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Respiratory Flashcards

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1
Q

In what form is the majority of carbon dioxide in the blood carried?

A

bicarbonate ions

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2
Q

REM sleep behaviour disorder has which gender predominance?

A

Massive male predominance

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3
Q

To what drug does REM sleep behaviour disorder respond?

A

Clonazepam

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4
Q

Vital capacity is the sum of…

A

TV + inspiratory reserve vol + expiratory reserve vol

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5
Q

What 2 mutations are present in majority of cases of inherited PAH?

A

mutations in receptors of the transforming growth factor-beta family (BMPR2) and activin like kinase type 1 (ALK1)

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6
Q

A-a gradient equation

A

(150 - pCO2/0.8) - PaO2

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7
Q

HLA allele in Narcolepsy

A

HLA DQB1*0602

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8
Q

Reduced levels of … are seen in the … of people with narcolepsy

A

Hypocretin (wakefulness assoc. neurotransmitter), CSF

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9
Q

Acid Base disturbance of salicylate poisoning

A

primary respiratory alkalosis from salicylate induced hyperventilation; metabolic acidosis due to salicylate interference w. intermediary metabolism -> overproduction of organic acids

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10
Q

Lung volume changes in pregnancy

A

RV and ERV gradually reduce; FRC decreases and IC increases by same amount so TLC stable

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11
Q

At which lung volume is PVR lowest?

A

FRC, because inward elastic forces of lung are in equilibrium with outward elastic forces of chest wall

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12
Q

Feature of a lung nodule that is highly predictive of malignancy

A

High Houndsfield density (>20 HU)

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13
Q

Major side effect of Nintedanib

A

Diarrhoea- in >60%

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14
Q

Does Pirfenidone improve dyspnoea scores?

A

No

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15
Q

Gas trapping increases what spirometry measurement?

A

RV and FRC

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16
Q

Normal A-a gradient

A

(Age/4) + 4; typically <15mmHg

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17
Q

Causes of a raised KCO

A

obesity, asthma, haemorrhage, polycythaemia, L to R shunt

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18
Q

O2 dissociation curve shift to the right

A

acidosis, rise in DPG, rise in temp

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19
Q

What causes a large decrease in VC with lying down?

A

diaphragmatic palsy

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20
Q

Slow VC > FVC suggests

A

dynamic airway collapse

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21
Q

3 congenital causes of bronchiectasis

A

Marfan’s, ciliary dysfunction, alpha-1 AT

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22
Q

Condition with highest sputum mucin concentration

A

Primary ciliary dyskinesia

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23
Q

SE of hypertonic saline

A

bronchspasm

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24
Q

when to initiate hypertonic saline in bronchiectasis?

A

> 3 exac/yr

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25
Abs for. mdr-Pseud
beta-lactam + aminoglycoside
26
drugs w/o evidence in bronchiectasis?
PO steroid, tiotropium
27
Rx duration for M abscessus
12 months
28
CF GI Manifestations:
DIOS, fibrosing colonopathy

29
CF most common mutation
F508deletion
30
CF F508deletion mechanism
Defective trafficking and opening
31
CF F508deletion rx
Homozygotes with: Ivacaftor + tezacaftor + exelacaftor
 | Hetero: Iva and teza alone

32
Ivacaftor MOA
potentiator, opens channel (good for G551D)
33
tezacaftor + exelacaftor
 + lumacaftor MOA
traffickers
34
tezacaftor + exelacaftor
 effect
Increase FEV1 by: 5-15%
35
Diagnose CF by one of 4:
mec ileus, heelprick immunoreactive trypsinogen, sweat test >60mmol, gene test

36
CF Transplant indications

FEV1 <35% PaO2 <60 PaCO2>55 Infections: Resistance or increasing exac QoL

37
In asthma, what is a Positive methacholine challenge?
drop >20% FEV1
38
In asthma, what is a Positive mannitol challenge?
drop >15%
39
Gold standard for exercise-induced asthma
Eucapnic voluntary hyperventilation >10% fall

