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BPT > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the mechanism of action of Riocoguat?
What types of pulmonary hypertension is it used for?
What trial confirmed the two uses?

A

Agonist of guanylate cyclase leading to vessel relaxation
Type 1 and type 4 (CTEPH)
REPLACE trial

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2
Q

What is Kartagener syndrome?
What is its inheritance?
Classic features?

A

Primary ciliary dyskinesia
Autosomal recessive
Situs invertus, chronic sinusitis, bronchiectasis, infertility

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3
Q

What type of emphysema is endobronchial valve treatment recommended?
What trial proved this?

A

Heterogenous emphysema without collateral ventilation
TRANSFORM trial

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4
Q

What are the advantages of systemic thrombolysis versus catheter-directed thrombolysis for large pulmonary embolism?
What is the major disadvantage?
What two studies support catheter over systemic thrombolysis?

A

Advantages: decreased death, improved quality of life, reduced right heart strain, less long term pulmonary hypertension
Disadvantage: major haemorrhage
Studies: PERFECT and SEATTLE II

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5
Q

What type of lung cancer has the best prognosis?
What is its 5 year survival average?

A

Carcinoid
Typical = 85-90%
Atypical = 50-70%

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6
Q

What is the 5 year survival of stage 1 small cell lung cancer?
What about stage 1 non-small cell lung cancer?

A

Small cell = 45-50%
Non-small cell = 30%

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7
Q

When is PET scanning most useful in assessing lung cancer (3 situations)?
What size lesion is PET not useful for?

A

1) Solitary pulmonary nodules – distinguishes benign vs malignant. – sens 96%, spec 78%.
2) Carcinoma staging
3) Surveillance

Not useful when lesion is <1cm.

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8
Q

What did the MIST2 study prove in regards to pleural drainage?

A

Alteplase and Dornase are effective in preventing surgical intervention in chest drains for parapneumonic effusions

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9
Q

What is the action of Alteplase?
What is the action of Dornase?

A

Alteplase converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin as well as fibrinogen.
Dornase alfa is a recombinant human deoxyribonuclease I (rhDNase) that cleaves down extracellular long-chain DNA in the sputum

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10
Q

What is the Bohr effect?

A

Describes when acidosis shifts the oxyhemoglobin dissociation curve to the RIGHT. A decrease in pH reduces hemoglobin’s affinity for oxygen, enhancing oxygen release to the tissues.

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11
Q

What causes flow-volume curves to show normal expiration but the flow limitation during inspiration produces an “inspiratory plateau”?
Why?

A

Vocal cord paralysis.
during expiratory the cords are blown open but during inspiration the weak cord is drawn inward, causing flow restriction

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12
Q

In stage II and III NSCLC, after surgery what chemo if offered?

A

Cisplatin and Vinorelbine

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13
Q

What is the mechanism of action of Erlotinib?

A

Erlotinib is a tyrosine kinase inhibitor that targets the epidermal growth factor receptor (EGFR). It has been shown to improve survival in certain types of cancer, particularly non-small cell lung cancer (NSCLC)

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14
Q

What does it mean if FeNO increases >10ppm or >60% over baseline?

A

An increase of more than 10 ppb or more than 60% over baseline threshold means that there is ongoing eosinophilic inflammation and therefore would suggest the need for steroids.

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15
Q

What is the mechanism of action of Nintendanib?
What are the three growth factor cells it acts upon?
What part of PFTs does it slow the decline?

A

Intracellular tyrosine kinase inhibitor
Acts on Fibrogenic, Platelet and Vascular endothelial cells
Slows the decline in FVC

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16
Q

What does DLCO measure?
What does a reduced DLCO indicate?
What diseases common have low DLCO?

A

Measures the efficiency of gas transfer from the alveoli into the blood.
Reduced DLCO can indicate issues in alveolar surface area, membrane thickness or capillary blood volume.
Diseases = pulmonary fibrosis, emphysema, pulmonary vascular disorders

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17
Q

What type of lung cancer is Lambert-Eaton myasthenia syndrome associated with?
Where does is act on the neuromuscular junction?

A

Small cell lung cancer
Autoimmune antibodies acting on pre-synaptic calcium channels

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18
Q

What type of electrolyte abnormality occurs in squamous cell lung cancer?
How does it occur?

A

Hypercalcaemia
Caused by ectopic production of parathyroid hormone-related peptide (PTHrP)

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19
Q

What is first line treatment for PJP?
Back up options?

A

Trimethoprim-sulfamethoxazole
Clindamycin or Pentamidine

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20
Q

What is the pathophysiology of emphysema?
What phase of the respiratory cycle does it lead to air flow obstruction?

A

Chronic lung disease that is characterised by destruction of alveoli and loss of lung elasticity
Flow obstruction in expiration

21
Q

What are the 5 causes of hypoxemia ?

A

Hypoventilation
V/Q mismatch
Right to left shunt
Diffusion limitation
Reduced inspired oxygen tension

22
Q

What are some pharmacological treatments for restless legs syndrome?
What is a simple oral supplement that can be used?

A

Levodopa, Pramipexole
Iron supplement

23
Q

What are the hallmark symptoms of narcolepsy?

A

Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnagogic hallucinations

24
Q

What 3 letter acronym (an enzyme) is elevated in small cell lung cancer?

