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RACP Written Exam > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is Elastic recoil

A

tendency for lungs to collapse inwards and chest wall to spring outwards

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2
Q

what is compliance and when is it changed

A

change in lung volume and pressure is inversely proportional to wall stiffness
increased by surfacant
increased means easier to fill (elderly, emphysema)
decreased more difficult (fibrosis, pneumonia, ARDS, oedema)

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3
Q

Pulmonary wedge pressure is the equivalent of?

A

pressure of LA

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4
Q

A-a gradient

A

normal = age/4 + 4
normal in high altitude or hypoventilation
raised in diffusion limitations (fibrosis), V/Q mismatch (COPD, oedema, PE) or R -> L shunt

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5
Q

Causes of right shift of O2 dissociation curve

A

CADET looks right
CO2 increased
acidosis
DPG increased
Exercise
Temp increased

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6
Q

What is eisenmengers syndrome

A

Left to right shunt becomes right to left due to pulm HTN
Cyanosis, clubbing, hypoxia

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7
Q

Cyanide symptoms

A

headaches, SOB, drowsiness, seizure, cherry red skin, red venules in retina , bitter almond breath

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8
Q

Cyanide poisening lab findings

A

normal pa02, elevated lactate (HAGMA)

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9
Q

Cyanide treatment

A

decontamination
hydroxocobalamin
sodium thiosulfate

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10
Q

Carbon monoxide poisening labs

A

normal Pa02, raised carboxyHb

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11
Q

CO poisening treatment

A

100% O2
hyperbaric if severe

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12
Q

Methhaemoglobinaemia treatment

A

Methylene blue and Vit C

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13
Q

Most common type of head and neck cancer

A

squamous cell carcinoma

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14
Q

Fat emboli etiology and sx

A

long bone fractures and liposuction
hypoxia, neuro (reduced GCS, confusion, seizures) and petechial rash

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15
Q

Head and neck cancer tx

A

pembro and chemo better
PDL >20% can do pembro only
PDL 1-20% - pembro and chemo (5FU and cisplatin)
PDL 0% - chemo only

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16
Q

Asthma is example of which hypersensitivity

A

Type 1

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17
Q

Usual age of diagnosis of idiopathic pulm fibrosis

A

60s

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18
Q

HRCT pattern of idiopathic pulm fibrosis

A

UIP (subpleural reticular opacities, honeycombing, traction bronchiectasis)
Peripheral and lower lobe predominance

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19
Q

Treatment for idiopathic pulm fibrosis

A

supportive with oxygen
antifibrotics (pirfenidone or nintedanib) -> reduced PFT decline

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20
Q

Type of hypersensitivity in hypersensitivity pneumonitis

A

T3 and 4 mixed
(thermophilic actinomyces and asperigillous)

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21
Q

Difference between acute vs chronic hypersensitivity pneumonitis

A

acute -> agent triggers IgG Ab -> inflammation and neutrophils
chronic -> CD4 Th1 delayed hypersensitivity TLR 2 and 9 pathways
Th1 and Th17 promote lung inflammation

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22
Q

Hypersensitivity pneumonitis HRCT findings

A

mid-upper zone prodominance of centrilobar ground glass and mosaic attenuation

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23
Q

Sarcoidosis classic grnaulomas made of

A

non-necrotising with tightly packed central area with macrophages, epitheloid cells and multinucleated giant cells with CD4 T cells surrounds by CD4 and 8 T and B cells

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24
Q

What is lofgren syndrome

A

sarcoidosis
bilateral hilar adenopathy plus erythema nodosum plus periarticular arthritis

