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FRACP NOSH 2020 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How many generations of airways from trachea to alveoli?

How many have cartilage support?

A

23 generations total

16 have cartilage

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2
Q

What is the gene involved in AAT deficiency?

Which alleles are highest risk for cirrhosis?

Which are highest risk for emphysema?

A

Gene is called SERPINA1 on chromosome 14

Usually occurs in those homozygous for Z or M(malton) alleles

ZZ homozygotes ot ‘null’ alleles

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3
Q

What is the mechanism of COPD development in AAT deficiency?

A

Results from imbalance between neutrophil elastase in lung, and AAT

  • Increased elastase burden
  • Increased destruction of elastin
  • Lung proteolytic degradation
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4
Q

What is the function of alpha-1 trypsin?

A

AAT is a protease inhibitor, which inhibits elastase.

Thus deficiency leads to excessive elastin destruction

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5
Q

What is “Samter’s Triad” in AERD?

A

Nasal polyps, asthma, and sensitivity to aspirin

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6
Q

What is the main substance implicated in AERD?

A

Leukotrienes

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7
Q

What does high FENO indicate?

A

Predicts response to ICS

Measure of eosinophilic inflammation

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8
Q

What is the most effective strategy to halt progress in COPD?

A

Smoking cessation

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9
Q

What are the 3 interventions in COPD with mortality benefit?

A

Smoking cessation
Long term O2 therapy if meeting criteria
Transplant / lung reduction surgery

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10
Q

PaO2 cut offs for home O2?

A 
PaO2 <55
PaO2 <60 in
- RHF
- Pulmonary HTN
- Secondary polycythaemia
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11
Q

Most common side effect of ICS?

A

Hoarse voice

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12
Q

Most common bacterial cause of COPD exacerbation?

A

Haemophilus influenzae

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13
Q

What is the BODE Index?

A

Predictor of mortality in COPD

B - BMI low
O - Obstruction (FEV1)
D - Dyspnoea score
E - exercise tolerance

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14
Q

MOst common genetic mutation in Type 1 pulm HTN?

A

Bone morphogenetic protein receptor type 2 (BMPR2) mutations

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15
Q

Most common genetic mutation in Type 1 pulm HTN?

A

Bone morphogenetic protein receptor type 2 (BMPR2) mutations

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16
Q

What is the most common genetic mutation in CF?

A

Delta F508

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17
Q

What does the CFTR protein do when functioning normally?

A

CFTR protein functions mainly as a chloride channel

  • also regulates activity of other chloride and sodium channels on cell surface
  • Active at the apical membrane of epithelial cells
  • Regulates movement of sodium and water across cell membrane
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18
Q

What are the mechanisms of hypoxia which will give a raised A-a gradient?

A

V/Q mismatch
Shunt
Diffusion abnormality

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19
Q

What is the equation for A-a gradient calculation?

A

[150 - (PaCO2 x 1.25)] - PaO2

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20
Q

What is a normal A-a gradient?

A

Should be around Age/4 + 4

21
Q

What are the mechanisms of hypoxia which will give a normal A-a gradient?

A

Hypoventilation

Low FiO2

22
Q

What are the two main mechanisms for hypercapnia?

A

Decreased minute ventilation

Increased dead space

23
Q

What are the 2 main mechanisms for decreased minute ventilation?

A

“can’t breathe” - decreased respiratory drive

“won’t breathe” - decreased nerve / muscle function, or thoracic cage limitation

24
Q

What is the criteria for obstruction on PFTs?

25
What is the criteria for reversibility of obstruction on PFTs?
Improvement of >12% and >200ml in FEV1 or FVC
26
What causes reduced DLCO in absence of significant restriction or obstruction?
Pulmonary vascular disease (e.g. thromboembolic disease, pulmonary HTN)
27
When are MIP / MEP useful to measure in PFTs?
To evaluate for respiratory muscle weakness
28
What is the 12 month mortality after an exacerbation of COPD requiring admission?
25%
29
What is the PBS criteria for triple therapy in COPD?
FEV1< 50 and history of repeated exacerbations with significant symptoms despite dual therapy
30
What is the biological therapy option for severe allergic asthma?
Omalizumab | - IgE mab
31
What is the biological therapy option for severe eosinophilic asthma?
Mepolizumab | - anti-IL 5 ab
32
What are the classic pathological features of Usual Interstitial Pneumonia (IPF)?
Honeycombing Traction bronchiectasis Reticular opacities
33
What is nintedanib? Common SE?
Anti-fibrotic for IPF Multi-kinase inhibitor SE: diarrhoea
34
What is pirfenidone?
Anti-fibrotic for IPF Inhibits TGF-beta and fibroblast proliferation
35
What are the classic pathological features of Non-specific Interstitial Pneumonia?
Ground glass opacity Traction bronchiectasis Reticular opacities
36
Which immune cells are key to sarcoidosis pathogenesis?
Th1 cells
37
What is the leading cause of pulmonary HTN worldwide?
Schistosomiasis
38
What class of drugs are ambrisentan, macitentan, bosentan? How do they work?
Endothelin receptor antagonists Work to block endothelin receptor, which inhibits vasoconstriction
39
Which 2 medication classes should NOT be used in combination in pulmonary HTN?
``` sGC stimulators (Riociguat) + PDE5 inhibitors - increased risk of hypotension and death ```
40
What is the role of azithromycin in bronchiectasis?
For patients with 3 or more exacerbations per year Dosing 500mg 3x / week Anti-inflammatory, reduces exacerbation frequency
41
Where is the brain centre for inspiration?
Dorsal medullary centre
42
Where is pulmonary surfactant produced?
Type 2 alveolar epithelial cells
43
3 ILD conditions linked to smokng?
Respiratory bronchiolitis - associated Desquamative Langerhans histiocytosis
44
Main site of airway resistance in lungs?
Medium-sized bronchioles
45
What causes NSIP pattern (~4)
CTD HIV Drugs Hypersensitivity
46
What is Light’s criteria?
If at least one of the following three criteria is fulfilled, the fluid is defined as an exudate: - Pleural fluid protein/serum protein ratio >0.5 - Pleural fluid LDH/serum LDH ratio >0.6 - Pleural fluid LDH greater than 2/3 the upper limits of the laboratory’s normal serum LDH
47
What are pleural fluid tumour markers for mesothelioma?
Mesothelin | Fibulin 3
48
What are 3 common presentations of adult-diagnosed CF?
GI symptoms Diabetes Infertility

FRACP NOSH 2020 (18 decks)

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