40
In asthma, what does FENo: >50ppb mean?
likely steroid responsive; not if <25ppb
41
Mepoliziumab MOA
Anti-IL5
42
Benralizumab MOA
Anti-IL5R
43
Omalizumab MOA
Anti-IgE, but not effective if IgE >1300 (too much to bind)
44
ABPA clinical findings
Asthma, bronchiectasis, fleeting infiltrates
45
ABPA lab
IgE >1000, Eo >0.5, Aspergillus IgG precipitans
46
ABPA rx
Steroids and itraconazole
47
COPD x3 indications for Abx
Fever, sputum vol increase, change in sputum colour
48
BODE predicts:
respiratory death in COPD
49
BODE is made up of
BMI; FEV1; dyspnoea scale; 6MWT distance;
50
LTOT indications
Pa O2 <55 or PaO2 55-59 with pulmon HTN or polycythaemia
51
ICS candidates in COPD
FEV1 <50%, 2 or more moderate exac/year, eosinophilia, asthma concurrent
52
Who not to give ICS in COPD
repeated pneumonia, low eos, myobacterial infection
53
DECAF score for worse outcomes in exacs of COPD
Dyspnoea scale; eosinopaenia; consolidation on CXR; acidaemia pH <7.30,; afib
54
SpO2 measurement in CO poisoning
Pulse oximeter will be normal, PaO2 will be normal
55
O2 sats vs gas measurement in MetHb
Pulse Ox will read low, PaO2 will be normal
56
Lemiere's disease is due to which organism...
Fusobacterium
57
ARDS key ventilation targets
TV 6-8ml/kg; peak plateau pressure <30cmH2o
58
When to consider ECMO in ARDS
When PF <80 | PF is PaO2/FiO2
59
Level of MIP/SNIP that predicts T2RF in MDN
<1/3
60
Normal MIP/MEP F or M
F: 90 M: 140
61
Apnoea definition
cessation of airflow >10s
62
Definition of hypopnoea
>30% reduction in airflow for >10s with EEG arousal OR sats drop 4%
63
Respiratory disturbance Index (RDI) equation
AHI + RERA (resp effort related arousal)
64
AHI normal/moderate/severe
Mild5-15, mod 15-30, severe >30
65
OSA definition
AHI >5 with symptoms; or AHI >15
66
OHV triad
BMI >30, awake PaCO2 >45, sleep disordered breathing
67
CPAP adherence definition
>4 hours/ night
68
Type 1 Narcolepsy definition
>3/12 EDS + cataplexy + positive MSLT OR low CSF hypocretin
69
Type 2 Narcolepsy definition
>3/12 EDS + positive MSLT + normal hypocretin
70
Positive MSLT
sleep within 8 mins x2 on test
71
Rx of excessive daytime sleepiness
Dexamphetamine or modafinil
72
Rx of cataplexy
SSRI/SNRI
73
Lofgren syndrome
Sarcoidosis: Arthritis + EN + bilateral hilar LN
74
Key aspect of Lofgren's for Ix and Rx
No further Ix needed if textbook; Mgmt NSAIDs
75
Sarcoid stages
1: Hilar/mediastinal LN; 2: LA and parenchymal infiltrates; 3: parenchymal infiltrates; 4: fibrosis
76
Sarcoid stages mgmt
1: 95% resolve spont; 2: steroids; 3: steroids
77
Radiographic predictors of malignancy
nodule >3cm, poorly marginated or spiculated, UL location
78
PET is not good for:
<0.7cm, carcinoid, bronchoalveolar adenoCa
79
Three key pathways for pulmonary HTN
endothelin, nitric oxide, prostacyclin
80
Triad for definition of pHTN
mPAP >25, PVR >3, PAW <15
81
pulmonary HTN positive vasodilator challenge
10-40 reduction mmHg, stable or rise in CO
82
Adverse reaction to vasodilators that occurs with PVOD
pulmonary oedema
83
2 main RHC prognostic markers
Cardiac Index, RAP
84
Group most likely to respond to vasodilators in pHTN
idiopathic pulmonary arterial HTN, anorexigen
85
Specific medical rx for CTEPH
Riociguat
86
Gene assoc. w. familial PAH
BMPR2
87
Contraindications to bronchoscopy
