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1
Q

How does acute mountain sickness present and how is it managed

A

at 2500-3000m
headache, nausea, fatigue over 6-12hrs
Mx descent
prophylaxis acetazolamide

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2
Q

Pathophysiology HAPE

A

> 4000m
hypoxia -> uneven pulm vasoconstriction & blood flow -> areas with increased blood have increased cap pressure and leak causing oedema

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3
Q

HAPE management

A

descent
nifiedipine, dex, acetazolamide

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4
Q

HACE pathophysiology

A

hypoxia causes cerebral vasodilation increases cerebral blood flow causing oedema

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5
Q

HACE presentation and management

A

headache, ataxia, papilloedema
Mx: descent, dex

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6
Q

acute Mx asthma

A

SABA
Pred
SAMA
IV MG
IV amiophylline
I&V
ECMO

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7
Q

Diagnosis of asthma <5

A

clinical

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8
Q

Diagnosis asthma 5-16

A

spirometry and BDR test
FeNO if normal spiro or obstructive spiro with -ve BDR test

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9
Q

Diagnosis asthma >17

A

spiro and BDR test
FeNO
?occupational

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10
Q

Causes of acute exercabtion of COPD

A

h. influenza
strep pneumoniae
moraxella catarrhalis
rhinovirus

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11
Q

NIV starting settings

A

pH <7.35
EPAP 4-5cm h20
IPAP 10-15cm H20

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12
Q

How is COPD diagnosed

A

post bronchodilator spiro
FEV1/FVC <70%
FEV1 >80%: mild
FEV1 50-80%: mod
FEV1 30-50%: severe
FEV1 <30%: very severe

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13
Q

CXR findings in COPD

A

hyperinflation
bullae
flat hemidiaphragm

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14
Q

signs of asthma/steroid responsiveness in COPD

A

asthma/atopy hx
increased eosinophils
FEV1 variation
diurnal variation PEF

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15
Q

When to consider LTOT

A

2 ABG more than 3 weeks apart
pO2 <7.3 or 7.3-8.0 +
polycythaemia, peripheral oedema or pulmonary hypertension

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16
Q

What causes lung mets & appearance on CXR

A

Breast
bladder
prostate
renal
colorectal

  • cannonball
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17
Q

Carcinoid ca

A

40-50
long Hx
cherry red ball on broncoscopy
Mx: surgical

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18
Q

Small cell lung CA

A

ectopic ADH: low Na
ACTH: Cushings
Lambert Eaton Syndrome
Mx: chemo/radio

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19
Q

Non small cell lung Ca

A

Radiotherapy
Mediastinoscopy prior to surgery ?lymph node involement

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20
Q

CI to non small cell lung Ca surgery

A

SCV obstruction
Vocal cord paralysis
FEV1 <1.5
Malignant effusion

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21
Q

Squamous cell Ca

A

PTH related protein: High Ca
Clubbing
HPOA
TSH: hyperthyroid

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22
Q

Adenocarcinoma

A

gynaecomastia
HPOA

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23
Q

Cystic fibrosis gene and inheritance type

A

chromosome 7
autosomal recessive

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24
Q

Cystic fibrosis defect

A

defect in CFTR which codes cAMP regulated chloride channel

25
Organises that colonise in CF pts
s. aureus p. aeruginsosa burkholderia cepacia *CI to transplant* aspergillus
26
Mx CF
chest physio high cal high fat diet, pancreatic enzyme sups, vit sups lung transplant *b cepecia CI* Orkambi - homozygous
27
Causes of transudate pleural effusion
protein <30 HF, low albumin, hypothyroid
28
Causes of exudate pleural effusion
protein>30 infection, CTD, Ca, pancreatitis, PE
29
When do you use lights criteria
When protein 25-35
30
What could low glucose in pleural effusion indicate
RA, TB
31
What would high amylase in pleural effusion indicate
pancreatitis, oesophageal perforation
32
what would blood in pleural effusion indicate
mesothelioma, PE, TB
33
When would you insert a chest drain if pleural effusion likely from infection
if aspirate is cloudy/purulent or pH <7.2
34
What is sarcoidosis
non caseating granulomas, unknown cause
35
Sarcoidosis presentation
young adult, african erythema nodusum BHL swinging fever polyarthralgia SOB, cough, malaise, weight loss, hypercalcaemia
36
Management of sarcoidosis
2/3rds self limiting steroids if - symptomatic + CXR S2-S3 - hypercalcaemia -eye, heart, neuro involvement
37
Poor prognostic factors of Sarcoidosis
insidious no erythema nodosum extra pulm CXR S3-4 Black or afro/Caribbean
38
CXR stages of sarcoidosis
1- BHL 2- BHL + interstitial infiltrates 3- diffuse interstitial infiltrates only 4- diffuse fibrosis
39
What is ARDS
increased permeability of alveolar capillaries leading to fluid in alveoli
40
Causes of ARDS
infection trauma transfusion
41
Mx ARDS
Itu for organ support treat cause
42
What is alpha 1 antitrypsin deficincy genetic and inheritance pattern
autosomal recessive chromosome 14
43
How does A1AT deficiency present
PiZZ panacinar emphysema, cirrhosis, hepatocellular ca
44
Management A1AT def
no smoking, bronchodilators IV A1AT lung volume reduction surgery, lung transplant
45
types of pneumothorax
primary: young, tall, no lung disease secondary: lung disease traumatic iatogenic tension: displacement of mediastinal structures
46
management primary pneumothorax
<2cm and not SOB : discharge otherwise aspirate, chest drain if fails
47
management secondary pneumothorax
<1cm: 02 and observe 24h 1-2cm: aspirate, chest drain if fails >2cm/>50/SOB: chest drain
48
Management recurrent pneumothorax
VATS for pleurodesis +/- bullectomy
49
Discharge advice post pneumothorax
stop smoking no flying 2 weeks no diving
50
What is eosinophilic granulomatosis with polyangiitis
ANCA associated vasculitis asthma, sinusitis, SOB high eosinophils pANCA +ve
51
What is granulomatosis with polyangiitis
ANCA associated vasculitis upper and lower resp tract glomerulonephritis cANCA +ve renal bisopy: epithelial cresents in Bowmans capsule
52
Management of granulomatosis with polyangiitis
steroids cyclophosphamide plasma exchange
53
Symptoms of ABPA
wheeze, cough SOB eosinophilia +ve RAST for aspergillus raised IgE
54
Management of ABPA
1st line glucocorticoids 2nd line itraconazole
55
Causes of EAA
bird: avain proteins from poo farmers: saccharopolyspora retivirgula Malt: asp claratus
55
What kind of hypersensitity reaction is EAA
type III /IV
56
Presentation of EAA
acute: SOB, cough fever chronic: SOB, cough, lethargy, weight loss
57
Ix EAA
upper/mid fibrosis bronchoalvealor lavage: lymphocytosis IgG AntibodiesMan
58
management EAA
avoidance glucocorticoids

MRCP (19 decks)

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