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BPT > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Classification of ILD

A

ILD known cause

Granulomatous

Other forms (pLAM)

Idiopathic, interstitial pneumonias

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2
Q

Mosaic ventilation, segmental air trapping

Starry sky nodules

A

Hypersensitivity pneumonitis

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3
Q

ILD Associated with tuberous sclerosis and cysts on CT chest

A

pLAM

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4
Q

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

A

RB-ILD
DIP (desquamative)

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5
Q

Idiopathic ILD most response to steroids

A

COP

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6
Q

ILD mimicking ARDS, worst prognosis

A

AIP

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7
Q

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

A

LIP - lymphocytic interstitial pneumonia

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8
Q

Idiopathic ILD most commonly associated with autoimmune disease

A

NSIP

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9
Q

Features of UIP

A

Honeycombing
Subpleural reticulation
Basal predominance
Traction bronchiectasis

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10
Q

4 diffuse cystic lung diseases

A

pLAM
Langerhan’s cell histiocytosis
LIP
Birt Hogg Dube syndrome

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11
Q

Cystic lung disease associated with tuberous sclerosis

Often has FHx

A

pLAM

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12
Q

Cystic lung disease associated with smoking

A

Langerhans cell histiocytosis

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13
Q

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

A

LIP

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14
Q

Cystic lung disease with FHx of pneumothorax

A

Birt Hogg Dube syndrome

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15
Q

Nintedanib MoA and common A/E

A

MoA - blocks multiple TKI’s (VEGF, PDEGF

A/E - Diarrhoea

Contraindiacted in severe liver impairment

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16
Q

Pirfenidone MoA and common A/E

A

MoA - antifibrotic, inhibiting TGFb and fibroblast proliferation

A/E - Drug induced liver injury

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17
Q

UIP radiology features

A

Honeycombing
Subpleural reticulation
Basal predominance
Traction bronchiectasis

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18
Q

NSIP radiology features

A

Ground glass changes
Subpleural sparing

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19
Q

1st and 2nd line Treatment of OHS

A

OHS and OSA (90%) - CPAP

No OSA, and sleep hypoventilation - BiPAP

2nd line - BiPAP

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20
Q

Treats narcolepsy but not cataplexy

A

Modafanil - 1st line in narcolepsy

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21
Q

Good treatment of cataplexy

A

Sodium oxybate
Methylphenidate

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22
Q

REM sleep disorder features and significance

A

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

Predates dementia by 10 years, strongly associated with synucleiopathies

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23
Q

Hypersomnia
Hyperphagia
Hypersexuality

A

Klein Levin syndrome

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24
Q

Most common pattern ILD in RA

A

UIP

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25
Q

A/E of nitrofurantoin

A

Pulmonary fibrosis

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26
Q

Diffuse pulmonary infiltrates
Acute
Eosinophilia
Rapid response to steroids

A

Eosinophilic pneumonia

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27
Q

CFTR gene -which chromosome?

A

7

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28
Q

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

A

Reduce/absent production of CFTR, or reduced CFTR reaching membrane

1 - absent production
5 - reduced production

2 - reduce amount reaching membrane (FD508)

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29
Q

Most common CF allele

A

Delta F508

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30
Q

Ivakaftor
- Moa
- Uses

A

Binds to defective CFTR to increase function

Use in class 3 (defective regulation) and class 4 (defective travel of ions).

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31
Q

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

A

> 6 - trikafta

< 6 - orkambi

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32
Q

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

A

Delta F508

Class 2

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33
Q

MoA of Evusheld

A

Pre-exposure Ppx

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

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34
Q

CI to paxlovid

A

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

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35
Q

Nirmeltravir MoA

A

Inhibits COVID protease - prevents polyprotein processing and viral replication

36
Q

COVID therapy safe in pregnancy

A

Remdesevir

37
Q

Timeline within to use remdes

A

< 7 days

38
Q

MoA remdesevir

A

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

39
Q

MoA of baricitinib

A

Janus kinase 1 and 2 inhibitor

40
Q

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

A

Sildenafil

Bosentan and rociguat contraindicated

41
Q

Most common form lung cancer

A

Adenocarcinoma

42
Q

Upper lobe lung pathology

A

SET CAP
Siicosis
Extrinsice alveolitis
TB
CF
Ank Spon
PCP

43
Q

Lung Tx patients with highest survival?

