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RACP 2022 Written > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Causes of upper zone predominant pulmonary fibrosis?

A

S - silicosis (massive fibrosis), sarcoidosis
C - coal workers pneumoconiosis
H - histiocytosis (pulmonary langerhans histiocytosis - “cystic”)
A - allergic bronchopulmonary aspergillosis
A - ankylosing spondylitis
R - radiation
T - tuberculosis

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2
Q

Causes of lower zone predominant pulmonary fibrosis?

A

D - dermatomyositis, polymyositis
R - rheumatoid arthritis
A - asbestosis
S - scleroderma
C - cryptogenic (ideopathic) pulmonary fibrosis
O - “other”; drugs

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3
Q

Drugs that cause pulmonary fibrosis?
What pattern typically?

A

NSIP

CVS - Amiodarone, hydralazine
Chemo - MTX, Bleomycin
ABx - nitrofurantoin

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4
Q

Features on HRCT of usual interstitial pneumonia (UIP)?

What major condition is this associated with?

A

Honeycombing
Traction bronchiectasis
Reticular opacities
Subpleural (peripheral) and basal predominance

Idiopathic pulmonary fibrosis

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5
Q

Features on HRCT of non-specific interstitial pneumonia (NSIP)?

Name 5 causes

A

Ground glass opacities
Reticular opacities
Traction bronchiectasis
Diffuse changes - may have subpleural sparing

Idiopathic
Drug associated
Scleroderma
Hypersensitivity pneumonitis
HIV

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6
Q

Predominantly UIP or NSIP for below autoimmune conditions:
1. RA
2. Scleroderma
3. DM/PM
4. ANCA vasculitis
5. Sjogrens

A
  1. RA = UIP
  2. Scleroderma = NSIP
  3. DM/PM = NSIP
  4. Sjogrens = NSIP
  5. ANCA vasculitis = UIP
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7
Q

Features on radiograph of cryptogenic organizing pneumonia?

A

Bilateral patchy, diffuse ground glass opacities with normal lung volumes

Peripheral and lower lobe predominant

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8
Q

Benefits of HFNP compared with NIV in T1 respiratory failure?

A

Reduces all cause mortality
Reduces HAP
Reduces need for ventilation
Improved patient comfort

Unclear impact on hospital and ICU stay/admission

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9
Q

What FiO2 can nasal cannula deliver and at how many litres per minute?

A

1-6L/minute
FiO2 0.24-0.4

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10
Q

What FiO2 can a venturi mask deliver and at how many litres per minute?

A

2-15L/minute
FiO2 0.24 - 0.5

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11
Q

What FiO2 can a non-rebreather mask deliver and at how many litres per minute?

A

10-15L/minute
FiO2 0.6-0.9

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12
Q

What FiO2 can high flow nasal cannula deliver and at how many litres per minute?

A

15-60 litres/minute
FiO2 0.3 - 100

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13
Q

Drugs/toxins that are definitely associated with pulmonary arterial hypertension?

A

Appetite suppressants - fenfluramine, dexfenfluramine, aminorex

Toxins - rapeseed oil, methamphetamine

Dasatanib (TKI for CML)

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14
Q

Drugs/toxins that are possibly associated with pulmonary arterial hypertension?

A

Cocaine, amphetamines, Appetite suppressants - diethylproprion, Phentermine, Phenylopropanolamine
Leflunomide
IFN-alpha and IFN-beta
St. Johns wort
Bosutinib (TKI for CML)
Alkylating agents (i.e. cyclophosphamide)
Tryptophan
Direct acting agents against HCV
Chinese herb Qing Dai

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15
Q

Scoring system components for mortality and hospital duration in empyema?

A

RAPID

R - renal function: elevated BUN (<5, 5-8, >8 = 0, +1 or +2)
A - age (<50, 50-70, >70 = 0, +1, or +2)
P - purulenet pleural fluid (NON-PURULENT is worse; (Yes = 0, No = +1)
I - infection source (Community = 0, Hospital-Acquired = 1)
D - Dietary/Serum Albumin (>27=0, <27=+1)

Interpretation
0-2 points = Low risk (1.5% 3/12 mortality) 3-4 points = medium (17.8% 3/12 mortality)
5-7 = High risk (47.8% 3/12 mortality)

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16
Q

Indications for step up therapy in Asthma

A

Nocturnal symptoms or on waking
Daytime symptoms and/or need for reliever >2
Any limitation of activity

“Well controlled asthma” is therefore the opposite:
- daytime symptoms/need for SABA (not before exercise) ≤ 2 days per week
- no limitation to activities
- no nocturnal symptoms

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17
Q

Features of low risk lung nodules

A

<8mm (<5mm = 1% maignant, 5-0 = 2-6% malignant)

Solid appearance

Smooth borders

Singular nodule

Non-upper lobe location

Non-enhancing

18
Q

When to reimage a 9mm solid pulmonary nodule

What if part-solid?

What if nodule 6mm?

A

PET/CT at 3 months

Part solid –> CT at 3-6 months

6mm solid –> CT at 6-12 months

19
Q

Flow volume loop with inspiratory plateau but normal expiration?
What about if expiratory loop was also flattened?

