2 - PM

Question 1

Diagnosis: History of smoking, weight loss, anorexia

Answer 1

lung cancer

Question 2

Diagnosis: Dyspnoea, Bibasal crackles and S3

Answer 2

pulmonary oedema

Question 3

Diagnosis: Fever, night sweats, anorexia, weight loss

Answer 3

TB

Question 4

Diagnosis: Pleuritic chest pain, Tachycardia, tachypnoea

Answer 4

PE

Question 5

Diagnosis: Usually acute history of purulent cough

Answer 5

LRTI

Question 6

Diagnosis: Usually long history of cough and daily purulent sputum production

Answer 6

Bronchiectasis

Question 7

Diagnosis: Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur

Answer 7

Mitral regurgitation

Question 8

Diagnosis: Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity

Answer 8

Aspergilloma

Question 9

Diagnosis: Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity

Answer 9

Granulomatosis with polyangiitis

Question 10

Diagnosis: Haemoptysis
Systemically unwell: fever, nausea
Glomerulonephritis

Answer 10

Goodpastures

Question 11

What is the most likely causative organism on pneumonia in those with COPD

Answer 11

Streptococcus pneumoniae

Question 12

What is the most likely causative organism of infective exacerbation of COPD (not pneumonia)

Answer 12

Haemophilus influenzae

Question 13

Cystic fibrosis inheritance

Answer 13

Autosomal recessive (1/25)

Question 14

which rheumatoid drug can cause lung fibrosis

Answer 14

methotrexate

Question 15

why is FEV1/FVC ratio in fibrosis (restrictive) usually normal/increased

Answer 15

because both FEV1 (loss lung elasticity) FVC (loss of lung volume) are reduced

Question 16

organisms that causes 80% of CAP

Answer 16

Streptococcus pneumoniae

Question 17

Organism causing pneumonia classically in alcoholics

Answer 17

Klebsiella pneumoniae

Question 18

chest sounds for fibrosis

Answer 18

fine crackles

Question 19

most common lung cancer in non smokers

Answer 19

Lung adenocarcinoma

Question 20

lung cancer: peripheral lesion

Answer 20

Lung adenocarcinoma an large cell

Question 21

three main subtypes of non-small cell lung cancer:

Answer 21

Squamous cell, adenocarcinoma, large cell

Question 22

lung cancer: central lesion

Answer 22

squamous cell

Question 23

lung cancer: associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia

Answer 23

squamous cel

Question 24

lung cancer: clubbing

Answer 24

squamous cell

Question 25

COPD vaccinations

Answer 25

Annual influenza + one-off pneumococcal

Question 26

First line COPD treatment (after life style advice)

Answer 26

a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA) is first-line treatment

Question 27

2nd line COPD treatment

Answer 27

Depends of FEV1: FEV1 > 50% long-acting beta2-agonist (LABA), for example salmeterol, or: long-acting muscarinic antagonist (LAMA), for example tiotropium FEV1 < 50% LABA + inhaled corticosteroid (ICS) in a combination inhaler, or: LAMA

Question 28

tiotropium is?

Answer 28

long-acting muscarinic antagonist (LAMA)

Question 29

what causes right ventricular hypertrophy

Answer 29

pulmonary hypertension

Question 30

acute asthma escalation

Answer 30

1. Oxygen 2. Salbutamol nebulisers 3. Ipratropium bromide nebulisers 4. Hydrocortisone IV OR Oral Prednisolone 5. Magnesium Sulfate IV 6. Aminophylline/ IV salbutamol

Question 31

Lung cancer investigations in order

Answer 31

- x-ray - contrast CT - biopsy - possible PET

Question 32

criteria for pleural effusion

Answer 32

lights criteria

Question 33

Pleural effusion: exudates have a protein level of >30 g/L

Answer 33

exudate

Question 34

Pleaural effusion: exudates have a protein level of < 30 g/L

Answer 34

transudate

Question 35

pleural effusion: protein level if exudate

Answer 35

> 30g/L

Question 36

pleural effusion: protein level if transudate

Answer 36

< 30g/L

Question 37

when do you put in chest drain for suspected pleural infection

Answer 37

- cloudy or turbid | - pH is less than 7.2

Question 38

COPD treatment if FEV1 < 50%

Answer 38

LABA + inhaled corticosteroid (ICS) in a combination inhaler, or: LAMA

Question 39

COPD treatment if FEV1 > 50%

Answer 39

long-acting beta2-agonist (LABA), for example salmeterol, or: long-acting muscarinic antagonist (LAMA), for example tiotropium

Question 40

what is Asbestosis

Answer 40

prolonged asbestos exposure leading to lower lobe fibrosis 20-40 years later

Question 41

what is mesothlioma

Answer 41

cancer of the pleura

Question 42

Good pastures can cause pulmonary haemorrhage, what is diagnostic test for goodpastures

Answer 42

anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen

Question 43

1 child with CF, chances of second being carrier and having CF

Answer 43

Carrier: 50% Have: 25%

Question 44

most common bacterial cause of COPD exacerbation

Answer 44

Haemophilus influenzae

Question 45

pH that indicatesa need for intubation and ventilation in acute asthma

Answer 45

A pH less than 7.35 likely represents carbon dioxide retention in a tiring patient

Question 46

non-invasive ventilation for type 1 reps failure (i.e: pulmonary oedema)

Answer 46

CPAP (Continuous Positive Airway Pressure)

Question 47

non-invasive ventilation for type 2 reps failure (i.e: COPD)

Answer 47

BIPAP (Bilevel Positive Airway Pressure)

Question 48

Regarding CURB65, what score suggests severe pneumonia

Answer 48

3+ out of 5

Question 49

COPD - still breathless despite using salbutamol inhalers as required?

Answer 49

FEV1 > 50%: LABA or LAMA | FEV1 < 50%: LABA + ICS or LAMA

Question 50

1st spontaneous pneumothorax management

Answer 50

depends on air rim < 2cm leave > 2cm insert drain

Question 51

acute asthma PEFR indicating severe

Answer 51

PEFR 33 - 50% best or predicted | Can't complete sentences

Question 52

acute asthma PEFR indicating life threatening

Answer 52

PEFR < 33% best or predicted | Oxygen sats < 92%

Question 53

low Beclometasone dipropionate

Answer 53

100 mcg two puffs bd (so 200 mcg)

Question 54

moderate Beclometasone dipropionate

Answer 54

400 mcg two puffs bd = 400

Question 55

High Beclometasone dipropionate

Answer 55

250 mpg 2-4 puffs bd = 500-1000 mcg

Question 56

who gets ventilation perfusion scan apposed to CTPA in suspected PE

Answer 56

those with renal impairment due to contrast in CTPA