A

CF - as they are youngest

44
Q

Warm ischaemic time
- Higher in?
- Outcomes?

A

Ischaemic time at normal termperature

Higher in DCD (have to wait 60 minutes)

High early graft dysfunction, same survival outcomes

45
Q

FEV1 to refer for lung transplant in COPD?

A

< 25%

46
Q

BODE score

A

BMI
Obstruction (FEV1)
Dyspnoea (mCRC)
Excercise (6MWT)

3 for FEV1 < 35%
3 for stage 4 mCRC

47
Q

When to refer for lung transpant based on BODE

A

BODE 5 or more

48
Q

When to refer ILD for Lung Tx

A

UIP of fibrotic NSIp

Any functional or O2 impairment

49
Q

CI to lung reduction surgery

A

DLCO < 20
FEV1 < 20

50
Q

Benefits of lung reduction volume surgery

A

Overall survival advantage
Reduce hyperinflation

51
Q

1st line management of CLAD (PPx also)

A

Azithromcyin

52
Q

Management for CTEPH class 1/2 NYHA

A

ricoguat

53
Q

Most common cause pulmonary hypertension

A

L heart disease

54
Q

Rapidly progressive class I PAH

A

PVOD

55
Q

CUrative treatment for CTEPH

A

Endarterctomy - first line if feasible (assess with CTPA)

56
Q

mCR dyspnoea score

A

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

57
Q

> 50% VC drop when standing

Dyspnoea when standing

A

Diaphragmatic palsy

58
Q

Tests for unilateral diaphragamtic palsy

A

Sniff test - video fluoro, paradoxical rise

Low MIP

59
Q

Direct bronchoprovocation

A

Histamine, metacholine

60
Q

Indirect bronchoprovocation

A

Hypertonic saline, mannitol

61
Q

Benefit of bronchprovocation

A

High NPV

Rule out asthma

62
Q

High FeNO?

A

Measure of steroid hyperresponsiveness

63
Q

Value of CPET

A

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

64
Q

Bronchiectasis - treatment to prevent exacerbations

A

Long term azithro

65
Q

Aspergillus in sputum - when is it of consequence?

A

Any one immunosuppressed

Immunocompetent - both fungal elements and hyphae on stain

66
Q

Screening test for Kartegeners

A

Low NO exhalation

67
Q

Diagnosis of CF

A

FHX of clinic features

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

68
Q

Best way to test compliance with CFTR modulators

A

Nasal potential difference assessment

69
Q

Differentiate between acute and chronic eosinophilic pneumonia

A

Both are rapidly responsive to steroids

Acute will NOT have peripheral eosinophila because they are all in the lungs

70
Q

Light’s for exudative

A

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

Pleural LDH > 0.45

71
Q

Pleural fluid suggestive of empyema

A

ph < 7.2
Microorganism on gram stain
Pleural glucose < 40

72
Q

Decreased in O2 sats on CPET

A

Pulmonary vascular disease

73
Q

Muscles of inspiration

A

External intercostals
Diaphragm

74
Q

Muscle of expiration
- Passive
- Forces

A

Recoil of lungs and diaphragam

Abdominal muscles, internal intercostals

75
Q

Which lung volume is PVR lowest?

A

FRC

76
Q

When is D Dimer useful

A

If PE pre-test probability is low

Can rule out diagnosis

77
Q

MoA pirfenidone

A

Inhibits TGF-b

78
Q

Main A/E pirfinedone

A

Rash, photosensitivity

79
Q

MoA nintendanib

A

TKI for VEG/PDGF

80
Q

A/E of nintendanib

A

LFT derangement, diarrhoea

81
Q

CI to nintendanib

A

CPB and CPC cirrhosis

CYP3A4 and p glycoprotein inducers

82
Q

Which hormone stimulates respiration

A

Progesterone

Methoprogesterone used for sleep disordered breathing

83
Q

Most important peripheral chemoreceptor

A

Carotid bodies - detect PaO2 and increase ventilation

84
Q

Central chemoreceptors detect?

A

pH as a product of CO2

85
Q

Reason for improved excercise capacity in lung reduction

A

Improved elastic recoil

BPT (18 decks)

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