Respiratory Flashcards
Causes of upper zone predominant pulmonary fibrosis?
S - silicosis (massive fibrosis), sarcoidosis
C - coal workers pneumoconiosis
H - histiocytosis (pulmonary langerhans histiocytosis - “cystic”)
A - allergic bronchopulmonary aspergillosis
A - ankylosing spondylitis
R - radiation
T - tuberculosis
Causes of lower zone predominant pulmonary fibrosis?
D - dermatomyositis, polymyositis
R - rheumatoid arthritis
A - asbestosis
S - scleroderma
C - cryptogenic (ideopathic) pulmonary fibrosis
O - “other”; drugs
Drugs that cause pulmonary fibrosis?
What pattern typically?
NSIP
CVS - Amiodarone, hydralazine
Chemo - MTX, Bleomycin
ABx - nitrofurantoin
Features on HRCT of usual interstitial pneumonia (UIP)?
What major condition is this associated with?
Honeycombing
Traction bronchiectasis
Reticular opacities
Subpleural (peripheral) and basal predominance
Idiopathic pulmonary fibrosis
Features on HRCT of non-specific interstitial pneumonia (NSIP)?
Name 5 causes
Ground glass opacities
Reticular opacities
Traction bronchiectasis
Diffuse changes - may have subpleural sparing
Idiopathic
Drug associated
Scleroderma
Hypersensitivity pneumonitis
HIV
Predominantly UIP or NSIP for below autoimmune conditions:
1. RA
2. Scleroderma
3. DM/PM
4. ANCA vasculitis
5. Sjogrens
- RA = UIP
- Scleroderma = NSIP
- DM/PM = NSIP
- Sjogrens = NSIP
- ANCA vasculitis = UIP
Features on radiograph of cryptogenic organizing pneumonia?
Bilateral patchy, diffuse ground glass opacities with normal lung volumes
Peripheral and lower lobe predominant
Benefits of HFNP compared with NIV in T1 respiratory failure?
Reduces all cause mortality
Reduces HAP
Reduces need for ventilation
Improved patient comfort
Unclear impact on hospital and ICU stay/admission
What FiO2 can nasal cannula deliver and at how many litres per minute?
1-6L/minute
FiO2 0.24-0.4
What FiO2 can a venturi mask deliver and at how many litres per minute?
2-15L/minute
FiO2 0.24 - 0.5
What FiO2 can a non-rebreather mask deliver and at how many litres per minute?
10-15L/minute
FiO2 0.6-0.9
What FiO2 can high flow nasal cannula deliver and at how many litres per minute?
15-60 litres/minute
FiO2 0.3 - 100
Drugs/toxins that are definitely associated with pulmonary arterial hypertension?
Appetite suppressants - fenfluramine, dexfenfluramine, aminorex
Toxins - rapeseed oil, methamphetamine
Dasatanib (TKI for CML)
Drugs/toxins that are possibly associated with pulmonary arterial hypertension?
Cocaine, amphetamines, Appetite suppressants - diethylproprion, Phentermine, Phenylopropanolamine
Leflunomide
IFN-alpha and IFN-beta
St. Johns wort
Bosutinib (TKI for CML)
Alkylating agents (i.e. cyclophosphamide)
Tryptophan
Direct acting agents against HCV
Chinese herb Qing Dai
Scoring system components for mortality and hospital duration in empyema?
RAPID
R - renal function: elevated BUN (<5, 5-8, >8 = 0, +1 or +2)
A - age (<50, 50-70, >70 = 0, +1, or +2)
P - purulenet pleural fluid (NON-PURULENT is worse; (Yes = 0, No = +1)
I - infection source (Community = 0, Hospital-Acquired = 1)
D - Dietary/Serum Albumin (>27=0, <27=+1)
Interpretation
0-2 points = Low risk (1.5% 3/12 mortality) 3-4 points = medium (17.8% 3/12 mortality)
5-7 = High risk (47.8% 3/12 mortality)
Indications for step up therapy in Asthma
Nocturnal symptoms or on waking
Daytime symptoms and/or need for reliever >2
Any limitation of activity
“Well controlled asthma” is therefore the opposite:
- daytime symptoms/need for SABA (not before exercise) ≤ 2 days per week
- no limitation to activities
- no nocturnal symptoms
Features of low risk lung nodules
<8mm (<5mm = 1% maignant, 5-0 = 2-6% malignant)
Solid appearance
Smooth borders
Singular nodule
Non-upper lobe location
Non-enhancing
When to reimage a 9mm solid pulmonary nodule
What if part-solid?
What if nodule 6mm?
PET/CT at 3 months
Part solid –> CT at 3-6 months
6mm solid –> CT at 6-12 months
Flow volume loop with inspiratory plateau but normal expiration?
What about if expiratory loop was also flattened?
Flattened inspiratory plateua but normal expiration - variable extrathoracic obstruction (i.e. vocal cord paralysis)
Flattened inspiratory AND expiratory loop - fixed extrathoracic obstruction (i.e. tracheal stenosis)
Flow volume loop with expiratory plateau but normal inspiration?
Flattened expiratory loop but normal inspiration - variable extra thoracic obstruction (i.e. tracheal malacia)
Components of the ISARIC score for COVID deterioration
Age
Gender
Number of co-morbidities
Respiratory rate
Peripheral oxygen saturation on room air
Glasgow coma scale
Urea
CRP
Which are the 3 interstitial lung diseases associated with smoking? Do they improve with cessation of smoking?
Desquamative interstitial pneumonia
Langerhans cell histiocytosis (upper lobe)
Respiratory bronchiolitis interstitial lung disease (upper lobe; centrilobular emphysema)
Mostly yes
In what cancers do EGFR TKIs have a role?
Head, neck, lung, colorectal cancer
What is the major difference between erlotinib and osimertinib?
Osimertinib = active against T790 resistance mutations
Erlotinib/other egfr TKIsare not
