Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nimna's Flash Cards > Respiratory > Flashcards

Respiratory Flashcards

1
Q

3 aspects if asthma

A
  1. Variable airflow obstruction
  2. Bronchial hyper-responsiveness
  3. Airway inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is bronchial challenge testing done?

A
  1. For defence force

2. Atypical presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to assess degree of inflammation in asthma

A
  1. Eosinophil count

2. Exhaled Nitric oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Samter’s triad

A
  1. Asthma
  2. Aspirin intolerance
  3. Nasal polyps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chronic asthma + Recurrent pulmonary infiltrates + Very high IgE = ?

A

Allergic broncho-pulmonary aspergillosis.

- Check for aspergillus sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Symptoms of Eosinophilic Granulomatosis with polyangiitis

A

Common - asthma, nasal and sinus symptoms, and peripheral neuropathy.
Infrequent - cardiomyopathy, kidney disease, and gastrointestinal involvement

Can have haemoptysis if necrotizing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Add on therapies in Asthma

A
  1. Monteleukast - leukotrine receptor antaginist
  2. Macrolides - Azithromycin
  3. Tiotripium - LAMA
  4. MAB’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MAB in allergic asthma and efficacy

A

Omalizumab - targets IgE
reduce exacerbations by 50%
use only if IgE levels are high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MAB in eosinophilic asthma and efficacy

A

Mepolizumab + Benralizumab - targets IL-5 receptor.
Use if eosinophilia only.
reduce exacerbations by 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is pulmonary rehab?

A

A 6-8 week program with education and exercise components.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Difference in efficacy between dual COPD therapy (LAMA/LABA) and triple therapy (LAMA/LABA/ICS)

A

Reduced exacerbations in impact trial.

Increase risk of pulmonary infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of pleural effusions

A

CCF
Parapneumonic
Liver disease
Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does adenosine deaminase test for in pleural effusions?

A

High - TB/ infection

Very high - empyema/lymphoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Lights criteria

A
  1. Fluid protein/Serium protein >0.5
  2. Fluid LDH/Serum LDH >0.6
  3. Fluid LDH > 2/3 ULN.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pH for infective effusions

A

< 7.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of empyema/ infective effusions

A
  1. Abx
  2. Chest tube
  3. intrapleural tPA
  4. intrapleural DNAse
  5. VATs procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of recurrent malignant effusions

A
  1. Indwelling pleural catheter (rocket drain) - use LENTS score.
  2. Talc pleurodesis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Zoonotic pneumonias

A 
Tularemia - many animals 
Pasturella - Dogs and Cats 
Rhodococcus - horse, cow, pig 
Yersinia Pestis (Plague) - rodents/fleas 
Brucella - Slaughterhouses 
Coxiella Burnetti (Q fever) 
Psittacosis - birds 
Melioidosis - Northern Territory water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CURB65 score

A 
Confusion 
Urea 
RR 
BP 
Age >65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cause for increased risk of AMI post pneumonia

A

Cardiac microlesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

4 Types of respiratory failure

A

Type 1 - hypoxic
Type 2 - hypercapnic
Type 3 - Peri-operative
Type 4 - Shock related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Benefit of prone position in ARDs

A

Increases alveolar utility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tidal volume and pressure in ARDs

A

Do not use high pressure or volumes.
Tidal volume <6ml/kg
Pressure <30cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Is there a survival benefit to long term O2?

A

Yes. If >15hrs/day.

No improvement in exacerbations of illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Effect of NIV in NMD

A

Improved morbidity AND mortality.

Not effective to commence after bulbar dysfunction occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Number of REM/Non-REM cycles in normal sleep

A

3-5 cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Sleep study types

A

Type 1 - 7 channels with clinician
Type 2 - 7 channels no clinician
Type 3/4 - <4 channels. For screening only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How to differential central vs obstructive apnoeas

A

If respiratory effort seen on polysomnogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

OSA diagnostic criteria

A

AHI > 5/hr + symptoms.

