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Respiratory 3 Flashcards

1
Q

Which pHTN pathways causes SM hypertrophy and vasoconstriction?

Which pHTN pathways causes vasodilatation and proliferation?

A

Endothelin = vasoconstriction = increase PVR/PA pressure

NO and prostacyclin = vasodilatation

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2
Q

BMPR2 function?

A

inhibit SM proliferation - increase NO/ prostacyclin

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3
Q

Type IV - CTEPH - what treatment is indicated?

  • surgery
  • medical
A

surgery - pulmonary endartarectomy when have pulmonary oedema ( from pulmonary artery hypertension/obstruction)

Medical therapy = Riociguat

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4
Q

Anticoagulation in pHTN?

A

Warfarin and only in Type I, IV group

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5
Q

1st VTE episode
thrombophilia screening?
malignancy screening?

A

thrombophilia - no role if no family history

malignancy - no role if VTE is 1st unprovoked

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6
Q

pleural space pressure?

A

-3 to -5 cm H20

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7
Q

Clues of esophageal rupture in pleural fluid findings?

A

High amylase

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8
Q

Intrapleural fibrinolytic regimen?

A

ten(tPA) = 10 mg
DNase = 5 mg
give for 3 days

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9
Q

Limited or Extensive SCLC treatment

A

Cisplatin + Etoposide + cranial irradiation

2nd line is - irinotecan

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10
Q

Type 3 respiratory failure features?

A

Post=operative/sedative = low FRC

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11
Q

SNIP (sniff nasal inspiratory pressure) < 30 cm H20 means?

A

Diaphragmatic weakness

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12
Q

How NIV help in respiratory failure?

A

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

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13
Q

PET CT role in lymph nodes?

A

Nodes > 10 mm and High specificity for LN metastases

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14
Q

Pirfenidone mechanism in ILD?

side effect?

A

Acts on TGF-b and reduces fibroblast

Photosensitivity rash!

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15
Q

Nintedanib best use in what form of ILD?

A

Systemic sclerosis ILD

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16
Q

what form of ILD associated with Common variable immunodeficiency (CVID)?

A

Granulomatous lymphocytic ILD

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17
Q

clinical features of lymphangio-leiomyomatosis?

A

Women
Spontaneous pneumothorax
tuberous sclerosis
Renal angiomyolipoma - easily bleed

18
Q

Systemic sclerosis ILD - what drug has no role in it?

A

Methotrexate

19
Q

Telomeropathy
increased turnover clues?
decreased turnover clues?

A

Increased turnover

  • opportunistic infections
  • aplastic anemia

Decrease turnover

  • anticipation
  • osteoporosis/liver cirrhosis
  • PULMONARY FIBROSIS/ CAD
20
Q

Asthma

  • early phase what happens?
  • late phase what happens?
A

Early phase - allergen causing mast cell release - histamines/leukotrienes

Late phase - Cytokines causes Th2 mediated response

21
Q

Lymphocytic ILD has what?

Associated with?

A

Thin walled cysts!

A/w Sjogren/RA/HIV

22
Q

What conditions increases Serum alpha AAT and what reduces alpha AAT?

A

increase

  • Infection
  • Pregnancy
  • OCP

Reduces

  • liver disease
  • protein-losing enteropathies
23
Q

Foam cells suggestive of?

A

Pulmonary interstitial pneumonitis - caused by amiodarone

- Foam cells = alveolar macrophages - contains amiodarone phospholipid complex

24
Q

Pulmonary embolism - what ABG shows?

CXR shows?

A

respiratory ALKALOSIS
HYPOCAPNIA
hypoxemia

CXR - normal

25
Salicylate intoxication- what ABG shows?
Initial = Salicylate trigger respiratory center - hyperventilation ABG - respiratory ALKALOSIS, HYPOCAPNIA Only later metabolic acidosis!
26
Neurosarcoidosis - what cranial nerve usually affected?
5,8 + Optic neuropathy
27
Cryptogenic organizing pneumonia/BOOP - what see in imaging and pathology?
Imaging - bilateral lower lobe consolidation Granulation tissue intraluminal - Masson bodies
28
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)
29
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
30
To refer for lung transplant - when DLCO?
DLCO < 40%
31
Pulmonary Hypertension clinical sign?
Right ventricular heave - Loud P2 Fixed split S2 TR holosystolic murmur Elevated JVP, peripheral oedema
32
Pleural fluid in TB - what is found?
ADA > 40% = very sensitive for TB
33
Asbestosis pleural plaque occurs which part of pleural?
Parietal pleura
34
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
35
How does silica exposure prediposes to TB/fungal/Bacteria infection?
Silica particles Impairs macrophages
36
Beryllium ( Aerospace industry) causes what? Byssinosis is due to what?
Granulomatous pneumoconiosis - delayed hypersensitivity to beryllium Byssinosis - cotton dust inhalation
37
Commonest and best prognosis form of mesothelioma? | Worst prognosis?
Commonest and best prognosis- Epithelioid form Worst prognosis - Sarcomatoid
38
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
39
First line treatment for hemoptysis - from pulmonary peripheries -if failed?
pulmonary peripheries - BAE = Bronchial artery embolisation failed means need surgery!
40
Urinary legionella antigen test only detects what? What is suggestive of legionella infection?
Legionella serogroup Type 1 Pneumonia + Diarrhea/ Hyponatremia
41
Monoclonal antibodies for Th2 asthma ( Benralizumab,mepolizumab,omalizumab) when used?
When failed conventional therapy - last line of treatment When Serum IgE levels 30 - 700

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