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MRCP 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

indication for chest drain in pts with pleural effusion

A

turbid/cloudy aspirate

aspirate pH <7.2 in association with ?pneumonia

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2
Q

characteristic pleural fluid findings, what is the cause
low glucose
raised amylase
heavy blood staining

A

low glucose: Rheumatoid arthritis, TB
raised amylase: pancreatitis, oesophageal perf
blood: mesothelioma, PE, TB

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3
Q

what is Light’s criteria?

A

exudate if >1 of:
pleural protein / serum protein >0.5
pleural LDH / serum LDH >0.6
pleural LDH > 2/3rds upper limit of normal serum LDH

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4
Q

paraneoplastic features of squamous cell lung cancer

A

PTH-related protein secretion -> hypercalcaemia
clubbing
ectopic TSH production
hypertrophic pulmonary osteoarthropathy (HPOA)

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5
Q

paraneoplastic features of small cell lung cancer

A

Lambert-Eaton syndrome
SIADH
ACTH

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6
Q

what is the marker for COPD disease progression

A 
FEV1
>80% - mild
79 - 50% - mod
49 - 30% - severe
<30% - very severe
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7
Q

Mx of acute asthma

A

100% O2
neb salbutamol and neb ipratropium
IV magnesium sulphate 1.2-2g IV over 20mins
IV salbutamol

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8
Q

Mx of primary pneumothorax

A

air rim <2cm and not SOB - ?d/c
aspiration
if failed, chest drain

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9
Q

Mx of secondary pneumothorax

A

if >50 and SOB +/or rim >2cm –> chest drain
aspiration if 1-2cm rim
all pts should be admitted for 24hours and given O2

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10
Q

alpha-1 antitripsin deficiency
pathology
inheritance - which chrom?
features

A

lack of protease inhibitor
autosomal recessive - chrom 14
panacinar emphysema worse in lower lobes
liver cirrhosis and hepatocellular carcinoma

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11
Q

Mx of alpha-1 antitripsin deficiency

A

stop smoking
supportive: physio, bronchodilators
IV A1AT concentrates
volume reduction surgery, transplant.

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12
Q

pathology and features of Kartagener’s syndrome

A

primary ciliary dyskinesia

dextrocardia or sinus inversus
bronchiectasis
recurrent sinusitis
subfertility

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13
Q

when should HIV patients get PCP prophylaxis

A

when CD4 count <200

oral co-trimoxazole

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14
Q

features of PCP

A 
dyspnoea
dry cough
fever
few chest signs
pneumothorax is a common complication
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15
Q

Ix in PCP

A

CXR - bilateral intersitial pulmonary infiltrates
exercise induced desaturation
bronchiolavage needed as sputum often fails to show PCP (silver stain)

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16
Q

Mx of PCP

A

co-trimoxazole
IV pentamidine if severe
steroids if hypoxic

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17
Q

indication of thrombolysis in PE

A

hypotension

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18
Q

length of warfarin in pts with PE

A

3 months if identified cause
6 months if unprovoked
long term LMWH if active cancer

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19
Q

when should NIV be considered in COPD

A

when pH 7.25 - 7.35

if pH <7.25 then invasive ventilation should be considered.

20
Q

key indications for NIV

A

resp acidosis in COPD pH 7.25 - 7.35
type 2 RF 2ndary to chest wall deformity, neuromuscular disease or OSA
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation

21
Q

indications for steroids in sarcoidosis

A

hypercalcaemia
worsening lung function
eye, heart or neuro involvement

22
Q

most common lung cancer in non-smokers

A

lung adenocarcinoma - normally peripheral lesion

23
Q

define idiopathic pulmonary arterial hypertension (IPAH)

features

A

pulmonary pressure >25mmHg at rest, >30 in exercise
more common in females 20-40, progressive SOB, cyanosis, R ventricular heave, loud P2, raised JVP with prominent ‘a’ waves, tricuspid regurg

24
Q

Mx of idiopathic pulmonary arterial hypertension (IPAH)?

A

diuretics if RHF
anticoagulate
CCB, bosentan (endothelin-1 r antagonist) [TERATOGENIC], IV prostoglandins
heart-lung transplant.

25
Q

classical organism causing CAP in alcoholics

A

Klebsiella

26
Q

Causes of lower lobe lung fibrosis

A

drugs
CT disease (except ank spond)
cryptogenic fibrosing alveolitis
asbestosis

The rest is upper lobes (sarcoid, coalminers, EAA, TB, silicosis)

27
Q

most common type of lung cancer to cause cavitating lesions

A

squamous cell

28
Q

DDx for cavitating lung lesion on CXR?

A

bacterial abscess: (staph, klebsiella, pseudomonas)
infection: TB, fungal (aspergillosis, histoplasmosis, coccidioidomycosis)
ca (most common cavitating is squamous)
inflamm: RA, Wegener’s granulomatosis
PE

29
Q

What is the expected FEV1/FVC in a restrictive lung disease?

A

normal or increased (>80%)

reduced FEV1/FVC in obstructive lung disease

30
Q

examples of obstructive lung disease

A

asthma
COPD
bronchiectasis
bronchiolitis obliterans (seen in RA)

31
Q

examples of restrictive lung disease

A 
pulmonary fibrosis
asbestosis and Caplan's syndrome (coal dust exposure)
sarcoidosis
ARDS
kyphoscoliosis
neuromuscular disorders
32
Q

mainstay of treatment for small cell lung cancer

A

chemotherapy +/- adjuvant radiotherapy

33
Q

What is Lofgren syndrome?

features?

A

acute sarcoidosis

fever, bilateral hilar lymphadenopathy, polyarthralgia and erythema nodosum (painful shin nodules)

34
Q

what is the organism responsible for farmer’s lung?

A

Saccharopolyspora rectivirgula

35
Q

most common organism for COPD exacerbation?

A

Haemophilus influenzae

36
Q

What is the indication for Rivaroxaban?

A

Treatment and prophylaxis of DVT and PE

15mg BD for 21 days then 20mg OD for 3/6 months

37
Q

Mechanism of action of rivaroxaban

A

Factor Xa antagonist therefore decreases likelihood of thrombosis
Factor Xa activates prothrombin -> thrombin

38
Q

mechanism of action of varenicline

A

nicotine r partial agonist
start 1 week prior to stop date
SE:nausea, h/a, insomnia, weird dreams
C/I in preg and breastfeeding

39
Q

mechanism of action of bupropion

A

NA and dopamine reuptake i and nicotine r antagonist
start 1-2w prior to stop date
small risk of seizures
C/I in epilepsy, preg and breastfeeding, relative C/I in eating disorders.

40
Q

Mx of smoking in pregnant woman

A

CBT/structured self help/motivational interviewing 1st line
NRT 2nd line

(bupropion (NA and D reuptake i and nicotine ant) and varenicline (nicotine partial ag) are C/I)

41
Q

indications for home oxygen in COPD pts

A

PaO2 <7.3
or PaO2 7.3-8 with:
secondary polycythemia
clinical or echo evidence of pulmonary HTN

42
Q

features of legionella dz
Dx
Mx

A

dry cough, few chest signs, hyponatraemia, derranged LFTs
Dx by urinary antigen
Mx erythromycin

43
Q

How do you diagnose cystic fibrosis?

A

Sweat sodium level >60mmol/l

44
Q

causes of raised TLCO

A 
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
45
Q

causes of decreased TLCO

A 
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

MRCP 1 (15 decks)

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