AHI >15/hr +/- symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Screening tests for OSA

A

Berlin test
OSA 50 test.

NOT Epworth scale - this is for sleepiness only.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Effect of CPAP on cardiovascular risk

A

CPAP DOES NOT affect cardiovascular risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Effects of CPAP

A 
Increased cognitive function 
Improved mood 
Increased QOL 
Improved BP control 
Decreases MVA risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Effect of Leptin in OHS

A

Leptin causes decreased appetite and increased ventilatory drive.
In obesity Leptin is low causing reduced ventilatory drive. Leads to chronic hypercapnoea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Narcolepsy +/- Cataplexy diagnostic criteria

A
  1. Daytime somnolence
  2. Positive sleep latency test
  3. 2x sleep onset REM periods (REM within 15mins sleep onset)
  4. low CSF orexin/hypocretin (arousal hormones)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Management of Narcolepsy

A

Amphetamines
Modafenil
SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Definition of bronchiectasis

A

Permanent dilation of bronchi and bronchioles due to destruction of airway muscles and elastic connective tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of bronchiectasis

A
  1. Chest physio
  2. Inhaled hypertonic saline
  3. Treat pseudomonas colonisation
  4. SABA + LABA + LAMA + Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Treatment of chronic inflammation in bronchiectasis

A

Macrolides - erythromycin

SE

  • Resistance
  • QT prolongation
  • Mycobacterial infections.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Ix for Bronchiectasis

A
  • Full blood count and major immunoglobulin classes G, A, M, E
  • Sweat test in all children and selected adults - (see below)
  • Culture airway secretions, including specialised cultures for mycobacteria, particularly nontuberculous mycobacteria (NTM) in sputum-producing patients
  • Spirometry and lung volumes (when aged >6-years)
  • Aspergillus serology.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Gene mutation in Cystic fibrosis

A

CFTR gene C7

F508del

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Management of cystic fibrosis

A 
CFTR modulators 
Inhaled DNAse
Macrolides 
Hypertonic saline 
Lung transplant.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

CFTR modulators and MOA

A

Iva CaFToR - Potentiator - opens more Na/Cl channels in mutated CFTR. Used as monotherapy in gated mutations.

TezaCaFToR
Elexa CaFToR - Next generation - more effective
LumaCaFToR

MOA - Moves more mutated CFTR to cell surface, helps to correct the shape of the F508del mutation.
Used as combination therapy with Ivacaftor

Amplifiers - not yet available.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Inhaled Abx agents

A

Tobramycin

Colistin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Non-respiratory CF complications

A 
Pancreatic insufficiency 
Meconium ileus 
Distal intestinal obstruction (impaction in ileocecal junction) 
GORD 
rectal prolapse/ intersusseption 
Bone disease 
Absent vas deferens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Spirometry in obstructive lung disease

A

Low FEV1

Low FEV1/FVC ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Spirometry in restrictive lung disease

A

Low FEV1
Lower FVC
High FEV1/FVC ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Large airway obstruction patterns

A

Fixed- flattened inspiration and expiration curves
- postintubation stenosis, goiter, endotracheal neoplasms, and bronchial stenosis.
Variable intrathoracic- flattened expiration curve (inspiration is pulled open by negative pressure)
- tracheomalacia, polychondritis, and tumors
Variable extrathoracic - flattened inspiration curve (expiration is pushed open by airflow) - vocal cord paralysis, vocal cord constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the signs/symptoms of dyskeratosis congenita?

A

Caused by shortened telomere length.

Signs/Symptoms - nail dystrophy, skin hyperpigmentation, leucoplakia, MDS, pulmonary fibrosis, deranged LFTs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

gene in ILD

A

MUC5b - affects mucocilliary clearance. Think lack of clearance = build up of muck.

UIP pattern on imaging.
Associated with Rheumatoid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Management of scleroderma related ILD

A

Cyclosporin, Mycophenolate.
Autologous SCT
Nintedanib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

skin changes + pneumomediastinum

What is the disease and associated antibody?

