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MRCP PACES > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Indications for lung transplant
(FIVE)

A

Cystic fibrosis
Bronchiectasis
Pulmonary vascular disease
Pulmonary fibrosis
COPD

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2
Q

Reasons for double lung transplant
(TWO)

A

Greater prognosis - better survival
CF and bronchiectasis

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3
Q

Lung transplant medications
(THREE)

A

Tacrolimus
Mycophenolate
Steroids

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4
Q

Complications of lung transplant
(FOUR)

A

Acute rejection
Opportunistic infections
Bronchiolitis obliterans
Increased malignancy - skin and lymphoproliferative

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5
Q

Contraindications to lung transplant
(FOUR)

A

Recent malignancy
High or low BMI
Untreatable comorbidities heart/brain/kidneys
Active smoking/illicit drug use

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6
Q

Indication for VATS
(FOUR)

A

Wedge resection
Lobectomy
Bullectomy
Treatment of recurrent pneumothoraces

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7
Q

Benefits of VATS over open thoracotomy
(FOUR)

A

Reduced pain
Reduced wound complications
Reduced length of stay
Reduced healing time

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8
Q

Indications for lobectomy
(FOUR)

A

Lung cancer
Aspergilloma
TB
Lung abscess

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9
Q

Investigations for lung cancer
(SIX)

A

History
Exam
CXR
CT thorax (abdo, pelvis)
Tissue diagnosis - bronch/EBUC/CT guided
PET-CT

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10
Q

Work up for lung surgery
(FOUR)

A

Lung function tests
Transfer factor
Echo
Cardiopulmonary exercise testing

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11
Q

Histological subtypes of lung cancer

A

Small cell
Non small cell - adenoca (non-smoker), squamous cell ca (smoker)

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12
Q

Small cell lung cancer treatment
(TWO)

A

Rapidly progressive, diagnosed late
Chemotherapy
Palliative measures

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13
Q

Non-small cell lung cancer treatment
(THREE)

A

Surgery
Chemotherapy
Radiotherapy

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14
Q

Signs in pneumonectomy vs lobectomy
(THREE)

A

Pneumonectomy always tracheal deviation, lobectomy sometimes
Pneumonectomy no breath sounds, lobectomy reduced or normal
Pneumonectomy dull percussion, lobectomy normal

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15
Q

Respiratory causes of clubbing
(FOUR)

A

ILD
Bronchiectasis
CF
Lung cancer

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16
Q

Differences between primary and secondary pneumothoraces

A

Primary - spontaneous in otherwise healthy
Secondary associated with underlying lung disease

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17
Q

Investigations for asthma
(SEVEN)

A

Observations with sats
Bloods with FBC (eosinophilia), U+E, CRP
ABG in acute setting
RAST blood tests for allergens
CXR
Peak flow
Spirometry

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17
Q

What would spirometry show in asthma vs COPD?

A

Reduced FEV1 both
Preserved FVC both
Reduced FEV1/FVC ratio both
Asthma would improve with bronchodilation

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18
Q

Treatment of asthma
(FOUR)

A

SABA reliever
ICS
LABA/ICS
Montelukast

19
Q

Causes of airflow obstruction
(FOUR)

A

Asthma
COPD
Bronchiestasis
Bronchiolitis obliterans

20
Q

Causes of bibasal creps
(THREE)

A

ILD
CCF
Bronchiectasis

21
Q

Investigations for ILD
(EIGHT)

A

Observations with sats
Bloods with FBC, U+E, LFT, CRP
Autoimmune screen
ABG
CXR
HR-CT
Echo
Spirometry

22
Q

Autoimmune screen for ILD
(FOUR)

A

Rheumatoid factor
ANA
ANCA
Anti dsDNA

23
Q

Lung function test findings in fibrosis

A

Reduced FEV1
Reduced FVC
Preserved FEV1/FVC
Reduced total lung volume
Reduced transfer factor

24
Q

Treatment of ILD
(FOUR)

A

MDT input - PT/OT input
Treat underlying connective tissue disorder
Consider steroids if groundglass CT
Antifibrotic agent - pirfenidone

