respiratory

Question 1

which lung cancer is most associated with smoking?

Answer 1

small cell carcinoma

Question 2

which lung cancer is assoc. with paraneoplastic syndromes. and what are they?

Answer 2

SCC. SIADH, cushing’s, lambert eaton,

Question 3

indication for cPAP treatment in OSA

Answer 3

symptomatic w/ daytime dysfunction
cardiovascular risk factors
severe OSA determied by lab polysomnography

Question 4

what are some common complications of OSA?

Answer 4

CVS events - MI
daytime hypertension
cerebrovascular risk and mortality - stroke
motor vehicle accidents
pregnancy related hypertension and pre-eclempsia

Question 5

what are the risk factors of OSA?

Answer 5

male
obesity
smoking
craniofacial abnormalities - adenotonsillar hypertrophy
certain medical conditions - pregnancy, congestive heart failure, end stage renal failure, chronic lung disease, stroke, acromegaly, hypothyroidism, PCOS

Question 6

what are the non pharmacological treatment of OSA?

Answer 6

behavioural modification:

• weight loss and exercise
• change of sleeping position to the lateral recumbent position
• alcohol avoidance and smoking cessation
• avoidance of certain medications such as benzodiazepines
• stop driving and operating machinery until sx are stabilized by physician

Question 7

what are the investigations for latent TB vs active TB?

Answer 7

latent TB: tuberculin skin test OR quantiferon gold test
active TB: chest x ray and 3 x sputum samples w/ ziehl neelson stain (acid fast bacillli stain) in culture and molecular assay

Question 8

what are the limitations of tuberculin skin test?

Answer 8

cannot differentiate between latent or active disease

can have false positives if BCG is taken, reptitive manoutx test can cause false positive

Question 9

what are the features of primary TB?

Answer 9

gradual onset low grade fever
pleuritic chest pain
retrosternal/dull interscapular pain which may be worse with swallowing (enlarged bronchial lymph nodes)

Question 10

what are the features of reactivation TB?

Answer 10

cough, weight loss, fatigue, fever, night sweats (more severe TB)
yellow green sputum that may be blood streaked
anorexia, wasting and malaise

Question 11

what are the imaging features of primary TB?

Answer 11

tuberculoma in the lower lobe

unilateral adenopathy and pleural effusion

Question 12

what are the imaging features of secondary TB?

Answer 12

cavitary lesion in the apical posterior segment of the upper lobe
absence of lymphadenopathy
cavitatory lesions
complete lobar opafication if severe

Question 13

what is the treatment for TB (both latent and active)

Answer 13

latent TB treatment = isonazid therapy 
active TB treatment = 
initial phase (8 weeks) RIPE + continuous phase (18 weeks) rifampiciin/isoniazid

Question 14

pathogenesis of TB and route of transmission

Answer 14

M tuberculosis - strict aerobe, acid fast gram positive bacilli
transmitted through AEROSOLS and not droplets (hence require negative pressure room, and other precautions such as protective face masks)