A

amyopathic dermatomyositis.

Check for anti-MDA5 antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Lytic bone lesions + purple papular rash + lymphadeopathy + cysts and nodules on CT with upper zone predominance.

A

Langerhans cell histiocytosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is Lymphagioleiomyomatosis

A

Occurs in women of child-bearing age.
Can be associated with tuberous sclerosis
Progressive dyspnoea with costophrenic angle predominance.

54
Q

Condition with GM-CSF antibodies

A

Pulmonary alveolar proteinosis

GM-CSF allows clearance of surfactant by macrophages.

55
Q

Features of UIP on imaging

A
  • Subpleural reticulation
  • Worse at bases
  • traction bronchiectasis
  • Honeycombing
56
Q

Differences between UIP and NSIP

A

UIP = honeycombing, NSIP = ground glass changes.

NSIP has subpleural sparing

57
Q

Treatment of idiopathic pulmonary fibrosis

A

Anti-fibrotic therapy

  1. Pirfenidone - acts on TGF-beta
  2. Nintedanib - inhibits tyrosine kinases PDGF, VEGF, FGF.
58
Q

Features of UIP on histology

A

fibrotic lesions at different stages

honeycombing

59
Q

What are the Fleishner guidelines for solid lesions

A

<6mm - no follow up
6-8mm - 6month follow up CT
>8mm - single lesion - PET or biopsy.
Multiple lesions - 6 month follow up CT.

60
Q

What are the Fleishner guidelines for subsolid lesions

A

<6mm - no follow up unless multiple lesions

>6mm - CT at 6months then annually for 5years (years 3 and 5 only if ground glass)

61
Q

Cause of tree-in-bud appearance

A

impaction of mucous, pus or blood

62
Q

Causes for crazy paving appearance

A

pulmonary haemorrhage
Pulmonary alveolar proteinosis
ARDs

63
Q

CT sign for bronchectasis

A

Signet ring sign

64
Q

What are the 2 types of EBUS

A

Linear EBUS

Radial EBUS - has 360 degree view - used for peripheral lesions.

65
Q

Density of lung cancers

A

> 20 Hounsfield units

66
Q

Where are the chemoreceptors for the respiratory centre?

A

Carotid bodies

67
Q

Normal A-a gradient for age estimate

A

(Age/4) +4

68
Q

A-a gradient equation

A

PAO2 - PaO2

= (150 - 5/4x PaCO2) - PaO2

69
Q

Causes of right shift of oxygen dissociation curve

A

low pH
high CO2
high temp
high 23BPG (binds DEoxygenated Hb)

70
Q

MOA of mannitol in CF

A

Osmotic effect to thin secretions

71
Q

Condition associated with upper lobe pulmonary fibrosis

A

Ankylosing spondylitis

72
Q

What cell on BAL predicts steroid responsiveness in ILD?

A

Lymphocytes

73
Q

Management of CAP complicated by large parapneumonic effusion.

A

Diagnostic thoracentesis and culture.

74
Q

Causes of inaccurate Sats probe readings

A 
Hb <50 
Methaemoglobin 
Carbon monoxide 
Hypoperfusion
Hypothermia
75
Q

What is methaemoglobin

A

Where the iron in haemaglobin is in the Fe3+ form instead of the Fe2+ form - does not allow O2 to bind.

76
Q

Wells criteria

A 
PE/DVT is #1 diagnosis 
Clinical symptoms DVT
PMHx DVT or PE
Tachycardia 
Immobilisation
Haemoptysis 
Cancer
77
Q

At what lung volume is pulmonary vascular resistance the lowest

A

Functional residual capacity

78
Q

Criteria for secondary pneumothorax

A

Age >50 AND smoking Hx
OR
Evidence of underlying lung disease

All secondary pneumothoraxes must be admitted

79
Q

Criteria for chest drain in pneumothorax

A
  1. Primary pneumothorax >2cm or breathless and not relived by aspiration.
  2. Secondary pneumothorax >2cm or failed aspiration in size 1-2cm
80
Q