25
Q

Causes of interstitial lung disease
(EIGHT)

A

Idiopathic pulmonary fibrosis
Asbestosis
Silicosis
SLE
Rheumatoid arthritis
Amiodarone
Nitrofurantoin
Methotrexate

26
Q

Cause of cystic fibrosis

A

Autosomal recessive
CFTR gene - chromosome 7
Increased salt excretion - leading to thicker mucus

27
Q

Effects of cystic fibrosis
(SEVEN)

A

Respiratory - bronchiectasis
Pancreatic - exocrine insufficiency
Liver - failure
Kidney stones
Gallstones
Intestinal obstruction
Reproductive involvement

28
Q

Management of cystic fibrosis
(SIX)

A

MDT specialist centre
Chest physio - positional drainage
Mucolytics and nebulisers
Prophylactic abx nebulised/azithromycin
Creon for pancreas
Nutritional supplements (via PEG)

29
Q

Microbiology in cystic fibrosis

A

Most common pseudomonas
Burkholderia poor prognosis - contraindicates lung transplant

30
Q

Cystic fibrosis exam findings
(FIVE)

A

Productive cough
Clubbing
Coarse inspiratory crackles - upper lobes
Possible supplemental feeding
Portacath

31
Q

Diagnosis of CF

A

Heelprick blood test in newborns
Blood screening for mutation
Sweat test

32
Q

Features of yellow nail syndrome
(FOUR)

A

Yellow dystrophic nails
Lymphoedema
Pleural effusions
Bronchiectasis

33
Q

Investigations for bronchiectasis
(EIGHT)

A

Bloods with FBC, U+E, LFT, CRP
HIV test
Immunoglobulins
Aspergillus serology
Cystic fibrosis testing
Sputum sample for MC+S
Lung function tests
CXR
HR-CT

34
Q

Treatment of bronchiectasis
(FOUR)

A

MDT approach
Chest physio with postural drainage
Hypertonic saline nebs
Consider long term azithromycin
Prompt antibiotics for infection

35
Q

Causes of bronchiectasis
(SEVEN)

A

Idiopathic
Yellow nail syndrome
Immunodeficiency
Rheumatoid arthritis and connective tissue diseases
Pulmonary TB
Cystic fibrosis
Allergic bronchopulmonary aspergillosis

36
Q

Causes of pleural effusion
(EIGHT)

A

Exudate:
Para-pneumonic
Lung infarct from PE
Malignancy
Connective tissue diseases (sarcoid/rheumatoid)
Transudate:
Heart failure
Liver failure
CKD
Hypoalbuminaemia

37
Q

Differentiating between transudate and exudate

A

Light’s criteria:
Pleural protein, LDH vs serum protein, LDH

38
Q

Investigations for pleural fluid
(FIVE)

A

Protein
LDH
pH
Culture
Cytology and cell count

39
Q

Management of pleural fluid in parapneumonic effusion

A

Guided by fluid
pH negative/culture positive for drain
Otherwise should spontaneously resolve

40
Q

Management of effusion in lung cancer

A

Drainage
Consider pleurodesis/indwelling pleural catheter

41
Q

Indications for pneumonectomy
(TWO)

A

Cancer - NSCLC - more central tumours
Tuberculosis historically

42
Q

Spirometry findings in COPD

A

Obstructive picture
FEV1/FVC <0.7
FEV1 >80% mild
FEV1 50-80% moderate
FEV1 30-50% severe
FEV1 <30% very severe

43
Q

What is cor pulmonale

A

Right sided cardiac failure secondary to pulmonary disease
Chronic hypoxia leads to pulmonary vasoconstriction
This leads to pulmonary hypertension and right sided failure

44
Q

Treatment for cor pulmonale
(TWO)

A

Long term oxygen therapy - reduce hypoxia
Diuretics

45
Q

Inclusion criteria for LTOT

A

No smoking
PaO2 <7.3 (<8.0 in cor pulmonale)
PaCO2 not markedly increasing on O2

46
Q

Spirometry findings in ILD

A

Reduced FEV1
Reduced FVC
Preserved FEV1/FVC ratio
Reduced transfer factor

MRCP PACES (5 decks)

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