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MRCP 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

severity of ARDS

A

depends on hypoxaemia
mild: PaO2 > 200
mod: PaO2 100-200
severe: PaO2 < 100

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2
Q

actions of alpha 1 antitrypsin

A

defends against neutrophil elastase

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3
Q

types of asbestos lung disease

A

pleural plaques
pleural thickening (mostly at bases, restriction and reduced compliance, reduced total lung capcity, normal KCO)
pleural effusions (often spontaneously resolve, usually exudate)
asbestosis
lung ca

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4
Q

treatment of mesothelioma

A

talc or indwelling pleural catheters for symptomatic effusion
RTx, CTx (non curative)
surgery potentially curative

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5
Q

hard metal lung disease

A

caused by cobalt dust
from making cutting tools or jet engine parts
> fibrosis
multi nucleated giant cells in alveoli with granulomas

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6
Q

Aspergillus species

A

over 200
Aspergillus fumigatus causes 70% aspergillosis
A terreus resistant to amphoteracin B and has poor prognosis

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7
Q

Aspergillosis disease patterns

A
  1. invasive
  2. ABPA
  3. chronic pulmonary aspergillosis (CPA)
  4. isolated infection
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8
Q

invasive aspergillosis

A

spores germinate into hyphae in immunocompromised
> invade parenchyma
> inflammation, thrombosis, infarction)
> haematogenous dissemination to brain, skin, eyes, heart, kidney, liver, spleen, GI , bone

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9
Q

ABPA

A

hypersensitivity to antigens from Aspergillus
typically CF and asthma pts
type I and type III
bronchiectasis and airway obstruction

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10
Q

chronic pulmonary aspergillosis

A

destructive infection
> fibrosis and loss of lung tissue
aspergilloma (assoc w/ TB)
aspergillus nodule
chronic cavitary (usually immunocompetent)
chronic necrotising (assoc with COPD and ETOHXS)

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11
Q

aspergillus isolated infection

A

nails, eyes, skin, sinuses, ear canals
endocarditis
endophthalmitis

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12
Q

diagnosing invasive aspergillosis

A

positive serum aspergillus galactomannan
serum 1-3 beta D glucan (not specific for aspergillus)
PCR RNA
HRCT chest
HRCT or MRI sinuses, brain

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13
Q

ABPA diagnosis

A

total IgE antibodies
aspergillus specific IgE and IgG
positive weal and flare skin test
eosinophilia
CXR infiltrates, bronchiectasis
HRCT mucoid plugging, infiltrates and bronchiectasis

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14
Q

chronic pulmonary aspergillosis diagnosis

A

IgG
CXR and HRCT- upper lobe mobile mass with air crescent, multiple nodules and cavities

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15
Q

treating invasive aspergillosis

A

amphoteracin B or echinocandin (caspofungin)
colony stimulating factors
isavuconazole, voriconazole 3/12
prophylaxis posaconazole
surgery if lesions continuous with great vessels of pericardium or severe haemoptysis from single cavity

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16
Q

asthma lung function tests

A

increased volume, reduced FEV1 and FEV1: FVC ratio < 70%
variable PEFR > 20%
improved PEFR > 15% after bronchodilator or steroids

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17
Q

berylliosis

A

looks similar to sarcoid
non caseating granulomas in lungs and nodes
surrounding fibrous tissue
CXR: fine nodulation evenly distributed throughout and b/l hilar lymphadenopathy
> progressive SOB and RHF

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18
Q

causes of bronchiectasis

A

LRTI
idiopathic
Marfans, Williams Campbell
HIV, haem malignancy, post transplant
RA, sjogren
IBD
ABPA, CF
obstructed or compressed bronchus (malignancy)
chemical pneumonitis
primary ciliary dyskinesis, kartagener, young
A1AT

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19
Q

asthma management

A

SABA for everyone
add ICS
> add LRTA or LAMA

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20
Q

COPD management

A
  1. SABA or SAMA
    2a. (no asthma/steroid responsiveness) LABA + LAMA
    2b. LABA + ICS
  2. LABA + LAMA + ICS

remove ICS if it is not helping

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21
Q

indications for transplant in COPD

A

< 65y and:
- FEV1 and DLCO < 20% predicted
- history of hospitalisation w/ acute hypercapnia
- pulmonary HTN and/or cor pulmonale despite oxygen therapy

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22
Q

assessing COPD prognosis

A

BODE for 2y mortality
BMI, airflow Obstruction, Dyspnoea, Exercise

Decaf for inpatient mortality
Dyspnoea, Eosinophils < 0.05, Consolidation, Acidaemia, AF

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23
Q

simple vs progressive coal workers pneumoconiosis

A

simple:
small, asymptomatic round opacities
upper zones
focal emphysema

progressive:
nodule aggregation into larger opacities
possible cavitating lesions

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24
Q

Caplan syndrome

A

multiple round nodules in patients with seropositive RA with coal workers pneumoconiosis
in peripheral crops

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25
Q

myocoplasma pneumonia

A

occurs in 3-4 yearly epidemics
> 2 week prodrome

peri/myocarditis
erythema multiforme, nodosum, SJS
haemolytic anaemia, DIC, thrombocytopaenia
meningoencephalitis, neuopathies
bullous myringitis
hepatitis, pancreatitis

