FRACP questions Flashcards
(82 cards)
1
Q
Who would most likely benefit from endobronchial valve placement
A
2
Q
Asthma- COPD overlap syndrome
A
3
Q
Age adjustment for D-dimer
A
4
Q
Benefits of catheter directed thrombolysis
A
Reduction in risk of major haemorrhage
5
Q
Predictor on COPD of hospital readmission
A
6
Q
SMART-COP
A
7
Q
Which of the following primary lung cancer has the most favourable prognosis?
- adenocarcinoma
- large cell
- small cell
- squamous cell
- carcinoid
A
Carcinoid!
8
Q
Glycopyrronium bromide (LAMA) SE
A
9
Q
PET scanning for lung lesions
A
- tumours less than 5mm in size may not be detected
- hyperglycemia can reduce intracellular uptake of the radioactive substrate FDG
- false negative results can occur with carcinoid tumours
10
Q
Which of the followin gmalignancies has the highest mortality rate in Australia?
- lung cancer
- bowel cancer
- prostate cancer
- breast cancer
- pancreatic cancer
A
11
Q
Lofgren syndrome
A
A type of acute sarcoidosis
12
Q
Mechanism of hypercalcemia in sarcoidosis/granulomatous disease
A
13
Q
Pulmonary rehab in COPD
A
Does not improve lung function
14
Q
Which interstitial lung disease resolves with smoking cessation?
A
15
Q
Indication for pleural space drainage
A
16
Q
In mgt of Pleural effusion, what intervention is most helpful in reducing need for surgical drainage in those who have failed conservative mgt with chest drainage and ABx?
A
17
Q
RAPID score
A
18
Q
Fibrinolysis in PE
A
19
Q
Mesothelioma diagnosis
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20
Q
LENT score
A
LENT score used in malignant pleural effusion
- Stratify patients to low (319 days survival), medium (130 days) and high (44 days) risk to estimated survival and hence guide treatment
- Uses ECOG score, serum neutrophil to lymphocyte ratio and tumour type
Daily drainage increases spontaneous pleurodesis; 37% in 60 days. (AMPLE 2)
Talc administration through IPC improves the pleurodesis rate; 43% in 35 days
21
Q
What factors has the greatest impact on prognosis in NSCLC?
- staging of cancer at presentation
- presence of systemic symptoms
- histology type
- weight loss
- poor performance status
A
TNM staging!
TNM stage at presentation in patients with NSCLC has the greatest impact on the prognosis
22
Q
Pneumothorax management
A
23
Q
Standard of care chemotherapy for patients post resection for Stage II and II NSCLC
A
24
Q
Treatment of choice for non resectable stage III NSCLC in patient with a GOOD performance status
A
25
Erlonitib
26
NItric oxide and the airways
27
What factors confer a better resposne to Erlotinib?
HIgher repsosne rate with erlotinib:
1. EGFR mutation
2. Wild type K-ras
3. EGFR polysomy \>4 copies
28
What factors make a patient to have a higher likelihood of a response to Erlotinib?
Asian, female, never-smoker, adenocarcinoma
29
Management of patient with lung abscess
IV clindamyciin drugs of choice.
30
Most common organism causing lung abscess?
**_Anaerobes_**
* the bacteria in lung abscess reflect the predominantly anaerobic flora of the **gingival crevice.**
* Most common organisms are peptostreptococcus, prevotella, bacteroides spp and fusobacterium spp
31
Mycoplasma pneumoniae presentation
32
Which lung cancer is MOST associated with cavitating lesions?
Squamous cell
Other types may cause cavitating lesions - it is most commonly seen in squamous cell cancer
33
Management of uncomplicayed parapneumonic effusion
34
Pirfenidone in IPF
Oral antifibrotic medication
35
Nintedanib
36
Paraneoplastic features of lung cancer
Paraneoplastic features of lung cancer:
* Squamous cell
* PTHrp, clubbing, HPOA
* hyperthyridism due to ectopic TSH
* Small cell
* ADH,
* ACTH - not typical, HTN, hyperglycaemia, hypokalemia, alkalosis and muscle weakness are more common than buffalo hump
* Lambert-eaton syndrome (occurs almost exclusively in SCLC)
* Adenocacrinoma
* gynaecomastia
37
Increased DLCO
Severe obesity, Asthma, Mild LVF, POlycythaemia, Pulmonary haemorrhage, left to right intracardiac shunting
38
Hypoventilation
39
What is the main physiological mechanism of a normal PA-ao2 gradient?
40
Mechanism of hypoxemia in ILD is mainly due to?
Diffusion limitation and V/Q mismatch
41
Shunts and hypoxemia
Anatomic shunt: intracradiac shunt, pulmonary AVM, hepatpulmonary syndrome.
Physiologic shunt: atelectasis, disease with alveolar filling (pneumonia, ARDS)
These shunts causes extreme V/Q mismatch and are difficult to correct with supplemental oxygen. Whereas ILD, PE and COPD are caused by V/Q mismatch which can be corrected with low to moderate flow supplemental oxygen.
42
Medications and REM sleep
Bupropion and Trazadone increases REM sleep
43
Cheyne Stoke respiration
Periodic breathing from central sleep apnoea. Usually seen in patiemnts with LF.
Mx - treat the LVF, CPAP not helpful
44
Restless leg syndrome management
45
Why avoid prazosin in narcolepsy?
