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Mrcp > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Treatment of pulmonary arterial hypertension

A

IF positive response to acute vasodilator testing then calclium channel blockers… but the majority are negative.
IF neg use prostacyclin analogues: treprostinil, iloprost
or Endothelin receptor antagonist: bosentan

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2
Q

Mechanism of action of endothelin receptor antagonist (eg bosentan)

A

reduce pulmonary vascular resistance leading to reduced right ventricular systolic pressure

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3
Q

Symptoms of pulmonary arterial hypertension

A

Progressive exertional dyspnoea,

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4
Q

Genetic testing of a gentleman with alpha 1 antitrypsin deficiency shows PiMZ, what is the prognosis

A

This is hetrozygous (normal is PiMM) homo is PiSS (50% normal levels) or PiZZ (10% normal levels)

Heterozygous are likely normal so usually 60% normal

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5
Q

Genetic testing of a gentleman with alpha 1 antitrypsin deficiency shows PiMZ, what is the prognosis

A

This is hetrozygous (normal is PiMM) homo is PiSS (50% normal levels) or PiZZ (10% normal levels)

Heterozygous are likely normal so usually 60% normal

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6
Q

Oxygen dissociation curve left Vs right

A

Shift Left .. Lower oxygen delivery - Lower acidity, temp, 2-3 DPG, HbF, carboxy/methaemoglobin levels

shift Right … Raised oxygen delivery - Raised acidity, temp 2-3 DPG, raised CO2

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7
Q

How do you diagnose pulmonary hypertension

A

Cardiac catheterisation, to measure right heart pressure

Raised if greater than 25mmHg at rest or 30mmHg after exercise

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8
Q

What is hering bruer reflex

A

Stretch receptors - distension causing slowing of resp rate

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9
Q

What is hering bruer reflex

A

Stretch receptors - distension causing slowing of resp rate

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10
Q

Most common occupational cause of asthma exacerbation

A

Isocyanates eg spray painting and foam moulding using adhesives

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11
Q

Most common lung cancer in non smokers

A

Adenocarcinoma

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12
Q

Treatment for latent TB

A

Three months of isoniazid and rifampicin

Or six months of isoniazid

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13
Q

Diabetic Thai gentleman with cough and progressive SOB. Extremely unwell. BC burkhoideria pseudomallei. Diagnosis and treatment

A

Melioidosis and iv ceftrazadine

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14
Q

Pneumonia after the flu causative organism.

A

Staphylococcus aureus or mycoplasma or legionella

Both bilateral consolidation. Mycoplasma usually younger and dry cough with erythema multiform.

Legionella hyponatremia

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15
Q

Legionella Vs Mycoplasma

A

Both treated with macrolides like erythromycin.

Both have flu like proceed and dry cough.
Legionella has hyponatremia
Mycoplasma has haemolytic anaemia and erythema multiform

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16
Q

Egg shell calcification of hilar LN is classic sign for

A

Silicosis (with multiple well rounded nodules in your zone)

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17
Q

Lung cancer with hyponatremia

A

Small cell… Occurs because of ectopic ADH secretion

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18
Q

when do you start LTOT with COPD

A

COPD - LTOT if 2 ABG measurements of pO2 < 7.3 kPa
OR to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia (so high Hb)
peripheral oedema
pulmonary hypertension

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19
Q

Which organism can cause cavitation lesions in pneumonia

A

Staphylococcus aureus can do, especially when caused by strains capable of making cytotoxin panton valentine leukocidin.

Klebsiella can too (alcoholism)
And TB (drawn out subacute presentation)
Squamous cell carcinoma (smoking history) other cancer too but not as much

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20
Q

Treatment for pneumocystis jirovecii

A

Co-trimoxazole (septrin) or IV pentamidine in servere cases

Prednisolone if hypoxic

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21
Q

What produces surfactant

A

Type 2 pneumocystes…

functioning component is dipalmitoyl phosphatidylcholine (DPPC) which reduces alveolar surface tension.

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22
Q

Treatment for end stage lung disease in alpha 1 anti trypsin

A

Lung volume reduction surgery
,-removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung.

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23
Q

Patient in ED with multi drug resistant tb is trying to leave and has capacity

A

Tough! They can be detained under public health section.

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24
Q

Pneumothorax guidelines

A

If primary, under 2cm and no SOB then discharge
If not then aspirate
If that fails (>2 or still SOB) then chest drain

If secondary over 2cm and over 50yr then drain
If 1-2 aspirate and admit for 24hr.
If that fails then drain
If less than 1cm then admit for 24hr

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25
Q

Criteria for LTOT

A 
pO2 <7.3
Or pO2 7.3 - 8 kPa and one of the following:
secondary polycythaemia (high Hb)
peripheral oedema
pulmonary hypertension
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26
Q

Mantoux test 4mm diameter

A

Under 6 -negative, give BCG
6-15 positive, don’t give BCG
Above 15 tb infection

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27
Q

Bacteria related keeping birds

A

Chlamydia psittacosis
Atypical pneumonia
Organomegaly

Treat with tetracycline

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28
Q

diagnosis of adult w ?asthma

A

Adults with suspected asthma should have both a FeNO test and spirometry with reversibility

also referred to a specialist as possible occupational asthma if worse at work

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29
Q

Patient presents with Pneumonia and a Cold sore.. What is likely pathogen?

