MRCP Flashcards
(25 cards)
What are the causes of lung fibrosis?
Idiopathic Drugs - Methotrexate, Nitrofurantoin Connective Tissue Disease - SLE, Scleroderma Asbestosis Radiotherapy Extrinsic allergic alveolitis - occupational exposures Sarcoidosis TB Cryptogenic fibrosing alveolitis RA AS
Respiratory causes of clubbing?
Idiopathic Pulmonary Fibrosis
Bronchiectasis
Cystic Fibrosis
Lung Ca
What is the difference between an exudate and a transudate?
Exudate - high protein, local pathology, unilateral
Transudate - low protein, systemic pathology, bilateral
What are the causes of an exudative pleural effusion and transudative pleural effusion?
Exudate: Malignancy, TB, Pneumonia, PE
Transudate: Heart failure, nephrotic syndrome, Liver failure, Peritoneal dialysis
Differentials for a patient with a Lobectomy/Pneumonectomy scar?
Neoplasm - any kind of lung Ca - lobectomy or pneumonectomy
Bronchiectasis
COPD - volume reduction surgery
TB - Old treatment (pneumonectomy only)
Consider lung transplant, A1AT deficiency, empyema/abscess
Causes of bronchiectasis?
Cystic Fibrosis Post-TB, pneumonia Primary ciliary dyskinesia RA, IBD, GORD Allergic broncho-pulmonary aspergillosis
Signs and symptoms of Sarcoidosis?
General - constitutional symptoms
Respiratory - dry cough, SOB, chest pain, reduced lung function
Arthralgia - polyarthralgia, dactylitis
Neurological - peripheral and cranial polyneuropathy
Urine - increased calcium - stones
Low hormones - pituitary dysfunction
Ophthalmological - Uveitis, keratoconjunctivitis
Myocardial - Restrictive cardiomyopathy
Abdominal - Hepatosplenomegaly
Skin - Lupus Pernio and Erythema Nodosum (both painful)
Investigations in Sarcoidosis?
Raised Ca Raised ESR High Ig Bilateral hilar lymphadenopathy on CXR Restrictive spirometry Tissue biopsy - non caseating granulomas (in contrast to TB)
X Ray findings in Idiopathic Pulmonary Fibrosis?
Small peripheral opacities in the lower zones
Honeycombing is a late feature in IPF
Spirometry findings in IPF?
Restrictive pattern (Reduced FEV1, reduced FVC and increased FEV1/FVC ratio)
Most commonly isolated causative organism in Bronchiectasis?
Haemophilus Influenzae
Pseudomonas Aeruginosa
Klebsiella
Strep Pneumoniae
Paraneoplastic syndromes associated with squamous cell lung cancer?
Parathyroid hormone related peptide secretion causing hypercalcemia (normal - low PTH level)
Hypertrophic pulmonary osteoarthritis
Ectopic TSH secretion leading to hyperthyroidism
Cavitating lung lesions
COPD inhaler escalation guidelines - no asthmatic features?
- SABA/SAMA
- LABA + LAMA
- LABA + LAMA + ICS
COPD inhaler escalation guidelines - asthmatic features?
- SABA/SAMA
- LABA + ICS
- LABA + LAMA + ICS
Indications for prophylactic antibiotics in COPD?
Non smokers
Continuing to have exacerbations despite maximal inhaler therapy
Standard inhaler therapy is optimised
Sputum culture to rule out atypicals
CT Chest to exclude bronchiectasis?
Before starting do an ECG to rule out long QT
Most common cause for extrinsic allergic alveolitis?
‘Farmers lung’, ‘bird fanciers’ lung’, ‘malt workers lung’, ‘mushroom workers lung’ - occupational exposures
Contaminated hay (farmers) - source of S. Rectivirgula
Type 3 hypersensitivity reaction - immune mediated tissue damage in the acute phase, then Type 4
Asthma inhaler escalation guidelines?
- SABA
- ICS
- ICS + Leukotriene receptor antagonist
- ICS + LABA (+/- LTRA according to response)
- Add in varying combinations of MART
Contraindications to lung transplant?
CF - colonisation with Burkholderia Cepacia (associated with low survival rate, rapid disease progression and recurrence after transplant)
Systemic sepsis
Features of adenocarcinoma lung?
Non-smokers
Causes of predominantly lower zone fibrosis?
Asbestosis
IPF
Connective tissue disorders
Drug induced (e.g. Amiodarone)
Causes of predominantly upper zone fibrosis?
Coal dust TB Crystalline silica dust EAA Sarcoidosis
Causes of left shifted oxygen dissociation curve?
This leads to lower oxygen delivery to tissues (more bound) Alkalosis Pyrexia Carboxy/methaemoglobin HbF
Causes of right shifted oxygen dissociation curve?
This leads to raised oxygen delivery to tissues (less bound) Acidosis Raised CO2 Pyrexia Exercise
Major criteria for diagnosis of Allergic Bronchopulmonary Aspergillosis?
Features of asthma exacerbation Proximal bronchiectasis on CXR Eosinophilia Immediate skin reactivity to Aspergillus Increased serum IgE