A

Flattened inspiratory plateua but normal expiration - variable extrathoracic obstruction (i.e. vocal cord paralysis)

Flattened inspiratory AND expiratory loop - fixed extrathoracic obstruction (i.e. tracheal stenosis)

20
Q

Flow volume loop with expiratory plateau but normal inspiration?

A

Flattened expiratory loop but normal inspiration - variable extra thoracic obstruction (i.e. tracheal malacia)

21
Q

Components of the ISARIC score for COVID deterioration

A

Age
Gender
Number of co-morbidities

Respiratory rate
Peripheral oxygen saturation on room air

Glasgow coma scale
Urea
CRP

22
Q

Which are the 3 interstitial lung diseases associated with smoking? Do they improve with cessation of smoking?

A

Desquamative interstitial pneumonia
Langerhans cell histiocytosis (upper lobe)
Respiratory bronchiolitis interstitial lung disease (upper lobe; centrilobular emphysema)

Mostly yes

23
Q

In what cancers do EGFR TKIs have a role?

A

Head, neck, lung, colorectal cancer

24
Q

What is the major difference between erlotinib and osimertinib?

A

Osimertinib = active against T790 resistance mutations
Erlotinib/other egfr TKIsare not

25
Q

What is the most common cause of HAP?

A

Aerobic gram -ve bacilli

26
Q

Normal level of bicarb compensation of resp acidosis

A

for every 10mmhg CO2 above 40, bicarb increases by 1

27
Q

5 causes of increased DLCO
4 causes of deceased DLCO

A

Increased
- polycythemia
- pulmonary haemmorhage
- asthma
- high altitude
- left to right shunts
- obesity

Decreased
- smoking (false due to high CO)
- ILD
- anemia
- COPD

28
Q

Agents used for treatment of mesothelioma

A

Epithelioid: cisplatin + pemtrexed +/- bevacizumab

Non-epithelioid: nivolumab + ipilimumab

29
Q

Factors that reduce FRC

Impact on pre-oxygenation and safe apnea?

A

Pregnancy
Obesity
Very young age

Reduces efficacy and efficiency of pre-oxygenation therefore reduces safe apnoea time

30
Q

Targets of Nintedanib
Major effect?

A

Platelet derived growth factor, fibroblast derived growth factor, VEGF

Reduces decline in FVC

31
Q

Major paraneoplastic syndromes in small cell lung cancer

A

Lambert eaton
HPOA
Hypercalcemia
SIADH
ACTH excess

32
Q

Major paraneoplastic syndromes in squamous cell lung cancer

A

Hyperthyroidism (ectopic TSH)
HPOA
Hypercalcemia (PTH mediated)
Clubbing

33
Q

Equation for PAO2

A

PAO2 = FiO2 x (Patm - H20) - (PaCO2/R)

Normal values: FiO2 0.21, Patm 760, H20 47, resp quotient 0.8

PAO2 = 0.21 x (760 - 47) - (PaCO2/0.8)

34
Q

Antigen clusters associated with small cell lung cancers

A

Neuron specific enolase
Dopa decarboxylase Calcitonin chromogranin A CD 56 or neural cell adhesion molecule (NCAM) Gastrin releasing peptide Insulin like growth factor 1

35
Q

Effect of smoking on lung function tests
Effect of caffeine

A

Smoking = decreased DLCO
Caffeine = bronchodilation (increased FEV1)

36
Q

Favourable prognosis of Lung Cancer?

A

Carcinoid

37
Q

IV to Oral Converstion - tramadol, oxycodone, morphine, hydromophone

A

T1O2M3H5

38
Q

Conversion Ratio:
Morphine to codeine
Morphine to hydromoprhone
Morphine to oxycdone
Morphine to tapentadol
Morphine to tramadol

A

Codeine: 1:10
tapentadol 1:3
tramadol 1:5
oxycodone: 1.5:1
hydromorphone 5:1

39
Q

indications to drain pleural space parapneumonic effsuion

A

pH <7.2, large free flowing pleural effusion more then 50% of hemithorax, positive culture, positive gram stain.

40
Q

ILD associated with Sjogren’s Disease?

A

Lymphocytic interstitial pneumonitis

41
Q

Mab and Target for Asthma
Omalizumab
Dupilumab
Reslizumab
Mepolizumab

A

Omalizumab - targets IgE
Dupilumab IL 13 _ IL 4
Reslizumab IL 5
Mepolizumab IL 5
Itepekimab - IL - 33
Tezepilumab targetd TSLP

42
Q

Groups of PAH Tx

A

1) Idiopathic/familial/HIV/ Connectiv tissue Tx underlying considtion + transplant
2) Left Heart Disease - optimise HF therapy
3) Due to Resp Disease (COPD, ILD etc) - oxygen
4) chronic thromboemoblic - warfarin
5) Unclear/multifactorial - heam disorders, systemic disorders aka sarcoid scleraderma. - Treat underlying condition if possible

General Tx:
1) low prostacyclin - give prostacyclin eg Epoprostenol
2) Low nitric oxide - treat with phosphodisesterse type 5 inhbitor (sildenafil)
3) High endothelin 1 - Treat with endothelin recptor antagonist (Bosentan)
4) If positive vasoreactive test - Ca-blocker trial - nifedipine.

RACP 2022 Written (21 decks)

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