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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
Criteria for LTOT
``` pO2 <7.3 Or pO2 7.3 - 8 kPa and one of the following: secondary polycythaemia (high Hb) peripheral oedema pulmonary hypertension ```
26
Mantoux test 4mm diameter
Under 6 -negative, give BCG 6-15 positive, don't give BCG Above 15 tb infection
27
Bacteria related keeping birds
Chlamydia psittacosis Atypical pneumonia Organomegaly Treat with tetracycline
28
diagnosis of adult w ?asthma
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
29
Patient presents with Pneumonia and a Cold sore.. What is likely pathogen?
Streptococcus pneumoniae commonly causes reactivation of the herpes simplex virus resulting in 'cold sores'
30
Patient with dry cough and target lesions
mycoplasma is associated with erythema multiforme - target lesions
31
Lower zone vs upper zone fibrosis causes
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).
32
Bacterial causes of extrinsic allergic alveolitis... Bird fancier lung is caused by...
Avian proteins
33
Bacterial causes of extrinsic allergic alveolitis... Farmers' lung is caused by...
spores of Saccharopolyspora rectivirgula (formerly Micropolyspora faeni).... From contaminated hey
34
Bacterial causes of extrinsic allergic alveolitis... Malt workers' lung is caused by...
Aspergillosis clavatus
35
Bacterial causes of extrinsic allergic alveolitis... Mushroom workers' lung is caused by...
thermophilic actinomycetes
36
Drug causes of lung fibrosis
Amiodarone (1-5% of patients) Nitrofurantoin Methotrexate Bleomycin Lower zone fibrosis
37
Increased risk of lung cancer in smoker with asbestos exposure
10 X 5 =50
38
What is main component of pulmonary surfactant?
dipalmitoyl phosphatidylcholine (DPPC)
39
Patient with upper-mid fibrosis, lymphocytosis on lavage and no eosinophils... diagnosis
Extrinsic allergic alveolitis
40
What occupation predisposes you to tb?
``` Silicosis predisposes, so jobs like mining slate works foundries potteries ```
41
After pleural aspirate what are the three reasons to leave a drain in to drain infected pleural fluid?
Turbid fluid Growth from fluid pH < 7.2
42
Most common organism cause of COPD infection
H influenza Can also be strep pneumonia or moraxella catarrhalis If there is consolidation on cxr then strep pneumoniae is most likely
43
What is alpha 1 anti trypsin
Protease inhibitor of neutrophilic elastase
44
Copd, no features of asthma, not controlled on salbutamol, next step?
LABA + LAMA (Fluticasone or budesonide + tiotropium) IF asthmatic features LABA + ICS
45
Pneumothorax guidelines
Primary pneumothorax : < 2 and no symptom >> discharge and follow. > 2 or symptom >>> first aspiration >> fails drain . For secondary....admit all and: <1cm, admit with oxygen 1-2cm >>> go with Aspiration >>> failed go with drain . Age > 50 and >2cm or symp >>> straight to drain
46
Mnemonic for life threatening asthma
``` 33 92 CHESt PEFR <33 SpO2 <92% Cyanosis, confusion, coma, CO2 falsely normal Hypotension. Exhaustion Silent chest ```
47
Patient with RA gets dyspnoea... Obstructive picture on spirometry
bronchiolitis obliterans | Fibrosis is restrictive
48
29yr Patient presents with chronic cough and haemoptysis. Urinalysis blood++
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
Copd not controlled on salbutamol inhaler. No history of asthma.
Add combined LABA LAMA (Fluticasone or budesonide + tiotropium) If asthma history then add LABA + ICS
50
Lower Vs upper zone fibrosis causes
ACID causes lower, the rest upper Asbestosis Connective tissue disorders Idiopathic pulmonary fibrosis Drugs...... (Amiodarone, bleomycin, methotrexate)
51
Occupational causes of asthma
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
Diagnosis of asthma
Over 17yr everyone should have Spiro w reversibility AND FeNO
53
Altitude, pulmonary oedema, treatment
Descent and nifedipine / dex/ acetazolamide
54
Treatment for allergic bronchopulmonary aspergillosis (ABPA)
Prednisolone | Oral antifungals are often used as an adjunct
55
most common cause of secondary pneumothorax
COPD 50-70% of cases
56
'red-currant jelly' sputum
Klebsiella
57
asthma who are not controlled with a SABA + ICS
Leukotriene R antagonist
58
Lambert-Eaton syndrome. Diagnosis
Small cell Also ADH
59
Asthma, ulnar nerve palsy, eosinophilia
churg Strauss, aka Eosinophilic Granulomatosis with Polyangiitis
60
What drug can trigger chrurg Strauss
Leukotriene receptor antagonists Remember can be mononeuritis
61
Treatment for sarcoid
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
NIV settings
IPAP 10 EPAP 5
63
Contraindications to lung cancer surgery
SVC obstruction, FEV < 1.5 MALIGNANT pleural effusion vocal cord paralysis
64
Bronchiectasis: most common organism
H influenza
65
Lofgren's syndrome
Acute form of sarcoidosis - erythema nodosum - bilateral hilar lymphadenopathy (BHL) - polyarthralgia or polyarthritis Thought to be caused by Ascaris lumbricoides
66
allergic bronchopulmonary aspergillosis features
``` Asthma-like Proximal bronchiectasis Blood eosinophilia Immediate skin reactivity to Aspergillus antigen Increased serum IgE (>1000 IU/ml) ```
67
Heerfordt syndrome
subset of sarcoidosis Combo of: parotid enlargement, fever, and anterior uveitis
68
investigation of choice for upper airway compression
Flow volume loop A normal flow volume loop is often described as a 'triangle on top of a semi circle'
69
Varenicline MOA
nicotinic receptor partial agonist Causes nausea, Contra with suicide, breast feeding/preg
70
Bupropion MOA
a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist also Contra in breast feeding/preg And epilepsy
71
Vital capacity
- maximum volume of air that can be expired after a maximal inspiration 4,500ml in males, 3,500 mls in females
72
When might you get Calcification in lung metastases
uncommon EXCEPT in the case of chondrosarcoma or osteosarcoma.
73
Chest drain triangle of safety
base of the axilla lateral edge pectoralis major 5th intercostal space anterior border of latissimus dorsi
74
What affects transfer factor
raised: asthma, haemorrhage (wegeners), left-to-right shunts, polycythaemia low: everything else anything that reduces alveolar surface area will reduce TLCO... Except asthma
75
Management of bronchiectasis (non CF)
inspiratory muscle training + postural drainage
76
What is not a risk factor for lung cancer....?
Coal dust! | Does cause pneumoconiosis/progressive massive fibrosis though
77
erythema nodosum in sarcoidosis
Is good prognostic factor
78
Transfer factor
Rate of diffusion blood to air So fibrosis/scarring /restrictive would be reduced Pulmonary haemorrhage, hyperaemia, hyperkinetic increases. Asthma
79
Asbestos cancers
Mesothelioma, but also bronchial carcinoma, laryngeal cancer and ovarian cancer.
80
Patient with HIV and PCP. Severe infection
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
flu-like symptoms preceding a dry cough, bilateral consolidation on x-ray, erythematous lesions on his limbs and trunk
Mycoplasma (rash was erythema multiforme)
82
Patient from home w HIV.. SOB, productive cough, septic. coarse crackles on R chest. XR consolidation on RLZ. organism?
Streptococcus pneumoniae (CAP) Remember  Pneumocystis jirovecii tends to present w very few chest signs and bilat consolidation

Mrcp (21 decks)

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