26
Q

Horders spots

A

rose spots on face
associated with psittacosis

27
Q

CURB 65

A

confusion
RR > 30
SBP < 90 or DBP < 60
age > 65y

admit if 3 or more

28
Q

legionella length of treatment

A

21 days

29
Q

CF colonisation

A

children: staph then haemophilus
adolescents: pseudomonas

30
Q

CF drug management

A

inhaled bronchodilator and ICS
rhDNase mucoactive agent
tobramycin for chronic pseudomonas
azithromycin, ibuprofen, pred
fluclox as staph prophylaxis for under 3ys
CFTR modulator ivacaftor
pancreatin, fat soluble vits ADEK

31
Q

lung transplants absolute contraindications

A

Burkholderia cepacia colonisation
sepsis
multi organ dysfunction
non adherence to tx
morbid obesity
refractory GORD

32
Q

eosinophilic granulomatosis with polyangiitis lung biopsy

A

necrotising granulomas with central eosinophilic core and necrotising vasculitis

33
Q

hypersensitivity pneumonitis

A

Th-1 mechanism
IgG mediated
acute- symptoms appear within hours of high level exposure and resolve within 48h, no fibrosis
chronic- gradual after prolonged low level exposure
can develop into fibrosis or emphysema
biopsy: mononuclear infiltrate, non caseating granulomas
reversible if diagnosed early

34
Q

drugs causing fibrosis

A

amiodarone
sulfasalazine, MTX
bisulfan, bleomycin
cyclophosphamide
nitrofurantoin
gold
melphalan

35
Q

lambert eaton treatment

A

3, 4 diaminopyridine
or pyridostigmine

36
Q
A
37
Q
A
38
Q
A
39
Q

gynaecomastia is associated with what lung cancer?

A

large cell and adenocarcinoma

39
Q

hyperthyroid is associated with what lung cancer?

A

squamous

39
Q

SCLC paraneoplastic syndromes

A

SIADH
ectopic ACTH
Lambert Eaton (weakness IMPROVES with repeated contraction)

40
Q

HPOA

A

hypertrophic pulm osteoarthropathy
assoc w/ adrenocardinoma
periostitis, arthritis, clubbing

41
Q

pancoast

A

non SCLC
superior sulcus
hand atrophy, horners

42
Q

lung transplant donor criteria

A

< 55y
ABO compatible
clear CXR
pao2 > 300
< 20 pack years
no chest trauma, aspiration, sepsis or prior cardiopulm surgery
no organisms on gram stain
no purulent secretions at bronchoscopy

43
Q

mesothelioma staging

A

1a. ipsilateral partietal pleura
1b. visceral pleural involvement
2. diaphragm or lung involvement
3. any locally advanced or nodes N1 or N2
4. locally advanced unresectable, N3 (contralateral nodes or internal mammary or supraclavicular nodes)

44
Q

byssinosis

A

occupational lung disease from cotton dust, flax, hemp
acute or chronic

45
Q

PE extra heart sounds

A

TR murmur
widely split S2

46
Q

PE admission criteria

A

haemodynamic instability
pregnant or postpartum
level 2 Wells > 4

47
Q

contraindications to DOAC for PE

A

active cancer
renal impairment
antiphospholipid syndrome
haemodynamic instability

> LMWH at least 5/7
dabigatran/edoxaban or warfarin

48
Q

pulmonary HTN WHO groups

A
  1. pHTN
  2. pHTN + left heart disease
  3. pHTN + lung disease/hypoxaemia
  4. pHTN + chronic thrombotic/embolic disease
  5. pHTN + disorders directly affecting pulm vasculature (schisto, sarcoid, glycogen storage)
49
Q

pHTN treatment

A

anticoagulation
digoxin
PGI2 continuous IV infusion while a/w transplant
PDE5i
bosentan
CCB

pulm endarterectomy
balloon pulm angioplasty
atrial septostomy
heart lung transplant

50
Q

pulmonary TB in HIV patients

A

consolidation, miliary, effusions
cavitation is less common

51
Q

PCP prophylaxis

A

cotrimoxazole
for pt with CD4 < 200
for pt with previous PCP

52
Q

normal mean pulmonary arterial pressure

A

15-30 mmHg

53
Q

chemoreceptors involved in respiration

A

central:
on ventral medulla
respond to H+ from CO2

peripheral:
carotid bodies and aortic bodies
respond to hypoxaemia, hypercapnia, pH

54
Q

Lofgren syndrome

A

bilateral hilar lymphadenopathy + erythema nodosum
+ fever + arthralgia

55
Q

sarcoid CXR grading

A

0: clear
1: BHL
2: BHL + pulmonary infiltrates
3: diffuse pulmonary infiltration
4: fibrosis

56
Q

silicosis

A

quarry workers, hard rock miners, ceramic manufacturers, AKA Potter’s Rot

increased risk of CTD, vasculitis, CKD
many have polyclonal hypergammaglobulinaemia, rheum factor, ANA, immune complexes

acute:
weeks-5y from exposure
involves v high levels of dust

accelerated:
5-15y latency
high levels of silica
can progress after removal of source

simple chronic:
most common, low level exposure
20y latency
risk of progressive massive fibrosis

57
Q

silicosis investigation and treatment

A

CXR: non calcified round opacities in upper zones similar to coal pneumoconiosis
egg shell calcification around enlarged hilar glands
> bronchodilators if also COPD
> lavage if acute
> transplant

58
Q

how to prevent peripheral neuropathy with anti TB treatment

A

risk from isoniazid
give pyridoxine for people with ETOHXS, diabetes, renal failure

59
Q

indications for mechanical ventilation

A

severe hypoxaemia < 8.3 kpa despite 0.6 FiO2
PaCO2 > 6kpa

MRCP 2 (12 decks)

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