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MRCP Part 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

WHat is alpha 1 antitrypsin deficiency?

A

Common inherited condition caused by a lack of protease inhibitor (Pi) normally produced in the liver

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2
Q

Where is alpha 1 antitripsyin located?

A

Chromosome 14

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3
Q

Inheritance of alpha 1 antitrypsin deficiency

A

Autosomal recessive / co dominant fashion

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4
Q

WHat does heterozygous PiMZ mean?

A

If non smoker low risk of developing emphysema but may pass on A1AT gene to children

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5
Q

What does homozygous PiSS mean?

A

50% normal A1AT levels

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6
Q

What does homozygous PiZZ mean?

A

10% normal A1AT levels

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7
Q

Patients who manifest A1AT disease usually have what phenotype?

A

PIZZ

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8
Q

How does A1AT deficiency manifest?

A

Paraacinar emphysema, marked in lower lobes
Liver cirrhosis and HCC in adults
Cholestasis in children

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9
Q

Investigations for ALAT defiency

A

A1AT concentrations
Spirometry

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10
Q

What does spirometry show in ALAT deficiency?

A

Obstructive picture

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11
Q

Treatment of ALAT1 deficiency

A

No smoking
Supportive; bronchodilators and physio
IV aplha1-antitrypsin protein concentrations
Lung volume reduction surgery
Lung transplantation

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12
Q

Management of high altitude cerebral oedema (HACE)

A

Descent
Dexamethasone

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13
Q

Presentation of acute mountain sickness

A

Headache
Fatigue
Nausea

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14
Q

Prevention and treatment of acute mountain sickness

A

Gain altitude more than 500 meters
Acetozolamide

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15
Q

Presentation of HAPE

A

Classic pulmonary oedema features

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16
Q

Presentation of HACE

A

Headache
Ataxia
Papilloedema

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17
Q

Management of HAPE

A

Descent
Nifedipine
Dexamethasone
Acetozolamide
Oxygen if available

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18
Q

Investigations of suspected COPD

A

Post bronchodilator spirometry to demonstrate airflow obstruction (FEV1/FVC ratio < 70%)
CXR
FBC; exclude secondary polycythaemia
BMI calculation

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19
Q

CXR findings to support COPD

A

Hyperinflation
Bullae
Flat hemidiaphragm

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20
Q

Stage 1 COPD FEV1

A

FEV > 80%

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21
Q

Stage 2 (mod) COPD FEV1

A

FEV 50-79%

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22
Q

Stage 3 (severe) COPD FEV1

A

FEV 30-49%

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23
Q

Stage 4 (very severe) COPD FEV1

A

FEV < 30%

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24
Q

What is idiopathic pulmonary fibrosis?

A

Chronic lung condition characterised by progressive fibrosis of the interstitium of the lungs

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25
Q

Presentation of IPF

A

Progressive exertional dyspnoea
Bibasal fine end inspiratory creps on auscultation
Dry cough
Clubbing

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26
Q

Diagnosis of IPF

A

Spirometry
Impaired gas exchange; reduced transfer factor (TLCO)
CXR
High resolution CT
Serology

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27
Q

What spirometry is seen in IPF?

A

Restrictive picture (FEV1 normal/decreased, FVC decreased, FEV1/FVC increased)

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28
Q

CXR findings in IPF

A

Bilateral interstitial shadowing (ground class later progressing to honeycombing)

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29
Q

Serology in IPF

A

ANA + in 30%
RF + in 10%

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30
Q

Treatment of IPF

A

Pulmonary rehab
Oxygen
Lung transplant

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31
Q

Life expectancy IPF

A

3-4 years

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32
Q

Post bronchodilator FEV1/FVC found in any severity COPD

A

< 0.7

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33
Q

What is bronchiectasis?

A

Permenant dilatation of airways secondary to chronic infection or inflammation

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34
Q

Causes of bronchiectasis

A

Post infective; TB, measles, pertussis, pneumonia
CF
Bronchial obstruction; foriegn body, cancer
Immune deficiency; Selective IgA, hyppogammaglobuninaemia
Allergic bronchopulmonary aspergillosis
Ciliary dyskinetic syndrome (kartageners syndrome, youngs syndrome)
Yellow nail syndrome

35
Q

CXR findings in bronchiectasis

A

Tramlines

36
Q

CT findings in bronchiectasis

A

Tram tracks
Signet ring signs

37
Q

What does a normal CO2 in a patient with severe acute asthma attack indicate?

A

Life threatning asthma

38
Q

Classification of moderate asthma

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
HR < 100bpm

39
Q

Classification of severe asthma

A

PEFR 33-50%
Cant complete sentences
RR > 25
HR > 100bpm

40
Q

Classification of life threatning asthma

A

PEFR < 33 % best or predicted
O2 sats < 92%
Normal PCO2
Silent chest
Cyanosis
Feeble respiratory effort
Bradycardia
Dysrhytmia
Hypotension
Exhaustion
Confusion
Coma

41
Q

Treatment of acute asthma exacerbation

A

O2 therapy if needed
SABA
Prednisolone PO
Ipratropium bromide neb
IV magnesium sulphate

42
Q

Criteria for admission in acute asthma exacerbation

A

Life threatning asthma
Previous near fatal asthma attack
Pregnancy
Presentation at night
Attack occurring despite using corticosteriod

43
Q

Do pleural plaques undergo malignant change?

