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MRCP PART 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

CD4 count in HIV for septin prophylaxis

A

<200

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2
Q

most common cause of pneumonia

A

Strep pneumo

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3
Q

Common cause of pneumonia with cold agglutins present?

A

Mycoplasma pneumoniae

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4
Q

CAP in pregnancy (if treated in community)? if allergy to 1st line?

A

Amox

Erythromycin
[would be doxy if not pregnant]

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5
Q

Class of antibiotic is clari?
Levofloxacin

A

C - Macrolide
Levo - fluoroquinolone

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6
Q

How long Rx for CAP, HAP, Leigionella

A

Cap - 5 days
HAP - 7-10
Leigon - 21 days

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7
Q

Severe Rhem A. Develops stridor. What is this? Ix? Rx?

A

Criocoarytenoid arthritis

Spirometry with flow volume loop
CT larynx
Laryngoscopy

IV steroids
Possible emergency trache

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8
Q

Cirrhosis -> SOB with normal CXR especially when standing

A

Hepatopulmonary syndrome

Due to vasodilation of vessles (mostly in lower lobes) which inhibits the ability of oxygen transfer.

When stand up -> more poorly oxygenated blood through lower lobes -> hypoxia

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9
Q

Chlamydia pssitaci penumonia would have what clue in question? What is it called when you have it?

A

Exposure to birds

Ornithosis

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10
Q

Primary pulmonary HTN linked to which drug use?

A

Amphetamines

[-fenfluramines (used as anorexic drugs in severe obesity) ]

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11
Q

What is cor pulmonale

A

Pulm HTN -> Right heart failure

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12
Q

Most Pulm HTN is secondary to COPD
What is the gene implicated in familial disease?

A

BMPR2 - Bone morphogenic protein receptor 2

[Big massive pulm respiratory 2] - Also on chromosome 2

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13
Q

Heart sound in pulm HTN?
Key thing on echo bar RV dilation/ hypertrophy

A

Loud P2

Peak tricuspid regurgitation velocity

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14
Q

PPH standard Rx

A

All get digoxin
Anticoag to prevent clot
PDE-5 inhibitors - Eg sildenafil

[May use bosentan which is a endothelin receptor blockade]

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15
Q

Drug to bridge severe pulm HTN to transplant ?

A

Prostacyclin (PGI2)
Given as IV continuous infusion though central line

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16
Q

CI to CTPA eg Severe CKD. What Ix?

A

VQ scan

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17
Q

Mab for severe allergic asthma

A

omalizumab - binds to IgE

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18
Q

Work prev making cutting tools / jet engines. -> slow progressive lung disease. Called? Seen on histology?

A

Hard metal lung disease - caused by cobalt particles

Multinucleated giant cells (Giant cell interstitial pneumonia)

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19
Q

What happens in CF ? Gene/chrom?

A

Abnormal Cloride transport
-> Thick secretions in Respiratory / gut / reproductive most commonly

CFTR - chromosome 7

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20
Q

Usual bugs in CF chest kids vs teens?

A

Kids - Staph aureus -> H influenzae

Teens - pseudomonas

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21
Q

What happens in GI system CF

A

Pancreatic duct blocked
-> exocrine deficiency -> ADEK deficiency + malabsorbsion of food
->Endocrine deficiency -> diabetes

Bowel obstruction due to undigested food

Obstruction of biliary tract -> cirrhosis and portal hypertension

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22
Q

Why are men with CF infertile

A

Often have congenital lack of vas deferens
(or blocked with thick secretions)

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23
Q

Acute chest pain in CF

A

Pneumothorax likely

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24
Q

Diagnosis of CF

A

Any of:
Guthrie heel prick test (blood spot immunoreactive tripsin test) -> sweat test for confirmation

Sweat cloride > 60mmol/l

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25
Q

First choice mucoactive agent in CF ?
Chronic Pseudomonas ?
Who gets fluclox prophylaxis

A

First choice mucoactive agent in CF ? Dornase alfa
Chronic Pseudomonas - Tobramycin inhaler

Children under 3 - fluclox prophylaxis against S aureus

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26
Q

Which bug colonisation is a contra indication to lung Tx in CF

A

Burkholderia cepacia

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27
Q

Histological of sarcoid. 2 bits?