A

Streptococcus pneumoniae commonly causes reactivation of the herpes simplex virus resulting in ‘cold sores’

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30
Q

Patient with dry cough and target lesions

A

mycoplasma is associated with erythema multiforme - target lesions

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31
Q

Lower zone vs upper zone fibrosis causes

A

Extrinsic allergic alveolitis, tuberculosis, silicosis and sarcoidosis all predominantly cause upper zone fibrosis.

ACID causes lower, the rest upper

Asbestosis
Connective tissue disorders
Idiopathic pulmonary fibrosis
Drugs…… (Amiodarone, bleomycin, methotrexate).

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32
Q

Bacterial causes of extrinsic allergic alveolitis… Bird fancier lung is caused by…

A

Avian proteins

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33
Q

Bacterial causes of extrinsic allergic alveolitis… Farmers’ lung is caused by…

A

spores of Saccharopolyspora rectivirgula (formerly Micropolyspora faeni)…. From contaminated hey

34
Q

Bacterial causes of extrinsic allergic alveolitis… Malt workers’ lung is caused by…

A

Aspergillosis clavatus

35
Q

Bacterial causes of extrinsic allergic alveolitis… Mushroom workers’ lung is caused by…

A

thermophilic actinomycetes

36
Q

Drug causes of lung fibrosis

A

Amiodarone (1-5% of patients)
Nitrofurantoin
Methotrexate
Bleomycin

Lower zone fibrosis

37
Q

Increased risk of lung cancer in smoker with asbestos exposure

A

10 X 5 =50

38
Q

What is main component of pulmonary surfactant?

A

dipalmitoyl phosphatidylcholine (DPPC)

39
Q

Patient with upper-mid fibrosis, lymphocytosis on lavage and no eosinophils… diagnosis

A

Extrinsic allergic alveolitis

40
Q

What occupation predisposes you to tb?

A 
Silicosis predisposes, so jobs like 
mining
slate works
foundries
potteries
41
Q

After pleural aspirate what are the three reasons to leave a drain in to drain infected pleural fluid?

A

Turbid fluid
Growth from fluid
pH < 7.2

42
Q

Most common organism cause of COPD infection

A

H influenza

Can also be strep pneumonia or moraxella catarrhalis

If there is consolidation on cxr then strep pneumoniae is most likely

43
Q

What is alpha 1 anti trypsin

A

Protease inhibitor of neutrophilic elastase

44
Q

Copd, no features of asthma, not controlled on salbutamol, next step?

A

LABA + LAMA

(Fluticasone or budesonide + tiotropium)

IF asthmatic features LABA + ICS

45
Q

Pneumothorax guidelines

A

Primary pneumothorax :
< 2 and no symptom&raquo_space; discharge and follow.
> 2 or symptom&raquo_space;> first aspiration&raquo_space; fails drain .

For secondary….admit all and:
<1cm, admit with oxygen
1-2cm &raquo_space;> go with Aspiration&raquo_space;> failed go with drain .
Age > 50 and >2cm or symp &raquo_space;> straight to drain

46
Q

Mnemonic for life threatening asthma

A 
33 92 CHESt
PEFR <33
SpO2 <92%
Cyanosis, confusion, coma, CO2 falsely normal
Hypotension.
Exhaustion
Silent chest
47
Q

Patient with RA gets dyspnoea… Obstructive picture on spirometry

A

bronchiolitis obliterans

Fibrosis is restrictive

48
Q

29yr Patient presents with chronic cough and haemoptysis. Urinalysis blood++

A

goodpastures… Pulmonary haemorrhages, longer history

Differences clues ….
1-Age : wegners 40+, churgs 50, good pasture <30 and then >60…
2- wegners epistaxis/sinusitis and renal failure, good pasture to pulmonary haemorrhage, churg eiosinophilia

49
Q

Copd not controlled on salbutamol inhaler. No history of asthma.