Which hormone stimulates respiratory drive

A

Progesterone

81
Q

Afferent nerve in cough reflex

A

Vagus nerve

82
Q

Pleural effusion with normal pH and low glucose

A

TB

Malignancy

83
Q

Parameter monitored in GBS respiratory crisis

A

FVC

84
Q

dyspnoea a few days following Gemcitabine

A

Capillary leak syndrome (APO)

85
Q

FBE finding in chylothorax

A

leukopenia

86
Q

What is Platypnea-orthodeoxia

A

Dyspnoea and deoxygenation when changing from a recumbent to an upright position.
It is usually caused by increased right -to - left shunting of blood on assuming an upright
position, with normal pressure in the right atrium

87
Q

Best investigation for Chronic thromboembolic pulmonary hypertension

A

VQ scan

88
Q

Best test for cardiac cause of pulmonary oedema

A

Pulmonary capillary wedge pressure

89
Q

Asthmatic with pneumonia + bilateral infiltrates that improves rapidly with steroids

A

Eosinophilic pneumonia.
Eosinophils drop quickly with steroids.
May be associated with Churg-Strauss.

90
Q

Pulmonary function test that has the greatest variability

A

FVC

91
Q

Pulmonary function tests post lobectomy

A

low DLCO and high DLCO/VA

92
Q

In what form is majority of CO2 carried in the blood

A

bicarbonate ions

93
Q

Which nerve supplies the diaphragm

A

Phrenic nerve

94
Q

Physiological effects of OSA on the cardiovascular system

A
  1. Increased sympathetic stimulation
  2. Decreased L ventricular preload
  3. Increased L ventricular afterload
  4. Decreased stroke volume and BPduring apnoea and increased stroke volume after apnoea.
  5. Hypoxia
95
Q

REM sleep behaviour disorder increases risk of which disease

A

Parkinsons/ Multi-systems atrophy, Lewy body dementia

96
Q

Changes to sleep in the elderly

A

Increased night time arousals, longer sleep latency, shorter sleep duration and increased daytime somnolence and napping. Reduced deep non-REM sleep.

97
Q

What is slow wave sleep

A

Stage 3 and 4 of non-REM sleep. Non dreaming. Information storing.

98
Q

Mutation in inherited pulmonary hypertension

A

Transforming growth receptors

  • Bone morphogenic protein receptor type 2 (BMPR2)
  • ALK1
99
Q

MOA of Omalizumab

A

Binds directly to IgE and decreases IgE binding to receptors (on mast cells and basophils)

100
Q

5 categories of pulmonary hypertension

A
  1. Idiopathic/Inherited/ Drug induced/ Systemic disorder
  2. Due to L heart disease
  3. Due to chronic lung disease - ILD, COPD, OSA
  4. Chronic arterial obstruction - CTEPH
  5. Other/Unknown/Multifactorial
101
Q

Treatment of pulmonary hypertension.

A
  1. Check responsiveness to CCB in type 1
  2. Ambrisentan/Bosentan
  3. Sildenafil/ Tadalfil
  4. Epoprostenol for Type 4.
102
Q

DLCO in asthma

A

elevated

103
Q

What part of the airways has the highest resistance?

A

Intermediate bronchi

104
Q

MOA of Bosentan/Ambrisentan in Pulmonary HTN

A

Endothelin receptor blocker - causes vasodilation.

105
Q

MOA of Sildenafil in Pulmonary HTN

A

Inhibits phosphodiesterase T5 (PDE5) in smooth muscle - causes vasodilation.

