CPC cirrhosis eGFR 5 days symptoms

Respiratory Flashcards by Isuru Gamage

Classification of ILD

ILD known cause

Granulomatous

Other forms (pLAM)

Idiopathic, interstitial pneumonias

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Mosaic ventilation, segmental air trapping

Starry sky nodules

Hypersensitivity pneumonitis

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ILD Associated with tuberous sclerosis and cysts on CT chest

pLAM

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Forms of ILD assocaited with smoking, and can be reversed by stopping smoking

RB-ILD
DIP (desquamative)

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Idiopathic ILD most response to steroids

COP

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ILD mimicking ARDS, worst prognosis

AIP

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ILD with peri-bronchovascular cysts (cysts next to dilated bronchi)

LIP - lymphocytic interstitial pneumonia

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Idiopathic ILD most commonly associated with autoimmune disease

NSIP

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Features of UIP

Honeycombing
Subpleural reticulation
Basal predominance
Traction bronchiectasis

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4 diffuse cystic lung diseases

pLAM
Langerhan’s cell histiocytosis
LIP
Birt Hogg Dube syndrome

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Cystic lung disease associated with tuberous sclerosis

Often has FHx

pLAM

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Cystic lung disease associated with smoking

Langerhans cell histiocytosis

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Cystic lung disease with FHx and associated with CTD (particularly Sjogren’s)

LIP

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Cystic lung disease with FHx of pneumothorax

Birt Hogg Dube syndrome

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Nintedanib MoA and common A/E

MoA - blocks multiple TKI’s (VEGF, PDEGF

A/E - Diarrhoea

Contraindiacted in severe liver impairment

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Pirfenidone MoA and common A/E

MoA - antifibrotic, inhibiting TGFb and fibroblast proliferation

A/E - Drug induced liver injury

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UIP radiology features

Honeycombing
Subpleural reticulation
Basal predominance
Traction bronchiectasis

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NSIP radiology features

Ground glass changes
Subpleural sparing

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1st and 2nd line Treatment of OHS

OHS and OSA (90%) - CPAP

No OSA, and sleep hypoventilation - BiPAP

2nd line - BiPAP

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Treats narcolepsy but not cataplexy

Modafanil - 1st line in narcolepsy

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Good treatment of cataplexy

Sodium oxybate
Methylphenidate

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REM sleep disorder features and significance

Intrusion of wakelfullness in REM –> lack of atonia in REM sleep

Predates dementia by 10 years, strongly associated with synucleiopathies

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Hypersomnia
Hyperphagia
Hypersexuality

Klein Levin syndrome

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Most common pattern ILD in RA

UIP

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A/E of nitrofurantoin

Pulmonary fibrosis

Diffuse pulmonary infiltrates Acute Eosinophilia Rapid response to steroids

Eosinophilic pneumonia

CFTR gene -which chromosome?

Severe CF characterised by? What classes of CFTR mutation fit this?

Reduce/absent production of CFTR, or reduced CFTR reaching membrane 1 - absent production 5 - reduced production 2 - reduce amount reaching membrane (FD508)

Most common CF allele

Delta F508

Ivakaftor - Moa - Uses

Binds to defective CFTR to increase function Use in class 3 (defective regulation) and class 4 (defective travel of ions).

1st line for CF with delta F508 (homozygote and heterozygote) - > 6 - < 6

> 6 - trikafta < 6 - orkambi

Mutation causing defective transport of CFTR protein to membrane - name - class

Delta F508 Class 2

MoA of Evusheld

Pre-exposure Ppx Recombinant IgG binds to S spike protein, prevents binding to ACE receptor and entry into host cell

CI to paxlovid

CPC cirrhosis eGFR < 30 On other medications metabolised by CYPS >5 days symptoms

Nirmeltravir MoA

Inhibits COVID protease - prevents polyprotein processing and viral replication

COVID therapy safe in pregnancy

Remdesevir

Timeline within to use remdes

< 7 days

MoA remdesevir

Inhibits RNA dependant RNA polymerase (forms adenosine triphoshates that competitively inhibit)

MoA of baricitinib

Janus kinase 1 and 2 inhibitor

Pulm HTN and pregnant - Which to use - What is CI

Sildenafil Bosentan and rociguat contraindicated

Most common form lung cancer

Adenocarcinoma

Upper lobe lung pathology

SET CAP Siicosis Extrinsice alveolitis TB CF Ank Spon PCP

Lung Tx patients with highest survival?

