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MRCP Part 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are ecg findings in PE?

A

large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III

RBBB (as right heart strain)
RAD
Sinus tahcycardia

TWI (if RV ischaemia)

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2
Q

Management of high altitude cerebral oedema?

A

Descent + dexamethasone

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3
Q

Best way to monitor progression in COPD?

A

FEV1

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4
Q

Diagnosing asthma in patients <5 years?

A

Clinical judgement

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5
Q

Diagnosing asthma in patients 5-16 yo?

A

1) All patient Spirometry with bronchodilator reversibility (BDR) test
2) FeNO (fraction exhaled nitrous oxide) if normal spirometry or obstructive spirometry with negative BDR test

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6
Q

Diagnosing asthma in patients 17+?

A

1) ask all patients if symptoms better away from work - if so, refer for possible occupational asthma
2) All patients Spirometry with bronchodilator reversibility (BDR) test
3) All patients FeNO test

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7
Q

What makes a positive FeNO test?

A

Adults: >=40ppb

Children: >=35ppb

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8
Q

What spirometry result indicates obstructive disease?

A

FEV1/FVC <70%

FVC normal

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9
Q

What spirometry result indicates restrictive disease?

A

Both FEV1 + FVC reduced –> therefore FEV1/FVC normal

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10
Q

What is allergic bronchopulmonary aspergillosis?

A

Results from allergy to aspergillus spores

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11
Q

If a question states bronchiectasis with eosinophilia what is the likely diagnosis?

A

allergic bronchopulmonary aspergillosis

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12
Q

How does allergic bronchopulmonary aspergillosis present?

A

Bronchoconstriction [wheeze, cough, dyspnoea] (may have asthma diagnosis)

with PROXIMAL bronchiectasis

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13
Q

What is the treatment of allergic bronchopulmonary aspergillosis?

A

steroids

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14
Q

Where does absestos cause lung fibrosis?

A

lower zones

From the roof

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15
Q

What are the causes of upper zone fibrosis?

A 
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
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16
Q

What are the causes of lower zone fibrosis?

A

idiopathic pulmonary fibrosis

most connective tissue disorders (except ankylosing spondylitis) e.g. SLE

drug-induced: amiodarone, bleomycin, methotrexate

asbestosis

17
Q

What is the initial settings for BIPAP in COPD?

A

IPAP - 10cm H2O

EPAP - 5cm H2O

18
Q

what is brupropion contraindicated in?

A

Epilepsy, pregnancy + breast feeding

19
Q

What condition should you use varenicline with caution in?

A

Depression / self-harm history as increased risk of relapse

20
Q

What are the indications for corticosteroid treatment in sarcoidosis?

A 
PUNCH:
Parenchymal lung disease
Uveitis
neurological or cardiac involvement
Hypercalcaemia
21
Q

commonest cause of infective exacerbation COPD?

A

Haemophilus influenzae

> strep pneumoniae > moraxella catarrhalis

22
Q

In exacerbations of COPD what do NICE recommend when to give antibiotics/treat as infective exacerbation?

A

if sputum purulent or clinical signs of pneumonia (including CXR showing consolidation; or inflam markers raised)

23
Q

What is Churg strauss syndrome? What is seen on serology

A

Eosinophilic granulomatosis with polyangitis

pANCA

24
Q

What is seen on serology with granulomatosis with polyangitis?

A

cANCA

25
Q

Give some presenting features of granulomatosis with polyangitis

A

URT sx’s: epsitaxis, sinusitis, nasal crusting

LRT: dsypnoea, haemoptysis

Rapidly progressive Glomerulonephritis / AKI / renal failure

Saddle shaped nose

Vasculitic rash etc

26
Q

If COPD not controlled with SABA or SAMA inhaler, what next?

A

Depends on whether asthmatic features/steroid responsive or not

if asthamtuc features/steroid responsive:
LABA + ICS

If not:
LABA + LAMA

27
Q

First line copd treatment

A

SABA or same

28
Q

What features may indicate if a pt with COPD would be steroid responsive?

A

Previous diagnosis asthma or atopy

Raised eosinophil count

Substantial variation in FEV1 over time

Substantial diurnal variation in peak flow

29
Q

Example of SAMA + LAMA

A

SAMA - ipratropium bromide

LAMA - tiotropium bromide

30
Q

What factors improve survival in stable COPD patients?

A

LTOT
Smoking cessation
Lung volume reduction surgery

31
Q

In patients who are young with emphysema what should you do / suspect?

A

A1AT levels ?deficiency

32
Q

What is the triangle of safety in chest drain insertion?

A

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

33
Q

Aminophylline MOA?

A

Phosphodiesterase inhibitor –> ^ cAMP –> to relax smooth muscle and to relieve bronchial spasm

Also stabilise mast cell membrane

34
Q

What types of lung cancer is associated with cavitating lesions?

A

Squamous cell

35
Q

What is the investigation of choice for sleep apnoea?

A

Polysomnography

36
Q

EXAM: What defines a large pneumothorax?

A

> 2cm

MRCP Part 1 (19 decks)

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