platelets <50, INR <1.5
88
Mgmt of lung nodule <6mm, solid and low risk
Nil
89
Mgmt of lung nodule <6mm, solid and high risk
optional CT at 12 months
90
Mgmt of 6-8mm nodule, solid, low or high risk
CT 6-12 months
91
Mgmt of nodule >8mm, solid
CT at 3 months, PET or tissue sampling
92
Crazy paving is
GGO, interlobular thickening, intralobular reticulation
93
PTx mgmt primary, <2cm and Asymptomatic
Nil
94
PTx mgmt if primary >2cm or dyspnoea
Aspirate
95
PTx mgmt if secondary, <2cm and asymptomatic
aspirate and admit
96
PTx mgmt if secondary, >2cm or Sx
Drain
97
When to check diff between protein levels in serum and pleural fluid? (SPPG)
If think fluid it transudative but appears exudative
98
SPPG suggesting exudate
SPPG <31
99
How to calculate SPPG
serum protein - pleural protein
100
If SPPG consistent with exudate, check:
check serum:pleural albumin gradient (SPAG)
101
SPAG consistent with exudate
<12g/L
102
ADA is produced by
cell mediated immune response
103
ADA value suggesting TB?
>40
104
ADA value suggesting lymphoma or empyema?
>250
105
Predominant cell type in TB pleural fluid
Lymphocytic
106
Differential diagnosis if pleural fluid >10% eosinophils (4 diagnoses)
Drugs, fungus, parasites, BAPE (benign asbestos pleural effusion)
107
Characteristic pleural fluid findings for peritoneal dialysis related effusion?
Glucose 2x serum | Low protein
108
Characteristics pleural fluid findings for urinothorax
Creatinine 5x serum
109
Pleural fluid findings in duropleural shunt
Beta-2-transferrin level elevated
110
Characteristic pleural fluid findings in ventriculopleural shunt
Acellular
111
Characteristic pleural fluid findings in trapped lung?
Pleural elastase >14.5
112
Antibiotics for CAP-associated empyema
Benpen+metro OR cef/metro Then Augmentin OR amox+metro Total 3-4 weeks
113
Antibiotics for HAP associated empyema
Taz QID
114
Classical findings for UIP
Subpleural reticulation, honeycombing, traction bronchiectasis, apical-basal gradient
115
4 features of NSIP
Ground glass opacities Subpleural sparing Apical-basal gradient Traction bronchiectasis
116
What is significant fall in FVC or DLCO?
FVC 10% | DLCO 15%
117
What DLCO cut-off is used to say lung biopsy ++ risky?
<35-40%
118
Hyaline membranes on lung biopsy suggests:
Acute interstitial pneumonia
119
Mechanism of pirfenidone and side effects
Reduces production of pro-fibrotic cytokines- TGF-b, IL1b, fibroblast growth factors AEs - GI, ALT/AST elevation, photosensitive rash
120
Nintedanib mechanism and S/E
Multi-target TKI (PDGF, VEGF, FGF) | Diarrhoea, CV risk, bleeding
121
Average FVC loss per year in IPF
150-200mL
122
PBS criteria for IPF anti-fibrotics?
FEV1 > 50% | DLCO > 30%
123
Pathogenesis of hypersensitivity pneumonitis
Type 3 hypersensitivity, mediated by IgG immune complexes
124
AIP biopsy histology
Hyaline membranes in the alveoli from diffuse alveolar damage
125
UIP/ IPF histology
Numerous fibroblastic foci
126
Causes of extra thoracic obstruction
Vocal cord paralysis, extra-thoracic goitre, laryngeal tumour
127
Causes of intrathoracic obstruction
Tracheomalacia of intrathoracic airways, bronchogenic cysts, tracheal lesions
128
Cause of fixed airway obstruction
Tracheal stenosis

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