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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
Presentation of IPF
Progressive exertional dyspnoea Bibasal fine end inspiratory creps on auscultation Dry cough Clubbing
26
Diagnosis of IPF
Spirometry Impaired gas exchange; reduced transfer factor (TLCO) CXR High resolution CT Serology
27
What spirometry is seen in IPF?
Restrictive picture (FEV1 normal/decreased, FVC decreased, FEV1/FVC increased)
28
CXR findings in IPF
Bilateral interstitial shadowing (ground class later progressing to honeycombing)
29
Serology in IPF
ANA + in 30% RF + in 10%
30
Treatment of IPF
Pulmonary rehab Oxygen Lung transplant
31
Life expectancy IPF
3-4 years
32
Post bronchodilator FEV1/FVC found in any severity COPD
< 0.7
33
What is bronchiectasis?
Permenant dilatation of airways secondary to chronic infection or inflammation
34
Causes of bronchiectasis
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
CXR findings in bronchiectasis
Tramlines
36
CT findings in bronchiectasis
Tram tracks Signet ring signs
37
What does a normal CO2 in a patient with severe acute asthma attack indicate?
Life threatning asthma
38
Classification of moderate asthma
PEFR 50-75% best or predicted Speech normal RR < 25 / min HR < 100bpm
39
Classification of severe asthma
PEFR 33-50% Cant complete sentences RR > 25 HR > 100bpm
40
Classification of life threatning asthma
PEFR < 33 % best or predicted O2 sats < 92% Normal PCO2 Silent chest Cyanosis Feeble respiratory effort Bradycardia Dysrhytmia Hypotension Exhaustion Confusion Coma
41
Treatment of acute asthma exacerbation
O2 therapy if needed SABA Prednisolone PO Ipratropium bromide neb IV magnesium sulphate
42
Criteria for admission in acute asthma exacerbation
Life threatning asthma Previous near fatal asthma attack Pregnancy Presentation at night Attack occurring despite using corticosteriod
43
Do pleural plaques undergo malignant change?
No
44
Do pleural plaques require follow up?
No
45
What is the most common form of asbestos related lung disease?
Pleural plaques
46
What is the severity of asbestosis related to?
Length of exposure
47
What does asbestosis tend to cause?
Lower lobe fibrosis
48
Presentation of asbestosis
SOB Reduced exercise tolerance Clubbing Bilateral end inspiratory crackles
49
What do lung function tests show in asbestosis?
Restrictive pattern with reduced gas transfer
50
Management of asbestosis
Conservative
51
What is a mesothelioma?
Malignant disease of the pleura
52
What is the most dangerous form of asbestos?
Crocidolite (blue)
53
Presentation of mesothelioma
Progressive SOB Chest pain Pleural effusion
54
Prognosis of mesothelioma
Very poor, 8-14 months
55
What is the most common form of cancer associated with asbestos exposure?
Lung cancer
56
What is extrinsic allergic alveolitis assosiated with?
Upper/mid zone lung fibrosis
57
What is extrinsic allergic alveolitis?
A condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles.
58
Examples of extrinsic allergic alveolitis
Bird fanciers lung; avian proteins from bird droppings Farmers lungs Malt workers Mushroom workers
59
Presentation of extrinsic allergic alveolitis
SOB Dry cough Fever Lethargy Productive cough (long term) Anorexia
60
Investigations of extrinsic allergic alveolitis
Imaging; upper/mid zone fibrosis Bronchoalveolar lavage; lymphocytosis Serologic assays for specific IgG antibodies NO eosinophilia
61
Management of extrinsic allergic alveolitis
Avoid precipitating factors Oral glucocorticoids
62
Smoking cessation drugs
NRT (nicoteine replacement therapy) Varenciline Bupropion
63
S/Es of NRT
N/V Headache Flu like symptoms
64
S/Es varenciline
Nausea Headache Imsomnia Abnormal dreams Used in caution with patients with hx of depression or self harm
65
Contraindications of varenciline
Pregnancy Breast feeding
66
What is there a small risk of when using bupropion?
Seizures
67
Contraindications of bupropion
Epilepsy Pregnancy Breast feeding Eating disorder is a relative contraindication
68
Treatment of smoking cessation in pregnant women
CBT Motivational interviewing Structured self help Can use NRT - mixed evidence and have to remove patches before going to bed
69
Is performing serial peak flows in someone with acute life threatning asthma helpful?
No
70
What is near fatal asthma characterised by?
Raised PCO2 Requiring mechanical ventilation with raised inflation pressures
71
What does a pH of < 7.35 represent in acute asthma?
Carbon dioxide retention in a tiring patient
72
Admission criteria for acute asthma
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
Management of acute asthma attack
O2 if hypoxic High dose inhaled SABA (Life threatning - nebulised is recommended) Corticosteriod (40mg PO pred)
74
What should be given if initital management for asthma does not work?
Nebulised ipratropium bromide IV mag sulphate IV aminophyline (senior staff)
75
Criteria for discharge post admission for asthma
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
OP treatment for newly diagnosed asthma
SABA
77
OP treatment for asthma which isnt controlled by SABA alone or newly diagnosed asthma with symptoms >3 times / week or night time waking
SABA + low dose ICS
78
OP treatment for asthma after SABA + ICS
Add leukotrine receptor antagonist (LTRA)
79
OP treatment for asthma after SABA+ICS+LTRA
SABA + low dose ICS + LABA Continue LTRA depending on patients response
80
OP Tx for asthma after SABA + ICS + LABA
SABA +/- LTRA Switch ICS/LABA for a maintenance and reliever therapy (MART) which includes a low dose ICS
81
OP Tx asthma after SABA + low dose MART
SABA +/- LRTA + medium dose ICS MART OR change back to a fixed dose of moderate dose ICS and a seperate LABA
82
OP Tx of asthma after SABA +/- LRTA and ICS moderate dose
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

MRCP Part 1 (7 decks)

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