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MRCP 2 > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

severity of ARDS

A

depends on hypoxaemia
mild: PaO2 > 200
mod: PaO2 100-200
severe: PaO2 < 100

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2
Q

actions of alpha 1 antitrypsin

A

defends against neutrophil elastase

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3
Q

types of asbestos lung disease

A

pleural plaques
pleural thickening (mostly at bases, restriction and reduced compliance, reduced total lung capcity, normal KCO)
pleural effusions (often spontaneously resolve, usually exudate)
asbestosis
lung ca

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4
Q

treatment of mesothelioma

A

talc or indwelling pleural catheters for symptomatic effusion
RTx, CTx (non curative)
surgery potentially curative

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5
Q

hard metal lung disease

A

caused by cobalt dust
from making cutting tools or jet engine parts
> fibrosis
multi nucleated giant cells in alveoli with granulomas

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6
Q

Aspergillus species

A

over 200
Aspergillus fumigatus causes 70% aspergillosis
A terreus resistant to amphoteracin B and has poor prognosis

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7
Q

Aspergillosis disease patterns

A
  1. invasive
  2. ABPA
  3. chronic pulmonary aspergillosis (CPA)
  4. isolated infection
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8
Q

invasive aspergillosis

A

spores germinate into hyphae in immunocompromised
> invade parenchyma
> inflammation, thrombosis, infarction)
> haematogenous dissemination to brain, skin, eyes, heart, kidney, liver, spleen, GI , bone

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9
Q

ABPA

A

hypersensitivity to antigens from Aspergillus
typically CF and asthma pts
type I and type III
bronchiectasis and airway obstruction

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10
Q

chronic pulmonary aspergillosis

A

destructive infection
> fibrosis and loss of lung tissue
aspergilloma (assoc w/ TB)
aspergillus nodule
chronic cavitary (usually immunocompetent)
chronic necrotising (assoc with COPD and ETOHXS)

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11
Q

aspergillus isolated infection

A

nails, eyes, skin, sinuses, ear canals
endocarditis
endophthalmitis

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12
Q

diagnosing invasive aspergillosis

A

positive serum aspergillus galactomannan
serum 1-3 beta D glucan (not specific for aspergillus)
PCR RNA
HRCT chest
HRCT or MRI sinuses, brain

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13
Q

ABPA diagnosis

A

total IgE antibodies
aspergillus specific IgE and IgG
positive weal and flare skin test
eosinophilia
CXR infiltrates, bronchiectasis
HRCT mucoid plugging, infiltrates and bronchiectasis

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14
Q

chronic pulmonary aspergillosis diagnosis

A

IgG
CXR and HRCT- upper lobe mobile mass with air crescent, multiple nodules and cavities

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15
Q

treating invasive aspergillosis

A

amphoteracin B or echinocandin (caspofungin)
colony stimulating factors
isavuconazole, voriconazole 3/12
prophylaxis posaconazole
surgery if lesions continuous with great vessels of pericardium or severe haemoptysis from single cavity

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16
Q

asthma lung function tests

A

increased volume, reduced FEV1 and FEV1: FVC ratio < 70%
variable PEFR > 20%
improved PEFR > 15% after bronchodilator or steroids

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17
Q

berylliosis

A

looks similar to sarcoid
non caseating granulomas in lungs and nodes
surrounding fibrous tissue
CXR: fine nodulation evenly distributed throughout and b/l hilar lymphadenopathy
> progressive SOB and RHF

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18
Q

causes of bronchiectasis

A

LRTI
idiopathic
Marfans, Williams Campbell
HIV, haem malignancy, post transplant
RA, sjogren
IBD
ABPA, CF
obstructed or compressed bronchus (malignancy)
chemical pneumonitis
primary ciliary dyskinesis, kartagener, young
A1AT

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19
Q

asthma management

A

SABA for everyone
add ICS
> add LRTA or LAMA

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20
Q

COPD management

A
  1. SABA or SAMA
    2a. (no asthma/steroid responsiveness) LABA + LAMA
    2b. LABA + ICS
  2. LABA + LAMA + ICS

remove ICS if it is not helping

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21
Q

indications for transplant in COPD

A

< 65y and:
- FEV1 and DLCO < 20% predicted
- history of hospitalisation w/ acute hypercapnia
- pulmonary HTN and/or cor pulmonale despite oxygen therapy

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22
Q

assessing COPD prognosis

A

BODE for 2y mortality
BMI, airflow Obstruction, Dyspnoea, Exercise

Decaf for inpatient mortality
Dyspnoea, Eosinophils < 0.05, Consolidation, Acidaemia, AF

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23
Q

simple vs progressive coal workers pneumoconiosis

A

simple:
small, asymptomatic round opacities
upper zones
focal emphysema

progressive:
nodule aggregation into larger opacities
possible cavitating lesions

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24
Q

Caplan syndrome

A

multiple round nodules in patients with seropositive RA with coal workers pneumoconiosis
in peripheral crops