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25
2 common/specific skin conditions to sarcoidosis
erythema nodosum lupus pernio
26
Lab findings in sarcoidosis
raised ACE levels hypercalcaemia BAL raised CD4/8 ratio
27
Mesothelioma cell markers
calretinin cytokeratin 5/6 in almost all (carcinomas are -ve)
28
Treatment for mesothelioma
chemo (cisplatin and pemetrexed) 2nd line vinorelbine RTx for chest wall pain
29
Distribution of lung involvement asbestosis and berylliosis/silicosis/coal workers
asbestos in the roof so affects the base of lung Beryllium/silica/coal in the ground so affects the upper lobes
30
What is caplan syndrome
RA plus pneumoconioses with intrapleural nodes
31
Most likely cancer with asbestos related lung disease
bronchogenic carcinoma (mesothelioma less likely)
32
Berylliosis histology findings
non-caesating granulomas
33
Berylliosis lab findings
raised blood beryllium lymphocyte proliferation test (BeLPT)
34
Berylliosis treatment
cessation of exposure if cough, for reduced FVC/TLC/DLCO <70% then glucocoticoids
35
Silicosis why increased TB risk
disrupt phagolysosomes and impair macrophages
36
ARDS treatment
mechanical ventilation - reduced TV and increase PEEP
37
Obstructive sleep apneoa diagnosed as
>5 apnea/hypopnea events per hour if symptomatic if asymptomatic >15 events per hour (resp distrubance index >15 per hour)
38
What testing appropriate in sleep apnea
if mild OSA or complicated/other sleep disorders -> formal PSG if mod/severe OSA -> home testing
39
Ventilation changes in obesity
decreased FRC, lung compliance and TLC
40
Diagnosis of pulmonary arterial HTN
mPAP >20, PVR > 2 wood units PCWP <15 to exclude LHD
41
Gene which is cause of heritable pulmonary artial HTN
BMPR2 gene (normally inhibits vascular smooth muscle proliferation) - inactiviating mutation
42
Treatment for vasoreactive PAH
CCB
43
treatment for non-vasoreactive PAH
class 1 sx -> monotherapy PDE5, ERA or riociguat class 2/3 sx -> dual ERA and NO-cGMP therapy clas 4 -> protanoid combo (epoproterol preferred)
44
Left heart disease pulm HTN diagnosis
mPAP >20 and PCWP >15
45
imaging for CTEPH
V/Q best screening, CTPA can help DSPA is gold standard for confirming and assessing for surgery eligibility
46
CTEPH treatment
lifelong anticoagulation if haemodynamically sig (PVR at rest 2-15 units) -> consider thromboendarterectomy If surgery not an option, riociguat is first line
47
Cause of clubbing
Plt and megakaryocytes lodge in digital vasculature -> local release of VEGF associated with pulm fibrosis, cystic fibrosis, bronchiectasis, congenital heart disease, IBD
48
Lights criteria for effusions
pleural LDH/serum LDH >0.6 pleural protein/serum protein >0.5 pleural LDH > 2/3 ULN
49
uncomplicated parapneumonic effusion vs complicated
uncomplicated - low glucose, low pH, raised PMNs complicated - lower glucose, very high LDH, lower pH <7.15, raised PMNs
50
TB effusion findings
raised ADA
51
pancreatitis associated pleural effusion findings
raised amylase
52
chylothorax findings
TGLs > 1.24
53
PTX treatment
if <2cm and stable - observe if >2 cm and stable -> aspirate first if recurrent -> chest drain if secondary -> VAT, 2nd line non-surg pleurodesis or prolonged chest drain
54
common bugs for lobar pneumonia
s pneumoniae legionella klebsiella
55
common bugs for bronchopneumonia
s pneumoniae s aures H influenzae klebsiella
56
Where does lung cancer tend to metastasis
liver, adrenals, bone, brain
57
What cancers give mets to lung
breast, colon, prostate and bladder
58
Small cell treatment for stage 1 and 2/3
surgery -> adjuvant cisplatin if LN involvement in 2/3 -> chemo only
59
extensive stage SCLC
carboplatin and etoposide plus maintence durvalumab
60
conditions associated with SCLC
neurological paraneoplastic Endocine (cushings due to secretes ACTH and SIADH)
61
SCLC mutations
myc oncogenes
62
Which is most common NSCLC
Adenocarcinoma
63
driver mutations of adenocarcinoma
EGFR 10-35% ALK 3-7% ROS1 1% KRAS
64
Chemotherapy for NSCLC without mutations
cisplatin plus pemetrexed add pembrolizumab if PDL1>1%, if >50% pembro only
65
Treatment if EGFR mutation
Erlotinib
66
What do to if NSCLC EGFR positive progresses on erlotinib
check for T790 mutation -> if present give osimertinib
67
treatment if ALK mutation in NSCLC
crizotinib or alectinib
68
Treatment if NSCLC ROS1 positive
crizotinib
69
Common metabolic issue with squamous cell lung ca
high Ca (secretes PTHrP)
70
associated condition with large cell carcinoma lung cancer
gynaecomastia (secretes HCG)
71
carcinoid syndrome associated with what vit deficiency
B3 -> cause pellagra (inflammed skin, diarrhoea, dementia, mouth sores)
72
Bronchial carcinoid tumour prognosis and associated sx
good prognosis carcinoid syndrome
73
MoA of bosentan
endothelin-1 receptor antagonist which decreases pulm vascular resistance ADR: hepatotoxic
74
