Other

Question 1

ARDS recommendation

Answer 1

strongly in favour:
tidal volume <6ml/kg IBW
plateau pressure <30cmH2O
prone position for moderate/severe ARDS >12 hours

Weakly in favour:
higer PEEP, neuromuscular blockers, ECMO

Question 2

ARDS grading

Answer 2

PaO2/FiO2 <300mmHg (40kPa) despite PEEP >5cmH2O
Mild: >200mmHg (27kPa)
Moderate: >100 (13 kPa)
Severe: <100 (13kPa)

Question 3

ECMO for ARDS

Answer 3

Severe ARDS
High lung injury score
hypercapnic pH <7.2
No CI to anticoagulation

Question 4

Guillain Barre syndrome - risk of respiratory failure

Answer 4

Bulbar dysfunction
facial weakness
Max Inspiratory Pressure <30
Max expiratory pressure <40
FVC drop >30% from baseline
FVC <15ml/kg

Question 5

Flow volume loops:
Causes of fixed upper airways obstruction

Answer 5

Tracheal stenosis
fixed central airway tumour
fibrotic structure
Goitre

Question 6

Flow volume loops:
causes of variable intrathoracic obstruction

Answer 6

Tracheomalacia
Bronchogenic cysts
lower tracheal lesions e.g. tumour
polychondritis

Question 7

Flow volume loops:
Causes of variable extrathoracic obstruction

Answer 7

Vocal cord paralysis
subglottic stenosis
extrathoracic tracheomalacia
polychondritis
mobile upper tracheal tumours
goitre

Question 8

Flow volume loops:
Causes of saw tooth palter

Answer 8

neuromuscular disease
parkinsons disease
OSA

Question 9

causes of high TLCO

Answer 9

Lying flat
Exercise
Asthma
Pulmonary haemorrhage
Polycythaemia
L-> R shunt
AV malformations
hyperthyroidism

Question 10

Causes of low TLCO

Answer 10

Emphysema
Fibrosis
Anaemia
R -> L shunt
PE
CO poisoning

Question 11

Causes of normal KCO and Low TLCO

Answer 11

Chest wall disease
NMD
Kyphoscoliosis
obesity
lung resection
pleural thickening

Question 12

Causes of isolated low TLCO

Answer 12

Pulm hypertension

Question 13

CPET

Answer 13

Normal - VO2 max >80%
Cardiac - High HR, Ventilatory reserve
Resp - VE >80%, HR reserve, low Vt

VO2 max <15ml/kg/min (40%) - severe
Anaerobic threshold <40% VO2 - abnormal

Question 14

CPET contraindications absolute

Answer 14

acute MI, angina
Arrhythmia
Haemodynamic instability
syncope
infective endocarditis
Acute myocarditis/pericarditis
uncontrolled CCF
AAA leaking or dissection
uncontrolled asthma
desat <85% RA

Question 15

CPET contraindication relative

Answer 15

uncontrolled hypertension
severe AS
Pulm hypertension
HOCM
VTE <2 weeks
pregnancy
Tachy/brady

Question 16

end expiratory pleural pressure

Answer 16

4kPa

Question 17

Aa gradient

Answer 17

pAO2 - paO2

pAO2 = piO2 - (paCO2 /0.8)

> 4 = v/Q mismatch

Question 18

Lobectomy mortality

Answer 18

~2-3%
FEV1 >1.5L

Question 19

Pneumonectomy mortality

Answer 19

~6-8%
FEV1 >2L

Question 20

Post-op FEV1

Answer 20

Pre-op FEV1 x seg after resection /19

<40% increases risk

Question 21

Surgical lung biopsy ILD 90 day mortality

Answer 21

4%

Question 22

Transplant criteria for COPD

Answer 22

BODE >7
Hospitalisations with exacerbations
pulm hypertension
cor pulmonale
FEV1 <25%
TLCO <20%
Homogenous distribution of emphysema
smoking cessation >6 months
completed pulm rehab
Resp failure - high CO2, low O2

Question 23

Transplant criteria for CF

Answer 23

FEV1 <30%
Rapid progression
increase frequency of exacerbations
ITU admission
resp failure, LTOT
pulm hypertension
severe recurrent haemoptysis
recurrent or refractory pneumothorax
6MWT <400m

Relative CI - burkholderia and abscesses

Question 24

Transplant criteria for ILD

Answer 24

TLCO <40% or drop by >15%
FVC drop by >10% over 6 months
6MWT desat to <88% or <250m or decline in 50m over 6 months
pulm htn
exacerbations
age <65

Question 25

Transplant criteria for pulm hypertension

Answer 25

NYHA >3 Rapidly progressive disease 6MWT <350m MAP 15mmHg cardiac index <2L/min/m2 IV inotropic support haemoptysis pericardial effusion

Question 26

Criteria for lung volume reduction surgery - COPD

Answer 26

FEV1 >20% TLC >100% RV >150% pCO2 <7.3 pO2 >6 6MWT >140 <3 ex in 12 months heterozygous emphysema - upper lobe intact fissures

Question 27

CI for lung volume reduction surgery

Answer 27

diffuse emphysema ILD giant bulla pulm hypertension

Question 28

Complications for LVRS

Answer 28

persistent air leak pneumonia T2RF post-op mortality 2-15%

Question 29

LVRS criteria

Answer 29

upper lobe heterogenous emphysema RV:TLC >60 TLCO >20 BMI >18 Not suitable in: severe comorbidities, chronic resp disease, malignancy, pulm hypertension

Question 30

Referral criteria for LVRS

Answer 30

nonsmoker >4months pulm rehab MRC >3 6MWT >140 FEV1 <50% TLCO >20% RV >150% RV:TLC >55% CO2 <7 BMI > 18

Question 31

Criteria for endobronchial valves

Answer 31

upper or lower lobe heterogeneous collateral ventilation negative RV >180% TLCO>20 BMI >18

Question 32

Birt Hogg Dube syndrome

Answer 32

AD condition. benign skin hamartomas, most commonly located on the head and neck; pulmonary cysts and spontaneous pneumothorax; and an increased risk of renal cancer.

Question 33

Obesity lung function test

Answer 33

Restrictive. low FRC. TLC/RV ratio presevered

Question 34

Normal RV/TLC ratio

Answer 34

<35%

Question 35

Empey index

Answer 35

FEV1/PEFR ratio normal <10; if >10 - upper airway obstruction

Question 36

Diaphragm paralysis - test

Answer 36

MIP and Sniff nasal insp pressure low MEP normal

Question 37

A-a gradient

Answer 37

normal 1-3 depending on age raised A-a gradient = inappropriately low PaO2 -> PE, R to L cardiac shunt