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BPT Sadness 😔 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the earliest time that someone can fly post spontaneous PTX?

A

1 week post check up XR; 2 weeks after successful drainage if no residual air

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2
Q

The most common organism causing infective exacerbations of COPD?

A

Haemophilus influenzae

Followed by:
• Streptococcus pneumoniae
• Moraxella catarrhalis

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3
Q

Which lung cancer is most associated with SIADH?

A

Small cell lung Ca

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4
Q

Patient has presented with shortness of breath, cough, chest pain, and brown sputum on a background of recently brittle asthma

OR

Bronchiectasis with eosinophillia

Most likely Dx?

A

ABPA

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5
Q

Symptoms of acute mountain sickness incl. fatigue, headache, nausea and vomiting following a recent hiking expedition

Tx/preventative?

A

Prevention of acute mountain sickness
• Limiting gain of altitude to 500m/day
• Increasing physical fitness
• Acetazolamide, a carbonic anhydrase inhibitor that causes metabolic acidosis and a compensatory respiratory alkalosis to increase respiratory rate and tissue oxygenation

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6
Q

Painful shin rash + cough should make you think?

A

Sarcoidosis
- Systemic disorder characterised by non-caseating granulomas

Features
• Acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
•Insidious: dyspnoea, non-productive cough, malaise, weight loss
• Skin: lupus pernio
• Hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

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7
Q

Triad suggests which condition?
1. Acute polyarthritis
2. Erythema nodosum, and
3. Hilar adenopathy

A

Löfgren syndrome

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8
Q

Role of nifedipine in HAPE?

A

Lowers vasoconstriction in response to hypoxia in people susceptible to HAPE, reducing pulmonary pressure and oedema

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9
Q

Which type of lung cancer is most associated with cavitation lesions?

A

Squamous cell

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10
Q

HLA association in bronchiectasis?

A

HLA-DR1
- bRonch1ectas1s

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11
Q

Indication for steroids in sarcoidosis?

A

Indications for corticosteroid treatment for sarcoidosis are: parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement

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12
Q

Chronic infection with which pathogen is an important CF-specific contraindication to lung transplantation?

A

Burkholderia cepacia

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13
Q

What are good prognostic factors in sarcoidosis?

A

• HLA B8
• Lofgren’s syndrome (bilateral hilar lymphadenopathy, erythema nodosum, polyarthritis and fever)

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14
Q

Causes of ARDS?

A

Causes
• Infection: sepsis, pneumonia
• Massive blood transfusion
• Trauma
• Smoke inhalation
• Acute pancreatitis
• Covid-19
• Cardio-pulmonary bypass

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15
Q

Wtf is Lofgren’s syndrome?

A

Lofgren’s syndrome is an acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.

It typically occurs in young females and carries an excellent prognosis.

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16
Q

Causes of bilateral hilar lymphadenopathy

A
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17
Q

Recurrent chest infections + subfertility makes you think?

A

Primary ciliary dyskinesia syndrome (Kartagener’s syndrome)

Features
• Fextrocardia or complete situs inversus
• Bronchiectasis
• Recurrent sinusitis
• Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

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18
Q

Factors which affect TLCO?

A

The transfer factor describes the rate at which a gas will diffuse from alveoli into blood. Carbon monoxide is used to test the rate of diffusion. Results may be given as the total gas transfer (TLCO) or that corrected for lung volume (transfer coefficient, KCO)

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19
Q

WTF is extrinsic allergic alveolitis?

A

Examples
• bird fanciers’ lung:avian proteins from bird droppings
• farmers lung: spores ofSaccharopolyspora rectivirgulafrom wet hay (formerlyMicropolyspora faeni)
• malt workers’ lung:Aspergillus clavatus
• mushroom workers’ lung: thermophilic actinomycetes*

Presentation
Acute (occurs 4-8 hrs after exposure)
• dyspnoea
• dry cough
• fever
Chronic (occurs weeks-months after exposure)
• lethargy
• dyspnoea
• productive cough
• anorexia and weight loss

Investigation
• imaging:upper/mid-zone fibrosis
• bronchoalveolar lavage: lymphocytosis
• serologic assays for specific IgG antibodies
• blood: NO eosinophilia

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20
Q

Causes for occupational asthma?

A
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21
Q

COPD severity on PFTs

A
22
Q

Alpha 1 anti-trypsin deficiency

A

Phenotypes

23
Q

Causes of pulmonary fibrosis (upper and lower)

A
24
Q

Most common pathogen in aspiration pneumonia with T2DM and EtOH?

A

Klebsiella pneumoniaeis a Gram-negative rod that is part of the normal gut flora. It can cause a number of infections in humans including pneumonia (typically following aspiration) and urinary tract infections.

Features ofKlebsiellapneumonia
• More common inalcoholic and diabetics
• May occur following aspiration
• ‘Red-currant jelly’ sputum
• Often affects upper lobes

25
Q

Which pathogen commonly causes pneumonia after influenza and can also be a complication of measles infection?

