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RACP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Berlin Criteria

A

For ARDS
- Acute onset
- Respiratory failure not primarily due to hydrostatic oedema
- Bilateral opacities on lung radiograph
- paO2:FiO2 < 300

Management
- Prone nursing
- Low tidal volume ventilation @ 6ml/kg

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2
Q

Home NIV indications in MND

A

VC < 50%
SNIP < 30cm H20
Low max insp pressure (MIP) - diaphragm and inspiratory muscles
Low max exp pressure (MEP) - abdominal and expiratory muscles

Imp in QOL and survival if commenced before bulbar dysfunction but prophylactic NIV before above indications worsens prognosis

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3
Q

Predictors of NIV failure

A

Acidosis < 7.25
Marked onset new hyperaemia
Respiratory distress signs with RR > 25
Non-pulmonary organ failure

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4
Q

Samters Triad

A

Asthma
Aspirin intolerance
Nasal Polyps

Rx with Leukotriene antagonists

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5
Q

Allergic Bronchopulmonary Aspergillus

A

Found in the soil, dust, water, vegetation (like dead leaves or compost piles),
- Chronic asthma with brown mucus plugs
- Recurrent pulmonary infiltrates
- Very high total IgE > 1000
- Positive skin test to aspergillus antigens
Rx with steroids, Mepolizumab (anti-IL5) and anti-fungals (Itraconazole)

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6
Q

Eosinophilic granulomatosis with polyangitis (EGPA)

A
  • Churgg Strauss Vasculitis with granulomas
  • Tissue and skin eosinophilia
  • Asthma
  • Cardiac involvement common
  • Renal involvement rare
  • 40% pANCA positive
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7
Q

Asthma Diagnosis

A

FEV1/FVC < normal
Reversibility > 12% or 200ml

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8
Q

Anti-IgE Immunotherapy

A

Omalizumab

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9
Q

Step 1 Asthma Management

A

PRN low dose ICS + Formoterol

+/- PRN SABA every-time ICS is used

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10
Q

Step 2 Asthma Management

A

Commence controller if using reliever > 3 times/week;
Daily low dose ICS

Reliever;
PRN low dose ICS + formetarol +/- SABA

+/-
PRN LTRA when SABA taken

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11
Q

Step 3 Asthma Management

A

Controller;
Daily low dose ICS + LABA
or
Daily low dose ICS + LTRA
or
Daily medium dose ICS alone

Reliever;
PRN Low dose ICS + formetarol

+/-
PRN SABA

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12
Q

Step 4 Asthma Management

A

Controller;
Medium dose ICS + LABA
or
High dose ICS alone +/- Tiotropium

Reliever;
PRN Low dose ICS + formetarol

+/-
PRN SABA

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13
Q

Step 5 Asthma Management

A

Controller
High dose ICS + LABA

plus
Omalizumab

Reliever;
PRN Low dose ICS + formetarol

+/-
PRN SABA
PRN PO corticosteroids

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14
Q

Definition well-controlled Asthma

A

day symptoms < 2 x weekly
night symptoms < 2 x monthly
Over lasy 4 week period

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15
Q

Mepolizumab & Benralizumab MOA

A

Binds IL-5 receptor for treatment of eosinophilic asthma. Effective in those with eosinophil levels > 150 regardless of IgE Level

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16
Q

Dupilumab MOA

A

Binds IL4 & IL13 receptor for Asthma and severe eczema

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17
Q

Alpha-1 anti-trypsin

A

Basilar pan-acinar emphysema
Associated with;
- hepatic cirrhosis and HCC
- panniculitis of skin
- Bronchiectasis
- Check alpha-1 antitrypsin level if COPD < 45 yrs old, FHx or absence of RF

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18
Q

mMRC dyspnoea score

A

Dyspnea only with strenuous exercise = 0

Dyspnea when hurrying or walking up a slight hill = 1

Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace = 2

Stops for breath after walking 100 yards (91 m) or after a few minutes = 3

Too dyspneic to leave house or breathless when dressing = 4

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19
Q

GOLD classification

A

A - < 1 exac/year, mMRC 0-1, CAT < 10
B - < 1 exac/year, mMRC > 2 , CAT > 10
C - > 2 exac/year, mMRC 0-1, CAT < 10
D - > 2 exac/year including hospitilisation, mMRC > 2, CAT > 10

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20
Q

Youngs Syndrome

A

Bronchiectasis, chronic sinusitis and Azospermia due functional blockage of the sperm in the caput epididymis, which is usually enlarged and palpable in the scrotum. Can occur later in life

