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1
Q

Cells producing surfactant?

A

Type 2 alveolar epithelial cells

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2
Q

FEV1

A

Volume of gas expired in first second of forced expiration

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3
Q

FVC

A

Total volume of gas expired on forced expiration

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4
Q

Normal FEV1:FVC?

A

70-80%

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5
Q

Obstructive vs restrictive FEV1/FVC pattern?

A

Obstructive is a preserved FVC with a reduced FEV1:FVC - obstruction limits the amount in 1 second but the capacity is not restricted

Restrictive is a preserved FEV1:FVC but with a reduced FVC - they can blow lots of air out but the total capacity is limited

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6
Q

Obstructive vs restrictive airway diseases

A

Obstructive - asthma/COPD

Restrictive - PF/obesity/neuromuscular/pleural disease

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7
Q

Diffusion impairment in hypoxaemia?

A

Pulmonary oedema or ILD

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8
Q

Dissociation curve to the right?

A

High temperature
Acidosis
Hypercapnia
Increased 2,3-GPD - encourages offloading of oxygen to tissues
Altitude

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9
Q

Dissociation curve to the left?

A

Alkalosis
Low temperature
Hypocapnia
Carboxyhaemoglobin
Foetal haemoglobin

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10
Q

Variable and reversible airflow obstruction?

A

Asthma

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11
Q

Exhaled nitric oxide concentration in asthma?

A

Increased, >40 parts per billion
Do this in all suspected asthmas over 17 years
In children only do it if the spirometry is normal/not as expected

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12
Q

Common Ig response in asthmatics?

A

IgE

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13
Q

Testing for specific IgE responses?

A

RAST

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14
Q

Monoclonal antibody sometimes used in severe allergic asthma? What does it bind to?

A

Omalizumab
IgE

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15
Q

Asthma not controlled on SABA?

A

Add low dose ICS

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16
Q

ASthma not controlled on SABA + ICS?

A

Add LTRA

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17
Q

Asthma not controlled on SABA + ICS + LTRA?

A

SABA + ICS + LABA +/- LTRA

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18
Q

Asthma not controlled on SABA + ICS + LABA +/- LTRA?

A

SABA + MART +/- LRTA

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19
Q

Life-threatening asthma features?

A

Hypoxaemia
PEFR<33%
Exhaustion
Bradycardia/arrhythmia
Hypotension
Silent chest
Altered consciousness
Poor respiratory effort
Cyanosis

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20
Q

ITU referral in asthma?

A

Deteriorating PEFR despite Rx
Persistent or worsening hypoxia
Rising CO2
Acidosis
Altered consciousness/exhaustion
Resp arrest

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21
Q

FEV1:FVC in COPD?

A

<70

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22
Q

FEV1 in COPD?

A

Classically <80% predicted

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23
Q

Most common exaccerbating organisms in COPD?

A

H flu - most common
Strep pneumoniae
Less common - staph, moraxella

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24
Q

Score for objective measure of COPR prognosis?