A

Multinucleated giant cells with macrophage, lymphocytes and epithelioid histocytes

Non caseating granulomas

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28
Q

Lymphadenopathy, splenomegaly, erythema nodosum, uveitis

A

Sarcoid

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29
Q

Sarcoid with fever, uveitis, parotid enlargement, CN palsies =

A

Heerfordt-waldenstrom syndrome

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30
Q

Which is most common electrolyte abnormality in sarcoid

A

HyperCa

  • Either from renal / bone involvement
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31
Q

Bi hilar lymph enlargement, erythema nodosum, fever, arthralgia = which syndrome

A

Lofgren syndrome (sarcoid)

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32
Q

Common blood test in Sarcoid?

A

Rasied serum ACE
(May have anaemia / leuopenia due to bone marrow/ spleen involvement
May Have derranged LFTs/Ur/Cr)

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33
Q

What is found on bronc lavage of sarcoid

A

Raised CD4:CD8 ratio

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34
Q

Corticosteroids in sarcoid are first line. When do they get used?

A

Any neuro / opthal symptoms
Raised serum Ca

[Most people 60% have spontaneous resolution over 2-5 years)

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35
Q

What FEV1:FVC is obstruction

A

<0.7

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36
Q

What is doxapram

A

Respiratory stimulant
Usually used in post op hypoventilation
[sometimes used in COPD with persistent hypercapnia + acidosis in hospital]

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37
Q

2 scoring tools for COPD
Which for general prognosis ?
Which for inpatient exacerbation ?

A

BODE

DECAF

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38
Q

Old TB cavity often gets infected with what?

A

Aspergilioma

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39
Q

What does radiation pneumonitis look like on XR? What else might make you think this rather than an infective cause

A

Patchy shaddowing.

Normal WCC
Only mild fever
Non productive cough

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40
Q

Most common cause of occupational asthma

A

Isocyanates
[followed by flour/grain]

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41
Q

When could you just discharge a PTX home

A

<50years, spontaneous and <2cm

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42
Q

How to test eosinophilic airway inflamation

A

FeNO testing

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43
Q

Anti-GBM target?
Main Presentation?
Rx?

A

Good pastures (antibodies target alpha-3 chain of collagen IV)
HLA-DR2 / DR15 / DRB1

Rapidly progressive glomerulonephritis and pulm haemorrhage

Pred, cyclophosphamide, Palsma exchange

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44
Q

Granulomatosis with polyangitis blood test

A

C-ANCA directed at PR3

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45
Q

Most common Ca in lung

A

Mets

Then Squamous cell

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46
Q

Length of Rx for PE
Provoked?
Unprovoked?
Ca?
Recurrent?

A

3 months

6 months

3-6 months

Lifelong

[These are all reviewed in clinic and based individually]

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47
Q

Which therapy in COPD has been shown to impact long term survival

A

Stopping smoking

LTOT - in those who meet crieria

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48
Q

What is Kco and how do you calculate it

A

Kco is the transfer coefficient. It represents the uptake of carbon monoxide (Tlco) per liter of effective alveolar volume (Va)

Kco = Tlco/Va

[It allows for correction of any lung size reduction Eg resection as both Tlco and Va will be reduced to a similar amount]

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49
Q

What causes a high Kco? Low?

A

High - conditions where there is an increase in red cells in lungs Eg Polycythaemia, haemorrhage, increased flow.

-Rarely also be increased in restrictive pathologies where you get an increased density of pulmonary capillaries in relation to lung tissue.

Low - Pneumonia / PE / Asthma / intersitial lung disease etc..

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50
Q

Which pneumonia bug causes haemolytic anaemia most commonly

A

Mycoplasma pneumonia

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51
Q

What type of fungi are aspigillous

A

filamentous

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52
Q

Imaging of choice and blood test for aspergillous

A

CT
Serum galactomanam (aspergilous antigen)

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53
Q

Most common form of aspergillos? Which is type carries a worse prognosis and why?

