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MRCP Hyunie > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Features of Granulomatosis with polyangiitis (wegeners)

A

C-ANCA +ve
Chronic sinusitis
Renal Failure (Nephritic syndrome)

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2
Q

Features of EOSINOPHILLIC polyangiitis (Churg strauss)

A

P-ANCA +ve
Asthma
Eosinophillia

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3
Q

What inheritance is alpha-1 anti trypsin deficiency

A

Autosomal Recessive
Chromosome 14
Disease manifests in piZZ gene

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4
Q

How to investiagate alpha-1 anti trypsin deficiency

A

alpha-1 anti trypsin Concentrations
Spirometry - obstructive picture

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5
Q

Features of alpha-1 anti trypsin deficiency

A

Lungs - Panacinar emphysema - mostly in lower lobes, emphysema
Liver - Cirrhosis. Hepatocellular carcinoma (adults) and Cholestatsis (Children)

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6
Q

What is alpha-1 anti trypsin deficiency

A

Lack of protease inhibit (Pi) produced by LIVER.
A1AT usually protects cells from neutrophil elastase

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7
Q

How to manage alpha-1 anti trypsin deficiency

A

No smoking
Supportive- bronchodilators, PT
IV A1AT protein
Surgery - lung volume reduction surgery

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8
Q

Light’s criteria

A

Testing if its exudative
1. Protein - FLUID : SERUM >0.5
2. LDH - FLUID : SERUM >0.6
3. LDH fluid >200 (more than 2/3 of upper limit)

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9
Q

Silicosis CXR features?

A

Egg shell calcification of hilar lymph nodes

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10
Q

Smoking Cessation Rx and SE/Cautions

A
  1. NRT - Nausea
    2, Varenicline - Nicotinic receptor agonist
    - Nausea, vivid dreams
    - Can exacerbate depression
  2. Bupropion - Dopamine+Norepiephrine reuptake inhibitor + nicotinic receptor agonist
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11
Q

First test for suspected Asthma

A
  1. Check FBC - to check eosinophil / FeNO
  2. Spirometry is uses AFTER
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12
Q

Burkholdemia Cepacia

A
  • In CF patients
  • Rapidly progressing
  • CI for lung transplant
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13
Q

Gener mutations for Cystic Fibrosis

A

Delta F508 mutation
- Abnormalities in Chloride channels
- Treated with ORKAMBI

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14
Q

Kartagener’s syndrome

A
  • Similar to CF but sweat test is negative
  • Recurrent infections, subfertility, primary ciliary dyskinesia
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15
Q

NIV - BiPAP settings

A

EPAP - 4-5cm
IPAP - 10cm

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16
Q

Test for obstructive sleep apnoea

A

Polysomnography

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17
Q

COPD progression and stages

A

Based on FEV1
Stage 1 >80%
Stage 2 50-79%
Stage 3 30-49%
Stage 4 <39%

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18
Q

Oxygen dissociative curve

A

To the left - Less oxygen to tissues (low temp,H+,pCO2)
To the right - More oxygen to tissues (high temp,H+,pCO2)

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19
Q

What is Transfer factor

A

Measures alveoli to the blood using CO
HIGH -Asthma,pul.haemorrhage,exercise,L->R shunt, Polycythatemia,Hyperkinetic
LOW - Pul.fibrosis,Pneumonia,PE,Emphysema,Anaemia,Low CO

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20
Q

Upper lobe Fibosis Mneumonic

A

BREASTS
B- Berylliosis
R- Radiation
E- EAA
A- Aspergillosis,ankylosing spondylitis
S- Silicosis
T- TB
S- Sarcoidosis

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21
Q

Lower lobe Fibrosis Mneumonic

A

SCARAB
S-Systemic sclerosis
C-Cryptogenic fibrosing alveolitis
A- Amiodarone and other drugs: bleomycin,busulphan,nitrofurantoin
R/A- Rheumatoid arthritis
B- Bronchiectasis

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22
Q

Pneumothorax - high risk factors

A
  1. Hypoxia
  2. 50+
  3. Previous lung disease
  4. Bilateral pneumothorax
  5. Haemothorax
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23
Q

Altitude disorders

A
  1. AMS (altitude mountain sicknesS)
  2. HAPE (high altitude pulmonary edema)
  3. HACE (high altitude cerebral edema)
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24
Q