A

BODE

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25
COPD grades of airflow obstruction (FEV1)
Mild - at least 80% Mod - 50-79% predicted Severe - 30-49% predicted Very severe - <30% predicted
26
COPD causes
Smoking A-1 antitrypsin Coal Cotton Cement Cadmium Grain
27
"Asthmatic/steroid responsive" features in COPD
Any previous, secure diagnosis of asthma or of atopy Higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up Substantial variation in FEV1 over time (at least 400 ml) Substantial diurnal variation in peak expiratory flow (at least 20%)
28
Treatment for COPD WITHOUT "Asthmatic/steroid responsive" features"
LABA + LAMA + SABA for bronchodilation
29
Treatment for COPD WITH "Asthmatic/steroid responsive" features"
LABA + ICS You can add LAMA
30
Transplant basic criteria in COPD?
Under 65 FEV1 and DCLO <20%, history of severe hospitalisaton +/- cor pulmonale despite O2 therapy
31
Transplant basic criteria in COPD?
Under 65 FEV1 and DCLO <20%, history of severe hospitalisation +/- cor pulmonale despite O2 therapy
32
Normal alpha 1 AT genotype?
PiMM
33
Abnormal alpha 1 AT genotypes?
PiMZ - carrier - may pass on to children but low risk of lung disease in non-smoker PiSS - 50% A1AT levels PiZZ - most severe deficiency and most likely to manifest disease - 10% A1AT levels
34
What is alpha 1 AT?
Protease inhibitor
35
Effects of A1AT deficiency?
Emphysema, mostly lower lobes Liver: cirrhosis and HHC in adults, cholestasis in children
36
LTOT criteria?
pO2 <7.3 on at least two separate occasions OR <8.0 with evidence of PHTN, polycythemia, peripheral oedema or nocturnal hypoxaemia
37
Gram +ve cocci in COPD?
Moraxella
38
Most common organism in central line infections?
Staph epidermidis
39
Markers of poor prognosis in CAP beyond CURB?
Hypoxaemia despite O2 therapy Multilobar involvement WCC <4 or >20 Low albumin Bacteraemia
40
Herpetic cold sores with pneumonia?
Strep pneumoniae
41
Capsular polysaccharide detected in pneumonia?
Strep pneumoniae
42
Nasty complications of mycoplasma pneumonia?
Peri/myocarditis SJS Erythema multiforme/nodosum DIC Meningitis Hepatitis/pancreatitis
43
Pneumonia in an alcoholic?
Klebsiella
44
Bacterial pneumonia which may follow a recent viral illness?
S aureus
45
Cavitating lung organisms?
S aureus Klebsiella Legionella Anaerobes Pseudomonas TB
46
Ghon focus?
Area of primary TB infection in the lung, classically the stage at which infection is halted in immunocompetent hosts
47
Symptoms of primary TB infection?
Usually asymptomatic but occasionally pleurisy secondary to pulmonary oedema/lymphadenopathy
48
Crescent/halo sign in upper lobe cavity?
Aspergilloma
49
Ghon focus?
Small lung lesion in TB in the mid-lower zone. Primary TB infection is usually halted at this point
50
Reactivation of TB?
Immuosuppressants - incl. steroids, MTX, anti-TNF alpha HIV Malignancy Malnutrition
51
Choroidal tubercles on fundoscopy?
Miliary TB
52
AAFB stain?
Ziehl-Neelsen Auramine
53
Asymptomatic but positive Mantoux and then positive interferon Y test?
Give prophylaxis: Either Isoniazid for 6 months OR Rifampicin and isoniazid for 3 months
54
TB treatment?
Rifampicin Isoniazid Pyrazinamide Ethambutol
55
Eye disease on TB treatment?
Ethambutol
56
Hepatitis on TB treatment?
Rifampicin Isoniazid Pyrazinamide
57
Peripheral neuropathy on TB treatment? Treatment?
Isoniazid Rx with pyridoxine
58
Addition to TB treatment in tuberculous meningitis?
Steroids
59
Vaccines contraindicated in HIV patients?
Live vaccines BCG Yellow fever Oral polio Nasal flu Varicella MMR
60
Most severe pattern of bronchiectasis?
Cystic
61
Causes of bronchiectasis?
Post infective Alpha 1 AT Cystic fibrosis Congenital - Marfan, Williams-Campbell Immunocompromise Aspergillosis Sarcoid/pulm fibrosis Chemicals Ciliary dyskinesis
62
Most common sputum isolate in bronchiectasis?
H influ
63
PFTs in bronchiectasis
Generally obstructive
64
Thickening of bronchial walls, ring shadows, fluid levels on CXR?
Bronchiectasis
65
Diagnostic test for bronchiectasis?
HRCT
66
Bronchiectasis associations?
RA (30%) Malignancy Sjogren IBD Ank spon
67
Treatment for bronchiectasis with underlying immune deficiency?
IV I-gamma-G
68
CF chromosome?
7
69
Most common CF mutation?
F508del
70
Diagnosis of CF?
Sweat test (chloride) Genetic analysis
71
PFTs in CF? Why?
Obstructive It's bronchiectasis
72
Neonatal presentation of CF?
Meconium ileus
73
Adult GI manifestation of CF?
Distal intestinal obstruction syndrome Malabsorption
74
Fertility in CF?
Most males are infertile Females slightly less fertile
75
Chronic colonisation in CF?
Pseudomonas
76
Group of organisms colonised in some CF patients which carries a poor prognosis?
Burkholderia
77
Nebulised Abx in CF?
Colistin or tobramycin
78
Drug given in CF sometimes and in stubborn empyema?
DNase
79
NIV in bronchiectasis?
Rarely benefitial
80
New therapy licensed for some CF patients which targets CFTR?
Ivacaftor/Lumacaftor
81
CF birth rate?
1 in 2500
82
CF inheritance?
AR
83
CF-specific contraindication to lung transplant?
Burkholderia cepacia colonisation
84
A history of bronchiectasis and eosinophilia - think?
ABPA
85
Treatment of ABPA (x2)
Prednisolone Itraconazole sometimes
86
Rounded opacity on CXR in someone with previous TB?
Aspergilloma
87
Aspergilloma most common fungal organism?
A. fumigatus
88
Non-invasive diagnostic test for aspergilloma?
Serology for aspergillus precipitins
89
Gradual development of wheeze, haemoptysis, well demarcated lung lesion, no weight loss?
Carcinoid?
90
Pneumonia in asolescent/young adule, headache/malaise/cough, pharyngitis/myringitis, cold agglutinins, muscle tenderness, dramatic CXR?
Mycoplasma pneumonia
91
Drugs which increase theophylline levels?
Cipro Clari COCP
92
Pneumothorax, fibrofolliculomas, renal Ca?
Brit-Hogg Dube syndrome
93
Exotic travel history, blood eosinophilia, mention of filaria?
Tropical pulmonary eosinophillia assoc with Wuchereira bancrofti
94
First line treatment for legionella?
Clari
95
Most common pathogens in CF - early years and adulthood
Early years - staph aureus Adulthood - pseudomonas

MRCP 1 (24 decks)

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