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21
Q

Pseudomonas strains with worse outcomes

A

AUST-01 in Melbourne
AUST- 02 in Brisbane

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22
Q

Smoking related ILD

A
  • Respiratory bronchiolitis associated with ILD
  • Desquamating interstitial pneumonia
  • Pulmonary Langerhans cell histocytosis
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23
Q

Lymphangioleiomyomatosis

A
  • Women 30-40
  • Spontaneous PTX
  • Chylous effusions
  • CT showing cystic disease
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24
Q

Idiopathic interstitial pneumonias

A
  1. Idiopathic pulmonary fibrosis
  2. Non-specific interstitial pneumonia
  3. Acute interstitial pneumonia
  4. Crypotogenic organising pneumonia
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25
Q

Empyema diagnosis

A

pH < 7.2
Gram stain +
Glucose < 3.3

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26
Q

Rapid Score

A

For pleural effusion
- Renal - Urea > 8
- Age > 70
- Purulent
- Infection - HAP
- dietary factors - Albumin < 27

High risk for poor outcome with pleural effusion

27
Q

LENT Score

A

Predicts survival with malignant pleural effusions;

LDH
ECOG
Neutrophil:Lymphocyte ration
Tumour type

28
Q

Riociguat

A

Dual mode of action, directly stimulating soluble cyclic guanosine monophosphate (cGMP) independently of nitric oxide, and increasing the sensitivity of cGMP to nitric oxide.

29
Q

Apnoea-Hypopnoea Scale

A

Number of apnoeas or hypopnea per hour

Normal < 5
Mild 5 - 14 (treat only if symptomatic)
Moderate 15-30 (treat regardless)
Severe 30 +

30
Q

Kartegener Syndrome

A
  • Associated with DNAI1, DNAH5
  • Situs invertus
  • Chronic sinusitis
  • Bronchiectasis
  • Infertility (male and female)
  • Variable lung function and course - not diagnostic
31
Q

CODEX score

A

Prediction of outcome 3-12 months after hospital admission for COPD

Comorbidities
Obstruction
Dyspnoea
Exacerbations [reviously

32
Q

Lofgren syndrome

A
  • Sarcoidosis
  • Hilar adenopathy
  • Migratory polyarthritis
  • Erythema Nodosum

Associated with a good prognosis,with >90% of patients experiencing disease resolution within 2 years.

33
Q

Treatments NSCLC

A

ANTI - PDL (Durvalumab), ANTI-PD1 (Pembrolizumab, Nivolumab), TYROSINE KINASE inhibit against EGFR, ALK, ROS1

Higher likelihood to TK inhibitors if Asian, female, never-smoker, adenocarcinoma

34
Q

KCO

A

KCO = DLCO (diffusion capacity at one alveolar unit)/VA (accessible alveolar volume)

Low DLCO but high KCO
- Kyphoscoliosis
- Lobectomy
- Severe pleural disease
- diaphragmatic paralysis

35
Q

Causes high DLCO

A

SAMPPLE
- Severe obesity
- Asthma
- Mild LVF
- Polycythaemia
- Pulmonary haemorrhage
- L to R) intracardiac shunting
- Exercise - associated with increased CO

36
Q

REM Sleep disorders

A

Narcolepsy is the disruption of wakefulness into REM (HLA DQB1 0602)

REM behaviour disorder; disruption of REM into wakefulness -> male predominance

37
Q

Staging NSCLC

A

Early - Stage 1-3a (surgical resection)
- Stage 1; < 3cm < 2 nodes
- Stage 2; < 5cm < 2 nodes
- Stage 3a; > 5cm < 1 node

Late - Stage 3b - 4
- Stage 3b; > 5cm > 2 nodes
- Stage 4 any contralateral node or dissemination

38
Q

Aspergillus

A

Associated with bronchopulmonary allergic aspergillus
From compost, soil, dust decaying material
High IgE > 1000, eosinophilia
Positive skin test
Galactomannan (constituent of the aspergilus cell wall) used to Dx invasive aspergillus commonly on immunocompromised patients
Rx with steroids and anti-fungals

39
Q

Small cell Lung Ca

A
  • Strong association with smoking
  • Common mets to brain requires prophylactic whole brain radiation
  • Staging; Local - ipsilateral and single radiation site, Extensive - contralateral, metastatic or outside single radiation field
  • Rx with platinum based CTX (cisplatin + etoposide), radiation plus prophylactic whole brain radiation
  • Paraneoplastic syndromes
40
Q

Cystic Fibrosis Gene Variants

A

Defects in gene on Chromosome 7 associated with CFTR ( Cystic fibrosis transmembrane conductance regulator)

  • Delta 508 - most common - trafficking defect associated with pancreatic exocrine insufficiency and lung disease
  • G551D - defective channel regulation, gate is produced but does not function
  • G542X - Non-functional gate
  • R117H
41
Q

