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MRCP Combined > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the most common organism causing exacerbations of COPD?

A

Infective: s.pneumoniae

Non-infective: h.influenzae

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2
Q

What are the symptoms of A1AT?

A

Panacinar/lower lobe emphysema

Cirrhosis and HCC adults, cholestasis children

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3
Q

What is the criteria for LTOT?

A

Blood gases on 2 occasions at least 3 weeks apart:
pO2<7.3kPa
pO2 7.3-8 AND secondary polycythaemia, peripheral oedema, or pulmonary hypertension

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4
Q

What are the indications for lung transplant in cystic fibrosis?

A

Life threatening exacerbation requiring ICU admission, pulmonary hypertension, FEV1<30% predicted, recurrent exacerbations requiring antibiotic therapy, recurrent/refractory pneumothorax
Recurrent haemoptysis not controlled by emobolisation

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5
Q

What is a contraindication to lung transplant in CF?

A

Colonisation with burkholderia cepacia

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6
Q

What is Orkambi?

A

Lumacaftor/Ivacaftor
For CF pts who are homozygous for delta F508 mutation
Lumacaftor increases the number of CFTR proteins that are transported to the cell surface

Ivacaftor is a potentiator of CFTR is already at the cell surface, increases the probability that the defective channel will be open and allow chloride ions to pass through the channel pore

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7
Q

What is pulmonary hypertension?

A

Sustained elevation in mean pulmonary arterial pressure >25mmHg at rest

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8
Q

What are the causes of Group 1 PAH?

A

Idiopathic
Familial
Associated with HIV, drugs, vascular disease, congenital heart disease with systemic to pulmonary shunts
Persistent PHTN of the newborn

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9
Q

What is group 2 pulmonary hypertension?

A

Related to left heart disease

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10
Q

What is group 3 pulmonary hypertension?

A

Secondary to lung disease/hypoxia, includes high altitude

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11
Q

What is group 4 pulmonary hypertension?

A

Due to thromboembolic disease

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12
Q

What is the inheritance of alpha-1 anti-trypsin deficiency?

A

Autosomal recessive/co-dominant

Chromosome 14

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13
Q

How are alleles classified in A1AT?

A

Alleles classified according to electrophoretic mobility: M for normal, for slow, Z for very slow

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14
Q

What are the genotypes in A1AT and which one is most likely to manifest disease?

A

PiMM - normal
PiSS - 50% normal A1AT
PiZZ - 10% normal A1AT

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15
Q

What are the symptoms of PiMZ genotype?

A

Unlikely to develop clinically significant symptoms

Increased risk of liver and lung disease therefore should avod smoking

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16
Q

What are the causes of occupational asthma?

A 
Isocyanates (spray painting)
Platinum salts
Flour
Soldering flux resin
Glutaraldehyde
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17
Q

How is occupational asthma diagnosed?

A

Serial PEFR measurements

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18
Q

What is the FeNO test?

A

Fractional exhaled nitric oxide

Levels of NO rise in inflammatory cells particularly eosinophils

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19
Q

What is the treatment of primary pneumothorax?

A

<2cm and not SOB - discharge

>2cm: aspiration –> still >2cm/SOB –> chest drain

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20
Q

What is the treatment of secondary pneumothorax over 50 years?

A

<1cm –> oxygen and admit 24h
1-2cm –> aspiration –> chest drain
>2cm/SOB –> chest drain

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21
Q

What are the causes of a transudate pleural effusion?

A 
<30g/L protein
Heart failure
Hypoalbuminaemia e.g. liver disease, nephrotic syndrome, malabsorption
Hypothyroidism
Meig's syndrome
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22
Q

What are the causes of an exudate pleural effusion?

A 
Infection
CTD
Malignancy
Pancreatitis
PE
Yellow nail syndrome
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23
Q

What is the cause of ARDS?

A

Increased permeability of the alveolar capillaries leading to fluid accumulation in the alveoli

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24
Q

Which patients are more likely to develop Klebsiella pneumonia?

A

Diabetes
Alcoholism
Immunocompromised
IVDU

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25
Q

What is aspergilloma?

A

Mycetoma that colonises an existing lung cavity e.g. secondary to TB, cancer, or CF

26
Q

How is aspergilloma diagnosed?

A

CXR: round opacity, crescent sign

Aspergillus IgG precipitins

27
Q

What are the symptoms of psittacosis?

A 
History of bird contact
Flu like symptoms
Pneumonia with dry cough and chest pain
Headache
Organomegaly
Failure to respond to penicillin
28
Q

What is the treatment of psittacosis?

A

1st line tetracyclines e.g. doxycycline

29
Q

What are the paraneoplastic features of squamous cell lung cancer?

A

PTH-rp
Hypertrophic pulmonary osteoarthropathy
TSH secretion

30
Q

What are the paraneoplastic features of small cell lung cancer?

A

ADH
ACTH
Lambert-Eaton syndrome

31
Q

What are 4 risk factors for lung cancer?

