Respiratory 3 Flashcards
Which pHTN pathways causes SM hypertrophy and vasoconstriction?
Which pHTN pathways causes vasodilatation and proliferation?
Endothelin = vasoconstriction = increase PVR/PA pressure
NO and prostacyclin = vasodilatation
BMPR2 function?
inhibit SM proliferation - increase NO/ prostacyclin
Type IV - CTEPH - what treatment is indicated?
- surgery
- medical
surgery - pulmonary endartarectomy when have pulmonary oedema ( from pulmonary artery hypertension/obstruction)
Medical therapy = Riociguat
Anticoagulation in pHTN?
Warfarin and only in Type I, IV group
1st VTE episode
thrombophilia screening?
malignancy screening?
thrombophilia - no role if no family history
malignancy - no role if VTE is 1st unprovoked
pleural space pressure?
-3 to -5 cm H20
Clues of esophageal rupture in pleural fluid findings?
High amylase
Intrapleural fibrinolytic regimen?
ten(tPA) = 10 mg
DNase = 5 mg
give for 3 days
Limited or Extensive SCLC treatment
Cisplatin + Etoposide + cranial irradiation
2nd line is - irinotecan
Type 3 respiratory failure features?
Post=operative/sedative = low FRC
SNIP (sniff nasal inspiratory pressure) < 30 cm H20 means?
Diaphragmatic weakness
How NIV help in respiratory failure?
NIV causes increases intrathoracic pressure therefore less blood fills ventricles ( so reduces RV PRELOAD)
NIV increase alveolar recruitment and reduces work of breathing
-hence reduces LV AFTERLOAD
PET CT role in lymph nodes?
Nodes > 10 mm and High specificity for LN metastases
Pirfenidone mechanism in ILD?
side effect?
Acts on TGF-b and reduces fibroblast
Photosensitivity rash!
Nintedanib best use in what form of ILD?
Systemic sclerosis ILD
what form of ILD associated with Common variable immunodeficiency (CVID)?
Granulomatous lymphocytic ILD
clinical features of lymphangio-leiomyomatosis?
Women
Spontaneous pneumothorax
tuberous sclerosis
Renal angiomyolipoma - easily bleed
Systemic sclerosis ILD - what drug has no role in it?
Methotrexate
Telomeropathy
increased turnover clues?
decreased turnover clues?
Increased turnover
- opportunistic infections
- aplastic anemia
Decrease turnover
- anticipation
- osteoporosis/liver cirrhosis
- PULMONARY FIBROSIS/ CAD
Asthma
- early phase what happens?
- late phase what happens?
Early phase - allergen causing mast cell release - histamines/leukotrienes
Late phase - Cytokines causes Th2 mediated response
Lymphocytic ILD has what?
Associated with?
Thin walled cysts!
A/w Sjogren/RA/HIV
What conditions increases Serum alpha AAT and what reduces alpha AAT?
increase
- Infection
- Pregnancy
- OCP
Reduces
- liver disease
- protein-losing enteropathies
Foam cells suggestive of?
Pulmonary interstitial pneumonitis - caused by amiodarone
- Foam cells = alveolar macrophages - contains amiodarone phospholipid complex
Pulmonary embolism - what ABG shows?
CXR shows?
respiratory ALKALOSIS
HYPOCAPNIA
hypoxemia
CXR - normal
Salicylate intoxication- what ABG shows?
Initial = Salicylate trigger respiratory center - hyperventilation
ABG - respiratory ALKALOSIS, HYPOCAPNIA
Only later metabolic acidosis!
Neurosarcoidosis - what cranial nerve usually affected?
5,8 + Optic neuropathy
Cryptogenic organizing pneumonia/BOOP - what see in imaging and pathology?
Imaging - bilateral lower lobe consolidation
Granulation tissue intraluminal - Masson bodies
Lymphangioleiomyomatosis (LAM) - what mutation>
TSC1 and 2 ( hamartin and tuberin) that controls mTORI signalling pathway
- angiomyolipomas ( benign fatty kidney tumor) - can burst and bleed
- lymphangioleiomyomas ( cystic structures in axial lymphatics)
What is Hamman rich syndrome?
-Hamman Rich is a foul idiot - mneumonic
Fulminant form of Idiopathic Interstitial pneumonitis
-rapid progression and respiratory failure
-Key features;
Temporally uniform lesion in lungs CT - lung injury happen at a single point of time
To refer for lung transplant - when DLCO?
DLCO < 40%
Pulmonary Hypertension clinical sign?
Right ventricular heave - Loud P2
Fixed split S2
TR holosystolic murmur
Elevated JVP, peripheral oedema
Pleural fluid in TB - what is found?
ADA > 40% = very sensitive for TB
Asbestosis pleural plaque occurs which part of pleural?
Parietal pleura
Spinal deformity reduces what lung function test parameters?
Elderly reduces what lung function test parameters?
How to elderly compensate for this?
Spinal - Reduced TLC, VC
Elderly - Reduced FRC ( lower lung compliance ) - so increase work of breathing
Increases RR but at low Tidal volume
How does silica exposure prediposes to TB/fungal/Bacteria infection?
Silica particles Impairs macrophages
Beryllium ( Aerospace industry) causes what?
Byssinosis is due to what?
Granulomatous pneumoconiosis - delayed hypersensitivity to beryllium
Byssinosis - cotton dust inhalation
Commonest and best prognosis form of mesothelioma?
Worst prognosis?
Commonest and best prognosis- Epithelioid form
Worst prognosis - Sarcomatoid
Is mesothelioma sensitive to radiotherapy?
Malignant pleural effusion - recurrent. Choice of management?
Yes to moderately high doses of radiation
but only as single therapy
-not really survival benefit if combined with surgery
Talc pleurodesis
First line treatment for hemoptysis - from pulmonary peripheries
-if failed?
pulmonary peripheries - BAE = Bronchial artery embolisation
failed means need surgery!
Urinary legionella antigen test only detects what?
What is suggestive of legionella infection?
Legionella serogroup Type 1
Pneumonia + Diarrhea/ Hyponatremia
Monoclonal antibodies for Th2 asthma ( Benralizumab,mepolizumab,omalizumab) when used?
When failed conventional therapy - last line of treatment
When Serum IgE levels 30 - 700