CFTR modulators

A
  • Ivacaftor; opens channel
  • Tezacaftor; moves channel to surface
  • Elexacaftor

G551D - Ivacaftor
homozygous delta508 - Ivacaftor + Tevocaftor
heterozygous delta508 - Ivacaftor + Tevocaftor + Elexacaftor

42
Q

Indications for lung transplant in CF

A

FEV1 < 35% predicted with rapid rate of decline
Increase frequency exacerbations
pO2 < 60mmHg
PCO2 > 50mmHg
Clinical organism resistance
Impaired QOL

43
Q

Haemodynamics in pulmonary hypertension

A

Where pulmonary wedge pressure = left atrial pressure

44
Q

A-a gradient

A

Diffusion of air into alveolar = Age/4 + 4
Normal = hypoxia associated with hypoventilation, not lung disease
Abnormal = hypoxia associated with lung disease

45
Q

Vital Capacity

A

Tidal volume + inspiratory reserve + expiratory reserve

46
Q

Genes type 1 PAH

A
  • BMPR2
  • ALK1

Female predominance

47
Q

Anti fibrotics

A

Pirfenidone; acts at TGF-beta to reduce fibroblast proliferation, SI of photosensitive rash ** improves survival but not dyspnoea scores **

Nintedanib; Inhibits multiple tyrosine kinases (PDGF, VEGF, FGF), SI of diarrhoea

For treatment patient must have VC > 50%, DLCO > 30%

48
Q

R) shift O2 dissassociation curve

A

CADET shift right!
CO2
Acidosis
DPG (2,3)
Exercise
Temperature increase

49
Q

Strains Pseudomonas with worse outcomes

A

AUST-01 in Melbourne
AUST- 02 in Brisbane

50
Q

Rx with no evidence in Bronchiectasis

A

Tiotropium and Steroids

51
Q

Indications for NIV in MND

A
  • VC < 50%
  • SNIP < 30cm H20
  • Low max insp pressure (MIP) - diaphragm and inspiratory muscles
  • Low max exp pressure (MEP) - abdominal and expiratory muscles

Imp in QOL if commenced before bulbar dysfunction but prophylactic NIV before above indications worsens prognosis

52
Q

Metacholine test

A

Repeated measurements of FEV1
If falls < 20% - considered positive

53
Q

Exhaled NO in Asthma

A

> 50ppb exhaled NO indicates steroid responsiveness in allergic asthma

54
Q

Biologicals used in Asthma

A

Omalizumab - binds IgE for treatment of allergic asthma

Mepolizumab- binds IL-5; for treatment of eosinophilic asthma. Effective in those with eosinophil levels > 150 regardless of IgE Level

Benralizumab - IL-5 receptor

Dupilumab - Binds IL4 & IL13 receptor for Asthma and severe eczema

55
Q

Eosinophilic granulomatosis polyangitis

A
  • Small vessel vasculitis
  • Asthma
  • Tissue & blood eosinophilia
  • Rhinosinusitis
  • Granulomatous lung lesions
  • Cardiac disease accounts for 50% of deaths
  • Rarely renal involvement
56
Q

MOA erythromycin

A

Bind the 50s/30s ribosomal complex on RNA to stop protein transcription in susceptible bacteria

Can increase risk of non-Tb mycobacterium

57
Q

“radiating recall” pneumonitis

A

Exposure to etoposide, gemcitabine, paclitaxel and pemitrexed after radiation can cause delayed pnuemonitis

58
Q

Crypotegenic organising pneumonia

A

Acute, migratory infiltrates preceded by a flu-like illness for 6-8 weeks. Non-responsive to antibiotics and treated with steroids.

59
Q

Acute interstitial pneumonia

A

Mimics ARDS without the risk factors

60
Q

Idiopathic pulmonary fibrosis

A

> 50 years
Radiological findings of usual interstitial pneumonia
Diagnosis of exclusion
Associated with Telomeropathy syndrome ; Short telomeres found in 20-25% of patients
Rx anti-fibrotics; slows progression but not mortality

61
Q

Non-specific pulmonary fibrosis

A
  • Young population
  • Bilateral lower lobe reticular changes
  • ground glass without Honeycombing
  • Commonly associated with autoimmune disease

Types;
- Cellular
Worse prognosis and poor response to treatment
- Fibrotic
Better prognosis and response to treatment

62
Q

Lights criteria

A

For exudative effusion
Fluid Protein: Serum protein > 0.5
Fluid LDH: Serum LDH > 0.6
Fluid LDH > 2/3 normal serum LDH

63
Q

Types Pulmonary HTN

A

RACP (17 decks)

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