MoA of sildenafil
Phosphodiesterase 5 inhibitors -> raises cGMP which prolongs vasodilatory effect of NO
75
MoA of iloprost, epoprostenol
Prostacyclin analogs, direct vasodilatory effects on pulm vasc and systemic arterial vascular beds ADRs: flushing, jaw pain
76
MoA salbuatmol and formeterol
one is short, one is long acting beta-2 agonists
77
MoA of tiotropium, ipratropium
muscarinic antagonists, prevents bronchoconstriction
78
MoA omalizumab
binds unbound IgE so cant bind to Fc portion of mast cells
79
throphylline MoA
likely a PDE inhibitor -> bronchodilation
80
MoA mepolizumab
anti IL5 -> prevents eosinophils differenciation, activation and survival
81
Severity of obstruction grading in PFTs
mild >70 mod 60-70% mod severe 50-60 severe 35-50 very severe <35
82
Main 2 antifibrotics and MoA
Pirfenidone - TGFB and reduces fibroblast proliferation Nintedanib - inhibits multiple tyrosine kinases Both slow disease progression and improves survival, no sx benefit
83
Pirfenidone ADR
nausea photosensitvity rash
84
Nintedanib ADR
diarrhoea weight loss possible CVD risk can increase bleeding risk, avoid on anticoagulation
85
Most comon mutation pathway involved in idiopathic pulm fibrosis
mutations involving premature shortening of telomeres
86
Pattern of lung disease in RA
UIP
87
Pattern of lung disease in Systemic sclerosis
NSIP
88
pattern of lung disease in inflammatory myopathies
oragnising pneumonia
89
pattern of lung disease in sjogrens
lymphoid interstitual pneumonia
90
Names of smoking related ILDs
respiratory bronchiolitis - ILD desquamative interstitual pneumonia fulminant langerhans cell histiocytosis
91
mutation seen in 50% IPF
MUC5b gain of function
92
Mutation causing amyotrophic dermatomyositis with ILD
anti-MDA5
93
imaging findings in lymphangioleiomyomatosis
pulmonary cysts and renal angiomyolipomas
94
antibody associated with primary alveolar proteinosis
GM-CSF
95
What is sampter's triad
asthma aspirin intolerance nasal polyps
96
findings of ABPA
very high total IgE >1000
97
Omalizumab target
IgE
98
Mepolizumab target
IL 5 (main cytokines responsible for differenciation of eosinophils)
99
Benefits and risks of triple therapy in COPD vs double
triple have reduced exacerbations and hospitilisation, but increased pneumonia risk
100
Most common cause of bactyerial exacerbations of COPD
haemophilis, streptococcus, moraxella
101
3 most common causes of pleural effusion
malignancy HF infection
102
pH indicated by parapneumonic effusion
< 7.2
103
Benefit of inhaled hypertonic saline in bronciectasis?
Reduce exacerbations some QOL improvement
104
Pathophysiology of cystic fibrosis
CFTR usually allows Cl to leave the cell, if not able to leave, increase in Na uptake from lungs via ENaC, which brings water with it, drying out secretions
105
Cystic fibrosis mutations
DF508 G551D
106
Ivacaftor MoA
CFTR potentiator (opens channel of protein) used in homozygous DF508 mutations
107
Cystic fibrosis criteria for lung transplant referral
FEV1 < 35% increase freq of IV abx pO2 < 60 pCO2 >50 clinical organism resistance imapired QOL
108
Pathways for treatment of PAH
endothelin NO Prostacyclin
109
If evidence of precappillary PAH on RHC, which test would you do and why
Vasodilator challenge - eligible for CCB
110
RHC measurements for PAH
mPAP >20 if precapillary PAWP <15 if PAWP >15 suggests left heart failure (no vasodilator therapies)
111
Why are you unable to use vasodilators for group 2 (LV failure) PAH
worsening pressure gradient over alveolar bed -> pulm oedema
112
Cardiac sequale post pneumonia
new onset HF caused by bacterial translocation into myocardium
113
Normal characteristics of REM sleep
atonia on EMG and tonic/phasic eye movements second half of night
114
definition of apneoa
cessation of airflow for > 10 secs
115
Definition of hypopneoa
reduction in airflow by 30% or >10 secs followed by 4% O2 desat or EEG arousal
116
apneoa-hypopneoa index severity
normal < 5 mild 5-15 mod 15-30 severe >30
117
Benefits of CPAP
improves daytime sleepiness, depression, cognitive function, QOL, BP, MVA risk does not change CVD mortality
118
Leptins role in ventilation and OSA
leptin is a respiratory stimulant, if leptin resistance (ie in obesity) then can lead to hypoventilation
119
Difference between Narcolepsy T1 and T2
T1: with cataplexy, low Orexin on CSF T2: without cataplexy, normal orexin Both have >3mo excessive daytime sleepiness and positive multiple sleep latency tests (<8 mins to sleep)
120
Pathophysiology of narcolepsy
Autoimmune destruction of hypothalamic neurons which produce orexin (usually regulate arousal and transition between wake and sleep)
121
What is cataplexy?
sudden and transient episode of muscle weakness, asscoiated with concious awareness usually triggered by emotions ie laughing

RACP Written Exam (14 decks)

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