Can worsen catoplexy
46
* 50 y.o male, CXR shows "white out" of left lung. Bronchoscopy resulsts show undifferentiated carcinoma.
* Serum neuro specific enolase is elevated
* What is likely diagnosis?
Small cell lung cancer!
47
Treatment of SCLC
48
ICS use in asthma
49
Constrictive Bronchiolitis Obliterans
50
Galactomannan assay
**moderate accuracy for diagnosis of invasive aspergillosis in immunocompromised patients.** Test is more useful in patients who have haematological malignancy or who have undergone hematopoietic cell transplantation than in solid organ transplant recipients.
**Galactomannan** *- major constituents of aspergilus cell wall -* released during growth of hyphae- used to diagnose **invasive aspergillosis in** immunocompromised patients
51
What is the most common bacteria isolated in acute exacerbation of COPD?
**Haemophilus influenzae**
52
In 65 year old male with COPD, which of the following carries the greatest risk of death over the next 12 months?
Hospitalisation for an acute exacerbation of the disease = mortality of around 10% acutely. rising to 49% at one year
53
BODE index
**B**MI, airflow **O**bstruction, **D**yspnoea and **E**xercise capcity Index
54
Smoking cessation in COPD
Smoking cessation iis the intervention with greatest impact on mortality and rate fo FEV1 decline
55
LTOT in COPD patients indication to commence:
PO2\<55mmHg,
PO2 \<60mmHg with pulmonary HT/RHF
Mortality benefit only \> 16 hours/day
56
A-a gradient
PAO2-PaO2
## Footnote
**PAO2 = FiO2 x (Patm - Ph2o) - (PCO2 x 1.25)**
57
Contraindications to surgery in NSCLC
* stage IIIb or IV
* FEV1\<1.5
* malignant pleural effusion
* tumour near hilum
* vocal cord paralysis (Paralysis of a vocal cord, usually the left - implies extracapsular spread to mediastinal nodes, an indication of inoperability.)
* SVC obstruction
58
Eosinophilic bronchitis
Responds **well to ICS and oral steroids -Th2 inflammation.**
59
ICS and LABA effect in COPD patients
Positive effect on: QoL, reduced freq and delays exacerbations, improved symptoms
## Footnote
**BUT DOES NOT improve rate of decline or mortality**
60
Omalizumab
Anti-IgE
Good for allergic asthma
61
Which lung cancer is most associated with smoking?
Small cell lung cancer!
This type is the most aggressive and rapidly growing of all the types.
Only 1% of these tumours occur in non-smokers. SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively.
62
Characteristics of a pulmonary nodule that make it **more likely to be malignant?**
* larger lesions
* irregular abd spiculated borders
* Less density (eg. Hounsfield units \<147)
* doubling time between 20 - 400 days (eg. a nodule that has rapid doubling or VERY slow doubling unlikely to be malignant)
* Ground glass appearance
63
Vital capacity lung bvolume =
Tidal volume + Inspiratory reserve volume + expiratory reserve volume
64
What carries a poor prognosis in patients with cystic fibrosis?
* lowe FEV1
* High CO2
* High WCC
* Females
65
EVOLVE study in CF patients
Comibnation tezacaftor and ivacaftor was efficacious and safe in patients 12 years of age or older who had CF and were homozygous for the **CFTR Phe508del mutation**
66
Which ILD resolves with smoking cessation?
**Distal interstitial pneumonia** + respiratory associated bronchiolitis assoc ILD **(RBILD)**
67
Which of the following types of ILD is asscoiated with sjogrens disease?
**Lymphocytic interstitial pneumonitis**
68
UIP on HRCT
reticular pattern associated with honeycombing in up to 95% of cases - usually lower zone.
Honeycombing = UIP = poor prognosis
69
What intervention most likely to reduce risk of hospitalization in patient preseting with COPD exac?
**Outpatient treatment with oral prednisone** offers a small advantage over placebo in treating patients who are discharged from the ED with an exacerbation of COPD.
70
Thrombolysis indication in PE
High risk PE presenting with cardiogenic shock +/- persistst arterial hypotension with very few absolute contraindications.
71
Management of pregnant woman with suspected PE
72
Spontanous pneumothorax can be primary or secondary. What are risk factors for each?
Primary
* smoking
* positive family history
* Marfans syndrome
* Homocytinuria
* Thoracic endomeriosis in secondary pneumothorax
Secondary pneumothroax
* COPD for 70% cases
* PCP
* AIDS
* CF
* TB
73
Predictors of nicotine dependence:
1. smoking within minutes of waking
2. higher number of cigarettes smoked per day
74
Pulmonary arterial hypertension
75
With regards to pulmonary function tests - which is the best predictor of mortality in patients with idiopathic pulmonary fibrosis?
DLCO and FVC
76
What is the DLCO cut off for transplant referral in patients with IPF?
DLCO cut off of 40% is appropriate for transplant referral
77
Hypercalcemia in sarcoidosis
78
Dupilumab MOA in asthma
**fully human anti IL 4 and IL 13** that has been shown to be effective in the treatment of moderate to severe uncontrolled asthma
dec rate of severe exacerbations and improved lung function
79
What parameters are cosnidered significant when measuring disease progression in ILD?
80
What condition has predominantly lymphocytic cellular pattern on bronchoalveolar lavage (BAL)?
Sarcoidosis
81
Diagnosing UIP
82