A

Staphylococcus aureuspneumonia

26
Q

Bronchiectasis: most common organism?

A

Haemophilus influenzae

27
Q

What’s another name for IPF and what are some features?

A

Cryptogenic fibrosing alveolitis
Features
progressive exertional dyspnoea
bibasal fine end-inspiratory crepitations on auscultation
dry cough
clubbing

Diagnosis
spirometry: classically a restrictive picture (FEV1 normal/decreased, FVC decreased, FEV1/FVC increased)
impaired gas exchange: reduced transfer factor (TLCO)
imaging: bilateral interstitial shadowing (typically small, irregular, peripheral opacities - ‘ground-glass’ - later progressing to ‘honeycombing’) may be seen on a chest x-ray but high-resolution CT scanning is the investigation of choice and required to make a diagnosis of IPF
ANA positive in 30%, rheumatoid factor positive in 10% but this does not necessarily mean that the fibrosis is secondary to a connective tissue disease. Titres are usually low

28
Q

Which of the following may have predisposes someone to developing tuberculosis?

Cadmium
Coal dust
White asbestos fibres
Blue asbestos fibres
Silica

A

Silica
- Silica is toxic to macrophages

29
Q

What do pulmonary arteries do in the setting of acute hypoxia?

A

Pulmonary arteries vasoconstrict in the presence of hypoxia

30
Q

What pH of pleural fluid requires chest drain?

A

pH <7.2

31
Q

Fleischner’s sign on CXR suggests what?

A

PE

32
Q

Where is Asbestosis seen in lungs?

A

Lung bases
- As-BASE-tosis

33
Q

Progressive massive fibrosis is seen in which condition?

A

Silicosis

34
Q

Fleeting, fluffy opacity on CXR makes you think?

A

Pulmonary eosinophillia

35
Q

Signet ring sign suggests?

A

Bronchiectasis

36
Q

What shifts O2 dissociation curve to the Right (REDUCED O2 affinity)?

A

CADET face right
- ↑ CO2
- ↑ acid/H+
- ↑ 2,3 DPG
- ↑ exercise
- ↑ temperature

37
Q

Cause of upper lung fibrosis?

A

CHARTS (upper)
• Coal workers pneumoconiosis
• Hypersensitivity pneumonitis, histiocytosis
• Ank spond, ABPA - infective
• Radiation
• TB
• Silicosis, sarcoidosis

38
Q

Causes of lower lung fibrosis?

A

RAID (lower)
• RA + CTD (scleroderma)
• Asbestosis
• IPF
• Drugs e.g. MTX, amiodarone

39
Q

MLST level in type 1 narcolepsy?

A

MLST <8

40
Q

Causes of increased DLCO

A

Asthma
Pregnancy
Obesity
Pulmonary haemorrhage
Polycythaemia

41
Q

Which HLA is associated with narcolepsy with cataplexy?

A

HLA DQB1 06:02

42
Q

Treatment of CF (CFTR modulators)

A

CFTR potentiator: opens channel
- Ivacaftor; indicated for G551D
CTFR correctors: moves protein to cell surface
- Tezacaftor, elexacaftor, lumacaftor

Trikafta: TIE for both homo and hetero delta F508
- Tezacaftor + elexacaftor + ivacaftor

Delta 508
- Can give lumacaftor + ivacaftor

43
Q

Which non-mycobacterial pathogen can be colonised in cystic fibrosis patients?

A

Mycobacterium abcesses

44
Q

Mechanism behind infertility in cystic fibrosis?

A

Absence of vas deferens

45
Q

How to treat PAH which responds to vasodilator or vasoreactivity testing?

A

CCB
- Nifedipine, amlodipine, diltiazem (usually very high doses)

46
Q

Which mutation do you treat with ivacaftor?

A

G551D

47
Q

What FENO cut off for Dx of asthma?

A

FENO >50ppb

Spirometry
- Change in FEV1 of at least 200mL and 12% from baseline for adults post bronchdilator

48
Q

Asthma bronchial provocation AKA challenge testing?

A

Bronchial provocation tests of airway hyperresponsiveness include:
- Direct challenge tests (e.g. methacholine challenge test)
- Indirect challenge tests (e.g. exercise challenge test, eucapnic voluntary hyperpnea, hypertonic (4.5%) saline, mannitol challenge test)

If suspected exercise-induced asthma - can use mannitol challenge as alternative

49
Q

Most common genetic mutation in pulmonary HTN?

A

BMPR2

50
Q

Diagnosis of cystic fibrosis?

A

High nasal potential difference is found in CF

51
Q

What is A-a gradient calculation and what is normal?

A

A-a gradient: PAO2 - PaO2

Formula for RA (713 x FiO2) =
(150 - [CO2 x 1.25]) - PaO2

Normal 5-25

52
Q

What is the benefit of dupilumab in COPD?

A

Reduction in moderate to severe exacerbations of COPD
- Indicated in those with elevated eosinophil counts

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