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MRCP p1 > respiratory > Flashcards

respiratory Flashcards

1
Q

what are the symptoms of lofgren’s syndrome?

A

sarcoidosis sx encompassing - fever, joint pain, erythema nodsum, lymphadenopathy and bilateral hilar lymphadenoapthy

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2
Q

what is the treatment for lofgren’s syndrome?

A

good prognosis and does not usually require treatment

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3
Q

when do you consider immunosuppresive therapy in pt.s with sarcoid?

A

splenic/hepatic/renal/cardiac involvement
lupus pernio
hypercalcemia
eye/CNS involvement
deteriorating pulmonary function tests deteriorating chest x-ray changes

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4
Q

what are the features associated with poor prognosis in sarcoid?

A

insidious onset, symptoms > 6 months
absence of erythema nodosum
extrapulmonary manifestations: e.g. lupus pernio, splenomegaly
CXR: stage III-IV features
black people

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5
Q

what are the features of COPD that may be predict steroid responsiveness?

A
  • previous diagnosis of asthma and atopy
  • raised blood eosinophil count
  • substantial variation in FEV1 over time (atleast 400 ml)
  • substantial diurnal variation in PEFR (at least 20%)
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6
Q

what are the pre-requisites for oral prophylactic antibiotic therapy?

A

azithromycin

  1. should not smoke ad have standard treatemnts and continue to have exacerbations
  2. should have had a CT thorax (to exclude bronchiectasis)
  3. LFTs and ECG to exclude QT prolongation
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7
Q

what does it mean with the oxygen dissociation curve shifts to the left?

A

for given oxygen tension , there is increased saturation of Hb with oxygen i.e. decreased oxygen delivery to the tissues.
(more affinity)

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8
Q

what are the some of the causes of the oxygen curve shifting to the left?

A

The L rule

Shifts to L → Lower oxygen delivery, caused by
Low [H+] (alkali)
Low pCO2
Low 2,3-DPG
Low temperature

HbF, methaemoglobin, carboxyhaemoglobin

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9
Q

what are the causes of oxygen curve shifting to the right?

A

‘CADET, face Right!’ for CO2, Acid, 2,3-DPG, Exercise and Temperature

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10
Q

what are some of the obstructive lung diseases?

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

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11
Q

what are some of the restrictive lung conditions?

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

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12
Q

what is the discharge criteria for asthma?

A
  • been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours
  • inhaler technique checked and recorded
  • PEF >75% of best or predicted
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13
Q

what are the features of ARDS?

A
  • acute onset dyspnoea (within 1 week of a known risk factor)
  • pulmonary oedema: bilateral crackles/ bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
  • non-cardiogenic (pulmonary artery wedge pressure needed if doubt) - elevated RR
  • pO2/FiO2 < 40kPa (300 mmHg)
    low oxygen saturations
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14
Q

what are the causes of ARDS?

A
  • infections : sepsis, pneumonia
  • massive blood transfusion
  • trauma
  • smoke inhalation
  • acute pancreatitis
  • COVID
  • cardio-pulmonary bypass
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15
Q

what are the common organisms causing bronchiectasis exacerbations?

A
  • Haemophilus influenzae (most common)
  • Pseudomonas aeruginosa
  • Klebsiella spp.
  • Streptococcus pneumoniae
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16
Q

what is the main-stay of treatment for non-CF bronciectasis?

A

inspiratory muscle training and postural drainage

17
Q

what are the causes of respiratory alkalosis?

A
  • anxiety leading to hyperventilation
  • pulmonary embolism
  • salicylate poisoning*
  • CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
  • altitude
  • pregnancy

*salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

18
Q

what are the findings of allergic bronchopumonary aspergillosus?

A
  • eosinophilia
  • flitting CXR changes
  • positive radioallergosorbent (RAST) test to Aspergillus
  • positive IgG precipitins (not as positive as in aspergilloma)
  • raised IgE
19
Q

what is the treatment for allergic bronchopulmonary aspergillosis?

A
  • oral prednisolone
  • itraconazole
20
Q

what paraneoplastic conditions are small cell cancers associated with?

A

ADH (hyponatraemia), ACTH (cushing’s syndrome), Lambert-Eaton syndrome

21
Q

what paraneoplastic conditions are squamous cell cancers associated with?

A

PTHrP
HPOA - Hypertrophic pulmonary osteoarthropathy (HPOA)

22
Q

when is aspiration attempted in primary pneumothorax?

A

defined as > 2 cm or still short of breath - chest drain inserted

23
Q

when is chest drain inserted in secondary pneumothrax?

A

patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.

24
Q

when is aspiration attempted in secondary pneumothorax?

A

1-2cm - If aspiration fails

25
Q

what is the guidelines for secondary pneumothorax that is less than 1 cm?

A

<1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

26
Q

when is video-assissted throacoscopy surgery (VATS) adviced?

A

persistent air leak
insufficient lung re-expansion despite chest drain insertion
recurrent pneumothoraces

27
Q

what is the rule for flying post pneumothorax?

A

2 weeks after successful drainage if there is no residual air

1 week after x-ray

28
Q

what are the recommended settings for BIPAP in COPD?

A

IPAP = 10 H2O
EPAP = 4-5 H20
back up rate: 15 breaths/min
back up inspiration:expiration ratio: 1:3

29
Q

what are the common organisms causing exacerbations in bronchiectasis?

A

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

30
Q

what are the common bugs causing exacerbations in COPD?

A
  • Haemophilus influenzae
  • streptococcus pneumoniae
  • moraxella catarrhalis
31
Q

which asthma medication is used to unmask churg-strauss syndrome?

A

LTRA - monteukast

32
Q

what are the features of chrug strauss syndrome?

A
  1. Asthma
  2. Eosinophilia
  3. Presence of mononeuropathy or polyneuropathy
  4. Unfixed pulmonary infiltrates
  5. Presence of paranasal sinus abnormalities
33
Q

what are the stages of sarcoidosis on CXR?

A

Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates - diffuse
4 = fibrosis- diffuse

34
Q

what are the differentials to think of in pulmonary eosinophilia?

A

Churg-Strauss syndrome
allergic bronchopulmonary aspergillosis (ABPA)
Loffler’s syndrome
eosinophilic pneumonia
hypereosinophilic syndrome
tropical pulmonary eosinophilia
drugs: nitrofurantoin, sulphonamides
less common: Wegener’s granulomatosis

35
Q

what are the symptoms of Loffler syndrome?

A
  • transient CXR shadowing and blood eosinophilia
  • presents with a fever, cough and night sweats which often last for less than 2 weeks.

caused by Ascariasis lumbricoides

36
Q

what does TLCO stand for?

A

total gas transfer (TLCO)

the rate at which gas wlll diffuse from alveoli into blood
Carbon monoxide is used to test the rate of diffusion.

37
Q

what are some of the causes of raised TLCO?

A
  • asthma
  • pulmonary haemorrhage
  • left to right cardiac shunts
  • polycythaemia
  • hyperkinetic state
  • male gender, exercise
38
Q

what is an absolute contraindication for lung transplantation in patients with CF?

A

chronic infection with Burkholderia cepacia is an important CF-specific contraindication to lung transplantation

MRCP p1 (13 decks)

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