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MCQ knowledge > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Young patient with asthma is commenced on salmeterol, what is a potential side effect?

A

Paradoxically, it can cause an acute exacerbation of asthma possibly due to a hypersensitivity reaction.

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2
Q

True/False: where possible, asthmatics should have early intubation to improve outcomes.

A

False.

Avoid intubating asthmatics if possible, high pressures required and IV salbutamol/magnesium/aminophylline often required.

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3
Q

What base excess would trigger the need for bicarbonate?

A

less than -8

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4
Q

Restrictive lung disease from respiratory muscle weakness leads to what changes to the following parameters:

  1. FEV1
  2. FVC
  3. TLC
  4. RV
  5. RV/TLC
  6. TCO
A
  1. FEV1 - grossly lowered
  2. FVC - grossly lowered
  3. TLC - grossly lowered
  4. RV - high due to weakness
  5. RV/TLC - elevated, due to high RV
  6. TCO - not affected
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5
Q

OSA is risk factor for which 3 other conditions?

A
  1. CVA
  2. HTN
  3. Impaired glucose tolerance / Insulin resistance
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6
Q

What is decompression sickness?

A
  • When a diver returns to the surface gas tensions in the tissue exceed the ambient pressure.
  • This leads to liberation of free gas from the tissues in the form of bubbles.
  • Bubbles cause mischief (organ dysfunction by blocking blood vessels, rupturing or compressing tissue, or activating clotting and inflammatory cascades)
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7
Q

How is decompression sickness treated?

A
  • Hydration
  • O2-Rx (100%)
  • Hyperbaric oxygen therapy
  • Position the patient to improve forward blood flow

Hydrate - Oxygenate - Position

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8
Q

What is nitrogen narcosis?

A
  • Due to raised partial pressure of nitrogen in nervous system tissue, and usually occurs at depths greater than 100 feet
  • Features similar to alcohol or benzodiazepine intoxication.
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9
Q

T/F: diseases in which the uptake of oxygen is reduced across the alveolar-capillary interface cause parallel decreases in uptake of carbon monoxide as measured by DLCO.

A

True

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10
Q

What is the effect of anti-fibrotics Nintedanib and Pirfenidone on the natural history of idiopathic pulmonary fibrosis (IPF).

A

Slow further deterioration of lung function but does NOT reverse parenchymal lung damage.

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11
Q

What is Omalizumab?

When is it indicated?

A
  • Ab that binds to free IgE and prevent cross-linking and allergic inflammation.
  • Treats severe allergic asthma
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12
Q

What is Nintedanib?

When is it indicated (2)?

A

Inhibitor of multiple growth factors:

PDGFR (platelet-derived growth factor)
FGFR (fibroblast growth factor receptor)
VEGFR (vascular endothelial growth factor receptor)

Treatment for:

  1. IPF - antifibrotic effect
  2. Lung cancer - inhibits angiogenesis
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13
Q

What is Pirfenidone?

When is it indicated (1)?

A

Anti-fibrotic and anti-inflammatory due to inhibition of:

fibroblast proliferation
TGF-beta stimulated collagen production
IL-1
TNF-alpha

Treatment for IPF.

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14
Q

What is Montelukast?

When is it indicated (2)?

A

Leukotriene receptor antagonist (LTRA)

Treatment of:

  1. Asthma
  2. Seasonal allergies
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15
Q

What is Mepolizumab?

When is it indicated (1)?

A

mAB to IL-5

Treatment of severe eosinophilic asthma

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16
Q

Patient has cystic fibrosis and requires a lung transplant. Single or bilateral?

A

Bilateral - single lung transplant is CONTRAINDICATED in cystic fibrosis.

17
Q

Patient has a pulmonary function test and is noted to have reduced FEV1/FVC, lung volumes (TLV and RV, RV/TLC also reduced), DLCO and KLCO.

What is the diagnosis?

A

Pulmonary fibrosis

18
Q

Patient presents with fatigue and erythema nodosum with a CXR suggestive of hilar lymphadenopathy. Sarcoidosis is suspected - what associated features might you anticipate?

A
  1. Weight loss and night sweats
  2. Hypercalcaemia
  3. Polyarthritis
19
Q

What effect does emphysema do to residual volume?

