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MRCP part 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Cryptogenic organising pneumonia

A
  • Diffuse interstitial lung disease
  • M = F; presents in 5th-6th decade
  • No association with smoking
  • Symptoms: fever, malaise, cough, SOB
  • No response to antibiotics
  • Bloods: leukocytosis, high ESR / CRP
  • Imaging: bilateral patchy, diffuse consolidative, ground glass opacities
  • Lung function tests restrictive (but sometimes obstructive / normal)
  • Reduced transfer factor
  • Mx: sometimes steroids
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2
Q

Yellow nail syndrome

A
  • yellow, clubbed nails
  • bronchiectasis
  • pleural effusions
  • congenital lymphoedema
  • recurrent sinusitis
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3
Q

Lung cancer surgery indications and contraindiactions

A

Indications

  • stage 1 or 2 disease
  • FEV1 > 60% predicted

Contraindications

  • FEV1 < 1.5 litres (lobectomy)
  • FEV1 < 2L (pneumonectomy)
  • malignant pleural effusion
  • tumour near hilum
  • vocal cord paralysis
  • SVC obstruction
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4
Q

Non-small cell lung cancer types

A

Squamous cell: central, PTHrP secretion
Adenocarcinoma: non-smokers, peripheral
Large cell: aggressive, BhCG secretion

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5
Q

Non-small cell lung ca mx

A

1) Surgery: stage 1-2
2) Curative / palliative radiotherapy
Poor response to chemotherapy

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6
Q

Pneumonia cause in cases associated with cold sores

A

Strep pneumoniae

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7
Q

Cavitating pneumonia associated with alcoholics

A

Klebsiella

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8
Q

Bug that can cause IECOPD

A

Haemophilus influenzae

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9
Q

Post influenza pneumonia bug

A

S Aureus

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10
Q

How to assess suitability for lung cancer surgery

A
  • combined PET / CT gives an idea on LN involvement
  • FEV1 < 1.5 litres is considered a general cut-off point for lobectomy ( <2L for pneumonectomy)

Other general contraindications

  • malignant pleural effusion
  • tumour near hilum
  • vocal cord paralysis
  • SVC obstruction
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11
Q

Best long-term intervention for sleep apnoea

A 
Weight loss 
(CPAP may be needed in the interim as well)
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12
Q

Small cell lung cancer paraneoplastic syndromes

A
  • SIADH
  • ACTH secretion
  • Lambert-Eaton
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13
Q

Squamous cell carcinoma paraneoplastic syndromes

A
  • PTHrP
  • clubbing
  • hypertrophic pulmonary osteoarthropathy
  • ectopic TSH -> hyperthyroidism
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14
Q

Adenocarcinoma paraneoplastic syndromes

A
  • gynaecomastia

- hypertrophic pulmonary osteoarthropathy

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15
Q

Chronic asthma treatment ladder

A

1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS + montelukast
4) SABA + low dose ICS + LABA (+/- montelukast if it had any effect)
5) SABA (+/- montelukast) & maintenance and reliever LABA/ICS combo
6) Increase steroid dose
7) Increase steroid dose further OR add LAMA OR theophylline

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16
Q

FVC threshold for ventilatory support in neuromuscular disease

A

20ml/kg

17
Q

Chronic COPD treatment ladder

A

1) SABA / SAMA
2) LABA + ICS (if asthmatic features)
OR LABA + LAMA (if no asthmatic features)
3) LABA + LAMA + ICS
4) Roflumilast (>2 exacerbations in a year, despite triple inhaled therapy, where FEV1 is less than 50% of predicted)

Others

  • oral theophylline
  • mucolytics
  • lung volume reduction surgery
18
Q

Secondary pneumothorax management

A

Definition: significant respiratory co-morbidity OR over 50 and smoker

<1cm: oxygen, admit for observation

1-2cm and asymptomatic: aspiration -> chest drain if residual >1cm

> 2cm or symptomatic: chest drain

19
Q

Primary pneumothorax management

A

<2cm and asymptomatic: consider discharge

> 2cm or symptomatic: aspiration -> chest drain if residual >2cm

20
Q

Pneumocystis pneumonia prophylaxis

A

Co-trimoxazole OR nebulised pentamidine

21
Q

Management of severe pneumocystis pneumonia

A

IV clindamycin & primaquine
OR
IV pentamidine

AND prednisolone (if PO2 <9.3)

22
Q

Symptoms of extrinsic allergic alveolitis

A

E.g. bird fancier’s lung, farmer’s lung, malt worker’s lung
Acute: 4-8 hrs after exposure, SOB, dry cough, fever
Chronic: fibrosis (upper lobe predominant)

23
Q

Pulmonary alveolar proteinosis

A
  • Rare diffuse lung disease where alveolar sacs become filled with protein rich fluid
  • primary or secondary e.g. PCP / atypical mycobacteria as cause
  • fluid typically stains for PAS
  • ages 20-60
  • crazy paving pattern on CT
  • spirometry: restrictive, reduced TLC, reduced KCO
  • mx: washing alveoli with saline during bronchoscopy
24
Q

Bronchial carcinoid

A
  • flushing etc and diarrhoea when hepatic mets occur (carcinoid syndrome)
  • symptoms unrelated to smoking
  • ix: imaging and 5-IHAA
  • mx: surgery if no mets
25
Q

Yellow nail syndrome

A

Triad: primary lymphoediema, recurrent pleural effusions, dystrophic nails (lymphatic system abnormality as root cause)

  • associated with bronchiectasis and siusitis
  • pleural fluid typically clear exudate with lymphocytic predominace
26
Q

Allergic bronchopulmonary aspergillosis

A
  • DDx for raised blood eosinophilia (along with Churg-Straus and asthma)
  • Pulmonary infiltrates on CXR OR lobar collapse
  • Asthma
  • Blood & sputum eosinophilia
  • aspergillus precipitins
  • positive RAST
  • raised total IgE
  • may see aspergillus fumigatus hyphae on microscopy of sputum
  • Mx
    1) steroids PO
    2) itraconazole
27
Q

SVC obstruction mx

A

Dexamethasone may alleviate some symptoms
Endovascular stenting is likely to be needed asap
Treat the cause if possible

28
Q

Management of invasive bronchopulmonary aspergillosis

A

1) voriconazole

2) amphotericin B (less effective, also has more side effects)

29
Q

Aspergilloma mx

A

Voriconazole / itraconazole

Surgical resection

30
Q

Haemoptysis in CF patients

A
  • consider bronchial artery aneurysm -> CTPA to investigate

- tranexamic acid

31
Q

Nitrogen air embolism in diving

A
  • arises from venous blood

- if then presents with CVA, need echo to exclude ASD

MRCP part 2 (11 decks)

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