A

A. Fumigatus - 70% of cases

A. Terreus - Resistant to amphortericin B
[the Terrur mwah hahaha]

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54
Q

What is allergic bronchopulmonary aspergilliosis? Which type of Aspergilous usually? Who gets it ? Pathophysiology?

A

Hypersensitivity reaction to antigens from A Fumigatus

Usually people with CF / asthma due to increased mucous secretion / impaired mucocillliary clearance -> reduced clearance of spores

-> Type I and III hypersensitivity reactions
-> Proximal bronchi get dilated and filled with mucous -> bronchiectasis and airway obstruction

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55
Q

Which condition decribes an apsergilous cavity (or multiple) / aspergilioma

A

chronic pulmonary aspergiliosis

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56
Q

What is invasive aspergiliosis

A

Into lungs -> disseminate round body via blood

[may get direct invasion via paranasal sinus to orbit / brain]

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57
Q

BD glucan or glactomanan which is better? why? What other test for Invasive aspergillis

A

Galactomanan - (component of the cell wall)

BD glucan - positive in other fungal infections so less specific

PCR of ribosomal DNA

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58
Q

What blood findings in Allergic Bronchopulmonary aspergiliousis? Skin? On Chronic pulmonary Aspergilious?

A

Raised IgE (and aspergilis specific IgE/IgG)
Riased eosiniphils
Positive weal and flare reaction on skin test

CPA - Raised serum IgG antibodies

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59
Q

Sometimes aspergilius requires VATS - what is this? What stain is used?

A

Video Assisted Thoracic Sugery

Gomori’s Methanamine Silver (GMS) stain

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60
Q

Which drug used for Invasive aspergillosis and how long? prophylaxis in immunocompromised?

A

Voriconazole and isavuconazole - 3 months if improve
-> If deterirorate switch vori to Amphotericin B

Posaconazole

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61
Q

Usual Rx for Allergic Aspergilious

A

Steroids for exacerbations and management of underlying condition (eg asthma / CF)

Antifungals may be used as adjunct

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62
Q

aspergiloma doesn’t really respond well to antifungals. What is Rx ? Common acute complication and RX?

A

Often just monitored
Lobectomy

Embolisation to control haemoptysis

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63
Q

Gradual wheeze, haemoptysis well demarkated nodule on CXR in a non smoker

A

Broncial carcinoid

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64
Q

Definitive diagnosis of mesothelioma

A

Biopsy

[May get diagnosis from cytology of pleural fluid]

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65
Q

NIV has best evidence for ….

A

Decompensated Type 2 respiratory failure with acidosis

66
Q

Rx of pulm oedema and hypertension

A

Diruetics + GTN

-> NIV

67
Q

Most common cause of pulm fibrosis? Seen on XR? Rx?

A

Idioppathic pulmonary fibrosis

Bilateral lower zone reticulonodular shaddows

Pirfenidone

68
Q

Extrinsinsic Allergic alveolitis usually affects which area of lungs

A

Upper zones
[though if bad can affect everywhere]

69
Q

What difference would you expect in Peak flow in occupational asthma?

A

> 20% in area which triggers symptoms

70
Q

How much bronchodilator reversibility for asthma?

A

> 15%
or >200mls in FVC

71
Q

Herpes Labialis (cold sores) + pneumonia =

Viral infection -> pneumonia =

COPD -> Pneumonia =

A

Herpes Labialis (cold sores) = Strep penumonia

Viral infection -> = S aureus

COPD -> = H influenzae

72
Q

in hosital Rx of pneumonia Non severe? severe?

A

oral amox + clari

IV Co-amox + IV clari (not oral clari)

73
Q

Cushing syndrome in Small cell lung Ca presents how?

A

Not with classical features such as bufallo hump / central obesity as short history of this cancer….

-> Hypertension, hyperglycaemia, hypokalemia / muscle weakness

74
Q

Most common cause of bronchiectasis

A

Previous severe lung infection

75
Q

Most common cause of bronchiectasis

A

Previous severe lung infection

76
Q

Who gets idopathic bronchiectasis

A

Marfans

77
Q

CF bronchiectasis mucolytic ? If not cf?

