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Sophie’s Flash Cards > Respiratory > Flashcards

Respiratory Flashcards

1
Q

LENT score

A

For malignant pleural effusion (prognostic scoring system)

- Pleural fluid LDH, ECOG, neutrophil-tolymphocyte ratio, tumor type

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2
Q

Diagnosis of mesothlioma

A
  • Pleural biopsy via thoracoscopy (highest diagnostic yield) -> histology and immunohistochemistry
  • Serum mesothelin and fibulin 3: markers (mesothelin more diagnostic, fibulin more prognostic information)
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3
Q

Work up for FEV1/FVC < LLN

A 
VC ≥ LLN: obstruction 
VC < LLN
- TLC ≥ LLN: obstruction 
- TLC < LLN: mixed defect 
If obstruction 
- DLCO ≥ LLN: asthma, Chronic bronchitis
- DLCO < LLN: emphysema
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4
Q

Work up for FEV1/FVC ≥ LLN

A 
If VC ≥ LLN: normal ->
-  DLCO ≥ LLN: normal 
-  DLCO < LLN:: PV disorders 
If VC < LLN 
- TLC ≥ LLN: obstruction 
- TLC < LLN: restriction (if  DLCO ≥ LLN -> CW and NM disorders; if DLCO < LLN -> ILD, pneumonitis)
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5
Q

Extrathoracic obstruction

A
  • Vocal cord paralysis

- Vocal cord dysfunction

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6
Q

Oxygen dissociation curve

A 
percentage saturation of Hb (y) at various partial pressure of oxygen (x) 
Shift L (lower O2 delivery to tissues): lower H+, lower temp, lower 2,3DPG 
Shift R (higher O2): higher H2, higher temp, higher 2,3DPG
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7
Q

RAPID score

A
  • Clinical risk score for identifying risk for poor outcome with pleural effusion
    Renal - urea, Age, Purulence, Infection source, Dietary factors - albumin
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8
Q

Evidence for intrapleural tissue plasminogen activator and Dornase alfa (DNase)

A

improve fluid drainage and reduce frequency of surgical referral and the duration of hospital stay (MIST 2)

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9
Q

Indications for pleural space drainage

A
  • Large free flowing pleural effusion more than 50% hemithorax OR
  • Positive culture OR
  • Positive gram stain OR
  • pH < 7.2 suggesting presence of pus
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10
Q

ILD resolve with smoking cessation

A

Distal interstitial pneumonia (DIP)

Respiratory associated bronchiolitis associated ILD

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11
Q

Biomarkers for guarded prognosis from covid 19 pneumonia

A 
- D-dimer, cardiac trop I, serum ferritin, LDH, IL-6 
NOT lymphocyte (baseline higher in survivors than non-survivors)
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12
Q

Pulmonary rehab in COPD

A 
Improve 
- Emotional function 
- Exertional dyspnea
- QoL
- Exercise tolerance
But NOT lung function
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13
Q

Mechanism of hyperCa in sarcoidosis

A

Main mechanism
- Increased intestinal Ca absorption induced by high serum calcitriol concentration
- Activated mononuclear cells (esp macrophages) in the lung and LN in sarcoidosis and other granulomatous disease -> produce calcitriol from calcidiol independent of PTH
Other mechanism: PTHrP secreted from granulomatous tissue

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14
Q

Lofgren syndrome

A 
Subtype of acute sarcoidosis (good prognosis, >90% disease resolution within 2 years)
Triad of 
- Erythema nodosum
- Bilateral hilar adenopathy 
- Arthritis
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15
Q

PET scan

A

3 clinical settings

1) solitary pulmonary nodules - distinguish benign vs malignant (not useful when lesion <1cm)
2) Carcinoma staging
3) surveillance - great sens and spec for detecting recurrence or persistent malignant disease from changes caused by radiation or surgery

Hyperglycaemia can reduce intracellular uptake of radioactive substrate FDG

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16
Q

S/E of LAMA

A
  • Dry mouth (most frequently reported)
    Dyspepsia, gastroenteritis, insomnia, irritation affecting nasal and throat passages
    Cautious with narrow-angle glaucoma and urinary retention, renal impairment
17
Q

Prognosis for SCLC, NSCLC and carcinoid

A

Carcinoid > NSCLC > SCLC

18
Q

Clinical tool - highest accuracy of predicting patients requiring intensive respiratory and ventilatory support (IRVS)

A

SMART-COP ≥ 3 - 92% who received IRVS

19
Q

Index for mortality, hospital readmission from 3 months to 1 year after discharge
in COPD patients

A

CODEX index (comorbidity, obstruction, dyspnea, previous severe exacerbations)