A

NSE = neuron-specific enolase

25
Q

What stage of lung cancer is Durvalumab used?
What is its mechanism of action?
What trial supported its use pre and post surgery?

A

Resectable stage II to IIIb
It’s action is a PD-L1 inhibitor
AEGEAN

26
Q

How is bronchiolitis obliterans syndrome defined in post-transplant patients ?

A

Decline in FEV1, FEV1/FVC <70%, no restrictive deficits and no fibrotic-like opacities

27
Q

Criteria for lung transplant in ILD patients:

A

Pulmonary fibrosis with FVC <80% predicted or DLCO <40% predicted
Decline in FVC or DLCO >10% within 6 months
Supplemental oxygen requirement at rest or exertion
Pulmonary hypertension
Inflammatory ILD - progressive decline in function & radiographically despite treatment

28
Q

What is Samter’s triad?
What is it also known as?

A

Asthma + nasal polyps + aspirin/NSAID hypersensitivity
Also known as Aspirin-exacerbated respiratory disease (AERD)

29
Q

What type of pathogen is a galactomannan assay used for?

A

Invasive aspergillosis

30
Q

What is the most, second most and third most common bacteria causing infection in COPD patients?

A

Haemophilus influenzae
Streptococcus pneumoniae
Moxaxella pneumoniae

31
Q

What trials supported the use of long term oxygen therapy ?
How many hours a day minimum is required for benefit?

A

Trials = NOTT (nocturnal oxygen therapy trial) and MRC (medical research council)
Minimum 15hrs per day

32
Q

What trials supported the use of long term oxygen therapy ?
How many hours a day minimum is required for benefit?

A

Trials = NOTT (nocturnal oxygen therapy trial) and MRC (medical research council)
Minimum 15hrs per day

33
Q

What is the equation to calculate the alveolar partial pressure?

A

PA02 = (Fi02 x (Patm - PH20) is (PaC02 / Resp Quotient)

34
Q

How do you diagnose eosinophilic bronchitis ?
Treatment?
Is atopy more, less or the same as general population?

A

Diagnosis = >2.5% eosinophils in sputum, absence of airway hyperresponsiveness
Treatment = steroids
Atopy = same/slightly higher

35
Q

What type of inhaler is tiotropium?
What receptor does tiotropium act upon?

A

It is a long-acting, anti-muscarinic bronchodilator (LAMA)
Acts of M3 receptor

36
Q

What is the mechanism of action of Omalizumab?
How do asthmatic patients qualify?

A

Monoclonal antibody against IgE
Binds to free IgE and IgE bound to receptors, reducing the amount available to trigger allergic cascade
Qualify = mod-severe asthma, positive skin test to perennial aeroallergen (pollen) and symptoms inadequately controlled with inhaled corticosteroids

37
Q

What is the strongest predictive sign of malignancy for solitary pulmonary nodules on CT?
What size is considered higher risk?

A

Spiculated, irregular border
Size >5mm

38
Q

What level of chloride is required on sweat testing for CF?
On how many occasions ?
What is tested on a newborn screening for CF?

A

> 60mmol/L on two separate occasions
Newborn screen = elevated immune reaction to trypsinogen (IRT)

39
Q

What type of diuretic is contraindicated in sarcoidosis?
Why?

A

Thiazide
Risk of worsening hypercalcaemia

40
Q

what cell is elevated in COPD with type 2 inflammation?
What monoclonal antibody is used to treat this?

A

Eosinophils
Dupilumab

41
Q

What are the 3 types of lung aspergillosis infections?
Describe each

A

Allergic Bronchopulmonary Aspergillosis (ABPA): An allergic reaction in the lungs, usually affecting people with asthma or cystic fibrosis.
Aspergilloma (Fungal Ball): A mass of fungal hyphae, mucus, and debris forming in pre-existing lung cavities.
Chronic Pulmonary Aspergillosis: A long-term condition where Aspergillus causes lung damage over months or years.

42
Q

What are the two most common anti-TB drugs that TB becomes resistant to?
What are their mechanism of action?

A

Rifampicin and Isoniazid
Rifampin: bactericidal, inhibiting DNA-dependent RNA polymerase (RNAP).
Isoniazid: inhibit bacterial cell wall synthesis by activation of enzyme KatG

43
Q

What is better for MRSA; Linezolid or Meropenam?

A

Linezolid

44
Q

Age of onset for COP?
Males vs females?
Symptoms for 2 weeks, 2 months or 6 months?
Imaging findings?
Treatment?

A

Disease onset is typically in the fifth or sixth decades of life
Males and females affected equally
Symptomatic for less than two months
clinical presentation = mimics pneumonia
Imaging features = multiple ground-glass or consolidative opacities that tend to be at the lung periphery
Treatment = steroids

45
Q

What does high ACE levels indicate?

A

Sarcoid

46
Q

What gene is implicated in Alpha-1-antitrypsin disease?
What is the best genotype?
What is the worst?

A

SERPINA1
Best = MM
Worst = ZZ

47
Q

All of the following drugs could be used in the treatment of multi-drug resistant tuberculosis (MDR-TB) except?
What chronic lung condition can it be used for?
And which one of the other options does it increase risk of toxicity?
Clarithromycin
Moxifloxacin
Amikacin
Capreomycin
Linezolid

A

Clarithromycin
Chronic condition = Mycobacterium avium complex
Toxicity = Linezolid

48
Q
A

BPT (13 decks)

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