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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
Empyema diagnosis
pH < 7.2 Gram stain + Glucose < 3.3
26
Rapid Score
For pleural effusion - Renal - Urea > 8 - Age > 70 - Purulent - Infection - HAP - dietary factors - Albumin < 27 High risk for poor outcome with pleural effusion
27
LENT Score
Predicts survival with malignant pleural effusions; LDH ECOG Neutrophil:Lymphocyte ration Tumour type
28
Riociguat
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
Apnoea-Hypopnoea Scale
Number of apnoeas or hypopnea per hour Normal < 5 Mild 5 - 14 (treat only if symptomatic) Moderate 15-30 (treat regardless) Severe 30 +
30
Kartegener Syndrome
- Associated with DNAI1, DNAH5 - Situs invertus - Chronic sinusitis - Bronchiectasis - Infertility (male and female) - Variable lung function and course - not diagnostic
31
CODEX score
Prediction of outcome 3-12 months after hospital admission for COPD Comorbidities Obstruction Dyspnoea Exacerbations [reviously
32
Lofgren syndrome
- Sarcoidosis - Hilar adenopathy - Migratory polyarthritis - Erythema Nodosum Associated with a good prognosis,with >90% of patients experiencing disease resolution within 2 years.
33
Treatments NSCLC
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
KCO
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
Causes high DLCO
SAMPPLE - Severe obesity - Asthma - Mild LVF - Polycythaemia - Pulmonary haemorrhage - L to R) intracardiac shunting - Exercise - associated with increased CO
36
REM Sleep disorders
Narcolepsy is the disruption of wakefulness into REM (HLA DQB1 0602) REM behaviour disorder; disruption of REM into wakefulness -> male predominance
37
Staging NSCLC
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
Aspergillus
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
Small cell Lung Ca
- 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
Cystic Fibrosis Gene Variants
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
CFTR modulators
- Ivacaftor; opens channel - Tezacaftor; moves channel to surface - Elexacaftor G551D - Ivacaftor homozygous delta508 - Ivacaftor + Tevocaftor heterozygous delta508 - Ivacaftor + Tevocaftor + Elexacaftor
42
Indications for lung transplant in CF
FEV1 < 35% predicted with rapid rate of decline Increase frequency exacerbations pO2 < 60mmHg PCO2 > 50mmHg Clinical organism resistance Impaired QOL
43
Haemodynamics in pulmonary hypertension
Where pulmonary wedge pressure = left atrial pressure
44
A-a gradient
Diffusion of air into alveolar = Age/4 + 4 Normal = hypoxia associated with hypoventilation, not lung disease Abnormal = hypoxia associated with lung disease
45
Vital Capacity
Tidal volume + inspiratory reserve + expiratory reserve
46
Genes type 1 PAH
- BMPR2 - ALK1 Female predominance
47
Anti fibrotics
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
R) shift O2 dissassociation curve
CADET shift right! CO2 Acidosis DPG (2,3) Exercise Temperature increase
49
Strains Pseudomonas with worse outcomes
AUST-01 in Melbourne AUST- 02 in Brisbane
50
Rx with no evidence in Bronchiectasis
Tiotropium and Steroids
51
Indications for NIV in MND
- 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
Metacholine test
Repeated measurements of FEV1 If falls < 20% - considered positive
53
Exhaled NO in Asthma
> 50ppb exhaled NO indicates steroid responsiveness in allergic asthma
54
Biologicals used in Asthma
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
Eosinophilic granulomatosis polyangitis
- Small vessel vasculitis - Asthma - Tissue & blood eosinophilia - Rhinosinusitis - Granulomatous lung lesions - Cardiac disease accounts for 50% of deaths - Rarely renal involvement
56
MOA erythromycin
Bind the 50s/30s ribosomal complex on RNA to stop protein transcription in susceptible bacteria Can increase risk of non-Tb mycobacterium
57
“radiating recall” pneumonitis
Exposure to etoposide, gemcitabine, paclitaxel and pemitrexed after radiation can cause delayed pnuemonitis
58
Crypotegenic organising pneumonia
Acute, migratory infiltrates preceded by a flu-like illness for 6-8 weeks. Non-responsive to antibiotics and treated with steroids.
59
Acute interstitial pneumonia
Mimics ARDS without the risk factors
60
Idiopathic pulmonary fibrosis
> 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
Non-specific pulmonary fibrosis
- 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
Lights criteria
For exudative effusion Fluid Protein: Serum protein > 0.5 Fluid LDH: Serum LDH > 0.6 Fluid LDH > 2/3 normal serum LDH
63
Types Pulmonary HTN

RACP (17 decks)

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