung disease/hypoxia, includes high altitude

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11
Q

What is group 4 pulmonary hypertension?

A

Due to thromboembolic disease

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12
Q

What is the inheritance of alpha-1 anti-trypsin deficiency?

A

Autosomal recessive/co-dominant

Chromosome 14

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13
Q

How are alleles classified in A1AT?

A

Alleles classified according to electrophoretic mobility: M for normal, for slow, Z for very slow

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14
Q

What are the genotypes in A1AT and which one is most likely to manifest disease?

A

PiMM - normal
PiSS - 50% normal A1AT
PiZZ - 10% normal A1AT

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15
Q

What are the symptoms of PiMZ genotype?

A

Unlikely to develop clinically significant symptoms

Increased risk of liver and lung disease therefore should avod smoking

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16
Q

What are the causes of occupational asthma?

A 
Isocyanates (spray painting)
Platinum salts
Flour
Soldering flux resin
Glutaraldehyde
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17
Q

How is occupational asthma diagnosed?

A

Serial PEFR measurements

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18
Q

What is the FeNO test?

A

Fractional exhaled nitric oxide

Levels of NO rise in inflammatory cells particularly eosinophils

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19
Q

What is the treatment of primary pneumothorax?

A

<2cm and not SOB - discharge

>2cm: aspiration –> still >2cm/SOB –> chest drain

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20
Q

What is the treatment of secondary pneumothorax over 50 years?

A

<1cm –> oxygen and admit 24h
1-2cm –> aspiration –> chest drain
>2cm/SOB –> chest drain

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21
Q

What are the causes of a transudate pleural effusion?

A 
<30g/L protein
Heart failure
Hypoalbuminaemia e.g. liver disease, nephrotic syndrome, malabsorption
Hypothyroidism
Meig's syndrome
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22
Q

What are the causes of an exudate pleural effusion?

A 
Infection
CTD
Malignancy
Pancreatitis
PE
Yellow nail syndrome
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23
Q

What is the cause of ARDS?

A

Increased permeability of the alveolar capillaries leading to fluid accumulation in the alveoli

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24
Q

Which patients are more likely to develop Klebsiella pneumonia?

A

Diabetes
Alcoholism
Immunocompromised
IVDU

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25
What is aspergilloma?
Mycetoma that colonises an existing lung cavity e.g. secondary to TB, cancer, or CF
26
How is aspergilloma diagnosed?
CXR: round opacity, crescent sign | Aspergillus IgG precipitins
27
What are the symptoms of psittacosis?
``` History of bird contact Flu like symptoms Pneumonia with dry cough and chest pain Headache Organomegaly Failure to respond to penicillin ```
28
What is the treatment of psittacosis?
1st line tetracyclines e.g. doxycycline
29
What are the paraneoplastic features of squamous cell lung cancer?
PTH-rp Hypertrophic pulmonary osteoarthropathy TSH secretion
30
What are the paraneoplastic features of small cell lung cancer?
ADH ACTH Lambert-Eaton syndrome
31
What are 4 risk factors for lung cancer?
Smoking - 10x Asbestos - 5x Arsenic/radon/nickel/chromate Cryptogenic fibrosing alveolitis
32
What are the indications for steroids in sarcoidosis?
Uveitis Neuro/cardiac involvement Parenchymal lung disease Hypercalcaemia
33
What are the stages of sarcoidosis?
I - bilateral hilar lympad II - bilateral hilar lympah + infiltrates III - infiltrates IV - fibrosis
34
What are 5 poor prognostic features of sarcoidosis?
``` Insidious onset Absence of erythema nodosum Lupus pernio Stage III or IV on CXR Afro-Caribbean ```
35
How is sarcoidosis diagnosed?
EBUS ACE sensitivity 60%, specificity 70% Spirometry - restrictive
36
What is the cause of hypercalcaemia in sarcoidosis?
Increased concentrations of calcitriol as a result of increased activity of 1a hydroxylase produced by sarcoid macrophages
37
What subtype of sarcoidosis is characterised by parotid enlargement, fever, and anterior uveitis?
Heerfordt syndrome
38
What is Lofgren's sydrome
Acute form of sarcoidosis
39
Name the causes of upper zone fibrosis.
CHARTS ``` Coal worker's pneumoconiosis Histocytosis/hypersensitivity pneumonitis Ankylosing spondylitis Radiation Tuberuclosis Sarcoidosis/silicosis ```
40
Name the causes of lower zone fibrosis
CADI CTDs except ankylosing spondylitis Asbestosis Drugs e.g. amiodarone, bleomycin, methotrexate Idiopathic pulmonary fibrosis
41
What type of hypersensitivity reaction is EAA?
Type III
42
What are the symptoms of EAA?
Acute (4-8 hours): Dyspnoea, dry cough, fever Chronic: Dyspnoea, productive cough, lethargy, anorexia, WAL
43
How is EAA diagnosed?
Upper/midzone fibrosis BAL - lymphocytosis No eosinophils
44
Sillicosis is a risk factor for what?
TB - silica is toxic to macrophages
45
How is ABPA diagnosed?
Eosinophilia Positive RAST test to aspergillus Positive IgG precipitins Raised IgE >1000IU/ml
46
What are the symptoms of ABPA?
Asthma features Proximal bronchiectasis Fungal elements/brown flecks in sputum
47
What is the management of ABPA?
Oral steroids | Itraconazole 2nd line
48
What are the symptoms of Churg-Strauss syndrome?
``` Asthma Eosinophilia Mono/polyneuropathy Flitting pulmonary infiltrates Paranasal sinus abnormalities Extravascular eosinophils ```
49
What is the unmasking agent in Churg-Strauss syndrome?
Montelukast
50
Name 5 respiratory manifestations of rheumatoid arthritis
``` Bronchiolitis obliterans (obstructive picture) Pulm fibrosis Pleural effusion Pulm nodules Methotrexate pneumonitis Caplan's syndrome ```
51
What is cryptogenic organising pneumonia?
Diffuse interstitial lung disease that affects the distal bronchioles, respiratory bronchioles, alvolear ducts and walls
52
How is IPF diagnosed?
``` Restrictive spirometry Reduced TLCO Ground glass --> honeycombing High res CT ANA +ve in 30%, RF +ve in 10% ```
53
What is the treatment of IPF?
Pulm rehanb Pirfenidone O2 Lung Tx
54
What are the symptoms of acute mountain sickness?
Headache Nausea Fatigue Develops above 2500-3000m, over 6-12 hours
55
What is the cause of AMS?
Chronic hypobaric hypoxia
56
What is the prophylaxis for AMS?
Acetazolamide
57
What is the treatment of HACE and HAPE?
HACE: descent, dexamethasone HAPE: decent, nifedipine, acetazolamide, oxygen
58
What are the features of carbon monoxide poisoning?
``` Lactic acidosis Dizziness, vertigo, vomiting Headache Ataxia Severe- pink skin and mucosa, hyperpyrexia, arrhythmias, extra-pyramidal ```
59
How is CO poisoning diagnosed?
Elevated carboxyhaemoglovin >3% non smoker, >10% smoker Normal pO2, reduced SaO2 Pulse ox may be high
60
What is the pathophysiology of CO poisoning?
Co has 210 times the affinity for Hb than oxygen Impaired O2 delivery to tissues Left shift of dissociation curve Hypoxia
61
What is the treatment of CO poisoning?
100% high flow O2 minimum 6 hours Target saturations 100% Decreases the half life of COHb

MRCP (17 decks)

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