A

Smoking - 10x
Asbestos - 5x
Arsenic/radon/nickel/chromate
Cryptogenic fibrosing alveolitis

32
Q

What are the indications for steroids in sarcoidosis?

A

Uveitis
Neuro/cardiac involvement
Parenchymal lung disease
Hypercalcaemia

33
Q

What are the stages of sarcoidosis?

A

I - bilateral hilar lympad
II - bilateral hilar lympah + infiltrates
III - infiltrates
IV - fibrosis

34
Q

What are 5 poor prognostic features of sarcoidosis?

A 
Insidious onset
Absence of erythema nodosum
Lupus pernio
Stage III or IV on CXR
Afro-Caribbean
35
Q

How is sarcoidosis diagnosed?

A

EBUS

ACE sensitivity 60%, specificity 70%
Spirometry - restrictive

36
Q

What is the cause of hypercalcaemia in sarcoidosis?

A

Increased concentrations of calcitriol as a result of increased activity of 1a hydroxylase produced by sarcoid macrophages

37
Q

What subtype of sarcoidosis is characterised by parotid enlargement, fever, and anterior uveitis?

A

Heerfordt syndrome

38
Q

What is Lofgren’s sydrome

A

Acute form of sarcoidosis

39
Q

Name the causes of upper zone fibrosis.

A

CHARTS

Coal worker's pneumoconiosis
Histocytosis/hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
Tuberuclosis
Sarcoidosis/silicosis
40
Q

Name the causes of lower zone fibrosis

A

CADI

CTDs except ankylosing spondylitis
Asbestosis
Drugs e.g. amiodarone, bleomycin, methotrexate
Idiopathic pulmonary fibrosis

41
Q

What type of hypersensitivity reaction is EAA?

A

Type III

42
Q

What are the symptoms of EAA?

A

Acute (4-8 hours):
Dyspnoea, dry cough, fever

Chronic:
Dyspnoea, productive cough, lethargy, anorexia, WAL

43
Q

How is EAA diagnosed?

A

Upper/midzone fibrosis
BAL - lymphocytosis
No eosinophils

44
Q

Sillicosis is a risk factor for what?

A

TB - silica is toxic to macrophages

45
Q

How is ABPA diagnosed?

A

Eosinophilia
Positive RAST test to aspergillus
Positive IgG precipitins
Raised IgE >1000IU/ml

46
Q

What are the symptoms of ABPA?

A

Asthma features
Proximal bronchiectasis
Fungal elements/brown flecks in sputum

47
Q

What is the management of ABPA?

A

Oral steroids

Itraconazole 2nd line

48
Q

What are the symptoms of Churg-Strauss syndrome?

A 
Asthma
Eosinophilia
Mono/polyneuropathy
Flitting pulmonary infiltrates
Paranasal sinus abnormalities
Extravascular eosinophils
49
Q

What is the unmasking agent in Churg-Strauss syndrome?

A

Montelukast

50
Q

Name 5 respiratory manifestations of rheumatoid arthritis

A 
Bronchiolitis obliterans (obstructive picture)
Pulm fibrosis
Pleural effusion
Pulm nodules
Methotrexate pneumonitis
Caplan's syndrome
51
Q

What is cryptogenic organising pneumonia?

A

Diffuse interstitial lung disease that affects the distal bronchioles, respiratory bronchioles, alvolear ducts and walls

52
Q

How is IPF diagnosed?

A 
Restrictive spirometry
Reduced TLCO
Ground glass --> honeycombing
High res CT
ANA +ve in 30%, RF +ve in 10%
53
Q

What is the treatment of IPF?

A

Pulm rehanb
Pirfenidone
O2
Lung Tx

54
Q

What are the symptoms of acute mountain sickness?

A

Headache
Nausea Fatigue

Develops above 2500-3000m, over 6-12 hours

55
Q

What is the cause of AMS?

A

Chronic hypobaric hypoxia

56
Q

What is the prophylaxis for AMS?

A

Acetazolamide

57
Q

What is the treatment of HACE and HAPE?

A

HACE: descent, dexamethasone
HAPE: decent, nifedipine, acetazolamide, oxygen

58
Q

What are the features of carbon monoxide poisoning?

A 
Lactic acidosis
Dizziness, vertigo, vomiting
Headache
Ataxia
Severe- pink skin and mucosa, hyperpyrexia, arrhythmias, extra-pyramidal
59
Q

How is CO poisoning diagnosed?

A

Elevated carboxyhaemoglovin >3% non smoker, >10% smoker

Normal pO2, reduced SaO2

Pulse ox may be high

60
Q

What is the pathophysiology of CO poisoning?

A

Co has 210 times the affinity for Hb than oxygen
Impaired O2 delivery to tissues
Left shift of dissociation curve
Hypoxia

61
Q

What is the treatment of CO poisoning?

A

100% high flow O2 minimum 6 hours
Target saturations 100%
Decreases the half life of COHb

MRCP Combined (58 decks)

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