Respiratory

Question 1

What are the five radio graphic features of pulmonary fibrosis?

Answer 1

Reticulation
Traction bronchiectasis
Honeycombing
Architectural distortion 
Volume loss

Question 2

What are the radiological features of UIP (usual interstitial pneumonia)?

Answer 2

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

Question 3

What are the radiological features of NSIP (non-specific interstitial pneumonia)?

Answer 3

Ground glass change, apical-basal gradient, subpleural sparing, traction bronchiectasis

Question 4

What are the two antifibrotic drugs used to treat idiopathic pulmonary fibrosis?

Answer 4

Pirfenidone - targets TGF-B to reduce fibroblast proliferation
SE: hypersensitivity rash, GIT upset

Nintedanib - tyrosine kinase inhibitor
SE: GIT upset, bleeding risk, weight loss, ?CV risk

Both improve survival and slow decline in FVC

Question 5

What are the five classes of pulmonary hypertension?

Answer 5

Class 1 = primary pulmonary arterial hypertension
Class 2 = pulmonary hypertension secondary to left heart disease
Class 3 = pulmonary hypertension due to lung disease
Class 4= pulmonary hypertension due to arterial obstruction (thromboembolism)
Class 5 = idiopathic

Question 6

What drug classes are used to treat pulmonary hypertension?

Answer 6

Careful - only use pulmonary vasodilators in type 1 PAH (makes type 2 and 3 worse)

Endothelin receptor antagonists:

• ambriesantan
• macitentan
• bosentan

PDE-5 inhibitors

• sildenafil
• tadalafil
• Riociguat

Prostaglandin analogues
-Epoprostenol (IV gold standard for sick/high risk pts)