CF - as they are youngest

Warm ischaemic time - Higher in? - Outcomes?

Ischaemic time at normal termperature Higher in DCD (have to wait 60 minutes) High early graft dysfunction, same survival outcomes

FEV1 to refer for lung transplant in COPD?

< 25%

BODE score

BMI Obstruction (FEV1) Dyspnoea (mCRC) Excercise (6MWT) 3 for FEV1 < 35% 3 for stage 4 mCRC

When to refer for lung transpant based on BODE

BODE 5 or more

When to refer ILD for Lung Tx

UIP of fibrotic NSIp Any functional or O2 impairment

CI to lung reduction surgery

DLCO < 20 FEV1 < 20

Benefits of lung reduction volume surgery

Overall survival advantage Reduce hyperinflation

1st line management of CLAD (PPx also)

Azithromcyin

Management for CTEPH class 1/2 NYHA

ricoguat

Most common cause pulmonary hypertension

L heart disease

Rapidly progressive class I PAH

PVOD

CUrative treatment for CTEPH

Endarterctomy - first line if feasible (assess with CTPA)

mCR dyspnoea score

4 - can't leave house 3 - 100m 2 - Walks slower than someone same age

>50% VC drop when standing Dyspnoea when standing

Diaphragmatic palsy

Tests for unilateral diaphragamtic palsy

Sniff test - video fluoro, paradoxical rise Low MIP

Direct bronchoprovocation

Histamine, metacholine

Indirect bronchoprovocation

Hypertonic saline, mannitol

Benefit of bronchprovocation

High NPV Rule out asthma

High FeNO?

Measure of steroid hyperresponsiveness

Value of CPET

Can differentiate if dyspnoea is due to ventilation, pulmonary, cardiac or metabolic

Bronchiectasis - treatment to prevent exacerbations

Long term azithro

Aspergillus in sputum - when is it of consequence?

Any one immunosuppressed Immunocompetent - both fungal elements and hyphae on stain

Screening test for Kartegeners

Low NO exhalation

Diagnosis of CF

FHX of clinic features AND 1 of: - x2 positive sweat tests - 2 CF causing mutations - Nasal PD tracing typical for CF

Best way to test compliance with CFTR modulators

Nasal potential difference assessment

Differentiate between acute and chronic eosinophilic pneumonia

Both are rapidly responsive to steroids Acute will NOT have peripheral eosinophila because they are all in the lungs

Light's for exudative

Protein - pleural > 50% LDH - Pleural > 60% Pleural LDH > 0.45

Pleural fluid suggestive of empyema

ph < 7.2 Microorganism on gram stain Pleural glucose < 40

Decreased in O2 sats on CPET

Pulmonary vascular disease

Muscles of inspiration

External intercostals Diaphragm

Muscle of expiration - Passive - Forces

Recoil of lungs and diaphragam Abdominal muscles, internal intercostals

Which lung volume is PVR lowest?

FRC

When is D Dimer useful

If PE pre-test probability is low Can rule out diagnosis

MoA pirfenidone

Inhibits TGF-b

Main A/E pirfinedone

Rash, photosensitivity

MoA nintendanib

TKI for VEG/PDGF

A/E of nintendanib

LFT derangement, diarrhoea

CI to nintendanib

CPB and CPC cirrhosis CYP3A4 and p glycoprotein inducers

Which hormone stimulates respiration

Progesterone Methoprogesterone used for sleep disordered breathing

Most important peripheral chemoreceptor

Carotid bodies - detect PaO2 and increase ventilation

Central chemoreceptors detect?

pH as a product of CO2

Reason for improved excercise capacity in lung reduction

Improved elastic recoil

Respiratory Flashcards

(85 cards)