A

Increases residual volume

20
Q

Regarding the follow-up of a lung nodule, when should it occur in the following scenarios, also comment on any further investigations required:

  1. less then 4mm
  2. above 4 - 6mm
  3. above 6 - 8mm
  4. above 8mm
A

For LOW risk patients (no smoking/no risk factors):

  1. less then 4mm = no f/u
  2. above 4 - 6mm = 12m +/- no f/u if NAD
  3. above 6 - 8mm = 6-12m the 18-24m
  4. above 8mm = 3,6,9,12 then 24m +/- CT/PET/Bx

If HIGH risk (smoking/other risk factors):

  • then upstage every option e.g. less than 4mm = above 4 - 6mm
  • NB: 6 - 8mm onwards ALL require close f/u +/- further investigations.
21
Q

50% of patient with COPD have reversible airway obstruction - what is the name for this condition?

A

Asthma-COPD overlap syndrome (ACOS)

22
Q

T/F: Inhaled corticosteroid increases the number of beta-2 receptors.

A

True

23
Q

Cystic Fibrosis has which inheritance pattern?

A

AR (Autosomal Recessive)

24
Q

What Abx regimen is required for a VAP (ventilator associated pneumonia) suspects in an ICU patient that was recently extubated:

  1. Less than 5d in ICU and not in shock
  2. More that 5d in ICU +/- shock
A
  1. Less than 5d in ICU and not in shock

Tazocin (pipperacillin/tazobatam) IV for 7d - covers pseudomonas

  1. More that 5d in ICU +/- shock

Tazocin (pipperacillin/tazobatam) - covers pseudomonas
+ Vancomycin IV - covers MDR organisms (e.g MRSA)
+ Gentamicin IV STAT - cover gram negatives

25
Q

Severe eosinophilic asthma may be treated with which monoclonal Ab?

What is the MOA?

A

Mepolizumab = anti-IL5

26
Q

How is A-a gradient calculated?

A

A-a gradient = PAO2 - PaO2

Assuming sea level and patient being on RA:
PAO2 = 150 - (PaCO2/0.8)

Hence:
A-a gradient = [150 - (PaCO2/0.8)] - PaO2

ABGs will give PaCO2 and PaO2 values

27
Q

Given a patient’s age, how is A-a gradient estimated?

A

Estimated A-a gradient = (Age/4) + 4

Normal = below or equal to this estimate

Example: 40yo –> Est. AaG = 40/4 + 4 = 14

28
Q

For the following scenarios is the A-a gradient likely to be normal or elevated:

  1. High altitude
  2. Hypoventilation (benzodiazepines)
  3. Pulmonary fibrosis
  4. PE
  5. Right to left shunt
  6. Left to right shunt
A

Normal (parenchyma unchanged):

  1. High altitude
  2. Hypoventilation (benzodiazepines)

Elevated:

  1. Pulmonary fibrosis - diffusion defect
  2. PE - VQ mismatch
  3. Right to left shunt - severe VQ mismatch due to bypass of lung

Normal (trick)
6. Left to right shunt -

29
Q

Which 2 populations of COPD patients require pneumococcal vaccination?

A
  1. Age > 65 yrs

2. Young patient with chronic heart or lung disease

30
Q

T/F: LABA are superior to LAMA in reducing COPD exacerbation.

A

False - LAMA is superior to LABA

31
Q

T/F: In mild-moderate COPD ICS/LABA combinations are more effective than either component alone in reducing exacerbations and improving lung function.

A

False - this is true for moderate-severe COPD not mild-moderate.

32
Q

If a patient is NOT at sea level and on O2 therapy.

What is the full A-a gradient equation?

A

A-a gradient = [ FiO2 x (Patm - PH2O) - PaCO2/0.8] - PaO2

At sea level and RA:

A-a gradient = [150 - PaCO2/0.8] - PaO2

Where:
PAO2 = FiO2 x (Patm - PH2O) - PaCO2/0.8

On RA: FiO2 = 21% = 0.21
At sea level: Patm = 760 mmHg
Assuming 100% alveoli humidity: PH20 = 47 mmHg

PAO2 = 0.21 x (760 - 47) = 149.73 = approx 150

When not at sea level and on O2 therapy –> insert your given Patm and FiO2 into the above equation.

33
Q

Which of the following are associated with CSA vs. OSA:

  1. Elderly
  2. Low BMI
  3. Low Epworth Sleepiness Scale
  4. Male sex
  5. Self-reported heart failure
A

CSA patients are more likely to be:

  1. Elderly
  2. Low BMI
  3. Low Epworth Sleepiness Scale
  4. Male sex

Thin male old man that is NOT sleep = CSA

OSA patient are more likely to:
5. Self-reported heart failure

MCQ knowledge (22 decks)

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