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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
Q

2 common/specific skin conditions to sarcoidosis

A

erythema nodosum
lupus pernio

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26
Q

Lab findings in sarcoidosis

A

raised ACE levels
hypercalcaemia
BAL raised CD4/8 ratio

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27
Q

Mesothelioma cell markers

A

calretinin
cytokeratin 5/6 in almost all
(carcinomas are -ve)

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28
Q

Treatment for mesothelioma

A

chemo (cisplatin and pemetrexed)
2nd line vinorelbine
RTx for chest wall pain

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29
Q

Distribution of lung involvement asbestosis and berylliosis/silicosis/coal workers

A

asbestos in the roof so affects the base of lung
Beryllium/silica/coal in the ground so affects the upper lobes

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30
Q

What is caplan syndrome

A

RA plus pneumoconioses with intrapleural nodes

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31
Q

Most likely cancer with asbestos related lung disease

A

bronchogenic carcinoma
(mesothelioma less likely)

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32
Q

Berylliosis histology findings

A

non-caesating granulomas

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33
Q

Berylliosis lab findings

A

raised blood beryllium lymphocyte proliferation test (BeLPT)

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34
Q

Berylliosis treatment

A

cessation of exposure
if cough, for reduced FVC/TLC/DLCO <70% then glucocoticoids

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35
Q

Silicosis why increased TB risk

A

disrupt phagolysosomes and impair macrophages

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36
Q

ARDS treatment

A

mechanical ventilation - reduced TV and increase PEEP

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37
Q

Obstructive sleep apneoa diagnosed as

A

> 5 apnea/hypopnea events per hour if symptomatic
if asymptomatic >15 events per hour (resp distrubance index >15 per hour)

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38
Q

What testing appropriate in sleep apnea

A

if mild OSA or complicated/other sleep disorders -> formal PSG
if mod/severe OSA -> home testing

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39
Q

Ventilation changes in obesity

A

decreased FRC, lung compliance and TLC

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40
Q

Diagnosis of pulmonary arterial HTN

A

mPAP >20, PVR > 2 wood units
PCWP <15 to exclude LHD

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41
Q

Gene which is cause of heritable pulmonary artial HTN

A

BMPR2 gene (normally inhibits vascular smooth muscle proliferation)
- inactiviating mutation

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42
Q

Treatment for vasoreactive PAH

A

CCB

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43
Q

treatment for non-vasoreactive PAH

A

class 1 sx -> monotherapy PDE5, ERA or riociguat
class 2/3 sx -> dual ERA and NO-cGMP therapy
clas 4 -> protanoid combo (epoproterol preferred)

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44
Q

Left heart disease pulm HTN diagnosis

A

mPAP >20 and PCWP >15

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45
Q

imaging for CTEPH

A

V/Q best screening, CTPA can help
DSPA is gold standard for confirming and assessing for surgery eligibility

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46
Q

CTEPH treatment

A

lifelong anticoagulation
if haemodynamically sig (PVR at rest 2-15 units) -> consider thromboendarterectomy
If surgery not an option, riociguat is first line

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47
Q

Cause of clubbing

A

Plt and megakaryocytes lodge in digital vasculature -> local release of VEGF
associated with pulm fibrosis, cystic fibrosis, bronchiectasis, congenital heart disease, IBD

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48
Q

Lights criteria for effusions

A

pleural LDH/serum LDH >0.6
pleural protein/serum protein >0.5
pleural LDH > 2/3 ULN

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49
Q

uncomplicated parapneumonic effusion vs complicated

A

uncomplicated - low glucose, low pH, raised PMNs
complicated - lower glucose, very high LDH, lower pH <7.15, raised PMNs

50
Q

TB effusion findings

A

raised ADA

51
Q

pancreatitis associated pleural effusion findings

A

raised amylase

52
Q

chylothorax findings

A

TGLs > 1.24

53
Q

PTX treatment

A

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
Q

common bugs for lobar pneumonia

A

s pneumoniae
legionella
klebsiella

55
Q

common bugs for bronchopneumonia

A

s pneumoniae
s aures
H influenzae
klebsiella

56
Q

Where does lung cancer tend to metastasis

A

liver, adrenals, bone, brain

57
Q

What cancers give mets to lung

A

breast, colon, prostate and bladder

58
Q

Small cell treatment for stage 1 and 2/3

A

surgery -> adjuvant cisplatin
if LN involvement in 2/3 -> chemo only

59
Q

extensive stage SCLC

A

carboplatin and etoposide plus maintence durvalumab

60
Q

conditions associated with SCLC

A

neurological paraneoplastic
Endocine (cushings due to secretes ACTH and SIADH)

61
Q

SCLC mutations

A

myc oncogenes

62
Q

Which is most common NSCLC

A

Adenocarcinoma

63
Q

driver mutations of adenocarcinoma

A

EGFR 10-35%
ALK 3-7%
ROS1 1%
KRAS

64
Q

Chemotherapy for NSCLC without mutations

A

cisplatin plus pemetrexed
add pembrolizumab if PDL1>1%, if >50% pembro only

65
Q

Treatment if EGFR mutation

A

Erlotinib

66
Q

What do to if NSCLC EGFR positive progresses on erlotinib

A

check for T790 mutation -> if present give osimertinib

67
Q

treatment if ALK mutation in NSCLC

A

crizotinib or alectinib

68
Q

Treatment if NSCLC ROS1 positive

A

crizotinib

69
Q

Common metabolic issue with squamous cell lung ca

A

high Ca (secretes PTHrP)

70
Q

associated condition with large cell carcinoma lung cancer

A

gynaecomastia (secretes HCG)

71
Q

carcinoid syndrome associated with what vit deficiency

A

B3 -> cause pellagra (inflammed skin, diarrhoea, dementia, mouth sores)

72
Q

Bronchial carcinoid tumour prognosis and associated sx

A

good prognosis
carcinoid syndrome

73
Q

MoA of bosentan

A

endothelin-1 receptor antagonist which decreases pulm vascular resistance
ADR: hepatotoxic

74
Q

MoA of sildenafil

A

Phosphodiesterase 5 inhibitors -> raises cGMP which prolongs vasodilatory effect of NO

75
Q

MoA of iloprost, epoprostenol

A

Prostacyclin analogs, direct vasodilatory effects on pulm vasc and systemic arterial vascular beds
ADRs: flushing, jaw pain

76
Q

MoA salbuatmol and formeterol

A

one is short, one is long acting beta-2 agonists

77
Q

MoA of tiotropium, ipratropium

A

muscarinic antagonists, prevents bronchoconstriction

78
Q

MoA omalizumab

A

binds unbound IgE so cant bind to Fc portion of mast cells

79
Q

throphylline MoA

A

likely a PDE inhibitor -> bronchodilation

80
Q

MoA mepolizumab

A

anti IL5 -> prevents eosinophils differenciation, activation and survival

81
Q

Severity of obstruction grading in PFTs

A

mild >70
mod 60-70%
mod severe 50-60
severe 35-50
very severe <35

82
Q

Main 2 antifibrotics and MoA

A

Pirfenidone - TGFB and reduces fibroblast proliferation
Nintedanib - inhibits multiple tyrosine kinases
Both slow disease progression and improves survival, no sx benefit

83
Q

Pirfenidone ADR

A

nausea
photosensitvity rash

84
Q

Nintedanib ADR

A

diarrhoea
weight loss
possible CVD risk
can increase bleeding risk, avoid on anticoagulation

85
Q

Most comon mutation pathway involved in idiopathic pulm fibrosis

A

mutations involving premature shortening of telomeres

86
Q

Pattern of lung disease in RA

A

UIP

87
Q

Pattern of lung disease in Systemic sclerosis

A

NSIP

88
Q

pattern of lung disease in inflammatory myopathies

A

oragnising pneumonia

89
Q

pattern of lung disease in sjogrens

A

lymphoid interstitual pneumonia

90
Q

Names of smoking related ILDs

A

respiratory bronchiolitis - ILD
desquamative interstitual pneumonia
fulminant langerhans cell histiocytosis

91
Q

mutation seen in 50% IPF

A

MUC5b gain of function

92
Q

Mutation causing amyotrophic dermatomyositis with ILD

A

anti-MDA5

93
Q

imaging findings in lymphangioleiomyomatosis

A

pulmonary cysts and renal angiomyolipomas

94
Q

antibody associated with primary alveolar proteinosis

A

GM-CSF

95
Q

What is sampter’s triad

A

asthma
aspirin intolerance
nasal polyps

96
Q

findings of ABPA

A

very high total IgE >1000

97
Q

Omalizumab target

A

IgE

98
Q

Mepolizumab target

A

IL 5 (main cytokines responsible for differenciation of eosinophils)

99
Q

Benefits and risks of triple therapy in COPD vs double

A

triple have reduced exacerbations and hospitilisation, but increased pneumonia risk

100
Q

Most common cause of bactyerial exacerbations of COPD

A

haemophilis, streptococcus, moraxella

101
Q

3 most common causes of pleural effusion

A

malignancy
HF
infection

102
Q

pH indicated by parapneumonic effusion

A

< 7.2

103
Q

Benefit of inhaled hypertonic saline in bronciectasis?

A

Reduce exacerbations
some QOL improvement

104
Q

Pathophysiology of cystic fibrosis

A

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
Q

Cystic fibrosis mutations

A

DF508
G551D

106
Q

Ivacaftor MoA

A

CFTR potentiator (opens channel of protein)
used in homozygous DF508 mutations

107
Q

Cystic fibrosis criteria for lung transplant referral

A

FEV1 < 35%
increase freq of IV abx
pO2 < 60
pCO2 >50
clinical organism resistance
imapired QOL

108
Q

Pathways for treatment of PAH

A

endothelin
NO
Prostacyclin

109
Q

If evidence of precappillary PAH on RHC, which test would you do and why

A

Vasodilator challenge
- eligible for CCB

110
Q

RHC measurements for PAH

A

mPAP >20

if precapillary PAWP <15
if PAWP >15 suggests left heart failure (no vasodilator therapies)

111
Q

Why are you unable to use vasodilators for group 2 (LV failure) PAH

A

worsening pressure gradient over alveolar bed -> pulm oedema

112
Q

Cardiac sequale post pneumonia

A

new onset HF caused by bacterial translocation into myocardium

113
Q

Normal characteristics of REM sleep

A

atonia on EMG and tonic/phasic eye movements
second half of night

114
Q

definition of apneoa

A

cessation of airflow for > 10 secs

115
Q

Definition of hypopneoa

A

reduction in airflow by 30% or >10 secs followed by 4% O2 desat or EEG arousal

116
Q

apneoa-hypopneoa index severity

A

normal < 5
mild 5-15
mod 15-30
severe >30

117
Q

Benefits of CPAP

A

improves daytime sleepiness, depression, cognitive function, QOL, BP, MVA risk
does not change CVD mortality

118
Q

Leptins role in ventilation and OSA

A

leptin is a respiratory stimulant, if leptin resistance (ie in obesity) then can lead to hypoventilation

119
Q

Difference between Narcolepsy T1 and T2

A

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
Q

Pathophysiology of narcolepsy

A

Autoimmune destruction of hypothalamic neurons which produce orexin (usually regulate arousal and transition between wake and sleep)

121
Q

What is cataplexy?

A

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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