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RACP Written Exam 2021 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Formula for the A-a gradient

A

Fio2(Ppatm-Ppwater vapour) - (PaCO2/0.8) - PaO2

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2
Q

Causes of elevated A-a gradient

A

V/Q mismatch
Diffusion defect
Right to left shunt

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3
Q

Causes of hyperaemia with a normal A-a gradient

A

Alveolar hypoventilation

Low Fio2

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4
Q

Best predictive metric for IPF

A

FVC

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5
Q

What is the UIP pattern on HRCT

A

Traction Bronchiectasis
Subpleural Reticulations with basal predominance
Honeycombing

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6
Q

Two anti-fibrotic treatments considered in IPF

A

nintedanib and pirfenidone

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7
Q

Main side effect of Pirfenidone

A

Photosensitivity

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8
Q

In newly diagnosed asthma which will decrease exacerbations

A

ICS

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9
Q

Main cause of death in patients with stable moderate-sever COPD with no comorbidites

A

Cardiovascular

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10
Q

When should you consider introducing ICS in a patient with COPD

A

In the context of high eosinophil count

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11
Q

In former smokers which Abx can reduce infective exacerbations?

A

Azithromycin

A/E
Hearing loss
Gastrointestinal upset

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12
Q

Which intervention most effectively reduces disease progression in COPD?

A

Smoking cessation

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13
Q

Diagnosis of COPD

A

FEV1/FVC <0.70 with no reversibility

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14
Q

What is the most effective treatment in COPD to minima acute exacerbations, hospitalisations and symptoms?

A

LABA/LAMA combination

Note no improvement in underlying lung function
Also note that LAMA or LABA mono therapy is first line therapy

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15
Q

What additional puffer do you add in to a patient who has experienced an exacerbation of COPD?

A

ICS

Note increased risk of pneumonia

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16
Q

Antibiotics for infective exacerbation of COPD (fever, increased sputum production or change in sputum colour)

A

Doxycycline or Amoxicillin

+ Oral corticosteroids

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17
Q

What is Romuliflast?

A

PD4 inhibitor –> anti-inflammatory effects

Has been shown to reduce acute exacerbations of COPD

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18
Q

Effective strategies for smoking cessation

A

Pharmacological therapy + counselling

Nb: Combination NRT is more effective than single product

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19
Q

What benefits does NIV in patients with COPD derived T2RF deliver?

A
  1. Reduced intubation rates

2. Reduced hospital LOS

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20
Q

Effect of long term NIV

A

Reduced admission free survival

But ? reduced quality of life

21
Q

Pharmacological addition in patients with COPD commencing palliative care treatment?

A

Daily long acting opioids (kapanol) + laxatives

22
Q

Significant post-bronchodilator response

A

FER increases by 200ml and 12%

23
Q

What feature is identifiable on PFT in gas trapping?

A

elevate RV/TLC

24
Q

What feature is identifiable on PFT in gas trapping?

A

Elevated RV/TLC

25
Q

Best test for negative predictive value in asthma?

A

Methacholine bronchoprovocation test

20% fall in Fev1

Fals positives in allergic rhinitis, CF, heart failure, COPD and bronchitis

26
Q

When is nitric oxide increased in FENO testing?

A

Eosinophilic asthma.

27
Q

Cardinal features of AVPA

A

1) Bronchiectasis on CT

2) Elevated IgE

28
Q

Effect of ICS in asthma

A

Reduced airway remodelling
Down regulation of pro-inflammatory proteins

ICS = mainstay of treatment

ICS –> ICS+LABA –>

29
Q

In which patients would you use Omalizumab in asthma?

A

Allergic Asthma (Positive RAST) with elevated IgE (IgE>30I/U)

30
Q

In which patients would you use Mepolizumab in asthma

A

Eosinophilic asthma

  • Peripheral eosinophils > 150/microL
  • Sputum eosinophils > 3%

Mepolizumab monoclonal antibody to IL-5

31
Q

When to consider a surgical lung biopsy in possible ILD?

A

Age <50
Atypical HRCT
Rapidly progressive disease

Note 1-2% mortality of elective surgical lung biopsy

32
Q

Indications fort transplant in IPF

A

Patients <65
DLCO <40%
FVC <80%
Decrease in SPO2 88% (including on exertion)
Dyspnoea or functional limitation attributable to lung disease

33
Q

CT findings in NSIP

A

Ground glass opacity
Reticular Opacity
Traction bronchiectasis
Diffuse - can have sub pleural sparing

34
Q

Best investigation test for sarcoidosis

A

Endobronchial ultrasound guided hilar lymph node biopsy

Supportive
BAL: Elevated CD4:CD8

35
Q

Diagnosis of Pulmonary Arterial Hypertension

A

PAP: >20
PCWP >15
WU > 3

36
Q

Causes of pulmonary arterial hypertension

A

1) Connective tissues disease
2) HIV infection
3) Porta hypertension
4) Congenital heart disease
5) Schistosomiasis

37
Q

Heritable forms of PAH are usually associated with

A

BMPR2 - inhibits smooth muscle proliferation and induces apoptosis
> Only 25% of patients with BMPR2 mutations
> 70-80% of familial PAH have BMPR 2 mutation (autosomal dominant with incomplete penetrance and variable expressibility)

38
Q

What predicts mortality in patients with IPAH

A

Hypocapnea
RVEF <35%
PVR > 650 wood units

39
Q

Which patients should be offered CCB in PAH type w1

A

Those who response to inhaled NO or IV epoprostenol

> MPAP >10mmhg drop then <40

40
Q

Initial therapy for PAH?

A

Ambrisentan + Tadalafil

41
Q

Initial testing for bronchiectasis (incomplete)

A

1) FBC/UEC
2) IGE + Specific IgE to Aspegillus
3) Immungolbuins
4) Sputum MCS + AFB

42
Q

Treatment for frequent exacerbates (>3 or more exacerbations in the past 12 months)

A

Azithromycin
> Note QT prolongation (do ECG)
or
Erythromycin

43
Q

In CF colonisation with which organism predicts for worse outcomes?

A

Burkholderia

44
Q

Which subset of patients in CF benefit from Ivacaftor

A

G551D-CFTR mutation

45
Q

Which subset of patients in CF benefit from Ivacaftor + Elexacaftor + Tezecaftor

A

Delta 508 Homozygotes/Heterozygotes

46
Q

When to consider transplant in CF`

A 
FEV1<30%
Rapid decline 
Malnutrition + Diabetes
Frequent exacerbations
Relapsing or complicated pneumothorax 
ICU admission 
Recurrent haemopytisis
47
Q

Indication for Omalizumab

A

Asthma with elevated IGE (“In law grandma edna - Oma)

48
Q

Diagnosis of ABPA

A

1) Predisposing condition
- Asthma
- CF
2) Obligatory criteria
- Positive skin prick test or increased IGE levels to Aspergillus
- Elevated IgE concentration (>1000)
3) Other (2 must be present)
- Positive aspergillus precipitants or elevated IgE to A Fumigatus
- Radiology consistent with ABPA
- Total eosinophil count >0.5x10 in steroid naive patiens

RACP Written Exam 2021 (18 decks)

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