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MRCP 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Bupropion should not be used with?

A

Epilepsy as it reduces seizure threshold

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2
Q

Smoking cessation options

A

NRT, Varenicline and Bupropion. All to be offered with no priority

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3
Q

Varenicline

A

Nicotine receptor partial agonist
Nausea is the most common adverse effect
Caution in H/o depression and self harm
Contraindicated in Pregnancy and breast feeding

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4
Q

Psittacosis

A

Chlamydia psittaci
Fever and bird contact
Response to tetracyclines and macrolides (1st and 2nd line respectively)

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5
Q

Non-Small cell lung cancer surgery contraindications

A

SVC obstruction
FEV <1.5
Malignant pleural effusion
Vocal cord paralysis

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6
Q

Predisposing factors for OSA

A

Obesity
Macroglossia - hypothyroidism, amyloidosis, acromegaly

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7
Q

Upper zone fibrosis

A

Remember CHARTS
- Coal workers’ pneumoconiosis
- Histiocytosis
- AS
- Radiation induced
- TB
- Silicosis

Extrinsic allergic alveolitis
Sarcoidosis

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8
Q

Lower zone fibrosis

A
  • Asbestosis
  • Idiopathic pulmonary fibrosis
  • SLE
  • Drug induced - Amiodarone, Bleomycin, Methotrexate
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9
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A
  1. Bloods
    - Raised IgE
    - Raised eosinophils
  2. B/L pulmonary infiltrates
  3. Treatment
    Oral steroids
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10
Q

Primary Pneumothorax

A

< 2 cms - Discharge
> 2 cms - aspirate, if fails - chest drain

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11
Q

Secondary Pneumothorax

A

< 1 cm - Give oxygen and monitor
1-2 cms - aspirate, if fails - - > chest drain
> 2 cms/> 50 years old - chest drain

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12
Q

Most common cause of occupational asthma

A

Isocyanates

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13
Q

Indications for steroids in Sarcoidosis

A

Parenchymal lung disease
Uveitis
Hypercalcemia
Neurological or cardiac involvement

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14
Q

Prevention of Acute mountain sickness

A

Acetazolamide

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15
Q

Churg Strauss (EGPA) criteria

A

Any 4 among:
Asthma
Eosinophilia
Neuropathy
Sinus abnormalities
Flitting Pulmonary infiltrates
Extravascular eosinophils histologically

pANCA

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16
Q

Bronchiectasis causes

A

Post infective - TB, Measles, pertussis,
Cystic fibrosis
Bronchial obstruction - lung CA, FB
Immune deficiency like IgA
ABPA
Kartagener
Yellow nail syndrome

17
Q

Paraneoplastic features of lung CA

A

SCC - PTHrp, clubbing, HPOA
Small cell - ADH, ACTH, Lambert - Eaton

18
Q

Most common bacteria in IE COPD

A

Haemophilus influenzae

19
Q

Which chronic infection is a contraindication for lung transplant in a Cystic fibrosis patient?

A

Infection with Burkholderia cepacia

20
Q

Alpha 1 AT deficiency

A

AAT is a protease inhibitor
Autosomal recessive/co-dominant
Heterozygous - PiMZ low risk but can pass to children
Homozygous PiZZ - usually disease

Treatment
No smoking
Bronchodilators and physio
Lung volume reduction surgery

21
Q

COPD management

A

First line is SABA

Poor control despite SABA :-
- No asthmatic features or negative steroid responsiveness - LABA + LAMA
- Asthmatic features - LABA + ICS. If poor response, LABA + LAMA + ICS

22
Q

Criteria for steroid responsiveness in COPD

A
  • previous diagnosis of asthma
  • Higher eosinophil count
  • substantial variation in FEV1 over time (atleast 400 ml)
  • substantial diurnal variation in PEFR (atleast 20%)
23
Q

Raised TLCO

A

Asthma
Pulm Hemorrhage
Polycythemia
Left to right shunts

24
Q

Low TLCO

A

Fibrosis
Pneumonia
PE
Pulm edema
Emphysema
Anemia

25
Q

Investigation for suspected adult asthma

A

FeNO +Spirometry with reversibility

26
Q

Pulm HTN is Pulm arterial pressure greater than?

A

25 mm Hg at rest or 30 mm Hg after exercise

27
Q

Most common type of cavitating lung CA

A

SCC

28
Q

Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

A

Mainly type III hypersensitivity damage
Farmers lung: Saccharopolyspora rectivirgula
Malt workers lung: Aspergillus clavatus
Upper zone fibrosis
Oral steroids

29
Q

Oxygen dissociation curve

A

Left - Lower oxygen delivery, Lower acidity, Low temp, Low 2-3 DPG, HbF
Right - Raised oxygen delivery, Raised acidity, Raised temp and raised 2-3 DPG

30
Q

Pulmonary Eosinophilia causes

A

ABPA
Churg Strauss
Loeffler’s syndrome

Extrinsic allergic alveolitis DOES NOT CAUSE Eosinophilia

31
Q

Klebsiella risk factors

A

DM, Alcoholics

32
Q

Cystic fibrosis

A

Normal function of Cystic fibrosis Transmembrane regulator - Chloride channel
Chromosome 7

33
Q

Classic finding in Silicosis

A

Egg shell calcification and cavitation

34
Q

HLA associations

A

HLA DR1: Bronchiectasis
HLA DR2: SLE
HLA DR3: Autoimmune hepatitis, T1DM, SLE
HLA DR4: RA, T1DM
HLA B27: AS, Acute anterior uveitis

MRCP 1 (3 decks)

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