A

No

44
Q

Do pleural plaques require follow up?

A

No

45
Q

What is the most common form of asbestos related lung disease?

A

Pleural plaques

46
Q

What is the severity of asbestosis related to?

A

Length of exposure

47
Q

What does asbestosis tend to cause?

A

Lower lobe fibrosis

48
Q

Presentation of asbestosis

A

SOB
Reduced exercise tolerance
Clubbing
Bilateral end inspiratory crackles

49
Q

What do lung function tests show in asbestosis?

A

Restrictive pattern with reduced gas transfer

50
Q

Management of asbestosis

A

Conservative

51
Q

What is a mesothelioma?

A

Malignant disease of the pleura

52
Q

What is the most dangerous form of asbestos?

A

Crocidolite (blue)

53
Q

Presentation of mesothelioma

A

Progressive SOB
Chest pain
Pleural effusion

54
Q

Prognosis of mesothelioma

A

Very poor, 8-14 months

55
Q

What is the most common form of cancer associated with asbestos exposure?

A

Lung cancer

56
Q

What is extrinsic allergic alveolitis assosiated with?

A

Upper/mid zone lung fibrosis

57
Q

What is extrinsic allergic alveolitis?

A

A condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles.

58
Q

Examples of extrinsic allergic alveolitis

A

Bird fanciers lung; avian proteins from bird droppings
Farmers lungs
Malt workers
Mushroom workers

59
Q

Presentation of extrinsic allergic alveolitis

A

SOB
Dry cough
Fever
Lethargy
Productive cough (long term)
Anorexia

60
Q

Investigations of extrinsic allergic alveolitis

A

Imaging; upper/mid zone fibrosis
Bronchoalveolar lavage; lymphocytosis
Serologic assays for specific IgG antibodies
NO eosinophilia

61
Q

Management of extrinsic allergic alveolitis

A

Avoid precipitating factors
Oral glucocorticoids

62
Q

Smoking cessation drugs

A

NRT (nicoteine replacement therapy)
Varenciline
Bupropion

63
Q

S/Es of NRT

A

N/V
Headache
Flu like symptoms

64
Q

S/Es varenciline

A

Nausea
Headache
Imsomnia
Abnormal dreams
Used in caution with patients with hx of depression or self harm

65
Q

Contraindications of varenciline

A

Pregnancy
Breast feeding

66
Q

What is there a small risk of when using bupropion?

A

Seizures

67
Q

Contraindications of bupropion

A

Epilepsy
Pregnancy
Breast feeding
Eating disorder is a relative contraindication

68
Q

Treatment of smoking cessation in pregnant women

A

CBT
Motivational interviewing
Structured self help
Can use NRT - mixed evidence and have to remove patches before going to bed

69
Q

Is performing serial peak flows in someone with acute life threatning asthma helpful?

A

No

70
Q

What is near fatal asthma characterised by?

A

Raised PCO2
Requiring mechanical ventilation with raised inflation pressures

71
Q

What does a pH of < 7.35 represent in acute asthma?

A

Carbon dioxide retention in a tiring patient

72
Q

Admission criteria for acute asthma

A

Life threatning asthma
Failing to respond to initial treatment
Previous near fatal asthma
Pregnancy
An attack occuring despite already using oral corticosteriods
Presentation at night

73
Q

Management of acute asthma attack

A

O2 if hypoxic
High dose inhaled SABA (Life threatning - nebulised is recommended)
Corticosteriod (40mg PO pred)

74
Q

What should be given if initital management for asthma does not work?

A

Nebulised ipratropium bromide
IV mag sulphate
IV aminophyline (senior staff)

75
Q

Criteria for discharge post admission for asthma

A

Stable on their discharge medication (i.e. no oxygen or nebs) for 12-24 hrs
Inhaler technique checked or recorded
PEF >75% best or predicted

76
Q

OP treatment for newly diagnosed asthma

A

SABA

77
Q

OP treatment for asthma which isnt controlled by SABA alone or newly diagnosed asthma with symptoms >3 times / week or night time waking

A

SABA + low dose ICS

78
Q

OP treatment for asthma after SABA + ICS

A

Add leukotrine receptor antagonist (LTRA)

79
Q

OP treatment for asthma after SABA+ICS+LTRA

A

SABA + low dose ICS + LABA
Continue LTRA depending on patients response

80
Q

OP Tx for asthma after SABA + ICS + LABA

A

SABA +/- LTRA
Switch ICS/LABA for a maintenance and reliever therapy (MART) which includes a low dose ICS

81
Q

OP Tx asthma after SABA + low dose MART

A

SABA +/- LRTA + medium dose ICS MART
OR change back to a fixed dose of moderate dose ICS and a seperate LABA

82
Q

OP Tx of asthma after SABA +/- LRTA and ICS moderate dose

A

One of the following options
- Increase ICS to high dose
- A trial of an additional drug (e.g. long acting anti-muscarinic receptor antagonist or theophylline)
- expert therapy

83
Q
A

MRCP Part 1 (7 decks)

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