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BPT annoying facts > Respiratory 3 > Flashcards

Respiratory 3 Flashcards

1
Q

Which pHTN pathways causes SM hypertrophy and vasoconstriction?

Which pHTN pathways causes vasodilatation and proliferation?

A

Endothelin = vasoconstriction = increase PVR/PA pressure

NO and prostacyclin = vasodilatation

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2
Q

BMPR2 function?

A

inhibit SM proliferation - increase NO/ prostacyclin

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3
Q

Type IV - CTEPH - what treatment is indicated?

  • surgery
  • medical
A

surgery - pulmonary endartarectomy when have pulmonary oedema ( from pulmonary artery hypertension/obstruction)

Medical therapy = Riociguat

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4
Q

Anticoagulation in pHTN?

A

Warfarin and only in Type I, IV group

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5
Q

1st VTE episode
thrombophilia screening?
malignancy screening?

A

thrombophilia - no role if no family history

malignancy - no role if VTE is 1st unprovoked

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6
Q

pleural space pressure?

A

-3 to -5 cm H20

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7
Q

Clues of esophageal rupture in pleural fluid findings?

A

High amylase

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8
Q

Intrapleural fibrinolytic regimen?

A

ten(tPA) = 10 mg
DNase = 5 mg
give for 3 days

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9
Q

Limited or Extensive SCLC treatment

A

Cisplatin + Etoposide + cranial irradiation

2nd line is - irinotecan

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10
Q

Type 3 respiratory failure features?

A

Post=operative/sedative = low FRC

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11
Q

SNIP (sniff nasal inspiratory pressure) < 30 cm H20 means?

A

Diaphragmatic weakness

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12
Q

How NIV help in respiratory failure?

A

NIV causes increases intrathoracic pressure therefore less blood fills ventricles ( so reduces RV PRELOAD)

NIV increase alveolar recruitment and reduces work of breathing
-hence reduces LV AFTERLOAD

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13
Q

PET CT role in lymph nodes?

A

Nodes > 10 mm and High specificity for LN metastases

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14
Q

Pirfenidone mechanism in ILD?

side effect?

A

Acts on TGF-b and reduces fibroblast

Photosensitivity rash!

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15
Q

Nintedanib best use in what form of ILD?

A

Systemic sclerosis ILD

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16
Q

what form of ILD associated with Common variable immunodeficiency (CVID)?

A

Granulomatous lymphocytic ILD

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17
Q

clinical features of lymphangio-leiomyomatosis?

A

Women
Spontaneous pneumothorax
tuberous sclerosis
Renal angiomyolipoma - easily bleed

18
Q

Systemic sclerosis ILD - what drug has no role in it?

A

Methotrexate

19
Q

Telomeropathy
increased turnover clues?
decreased turnover clues?

A

Increased turnover

  • opportunistic infections
  • aplastic anemia

Decrease turnover

  • anticipation
  • osteoporosis/liver cirrhosis
  • PULMONARY FIBROSIS/ CAD
20
Q

Asthma

  • early phase what happens?
  • late phase what happens?
A

Early phase - allergen causing mast cell release - histamines/leukotrienes

Late phase - Cytokines causes Th2 mediated response

21
Q

Lymphocytic ILD has what?

Associated with?

A

Thin walled cysts!

A/w Sjogren/RA/HIV

22
Q

What conditions increases Serum alpha AAT and what reduces alpha AAT?

A

increase

  • Infection
  • Pregnancy
  • OCP

Reduces

  • liver disease
  • protein-losing enteropathies
23
Q

Foam cells suggestive of?

A

Pulmonary interstitial pneumonitis - caused by amiodarone

- Foam cells = alveolar macrophages - contains amiodarone phospholipid complex

24
Q

Pulmonary embolism - what ABG shows?

CXR shows?

A

respiratory ALKALOSIS
HYPOCAPNIA
hypoxemia

CXR - normal

25
Q

Salicylate intoxication- what ABG shows?

A

Initial = Salicylate trigger respiratory center - hyperventilation

ABG - respiratory ALKALOSIS, HYPOCAPNIA

Only later metabolic acidosis!

26
Q

Neurosarcoidosis - what cranial nerve usually affected?

A

5,8 + Optic neuropathy

27
Q

Cryptogenic organizing pneumonia/BOOP - what see in imaging and pathology?

A

Imaging - bilateral lower lobe consolidation

Granulation tissue intraluminal - Masson bodies

28
Q

Lymphangioleiomyomatosis (LAM) - what mutation>

A

TSC1 and 2 ( hamartin and tuberin) that controls mTORI signalling pathway

  • angiomyolipomas ( benign fatty kidney tumor) - can burst and bleed
  • lymphangioleiomyomas ( cystic structures in axial lymphatics)
29
Q

What is Hamman rich syndrome?

-Hamman Rich is a foul idiot - mneumonic

A

Fulminant form of Idiopathic Interstitial pneumonitis
-rapid progression and respiratory failure

-Key features;
Temporally uniform lesion in lungs CT - lung injury happen at a single point of time

30
Q

To refer for lung transplant - when DLCO?

A

DLCO < 40%

31
Q

Pulmonary Hypertension clinical sign?

A

Right ventricular heave - Loud P2
Fixed split S2
TR holosystolic murmur

Elevated JVP, peripheral oedema

32
Q

Pleural fluid in TB - what is found?

A

ADA > 40% = very sensitive for TB

33
Q

Asbestosis pleural plaque occurs which part of pleural?

A

Parietal pleura

34
Q

Spinal deformity reduces what lung function test parameters?

Elderly reduces what lung function test parameters?

How to elderly compensate for this?

A

Spinal - Reduced TLC, VC

Elderly - Reduced FRC ( lower lung compliance ) - so increase work of breathing

Increases RR but at low Tidal volume

35
Q

How does silica exposure prediposes to TB/fungal/Bacteria infection?

A

Silica particles Impairs macrophages

36
Q

Beryllium ( Aerospace industry) causes what?

Byssinosis is due to what?

A

Granulomatous pneumoconiosis - delayed hypersensitivity to beryllium

Byssinosis - cotton dust inhalation

37
Q

Commonest and best prognosis form of mesothelioma?

Worst prognosis?

A

Commonest and best prognosis- Epithelioid form

Worst prognosis - Sarcomatoid

38
Q

Is mesothelioma sensitive to radiotherapy?

Malignant pleural effusion - recurrent. Choice of management?

A

Yes to moderately high doses of radiation
but only as single therapy
-not really survival benefit if combined with surgery

Talc pleurodesis

39
Q

First line treatment for hemoptysis - from pulmonary peripheries

-if failed?

A

pulmonary peripheries - BAE = Bronchial artery embolisation

failed means need surgery!

40
Q

Urinary legionella antigen test only detects what?

What is suggestive of legionella infection?

A

Legionella serogroup Type 1

Pneumonia + Diarrhea/ Hyponatremia

41
Q

Monoclonal antibodies for Th2 asthma ( Benralizumab,mepolizumab,omalizumab) when used?

A

When failed conventional therapy - last line of treatment

When Serum IgE levels 30 - 700

BPT annoying facts (62 decks)

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