A

rhDNase

N-Acetylcistine

78
Q

Chronic Rx of bronchiectais

A

Vaccine - Pneumococcal and influenza

Abx prophylaxis - considered if >3 exacerbations / year

79
Q

Bronchiectasis has thickened and dilated airways. How might this appear on cxr

A

Small, cyst like spaces + crowded lung markings

80
Q

Pen allergic + breast feeding with pneumonia 1st choice?

A

Clary

81
Q

Most common cause of community empyema? Hospital?

A

Strep (pneumo / milleri)

Staph Aureus

82
Q

Lymphocyte predominant pleural effusion is?

A

TB
Or Malignancy

83
Q

Needed after thorascopy for biopsy of mesothelioma

A

Radiotherapy of tract site
[prevents tumour seeding and growth]

84
Q

Cotton worker with respiratory Sx worst in 1st hour of work?

A

Byssinosis

85
Q

Key sensitive test in allergic aspergillosis

A

Early positive skin prick test

86
Q

Respiratory failure in MSK conditions eg ankylosing spond

A

Type 2
[hypoventillation]

87
Q

Viral illness -> cavitating pneumonia =

A

Staph (most likely)

88
Q

What are the values in curb 65. How many for IV co-amox +clari

A

urea >7 mmol/L;
respiratory rate ≥30/minute,
systolic <90 mmHg and/or diastolic ≤60 mmHg
age ≥65 years

Score of 2 or more = severe

89
Q

Progressive DRY cough and SOB
Often seen in SLE, Post chest infection, post-transplant or penicillamine?

A

Bronchiolitis obliterans

[Bronchiectasis would have a productive cough]

90
Q

Coal workers lung associated with? Ca risk?

A

Progressive massive fibrosis
->cor pulminale

It is NOT associated with cancer

91
Q

Coal worker pneumociosis RhF and nodules in lungs =

A

Caplan syndrome

92
Q

1st line Ix in occupational asthma

A

Serial peak flow

93
Q

Kco in Idiopathic pulm fibrosis

A

about 60%

94
Q

Prev failed Tb treatment. What Ix before starting treatment again?

A

Rifampicin sensitivity testing

95
Q

CIs to surgical rx of lung Ca?
FEV1 levels?

A

Contralateral lymph nodes or worse
Pleural effusion / pleural involvement
FEV1 <1.5L

96
Q

What is Mendelson syndrome?

A

Aspirate something chemical Eg gastric juice
-> bronchoconstriction

97
Q

What is the most important antigen-presenting cell for sensitisation

A

Dendritic cell

98
Q

first loine rx Granulomatosis with polyangitis

A

Steroids + cyclophosphamide

99
Q

The characteristic hallmark of sarcoid?
What is a Schaumann body?

A

Non-caseating granuloma

Crystalised (calcium phosphate) central area in a sarcoid granuloma

100
Q

Fancy drug for idiopathic pulmonary fibrosis

A

nintedanib - Tyrosine kinase inhibitor
[it makes Nin defference]
or pirfenidone

[neither improves, but are thought to slow progression]

101
Q

Pulm HTN heart sound

A

Loud P2

102
Q

What happens to the alveolar-arterial gradient on exercise in chronic thromboembolic pulm HTN

A

Widens on exercise

103
Q

Investigation of severe inhalation burn injury

A

Bronch

104
Q

When has LTOT therapy been shown to improve life expectancy

A

COPD
Cor pulmunale

105
Q

Worsening asthma in adult. Raised eosinophils/ IgE and haemoptysis. Infiltrates on XR. Diagnosis?

A

Allergic bronchopulmonary aspergillosis

106
Q

Pneumothorax rx
Primary <2cm not breathless
Primary >2cm not breathless
Primary >2cm breathless
Secondary <2cm
Secondary >2cm breathless

A

Primary <2cm not breathless - conservative
Primary >2cm not breathless - Needle aspiration
Primary >2cm breathless - Chest drain
Secondary <2cm - needle
Secondary >2cm - chest drain

107
Q

How does A1AT prevent COPD

A

Elastase inhibitor

108
Q

Isocyanates Eg chemical factory are high risk for which type of lung Ca

A

Usually squamous

109
Q

Key thing in question which would make you not go for NIV in Exacerbation

A

Reduced conscious level

110
Q

Catagory 1-3 pneumoconiosis

A

1 - few opacities, clear lung markings
2 - some opacities, lung markings visible
3 - lots of opacities, lung markings obscured

111
Q

Epworth score for OSA

A

> 10

112
Q

Tracer on PET scanning

A

Flurodeoxyglucose
[rapidly dividing cells need lots of glucose so take it up]

113
Q

Best initial Ix for tracheal compression

A

Flow-volume loop

[usually more reduced inspiratory aspet]

114
Q

Hypersensitivity pneumonia Eg EAA are mediated by?

A

IgG

[Extrinsic allergic alveolitis is not an allergic reaction despite its name so there is no rise in IgE, skin prick tests…

115
Q

CABG - now ++SOB when lying flat with reduced VC when flat

A

Diapragmatic palsy

116
Q

Epworth score >10 and struggling to keep awake at wheel. Rx

A

CPAP

[weight loss too but this is more chronic Rx]

117
Q

LTOT indications

A

PO2 <7.3 when stable

PO2 <8 with risk factors … Oedema, polycythemia, Pulm HTN

118
Q

Gillian barre which breathing test

A

FVC

119
Q

Widespread eosinophilic granulomas in young persons with early and progressive fibrosis

A

Histiocytosis X
[Produce too many Langerhans cells]

120
Q

What is berylliosis

A

Occupational lung disease from manufacturing industry
[Presents similar to sarcoid with non caseating granulomas]

121
Q

What is histoplasmosis

A

Most common fungal lung disease in north America -> granulomas

122
Q

Vitamin suplements in CF

A

ADEK
malabsorption of fat soluble

123
Q

Usual interstitial pneumonia Vs Hypersensitivity pneumonitis on radiology

A

UIP - Subpleural reticulation
Honeycombing

Hypersensitivity - Ground glass shadowing with reticular and nodular findings

124
Q

Differentiate chronic and allergic aspergilliosis

A

Both have raised Aspergillus IgG Precepitins

Chronic
Cough and haemoptysis common

Allergic
More Sx of wheeze / raised IgE. May still have haemoptysis

125
Q

Pulm rehab what positive benefits

A

Increased exercise tolerance
Reduced hospital admissions

[Does NOT improve lung function]

126
Q

What is better at staging lymph node involvement in Lung Ca - CT or MRI?

A

CT

-Too much movement with respiration for MRI

127
Q

Exposure to TB and now positive tuberculin skin prick test but ASx. NICE guidelines for Rx

A

Rifampicin and Isoniazid for 3 months
or just Isoniazid for 6

Does not need time off work

128
Q

Pulm fibrosis - what is:
Elastic recoil?
Alveolar-arterial gradient on exercise?

A

Increased elastic recoil
-Low compliance = high recoil (as they stiff)

Widening of gradient on exercise
-Think becomes hypoxic on minimal exersion

129
Q

Consolidation and Foul smelling sputum

A

Anaerobic pneumonia

130
Q

Low transfer capacity eg 50% with mostly preserved Kco Eg 90% =?Eg?

A

Extra thoracic issues

Eg Obese, thorax abnormalities, neuromuscular dysfunction of chest wall

131
Q

Left raised hemidiaphragm - what is the ‘sniff test’

A

Forced inspiratory manouver
-> affected side paradoxically rises

[due to reduced intrathoracic pressure causing affected paralysed side to rise]

132
Q

TB Rx. When would the recommendation be to stop all therapy in relation to LFTs

A

ALT > 5x upper limit of normal

-Can then slowly re introduce meds, usually starting with ethambutol

133
Q

Cough for 6 months, worse in the morning when wakes and when walking outside. Pulm function tests / CXR unremarkable. What do you next?

A

High-dose inhaled steroids / oral steroid course.

-likely cough-variant of asthma. So Peakflow will be negative
-Unlikely reflux given symptoms when walking outside

134
Q

Where is fibrosis in EAA

A

Upper lobe

135
Q

What is the fibrotic lung pattern in scleroderma?

A

Non-specific interstitial pneumonia

136
Q

Emphysema Lung Function tests

A

Obstructive
Normal FVC with reduced FEV1:FVC

137
Q

Differentiate interstitial lung disease and obesity on pulm function tests

A

Both restrictive
Kco would be lower eg 60% in ILD and normal in obesity

138
Q

A1AT deficiency causes what in the lungs

A

Fibrosis, specifically Emphysema

139
Q

Volume of anatomical dead space

A

150mls

140
Q

Can you operate on a lung Ca with vocal cord palsy

A

NO as indicates soft tissue invasion

141
Q

COPD on salbutamol PRN. 2 Options for next line Rx

A

Inhaled steroid + Long acting bronchodilator

Long acting Anticholinergic

142
Q

Keeps birds which pneumonia is it

A

Chlamydia psittaci

143
Q

Upper lobe fibrosis causes

A

BREASTS

Berylliosis
Radiation
Extrinsic alergic alveolitis / eosinophilic pneumonia
Ankylosing spond / allergic bronchopulmonary aspergillosis
Sarcoid
TB
Silicossis

Important - Allergic Ankylosing spond, Sarcoid, Silicosis

[Lower
CABRIOS

Collagen vascular disease / cryptogenic fibrosis alveolitis
Asbestosis
Bronchiectasis
Rheum arthritis
Idiopathic
Other… (Blah never mind BNM) Bleomycin Nitrofurantoin MTX
Scleroderma]

144
Q

Asthma in ICS + SABA. What next

A

LRA eg montelukast
Or LABA

145
Q

Unilateral pleural effusion on CXR. Ix in order

A

Aspirate with US
-> CT

146
Q

How does a venturi deliver specific % FIO2

A

Air entrainment

147
Q

Why TB in silicosis

A

Silica acts as toxin to macrophages

148
Q

How to confirm dx of pleural Tb

A

Pleural biopsy + M&C

149
Q

What does FEF 25-75% reflect

A

status of small airways

150
Q

When do you hear Whispered pectoriloquy

A

lung consolidation
-cancer (solid mass)
-pneumonia (fluid mass)

151
Q

What chromosomal change seen in mesothelioma

A

Loss of material from chromosome 22

152
Q

OSA is predisposes to

A

Stroke, Arrythmias, CAD, T2DM

153
Q

Asthma Rx

A

SABA
+ICS
+Montelukast
+LABA

154
Q

Lower Lung fibrosis

A

CABRIOS

Collagen vascular disease / cryptogenic fibrosis alveolitis
Asbestosis
Bronchiectasis
Rheum arthritis
Idiopathic
Other… (Blah never mind BNM) Bleomycin Nitrofurantoin MTX
Scleroderma

Important - Bronciectasis, Asbestosis, Rheum A, Scleroderma

[Upper BREASTS
Berylliosis
Radiation
Extrinsic alergic alveolitis / eosinophilic pneumonia
Ankylosing spond / allergic bronchopulmonary aspergillosis
Sarcoid
TB
Silicossis]

155
Q

Spontaneous PTX
Flying?
Scuba dive?

A

5 days for flying if treated
Never scuba dive

156
Q

What is the cause of primary PTX

A

Rupture of apical subpleural blebs

157
Q

Sarcoid with hyper Ca and mild rise in Cr management

A

Rehydration

Pred only if persistent hypercalcaemia / neuro / opthal involvement

158
Q

Sarcoid. Diagnostic Ix? next best?

A

Biopsy
CT scan

Serum ace non specific and only raised in 60%

159
Q

What blood Ix might you do in new Dx of bronchiectasis ?

A

Serum Igs

[IgE might be allergic aspergillus
IgA might be deficienct]

160
Q

Bronchiectasis mainstay of Rx is?

A

Postural drainage

161
Q

2 most predictive measures of survival in COPD

A

Age
FEV1

MRCP PART 1 (22 decks)

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