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25
myocoplasma pneumonia
occurs in 3-4 yearly epidemics > 2 week prodrome peri/myocarditis erythema multiforme, nodosum, SJS haemolytic anaemia, DIC, thrombocytopaenia meningoencephalitis, neuopathies bullous myringitis hepatitis, pancreatitis
26
Horders spots
rose spots on face associated with psittacosis
27
CURB 65
confusion RR > 30 SBP < 90 or DBP < 60 age > 65y admit if 3 or more
28
legionella length of treatment
21 days
29
CF colonisation
children: staph then haemophilus adolescents: pseudomonas
30
CF drug management
inhaled bronchodilator and ICS rhDNase mucoactive agent tobramycin for chronic pseudomonas azithromycin, ibuprofen, pred fluclox as staph prophylaxis for under 3ys CFTR modulator ivacaftor pancreatin, fat soluble vits ADEK
31
lung transplants absolute contraindications
Burkholderia cepacia colonisation sepsis multi organ dysfunction non adherence to tx morbid obesity refractory GORD
32
eosinophilic granulomatosis with polyangiitis lung biopsy
necrotising granulomas with central eosinophilic core and necrotising vasculitis
33
hypersensitivity pneumonitis
Th-1 mechanism IgG mediated acute- symptoms appear within hours of high level exposure and resolve within 48h, no fibrosis chronic- gradual after prolonged low level exposure can develop into fibrosis or emphysema biopsy: mononuclear infiltrate, non caseating granulomas reversible if diagnosed early
34
drugs causing fibrosis
amiodarone sulfasalazine, MTX bisulfan, bleomycin cyclophosphamide nitrofurantoin gold melphalan
35
lambert eaton treatment
3, 4 diaminopyridine or pyridostigmine
36
37
38
39
gynaecomastia is associated with what lung cancer?
large cell and adenocarcinoma
39
hyperthyroid is associated with what lung cancer?
squamous
39
SCLC paraneoplastic syndromes
SIADH ectopic ACTH Lambert Eaton (weakness IMPROVES with repeated contraction)
40
HPOA
hypertrophic pulm osteoarthropathy assoc w/ adrenocardinoma periostitis, arthritis, clubbing
41
pancoast
non SCLC superior sulcus hand atrophy, horners
42
lung transplant donor criteria
< 55y ABO compatible clear CXR pao2 > 300 < 20 pack years no chest trauma, aspiration, sepsis or prior cardiopulm surgery no organisms on gram stain no purulent secretions at bronchoscopy
43
mesothelioma staging
1a. ipsilateral partietal pleura 1b. visceral pleural involvement 2. diaphragm or lung involvement 3. any locally advanced or nodes N1 or N2 4. locally advanced unresectable, N3 (contralateral nodes or internal mammary or supraclavicular nodes)
44
byssinosis
occupational lung disease from cotton dust, flax, hemp acute or chronic
45
PE extra heart sounds
TR murmur widely split S2
46
PE admission criteria
haemodynamic instability pregnant or postpartum level 2 Wells > 4
47
contraindications to DOAC for PE
active cancer renal impairment antiphospholipid syndrome haemodynamic instability > LMWH at least 5/7 > dabigatran/edoxaban or warfarin
48
pulmonary HTN WHO groups
1. pHTN 2. pHTN + left heart disease 3. pHTN + lung disease/hypoxaemia 4. pHTN + chronic thrombotic/embolic disease 5. pHTN + disorders directly affecting pulm vasculature (schisto, sarcoid, glycogen storage)
49
pHTN treatment
anticoagulation digoxin PGI2 continuous IV infusion while a/w transplant PDE5i bosentan CCB pulm endarterectomy balloon pulm angioplasty atrial septostomy heart lung transplant
50
pulmonary TB in HIV patients
consolidation, miliary, effusions cavitation is less common
51
PCP prophylaxis
cotrimoxazole for pt with CD4 < 200 for pt with previous PCP
52
normal mean pulmonary arterial pressure
15-30 mmHg
53
chemoreceptors involved in respiration
central: on ventral medulla respond to H+ from CO2 peripheral: carotid bodies and aortic bodies respond to hypoxaemia, hypercapnia, pH
54
Lofgren syndrome
bilateral hilar lymphadenopathy + erythema nodosum + fever + arthralgia
55
sarcoid CXR grading
0: clear 1: BHL 2: BHL + pulmonary infiltrates 3: diffuse pulmonary infiltration 4: fibrosis
56
silicosis
quarry workers, hard rock miners, ceramic manufacturers, AKA Potter's Rot increased risk of CTD, vasculitis, CKD many have polyclonal hypergammaglobulinaemia, rheum factor, ANA, immune complexes acute: weeks-5y from exposure involves v high levels of dust accelerated: 5-15y latency high levels of silica can progress after removal of source simple chronic: most common, low level exposure 20y latency risk of progressive massive fibrosis
57
silicosis investigation and treatment
CXR: non calcified round opacities in upper zones similar to coal pneumoconiosis egg shell calcification around enlarged hilar glands > bronchodilators if also COPD > lavage if acute > transplant
58
how to prevent peripheral neuropathy with anti TB treatment
risk from isoniazid give pyridoxine for people with ETOHXS, diabetes, renal failure
59
indications for mechanical ventilation
severe hypoxaemia < 8.3 kpa despite 0.6 FiO2 PaCO2 > 6kpa

MRCP 2 (12 decks)

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