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Specialities > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is A1AT?
Features?
Pathophysiology and inheritance?

A

Alpha-1 antitrypsin deficiency - AR or co-dominant inhertiance.
Lack of protease inhibitor normally produced by the liver -> panacinar emphysema, esp in lower lobes.
Cirrhosis and hepatocelluar ca in adults, cholestasis in children.

Often misdiagnosed as asthma or COPD.

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2
Q

What would you expect on a blood gas of someone in DKA?

A

Metabolic acidosis, with increased anion gap (due to ketones)

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3
Q

At what pO2 would you offer someone with COPD long-term O2 therapy?

A 
pO2 <7.3 kPa 
OR
7.3-8kPa with:
- secondary polycythaemia
- nocturnal hypoxaemia
- peripheral oedema
- pulmonary HTN
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4
Q

Varenicline or buproprion are prescribed as nicotine replacement therapy - how do they work?

A

Varenicline: nicotinic receptor partial agonist

Bupropion: NA and dopamine reuptake inhibitor, nicotinic antagonist

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5
Q

What is the most common sign seen on CXR when a patient has been exposed to asbestos in the past?

A

Pleural plaques - these are BENIGN and do not undergo malignant change. Generally occur after latent period 20-40 years

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6
Q

What is the most common form of cancer following asbestos exposure?

A

Bronchial carcinoma (more common than mesothelioma but has other causes)

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7
Q

What are the next steps in management for a patient with COPD that is still breathless despite first-line (SABA or SAMA) use?
How does this differ by FEV1?

A

FEV1 >50:
- LABA
or
- LAMA

FEV1 <50:
- LABA + ICS combo
or
- LAMA

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8
Q

What is the mx of cor pulmonale?

A

Loop diuretic for oedema

Consider LT O2.

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9
Q

What if a COPD patient is still breathless despite 2nd line therapy?
What if even this is ineffective? What if people can’t tolerate inhaled therapy?

A

If taking LABA then switch to LABA + ICS combo

If taking LAMA then add LABA + ICS combo

4: Trial theophylline (reduce dose if macrolide or fluoroquinolone abx co-prescribed)

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10
Q

What would the combination of ENT, respiratory and kidney involvement in a patient suggest?

A

Granulomatosis with polyangiitis (GPA) - formerly Wegener’s.

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11
Q

What are the features of Granulomatosis with polyangiitis?

A

(= autoimmune necrotising granulomatous vasculitis)

  • URT: Epistaxis, sinusitis, nasal crusting
  • LRT: Dyspnoea, haemoptysis
  • Rapidly progressive glomerulonephritis
  • Saddle-shape nose deformity
  • Vasculitic rash, eye involvment, CN lesions
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12
Q

What do cANCA classically relate to?

A

(cytoplasmic antineutrophil cytoplasmic antibodies)

Granulomatosis with polyangiitis

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13
Q

What do pANCA classically relate to?

A

(perinuclear antineutrophil cytoplasmic antibodies)
Churg-Strauss

(25% Gran with poly are cANA positive)

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14
Q

What would epithelial crescents in Bowman’s capsule on renal biopsy suggest?

A

Granulomatosis with polyangiitis

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15
Q

What is the mx of granulomatosis with polyangitis?

A

-Steroid
- Cyclophosphamide (90% response)
- Plasma exchange
Median survival is 8-9 years

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16
Q

What is the Ix of suspected asthma in adults?

A

All patients should:

  • Spirometry with bronchodilator reversibility test (BDR)
  • FeNO test (fractional exhaled nitric oxide - levels correlate with levels of inflammation)
17
Q

What is the combination of erythema nodusum and bilateral hilar lymphadenopathy on CXR pathognomonic of?
What other features might they have?

A

Sarcoidosis

  • Swinging fever
  • Polyarthralgia
  • Hypercalcaemia
  • Raised serum ACE
  • Uveitis
  • Insidious: dyspnoea, non-productive cough, malaise, weight loss
18
Q

What are the feature of Churg-Strauss syndrome?

A
  • Asthma
  • Eosinophilia (>10%)
  • Paranasal sinusitis
  • Mononeuritis multiplex
  • 60% pANCA +ve
19
Q

What is Samter’s triad?

A

Aspirin sensitive asthma:

  • Nasal polyps
  • Sensitivity to NSAIDs
  • Asthma
20
Q

What is the stepwise mx of asthma?

A

1: SABA
2: (or 1 if newly-diagnosed + symptoms >= 3 / week or night-time waking) SABA + low-dose ICS
3: SABA, low-dose ICS, LTRA
4: SABA, low-dose ICS LABA, continue LTRA depending on response
5: SABA +/- LTRA. Switch ICS/LABA for MART including low-dose ICS
6: SABA +/- LTRA + medium-dose ICS MART
7: SABA +/- LTRA + one of:
- High-dose ICS
- Trial LAMA or theophylline
- Refer

21
Q

What are the main contradictions to surgery in non-small cell ca?

A
  • SVC obstruction
  • FEV <1.5
  • Malignant pleural effusion
  • Vocal cord paralysis
  • Mets
  • General poor health
22
Q

When would you consider invasive ventilation in COPD when medical therapy is ineffective?

A

If pH <7.25

7.25-7.35 NIV - BiPAP

23
Q

What would be the typical x-ray and hx for aspergilloma?

A

Haemoptysis - may be severe.
Rounded opacity on CXR.

Past hx of TB, sarcoid, bronchiectasis, CF… i.e. anything causing a cavity.

24
Q

How does mitral stenosis cause haemoptysis?

What else would you find O/E?

A

Pulmonary congestion -> bronchial vein rupture, due to back pressure in LA

  • Dyspnoea
  • AF
  • Malar flush on cheeks
  • Mid-diastolic murmur
25
Q

How would you exclude cardiogenic pulmonary oedema in suspected ARDS?

A

Pulmonary capillary wedge pressure <18 mmHg

26
Q

What would you do if you suspected occupational asthma?

A
  • Serial measurements of peak flow at work and away from work
  • Refer to specialist
    (Isocyanates are most common cause - spray painting and foam moulding)
27
Q

What is the most important advice to give a patient following a primary pneumothorax in terms of preventing further?

A

Stop smoking (10% risk vs 0.1%)

28
Q

How do you differentiate acute and chronic respiratory acidosis?

A

Bicarbonate - high in chronic as metabolic compensation.

29
Q

What type of lung ca is most likely to cause a paraneoplastic syndrome?

A

Small cell.

30
Q

What is the most appropriate action to ensure settling of an asthma exacerbation?

A

Salbutamol nebs

Pred 40mg OD for 5 days

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