A

Add combined LABA LAMA

(Fluticasone or budesonide + tiotropium)

If asthma history then add LABA + ICS

50
Q

Lower Vs upper zone fibrosis causes

A

ACID causes lower, the rest upper

Asbestosis
Connective tissue disorders
Idiopathic pulmonary fibrosis
Drugs…… (Amiodarone, bleomycin, methotrexate)

51
Q

Occupational causes of asthma

A

GF works at PEPSI factory and comes home every day with asthma symptoms

GF— Glutaraldehyede. Flour
PEPSi :
Platinum salt
Epoxy resins
Proteiolytic enzymes
Soldering flux resins
Isocynayes
52
Q

Diagnosis of asthma

A

Over 17yr everyone should have Spiro w reversibility AND FeNO

53
Q

Altitude, pulmonary oedema, treatment

A

Descent and nifedipine / dex/ acetazolamide

54
Q

Treatment for allergic bronchopulmonary aspergillosis (ABPA)

A

Prednisolone

Oral antifungals are often used as an adjunct

55
Q

most common cause of secondary pneumothorax

A

COPD 50-70% of cases

56
Q

‘red-currant jelly’ sputum

A

Klebsiella

57
Q

asthma who are not controlled with a SABA + ICS

A

Leukotriene R antagonist

58
Q

Lambert-Eaton syndrome. Diagnosis

A

Small cell

Also ADH

59
Q

Asthma, ulnar nerve palsy, eosinophilia

A

churg Strauss, aka Eosinophilic Granulomatosis with Polyangiitis

60
Q

What drug can trigger chrurg Strauss

A

Leukotriene receptor antagonists

Remember can be mononeuritis

61
Q

Treatment for sarcoid

A

Oral corticosteroids

Treat if hypercal
Eye, heart or neuro inv
stage 2 or 3 disease on XR who are symptomatic

1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis
62
Q

NIV settings

A

IPAP 10 EPAP 5

63
Q

Contraindications to lung cancer surgery

A

SVC obstruction,
FEV < 1.5
MALIGNANT pleural effusion
vocal cord paralysis

64
Q

Bronchiectasis: most common organism

A

H influenza

65
Q

Lofgren’s syndrome

A

Acute form of sarcoidosis

  • erythema nodosum
  • bilateral hilar lymphadenopathy (BHL)
  • polyarthralgia or polyarthritis

Thought to be caused by Ascaris lumbricoides

66
Q

allergic bronchopulmonary aspergillosis features

A 
Asthma-like
Proximal bronchiectasis
Blood eosinophilia
Immediate skin reactivity to Aspergillus antigen
Increased serum IgE (>1000 IU/ml)
67
Q

Heerfordt syndrome

A

subset of sarcoidosis

Combo of:
parotid enlargement, fever, and anterior uveitis

68
Q

investigation of choice for upper airway compression

A

Flow volume loop

A normal flow volume loop is often described as a ‘triangle on top of a semi circle’

69
Q

Varenicline MOA

A

nicotinic receptor partial agonist

Causes nausea, Contra with suicide, breast feeding/preg

70
Q

Bupropion MOA

A

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

also Contra in breast feeding/preg
And epilepsy

71
Q

Vital capacity

A
  • maximum volume of air that can be expired after a maximal inspiration

4,500ml in males, 3,500 mls in females

72
Q

When might you get Calcification in lung metastases

A

uncommon EXCEPT in the case of chondrosarcoma or osteosarcoma.

73
Q

Chest drain triangle of safety

A

base of the axilla
lateral edge pectoralis major
5th intercostal space
anterior border of latissimus dorsi

74
Q

What affects transfer factor

A

raised: asthma, haemorrhage (wegeners), left-to-right shunts, polycythaemia
low: everything else

anything that reduces alveolar surface area will reduce TLCO… Except asthma

75
Q

Management of bronchiectasis (non CF)

A

inspiratory muscle training + postural drainage

76
Q

What is not a risk factor for lung cancer….?

A

Coal dust!

Does cause pneumoconiosis/progressive massive fibrosis though

77
Q

erythema nodosum in sarcoidosis

A

Is good prognostic factor

78
Q

Transfer factor

A

Rate of diffusion blood to air

So fibrosis/scarring /restrictive would be reduced

Pulmonary haemorrhage, hyperaemia, hyperkinetic increases. Asthma

79
Q

Asbestos cancers

A

Mesothelioma, but also bronchial carcinoma, laryngeal cancer and ovarian cancer.

80
Q

Patient with HIV and PCP. Severe infection

A

usually Co-trimoxazole
But if severe IV pentamidine
Also give prednisolone if severe hypoxaemia

Can give pentamidine aerosol as prophylaxis but there is risk of pneumothorax

81
Q

flu-like symptoms preceding a dry cough, bilateral consolidation on x-ray,
erythematous lesions on his limbs and trunk

A

Mycoplasma (rash was erythema multiforme)

82
Q

Patient from home w HIV.. SOB, productive cough, septic. coarse crackles on R chest. XR consolidation on RLZ. organism?

A

Streptococcus pneumoniae (CAP)

Remember Pneumocystis jiroveciitends to present w very few chest signs and bilat consolidation

Mrcp (21 decks)

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