Altitude Rx

A
  1. AMS: Acetylzolamide (carbonic anhydrase inhibitor)
  2. HAPE: Dexamethasone
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25
Bronchiectasis most common organism
H. Influenzae
26
Bronchiectasis worst prognosis organism
P.Aeriginosa
27
Contraindications to surgery in lung cancer (non-small cell)
1. SVC obstruction 2. Tumour near hilum 3. Vocal cord paralysis 4. Malignant pleural effusion
28
What condition causes bronchiolitis obliterans
Rheumatoid arthritis
29
Caplan's syndrome
Coal dust fibrosis
30
What PEFR is life threatening
<33%
31
What's associated with small cell lung cancer
1. ADH - hyponatraemia 2. ACTH - cushings 3. Lambert-eaton
32
What's associated with squamous cell lung cancer
1. PTHrp 2. Clubbing 3. HPOA
33
Lung Cancer risk
Smoking - x 10 Asbestos - x 5
34
ARDS features
1. Acute onset 2. Pulmonary oedema 3. Non-cardiogenic 4. FO2/FiO2 < 40kpA
35
Smoking cessation in pregnant ladies
First line is therapy NRT is an option. Others are CI
36
COPD Treatment
1. SABA/SAMA PRN 2. ?asthmatic features - YES : SABA/SAMA PRN + LABA + ICS - NO : SABA PRN + LABA + LAMA 3. SABA PRN + LABA + LAMA + ICS
37
What do you give when LABA + SABA don't work in COPD
Oral Theophylline
38
What cautions needed in oral theophylline re:abx
1. Reduce dose of oral theophylline 2. Macrolides : QT 3. Fluroquinonlones : Tendon rupture
39
Sarcoidosis steroid indication
Symptomatic Hypercalcaemia Eyes, heart or neuro involvement
40
Idiopathic pulmonary fibrosis CXR findings
1. Early: peripheral opacities 2. Late: honey-combing
41
What organism is found most commonly in alcoholics
Klebsiella (cavitating)
42
Risk factors in getting p.Aeruginosa
1. Long standing bronchiectasis 2. Long term uses of PPI
43
Test for upper airway obstruction/compression
Flow volume loop
44
What are the features of CRYPTOGENIC ORGANISING PNEUMONIA
1. Diffuse ILD 2. Leukocytosis + WCC and CRP raise
45
Lofgren's syndrome
Acute Sarcoidosis Erythema nodosum, CXR findings, Polyathralgia Common in Women
46
What medication can trigger Eosinophillic granulomatosis with polyangiitis?
Monteleukast (Leukotriene receptor antagonists)
47
What feature is associated with good prognosis in sarcoidosis?
Erythema nodosum
48
Whats the most common cause of occupational asthma
Isocyanates (paint stuff)
49
Stages of Sarcoid on CXR
1. BHL 2. BHL + infiltrates 3. infiltrates 4. Fibrosis
50
Symptom control options in non - CF bronchiectasis
Inspiratory muscle training Postural drainage
51
Criteria for LTOT
2 x ABG with pO2 <7.3 kPa
52
What is Catamenial Pneumothorax
Spontaneous pneumothoraces in women when menstruating
53
Lung Ca in non-smokers
Adenocarcinoma
54
Lung Ca in smokers
Squamous cell
55
What is associated with bilateral hilar lymphadenopathy
Lymphoma Sarcoid TB Pneumoconiosis: Berylliosis Fungi stuff
56
What chromosome mutation is CF
Chromosome 7
57
Symptomatic pneumothorax patients with no high-risk features should be offered
Conservative Needle aspiration Ambulatory service
58
What percentage of CXRs are reported as normal in Lung Ca
10%
59
What will improve survival of COPD
Smoking cessation LTOT
60
What predisposes him to develop TB?
Silica - due to impairment to clear bacteria causing chronic inflammation
61
Which lung cancer is most associated with cavitating lesions
Squamous cell
62
What causes cavitating lung lesions?
CATS BAW C - Cavitating abscess A - Aspergillosis T- TB S- Squamous Cell lung cancer B- Bronchogenic carcinoma A - Autoimmune disease (RA) W- Wegener's (granulomatosis with polyangiitis)
63
FEV1 definition
Air a person can forcefully exhaled in 1 second
64
FVC definition
Total air forced out after a max exhale
65
Obstructive picture spirometry
FEV1 reduced <70% FEV1/FVC <70%
66
Restrictive picture spirometry
FEV1 reduced / normal FEV1/FVC >70%
67
What is transfer factor
Rate a gas diffuses from alveoli to the blood Using CO
68
Causes of raised TLCO
Asthma Pulmonary haemorrhage Polycythaemia Left to Right shunt Hyperkinetic states Male, exercise
69
Causes of lower TLCO
Pulmonary fibrosis Pulmonary embolism Pulmonary oedema Pneumonia Anaemia Emphysema Low cardiac output
70
Fetal haemoglobin (HbF) what structure is it
2 x alpha 2 x gamma Oxygen binds more than adult Hb
71
Adult haemoglobin (HbA) what structure is it
2 x alpha 2 x beta
72
Oxygen dissociation curve (right and left meaning) + causes
Shifting to the Left (less oxygen delivered) - Low everything Shifting to the Right (more oxygen delivered) - Raised everything 2,3-DPG,temp,H+,pCO2
73

MRCP Hyunie (7 decks)

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