RESPIRATORY Flashcards

Question

Risk factors for TB: highest to lowest

Answer 1

Highest: HIV coinfection Transplant CKD H+N cancer Fibronodular CXR TNF-alpha antagonist Fred > 15 mg daily

Answer 2

IGRA - detects TB exposure - checks T cell response to TB - does not (+) with vaccination - False (-) in immunosupressed

Answer 3

TB mycobacterial culture

Answer 4

Checks for latent TB - also (strong +) in active

Answer 5

Standard 4 months RIPE then 2 months RI Resistance Aim 4 effective drugs, >3 after BDQ stopped Levoflox Amikacin Meropenem P-ASA Ethionamide Cycloserine Clofazimine Bedaquiline Linezolid

Answer 6

○ Severely ill: resp failure, ICU, hypotension in first 6-8 weeks ○ Meingeal: REDUCES MORTALITY ○ Pericardial ○ Pleural ○ Dissemianted NB: Rifampicin increases metabolism of steroids = need lower doses

Answer 7

HIV Immunocomp Preg HCWs < 35 Recent converter neg --> positive Recent exposure Close contacts of smear positive pulm

Answer 8

Rifamp Isoniazid Rifapentine SINGLE AGENT

Answer 9

Rifampcin: drug interactions, hepatitis, HS Izonaizid: hepatitis, rash, peripheral neuro - INH competes with vitamin B6 (pyridoxine) in its action as a cofactor in the synthesis of synaptic neurotransmitters - Results in ataxia, peripheral neuropathy, paraesthesia Ethambutol: optic neuropathy Pyrazinamide: hepatitis, skin, polyarthralgia, gout

Answer 10

Elastic recoil Tendency for lung to collapse and chest wall to spring outward Compliance Change in lung volume for change in pressure Inversely proportional Low compliance = harder to fill ○ High compliance = easier to fill

Answer 11

Incr H+ Incr CO2 Exercise Incr 2.3 BPG High altitude High temperature

Answer 12

Carbs/fats/proteins --> glucose + O2 --> H2O + CO2 + Energy

Answer 13

Pyruvate --> lactate

Answer 14

INCR * asthma * pulmonary haemorrhage (Wegener's, Goodpasture's) * left-to-right cardiac shunts * polycythaemia * hyperkinetic states * male gender, exercise DECR * pulmonary fibrosis * pneumonia * pulmonary emboli * pulmonary oedema * pHTN * emphysema * anaemia low cardiac output

Answer 15

Shunt: venous blood passes through lung unaltered Mixed venous + arterial bloods lowers arterial PaO2 Refractory to supplemental inspired O2 Has no effect no nonventilated alveoli Hb is already nearly fully saturated

Answer 16

Can improve lung function, QOL, exercise tolerance ○ REDUCES SIZE MISMATCHING BETWEEN HYPERINFLATED LUNGS + CHESTY CAVITY --> OUTWARD CIRCUMFERENTAL PULL ON BRONCHIOLES + elastic pull improved ○ Improvement in function of diaphragm + intercostal muscles --> decreases FRC ○ Improved LV filling + ED dimension ○ Reduction in lung volumes during exercise (dynamic hyperinflation) --> reduced exertional dyspnea, improved VR + CO (improved exercise tolerance 100%) ○ Improved endothelial function + blood pressure ○ Decreased circulating inflamamtory markers

Answer 17

- smoking cessation - the single most important intervention in patients who are still smoking - long term oxygen therapy in patients PaO2 < 60 - Triple therapy Home NIV

Answer 18

Type 1 - Cataplexy + POSITIVE mean sleep latency test OR low CSF hypocretin aka orexin - Natural history stable - Almost 100% are HLA DQB1*06:02 positive Type 2 - NO cataplexy - POSITIVE MSLT - Normal CSF hypocretin Spontaneous improvement - 15%

Answer 19

- Autoimmune destruction of hypothalamic neurons that produce hypocretin (orexin) --> disordered regulation of arousal + sleep/wake transition

Answer 20

* Mean sleep latency < 8 minutes * Episodes of REM in atleast 2 of the naps * REM sleep within 15 minutes of sleep onset Goes straight into REM

Answer 21

Low dopamine Low Fe Opioids improve

Answer 22

First line ○ Dopamine agonists § Pramiprexole □ Ses: sleepiness, impulsive behaviours, augmentation, paradoxical worsening of RLS (spreading to trunk, during day) Second line ○ Alpha delta ligands § Gabapentin/ pregabalin Opioids

Answer 23

§ Improves daytime sleepiness, depression, cognitive function, QOL, sys/diastolic BP, HTN, LVEF § Reduces MCA risk § Increased insulin sensitivity in patients with DM NO EVIDENCE THAT DECR CV MORTALITY

Answer 24

Absence of respiratory effort AND airflow for atleast 10 seconds Cheyne Stokes: Cyclic cresc/ decresc pattern of respiratory flow

Answer 25

Risk factor modification ○ Cease opioids CCF - Optimise heart failure therapy - NO EVIDENCE CPAP REDUCES MORTALITY ○ Consider trialling CPAP, BiPAP, O2

Answer 26

- Progressive hypoxemia/ hypercapnia throughout the night

Answer 27

CPAP improves survival ○ First choice if significant co-existing OSA ○ Reduces hypercapnia, RHF, pulm HTN, inmproves symptoms NIV ○ significant hypoventilation/ respiratory failure (acute or chronic)

Answer 28

Pleural fluid protein to serum protein ratio >0.5 Pleural fluid LDH to serum LDH ratio >0.6 Pleural fluid level >2/3 of upper value for serum LDH

Answer 29

Tachypnea (73%) Chest pain (pleuritic)- (66% - implies infarction)

Answer 30

- Troponin - RV dysfunction - PESI: PE severity index - Haem instability

Answer 31

FVC + FEV1 improve DLCO improves Improved functional capacity; however, a persistent exercise limitation remains regardless of the type of surgery or the underlying lung disease Disease specific changes ○ COPD § forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) increase § Better physical activity § Diaphragmatic strength improves ○ CF § FEV1 increases ○ ILD § VC improves ○ PAH § mPAP/ pulmonary vascular resistance/ cardiac index returns to normal

Answer 32

- Complex hypersensitivity reaction in response to colonisation of airways with Aspergillus fumigatus ○ Results in IgE and IgG mediated immune responses - Almost exclusively occurs in asthma/CF ○ ABPA without asthma or CF is a rare occurrence

Answer 33

Predisposing conditions (one must be present): - Asthma - Cystic fibrosis (CF) Obligatory criteria (both must be present): - Detectable serum IgE levels against Aspergillus fumigatus (>0.35 kU/L) ○ Or Aspergillus skin test positivity - elevated total IgE Other criteria (at least two must be present): - Precipitating serum antibodies to A. fumigatus or elevated Aspergillus fumigatus-specific IgG levels (>27 mg/L) - Radiographic pulmonary opacities consistent with ABPA (see 'Imaging'above) - Total eosinophil count >500 cells/microL in glucocorticoid-naïve patients (may be historical)

Answer 34

Specific: exercise/mannitol/saline Sensitive: methylcholine/histamine