20
Q

systemic thrombolysis vs Catheter directed thrombolysis

A
  • No difference in 30 day mortality rate
  • No difference in-hospital mortality
  • Increase risk of major haemorrhage
21
Q

Rivaroxaban > dabigatran

A

If history of dyspepsia

22
Q

Age adjustment D-dimer

A

Age X 10 in patients > 50 years

23
Q

Asthma-COPD overlap syndrome

A

Airflow limitation is not fully reversible, but often with current or historical variability

24
Q

Endobronchial valve placement

A

Procedures: with bronchoscopy, valve prevent air inflow during insp and allow air and mucus to exit during expiration
Beneficial for severe heterogeneous emphysema
- Improve lung function, dyspnea, exercise tolerance and QoL, safety profile
AVOID in severe bronchiectasis, fibrosis, severe paraseptal emphysema -> poor prognosis

25
Q

Long term O2 therapy for COPD

A

Indication: severe resting hypoxaemia - PaO2 ≤ 55mmHg or SpO2 ≤ 88%
at least 15 hours to proven beneficial

26
Q

HFNP vs NIV for acute hypoxemic respiratory failure

A
  • Increase patient comfort
  • Modest reduction in intubation
  • Modest reduction in hospital acquired pneumonia
  • Large reduction in all cause mortality
  • NOT reduced length of ICU stay
27
Q

Triple therapy for COPD

A

For patients already using LAMA/LABA dual therapy and have ongoing symptoms and risk for exacerbation
Those with ≥ 2 % (or 150 absolute) eosinophils on blood do better with addition of ICS

28
Q

ICS withdrawal and ICS continuation in COPD

A
  • Both decrease in absolute FEV1 (greater in withdrawal group)
    Possible reduce rates of pneumonia and minor infections e.g. oropharyngeal candidiasis
29
Q

Management of COPD that improves survival

A
  • Smoking cessation
  • Long term O2 therapy
  • Lung transplant
  • Lung volume reduction therapy
    NOT ICS and LABA
30
Q

Ix of Kartagener syndrome

A
  • Molecular testing for mutations in DNAI1 and DNAH5 (38% of primary ciliary dyskinesia)
  • Bronchoscopy: mucosal inflammation and mucopurulent secretions
  • Nasal biopsy (Brush or curettage)
  • Digital high speed video imaging (DHSV) of ciliary beat pattern
31
Q

Kartagener syndrome (subunit of primary ciliary dyskinesia)

A

Autosomal recessive disorder with genetic heterogeneity
Caused by ciliary immotility/ dysmotlity due to ultrastructural abnormalities of resp cilia and flagella of spermatozoa and fallopian tube
Clinical: situs invertus, resp distress of various severity -> chronic sinusitis and bronchiectasis. Flagella defects of spermatozoa and fallopian tube -> infertility/subfertility

32
Q

How to measure respiratory muscle weakness in motor neurone disease?

A

Measure maximal inspiratory pressure (MIP), maximal sniff nasal inspiratory pressure (SNIP) and maximal expiratory pressures (MEP)

  • MIP and SNIP reflect the strength of the diaphragm and other inspiratory muscles (if record low MIP -> confirm with SNIP)
  • MEP reflects the strength of abdominal muscle and other expiratory muscle
33
Q

Evidence of mandibular splint advancement

A

Suitable for mild to moderate disease or 2nd line who cannot tolerate CPAP
Significant improvement in AHI and other indices a/w OSAS including snoring volume

34
Q

Severity of OSA

A

Mild: AHI 5-15
Moderate: AHI 15-30
Severe: ≥ 30

35
Q

How to calculate pulmonary ventilation?

A

Ventilation = RR X TV

36
Q

Riociguat - useful in which group of PHTN

A

Guanylate cyclase stimulators
Dual mode of action: directly stimulate soluble guanylate cyclase independently of NO, increase sensitivity of soluble guanylate cyclase to NO -> increase level of cyclic guanosine monophosphate -> vasorelaxation and antiproliferative and antifibrotic effects
In group IV: it improve exercise capacity and pulmonary vascular resistance in CTEPH (CHEST-1 trial)

37
Q

Selexipag - benefits and s/e

A

Use: pulmonary arterial hypertension
Oral selective IP prostacyclin receptor agonist
Reduce risk of hospitalisation and delay disease progression (Griphon study NEJM 2015)
Most common s/e: headache

38
Q

Boyle’s law and the importance in diving

A

Behavior of gases under varying amount of atmospheric pressure. If diver holds his breath at 100 feet, continues holding while rising to 10 feet then the gas in his lungs increase 4 times -> if forget to exhale on way up, lung explode

Sophie’s Flash Cards (9 decks)

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