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MRCP 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Management of idiopathic pulmonary fibrosis

A

Pulmonary rehabilitation

Pirfenidone (an antifibrotic agent)

Nintedanib

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2
Q

Antidote for cyanide poisoning.

A

Hydroxocobalamin

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3
Q

Benzodiazepine overdose - treatment

A

Flumazenil

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4
Q

Theophylline - use

A

Bronchodilator in the management of asthma and COPD

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5
Q

BTS guidelines for lung nodules:

Nodule <5mm

A

Can be discharged

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6
Q

BTS guidelines for lung nodules:

Nodule 5-6mm, or =>8mm and low-risk

A

CT surveillance

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7
Q

BTS guidelines for lung nodules:

Nodule =>8mm and high risk

A

CT-PET, and if CT-PET shows high uptake then biopsy

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8
Q

Allergic bronchopulmonary aspergillosis - define + management

A

Allergy to Aspergillus spores

Oral glucocorticoids

Itraconazole is sometimes introduced as a second-line agent

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9
Q

Histoplasmosis - define + treatment

A

Fungus Histoplasma capsulatum

Amphotericin or Itraconazole

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10
Q

Extrinsic allergic alveolitis - define

A

Hypersensitivity induced lung damage due to a variety of inhaled organic particles

Immune-complex mediated tissue damage (type III hypersensitivity) although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in the chronic phase.

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11
Q

Most common infective causes of COPD exacerbations

A

Haemophilus influenzae (most common cause)

Streptococcus pneumoniae

Moraxella catarrhalis

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12
Q

Pulmonary hypertension - define

A

Sustained elevation in mean pulmonary arterial pressure of greater than 20 mmHg at rest

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13
Q

FEV1/FVC ratio < 0.7

A

Obstructive lung disease

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14
Q

COPD - still breathless despite using SABA/SAMA and a LABA + ICS

A

Add a LAMA

Tiotropium is a long-acting muscarinic antagonist (LAMA)

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15
Q

Microscopic polyangiitis

A

Small-vessel ANCA vasculitis.

Typically positive for p-ANCA, with antibodies against MPO (myeloperoxidase)

Mononeuritis multiplex

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16
Q

Exudates have a protein level of

A

> 30 g/L

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17
Q

Transudates have a protein level of

A

<30 g/L

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18
Q

Lung cancer is histologically subdivided as:

A

Non-small cell carcinoma (NSCLC) - (squamous cell carcinoma, adenocarcinoma, and large cell carcinoma)

Small cell carcinoma (SCLC)

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19
Q

Eosinophilic granulomatosis with polyangiitis - define

A

Churg-Strauss syndrome

ANCA associated small-medium vessel vasculitis.

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20
Q

Eosinophilic granulomatosis with polyangiitis - features

A

Churg-Strauss syndrome

Asthma
Blood eosinophilia (e.g. > 10%)
Mononeuritis multiplex
Renal involvement

pANCA positive in 60%

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21
Q

Small cell cancer - paraneoplastic features

A

ADH

ACTH - hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness

Lambert-Eaton syndrome

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22
Q

Squamous cell - paraneoplastic features

A

Parathyroid hormone-related protein (PTH-rp) secretion

Clubbing

Hypertrophic pulmonary osteoarthropathy (HPOA)

Hyperthyroidism due to ectopic TSH

23
Q

Smokers -> liver enzyme inhibitor or inducer?

24
Q

Omalizumab - MOA

A

Anti-IgE monoclonal antibody

Severe allergic asthma

25
Q

Etanercept - MOA

A

Anti-TNF antibodies

Rheumatoid arthritis

26
Q

Acute respiratory distress syndrome (ARDS) - define

A

Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli.

i.e. non-cardiogenic pulmonary oedema

27
Q

Obstructive - Spirometry

A

FEV1/FVC < 80%

28
Q

Obstructive - Examples

A

COPD:
Chronic bronchitis
Emphysema: including alpha-1 antitrypsin deficiency

Asthma

Bronchiectasis

29
Q

Restrictive - Spirometry

A

FEV1/FVC > 80%

30
Q

Restrictive - Examples

A

Idiopathic pulmonary fibrosis

Sarcoidosis
Histiocytosis

Drug-induced fibrosis: amiodarone, bleomycin, methotrexate

Asbestosis

Obesity
Scoliosis

31
Q

Granulomatosis with polyangiitis

A

Wegener’s granulomatosis

Renal Failure

Epistaxis / Haemoptysis

cANCA

Sinusitis, nasal crusting and pulmonary haemorrhage

32
Q

Exudates have a protein level of

33
Q

Treatment of histoplasmosis

A

Amphotericin or itraconazole

Commonly encountered in the Mississippi and Ohio River valleys

34
Q

Management of Granulomatosis with polyangiitis

A

Steroids
Cyclophosphamide (90% response)

Plasma exchange

35
Q

Treatment of choice for allergic bronchopulmonary aspergillosis

A

Oral Glucocorticoids

Oral Itraconazole (2nd line)

36
Q

Allergic bronchopulmonary aspergillosis (ABPA) - define

A

Hypersensitivity reaction to the fungus Aspergillus causing an eosinophilic pneumonia

37
Q

Salmeterol

A

LABA

Long-acting Beta Agonist

38
Q

Treatment of cystic fibrosis patients who are homozygous for the delta F508 mutation

A

Lumacaftor/Ivacaftor (Orkambi)

39
Q

? increases susceptibility to tuberculosis

40
Q

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Antibody?

A

pANCA positive in 60%

41
Q

Drug to prevent acute mountain sickness

A

Acetazolamide (carbonic anhydrase inhibitor)

41
Q

Management of HACE

A

Descent

Dexamethasone

42
Q

Management of HAPE

A

Descent

Nifedipine
Dexamethasone
Acetazolamide,
Phosphodiesterase type V inhibitors

Oxygen if available

43
Q

? is recommended in COPD where there are >=2 exacerbations per year and FEV1<50%

A

Roflumilast - Oral PDE-4 inhibitors

44
Q

Causes of lower zone fibrosis

A

MAID

Most connective tissue diseases (e.g. rheumatoid arthritis)

Asbestosis

Idiopathic pulmonary fibrosis, infection

Drugs (e.g. methotrexate, amiodarone, bleomycin)

45
Q

What drug can precipitate Eosinophilic granulomatosis with polyangiitis

A

Leukotriene receptor antagonists

Churg-Strauss syndrome

46
Q

Causes of upper zone fibrosis:

A

CHARTS

C - Coal worker’s pneumoconiosis

H - Histiocytosis/ hypersensitivity pneumonitis

A - Ankylosing spondylitis

R - Radiation

T - Tuberculosis

S - Silicosis/sarcoidosis

47
Q

Indications for corticosteroid treatment for sarcoidosis

A

Parenchymal lung disease

Uveitis

Hypercalcaemia

Neurological or cardiac involvement

48
Q

How many lobes does the right lung have?

49
Q

PR3

50
Q

MPO

51
Q

Lung Nodule 5-6mm

Nodule >6mm

A

CT at 1 year

CT in 3 months

52
Q

Treatment for MERS

A

Supportive

MRCP 2 (13 decks)

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