106
Q

MOA of Riociguat in Pulmonary HTN

A
  • Sensitises Guanylate cyclase to NO

- Directly stimulates Guanylate cyclase

107
Q

MOA of Iloprost in Pulmonary HTN

A

Prostacyclin receptor AGONIST

108
Q

Most common pathogen that Cystic fibrosis patients are colonised with

A

Pseudomonas

109
Q

Management of cystic fibrosis exacerbation with Pseudomonas colonisation

A

14 days ciprofloxacin + nebulised tobramycin or colistin

110
Q

Management of cystic fibrosis exacerbation WITHOUT Pseudomonas colonisation

A

Augmentin 14 days or Bactrim + amoxycillin

IV Beta-lactam + Aminoglycoside if severe

111
Q

Type of asbestos which is oncogenic

A

blue fibres - amphiboles.

112
Q

dyspnoea + chest wall pain

A

malignant mesothelioma.
Manage with radiotherapy - no benefit with chemo.
Avoid biopsy - high risk of seeding.
prognosis is 12months.

113
Q

occupational exposure which increases the risk of TB infection

A

Silica

114
Q

Role of Azithromycin in bronchiectasis

A

reduces exacerbations and sputum volume. prevents biofilm formation and inflammatory response to pseudomonas.
Patients require screening for Non-tuberculous mycobacteria are regular azithromycin will create resistance.

115
Q

Highest risk conditions for pneumothroax

A

COPD

PJP

116
Q

Effect of carbon monoxide on O2 dissociation curve

A

Left shift - Hb tries to hang on to O2 as much as possible.

117
Q

Nitrous oxide is elevated in which conditions

A

Asthma
Allergic rhinitis

NOT elevated in smoking

118
Q

What percentage of adult onset asthma is due to occupational exposure?

A

5-20%

119
Q

Most COMMON signs of PE (top 3 in order)

A
  1. Dyspnoea
  2. Tachypnoea
  3. Pleuritic chest pain
120
Q

Highest cause of mortality in lung transplant

A

Lung - Causes of death — Primary graft dysfunction (PGD), a form of ARDS/diffuse alveolar damage (DAD), which occurs in the early hours to days after transplant, is the leading cause of death in the first 30 days after transplantation, accounting for more than 25 percent of deaths

121
Q

Subtypes of A1AT and disease caused

A

PIMM = normal
PIZZ = mutated = abnormal protein build-up = liver and lung disease
PI Null Null/ PIQQ = no protein = severe lung disease

122
Q

Causes of a cavitating lung lesion

A

Infectious:

  • Anaerobes
  • Mycobacteria/ TB
  • Nocardia
  • Aspergillus
  • Staph aureus/ Klebsiella
  • Parasites - Entamoeba histolytica

Non- infectious

  • PE with infarct
  • GPA vasculitis
  • Neoplasm
  • Cysts
  • Sarcoid
  • Histiocytosis
123
Q

Management of CTEPH

A

Pulmonary artery endarterectomy.

if clear persistant segmental areas are present

124
Q

Types of bronchial provocation testing

A

Mannitol - needs 15% change
Methacholine - needs 20% change

Mannitol is more specific.

125
Q

What type of hypersensitivity is allergic extrinsic alveolitis (AKA hypersensitivity pneumonitis)

A

Type 3 (+ minimal type 4) - (despite the name)

126
Q

Management of IECOPD

A
  1. Inhalers
  2. Steroids
  3. Abx - NOTE, ABx is NOT necessarily needed for IECOPD, only if high volumes of purulent sputum is present with fever. If this is the case, can give Oral amoxycillin OR doxycycline. IV ABx is NOT required.
127
Q

Mechanism for fall in pulmonary vascular resistance during exercise

A

dilation of pulmonary capillaries

128
Q

Factors affecting pulmonary pressure

A
  1. cardiac output
  2. LA pressure
  3. Pulmonary artery resistance
129
Q

Physiological difference between men and women in lung function.

A

Men have a greater vital capacity (but not FEV1)

130
Q

Disease caused by e-cigarettes

A

Eosinophilic pneumonia
Organising pneumonia
Lipoid pneumonia

131
Q

Benefit of neuromuscular blockade in ARDs

A

No benefit. Outcomes for heavily sedated group with neuromuscular blockade and minimally sedated group were the same.

Nimna's Flash Cards (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions