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MRCP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Allergic bronchopulmonary aspergillosis presentation

A

Young male with bronchiectasis and eosinophilia

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2
Q

Management of allergic bronchopulmonary aspergillosis

A

oral glucocorticods and itraconazole can b used as a second line agent

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3
Q

Eosinophilic granulomatosis with polyangitis

A

AKA Churg-Strauss

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4
Q

Define eoshinophilic granulomatosis with polyangitis

A

pANCA associated small vessel vasculitis

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5
Q

Features of eosinophilic granulomatosis with polyangitis

A

asthma, blood eosinophilia, paranasal sinusitis, mononeuritis multiplexr

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6
Q

Small cell carcinoma presentation

A

Clubbing
Hyponatraemia
Lambert-Eaton syndrome

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7
Q

OSA: investigations

A

Epworth sleep study
Multiple sleep latency test

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8
Q

Diagnostic test for OSA

A

Sleep studies (polysomnography)

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9
Q

OSA: management

A

Weight loss
Stop smoking
CPAP
DVLA should be informedP

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10
Q

Paraneoplatic syndrome: small cell

A

ADH
ACTH (Cushings)
Lambert Eaton

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11
Q

Paraneoplastic syndrome: squamous cell

A

PTHpr release
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism

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12
Q

Paraneoplastic syndrome: adenocarcinoma

A

Gynaecomastia
HPOA (note seen more in SCC)

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13
Q

LTOT criteria COPD

A

Can increase survival

pO2 <7.3 or
pO2 7.3-8.0 and secondary polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension

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14
Q

Sarcoidosis staging

A

Stage 0: no CXR changes
Stage 1: bialteral hilar lymphadenopathy
Stage 2: BHL + infiltrates
Stage 3: infiltrates
Stage 4: fibrosis

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15
Q

Investigations for sarcoid

A

ACE levels are high
CXR - bilateral hilar lymphadenopathy
Hypercalcaemie, ESR raised
Non-caseating granulomas

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16
Q

Lights criteria for a pleural effusion

A

when protein is 25-30g/L

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17
Q

Exudate pleural effusion criteria

A

> 30g/L

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18
Q

Transudate pleural effusion criteria

A

<30g/L

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19
Q

Exudate is likely when

A

Pleural fluid protein divided by serum protein >0.5

Pleural fluid LDH divided by serum LDH >0.6

Pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

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20
Q

Low glucose on pleural effusion

A

RA, TB

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21
Q

Raised amylase

A

Pancreatitis, oesophageal pancreatitis

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22
Q

Heavy blood staining

A

mesothelioma, PE, TB

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23
Q

Pleural effusion cloudy/turbid

A

Need to put in a chest drain

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24
Q

Clear pleural fluid but pH <7.2 mx

A

Need to insert a chest drain

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25
Q

Management of recurrent pleural effusion

A
  • Recurrent aspiration
  • Pleurodesis
  • Indwelling pleural catheter
  • Drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
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26
Q

What can montelukast uncover

A

Eosinophilic granulomatosis with polyangitis

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27
Q

ARDS diagnosis

A

CXR and ABG

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28
Q

Criteria for ARDS

A
  1. Acute onset (within 1 week of a known risk factor)
  2. Pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
  3. Non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
  4. pO2/FiO2 < 40kPa (300 mmHg)
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29
Q

Management of ARDS

A
  1. ITU
  2. Organ support
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30
Q

COPD biPAP criteria

A
  1. COPD with respiratory acidosis pH 7.25-7.35 (if <7.25 may need to be on ITU and lower threshold for intubation)
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31
Q

BiPAP settings for COPD

A

Expiratory Positive Airway Pressure (EPAP): 4-5 cm H2O
Inspiratory Positive Airway Pressure (IPAP): RCP advocate 10 cm H20 whilst BTS suggest 12-15 cm H2O
back up rate: 15 breaths/min
back up inspiration:expiration ratio: 1:3

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32
Q

Cherry red spot on bronchoscopy

A

Lung carcinoid

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33
Q

Bronchiectasis most common organism

A

H influenzae

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34
Q

Acute asthma diagnosis: moderate

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

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35
Q

Acute asthma diagnosis: severe

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

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36
Q

Acute asthma diagnosis: life threatening

A

PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

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37
Q

Management of acute exacerbation of asthma

A
  1. O2 if <92% sats
  2. High dose SABA
  3. PO pred (40mg)
  4. Nebulised ipratropium bromide
  5. IV MgSO4
  6. IV aminophylline
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38
Q

Criteria for discharge

A

Stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours
Inhaler technique checked and recorded
PEF >75% of best or predicted

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39
Q

Chest drain insertion primary
<2cm

A

If asymptomatic discharge, if symptomatic for needle aspiration

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40
Q

Chest drain insertion primary >2cm

A

Aspiration if still symptomatic for chest drain

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41
Q

Chest drain insertion secondary >2cm

A

chest drain

42
Q

Chest drain insertion secondary 1-2cm

A

aspiration if fails for chest drain

43
Q

Chest drain insertion secondary <1cm

A

O2 and admission for 24 hours

44
Q

4 key features of kartagners syndrome

A
  1. Dextrocardia or complete situs inversus
  2. Bronchiectasis
  3. Recurrent sinusitis
  4. Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
45
Q

High altitude cerebral oedema management

A

Descent and dexamethasone

46
Q

Alpha 1 antitrypsin genetics

A

Chromosome 14
autosomal recessive/co-dominant

47
Q

Alpha 1 antitrypsin mobility

A

Alleles classified by their electrophoretic mobility
M: normal
S: slow
Z: very slow

48
Q

Alpha 1 antitrypsin management

A
  • bronchodilators
  • IV alpha 1 antitryripsin protein
  • surgery: lung volume reduction
49
Q

Buprion MOA
When is it CI

A

MOA: norephrine and dopamine reuptake inhibitor and nicotinic receptor antagonist

Epilepsy (can lower seizure threshold)

50
Q

Activities post pneumothorax

A

Stop smoking

Do not fly for 2 weeks (can wait 1 week post XR check up)

Scuba diving CI unless bilateral surgical pleurectomy, normal lung function and chest CT post op

51
Q

Indications for steroids

A

Chest x-ray stage 2 or 3 disease who are symptomatic.

If not symptomatic:
hypercalcaemia
eye, heart or neuro involvement

52
Q

COPD O2 sats

A

If pCO2 normal then 94-98%

53
Q

Cystic fibrosis
- genes

A

Autosomal recessive

Defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which codes a cAMP-regulated chloride channel

Delta F508 on the long arm of chromosome 7

54
Q

Organisms that commonly colonise in CF

A

Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus

55
Q

Cannonball mets

A

Commonly renal cancer

Others: cholangiocarcinoma, prostate cancer

56
Q

When do you get calcified lung mets?

A

Chondrosarcoma or osteosarcoma

57
Q

Occupational asthma management

A

Serum peak flow at work and at home

58
Q

Chlamydia psttachi abx

A

Doxycycline

59
Q

Stages of COPD

A

FEV1/FVC <0.7

1: Mild (symptoms need to be present) - FVC >80%
2: Moderate - FVC 50-79%
3. Severe 30-49%
4. Very severe <30%

60
Q

Most common cause of IECOPD

A

H. influenzae

61
Q

Common cause of aspiration pneumonia

A

Klebsiella

62
Q

Catamenial pneumothorax

A

Seen in menstruating women
To do with hormones

63
Q

Lofgrens syndrome

A

Acute form sarcoidosis characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia.

64
Q

Loffler’s syndrome

A

A cause of pulmonary eosinophilia thought to be caused by parasites such as Ascaris lumbricoides

65
Q

Elevated hemidiaphragm investigation

A

Fluroscopy (inaccurate for bilateral elevated hemidiaphragm)

66
Q

Narcolepsy symptoms

A

Typical onset in teenage years
Hypersomnolence
Cataplexy (sudden loss of muscle tone often triggered by emotion)
Sleep paralysis
Vivid hallucinations on going to sleep or waking up

67
Q

Narcolepsy management

A

Modafanil (can use sodium oxybate at night)

68
Q

Cataplexy symptoms

A

sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

69
Q

Cataplexy management

A

SNRI

70
Q

Cause of pneumonia in Spain/air con

A

Legionella

urinary antigen

mx: erythromycin

71
Q

Minimum amount of time on LTOT?

A

15 hours a day

72
Q

Bronchiectasis management

A

Airway clearance

73
Q

Latent pulmonary TB management

A

RI for 3 months (isoniazid with pyroxidine)
I for 6 months (with pyroxidine)

74
Q

Active TB management

A

RIPE (with pyroxidine) for 2 months, 4 months of RI (+pyridoxine)

75
Q

SE: rifampicin

A

potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms

76
Q

SE: isoniazid

A

peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor

77
Q

SE: pyrazinamide

A

hyperuricaemia causing gout
arthralgia, myalgia
hepatitis

78
Q

SE: ethambutol

A

optic neuritis: check visual acuity before and during treatment

79
Q

PJP management

A

Co-trimoxazole

80
Q

Antibody Scl-70?

A

Diffuse cutaenous systemic sclerosis

81
Q

Anti-centromere?

A

Limited cutaneous systemic sclerosis
- associated with pulmonary artery hypertension

82
Q

Mycobacterium malmoense diagnosis

A

Requires 2 samples from 2 different areas to be clinically significant

83
Q

Sniff test for unilateral paralysis of the diaphragm

A

One goes up and one goes down, seen on fluoroscopy

84
Q

Aspergilloma symptoms

A

Usually asymptomatic may have mild haemoptysis

85
Q

Invasive aspergillosis

A

Fever, lots of sputum, pleuritic chest pain

86
Q

Allergic pulmonary aspergillosis

A

Productive cough, wheeze, SOB

87
Q

Chronic pulmonary aspergillosis

A

chronic productive cough and SOB

88
Q

When to see raised transfer factor

A

When there is increased contents of the alveoli into the bloodCau

89
Q

Causes of raised transfer factor

A

Pulmonary haemorrhage
Polycythaemia
Early left heart failure
Exercise

90
Q

What to monitor for mortality in COPD

A

FEV1

91
Q

Pleural effusion transudative criteria

A

Increase in hydrostatic pressure or decrease in oncotic pressire

  • HF
  • cirrhosis
  • PE

low levels of protein

92
Q

Pleural effustion exudative criteria

A

inflammation of capillaries, makes them leaky = big proteins like LDH present

  • trauma
  • lupus
  • infection
  • malignant
93
Q

Lights criteria

A

Exudative if:

fluid protein : serum protein >0.5
fluid LDH: serum LDH >0.6
fluid LDH >/= 2/3 serum LDH

94
Q

When to drain a pleural effusion

A

If pH<7.2 as likely an empyema

95
Q

Meigs syndrome

A

Ovarian fibroma + ascites + pleural effusion

96
Q

Pleural effusion investigation
§

A
  1. US guided aspiration
  2. If appears to be malignant for CT thorax
97
Q

Most important vitamin to replace in CF

A

ADEK

98
Q

Eosinophilic pneumonia treatment

A

Systemic steroids

99
Q

Rheumatoid arthritis rare resp complication

A

Bronchiolitis obliterans

100
Q

Which way does the trachea move in a pneumothorax

A

Away from the pneumothorax

101
Q

Criteria for LTOT in COPD

A

paO2 < 7.3

Or pao2<8 AND
- pulmonary hypertension (RHF)
- secondary polycythaemia
- periphaeral oedema
- nocturnal hypoxia

MRCP (28 decks)

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