New respiratory learn

Question 1

What is Caplan’s syndrome

Answer 1

combination of rheumatoid disease and pneumoconiosis

- you’ll see massive fibrotic nodules and patient has history of coal dust exposure

Question 2

Recurrent chest infections and infertility

Answer 2

Kartagner’s syndrome/ cystic fibrosis

Question 3

Investigation for suspected lung cancer

Answer 3

Chest x-ray
CT with contrast
(biopsy should not be performed before a CT)

Question 4

When would you do PET scan?

Answer 4

In suspected non-small cell cancer

Question 5

Moderate asthma attack

Answer 5

PEFR 50-75% of best
Speech normal
RR <25
Pulse <110

Question 6

Severe asthma attack

Answer 6

PEFR 33-50% of best
Can’t complete sentences
RR >25
Pulse >110

Question 7

Life-threatening asthma attack

Answer 7

PEFR <33%
Oxygen <92%
Silent chest, cyanosis, feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

Question 8

Klebsiella can cause pneumonia in alcoholics, what other lung symptoms may it cause?

Answer 8

Commonly causes lung abscesses and pleural empyema

Question 9

What is Pott’s disease?

Answer 9

TB in the vertebrae

Question 10

Treatment of small cell lung cancer

Answer 10

Chemotherapy and radiotherapy

Question 11

Which testicle normally hangs lower?

Answer 11

Left testicle

remember may be opposite in Kartagener if they have situs invertus

Question 12

Low glucose in pleural fluid

Answer 12

Rheumatoid arthritis

Tuberculosis

Question 13

Raised amylase in pleural fluid

Answer 13

Pancreatitis, oesophageal perforation

Question 14

Heavy blood stained pleural fluid

Answer 14

Mesothelioma, pulmonary embolism, tuberculosis

Question 15

What can improve survival in COPD?

Answer 15

1) smoking cessation - this is THE most important thing

2) long-term oxygen therapy

Question 16

pO2 in hyperventilation

Answer 16

pO2 normal because no problem with gas exchange

Low pCO2 cos blowing it off

Question 17

Where is the “safe triangle” for chest drain insertion?

Answer 17

5th intercostal space, mid-axillary line

Borders - lat dorsi, pec major and line superior to axilla and nipple

Question 18

Histological finding in TB

Answer 18

Epitheliod histiocytes

Question 19

COPD symptoms in a young person, what diagnosis should you think of?

Answer 19

Alpha-1-antitrypsin deficiency

Question 20

Which antibodies might you see in idiopathic pulmonary fibrosis?

Answer 20

ANA

Question 21

Symptoms and signs of pulmonary oedema

Answer 21

Bibasal crackles and S3 are the most reliable signs

Question 22

What can you tell me about aspergilloma?

Answer 22

Often past history of TB
Haemoptysis may be severe
CXR shows rounded opacity

Question 23

Emphysema in which lobe zone in COPD?

Answer 23

Upper lobe

Question 24

Emphysema in which lobe in alpha-1-antitrypsin

Answer 24

Lower lobes

Question 25

What is Meig's syndrome?

Answer 25

OAP Ovarian tumour Ascites Pleural effusion

Question 26

How does pulmonary TB spread?

Answer 26

Through the pulmonary venous system

Question 27

If patients are taking inhaled steroids, what should they do after they've used them?

Answer 27

Rinse mouth straight after so you don't get thrush

Question 28

COPD FEV1 >50%

Answer 28

LABA or LAMA

Question 29

COPD FEV1 <50%

Answer 29

LABA + ICS | or LAMA

Question 30

Commonly causes a cavitating pneumonia in alcoholics and diabetics

Answer 30

Klebsiella (more common in upper lobes)

Question 31

Klebsiella - upper or lower lobes?

Answer 31

Upper lobes (think of window sills, they are higher - windowsiella)

Question 32

COPD and bronchodilators

Answer 32

COPD doesn't really improve after bronchodilators (in response to asthma)

Question 33

Symptom control in non-CF bronchiectasis

Answer 33

Inspiratory muscle training and postural drainage

Question 34

Why do you use inhaled corticosteroids in COPD?

Answer 34

To reduce the FREQUENCY of exacerbations

Question 35

Causes of upper zone fibrosis?

Answer 35

* Coal worker’s pneumoconiosis * Histiocytes/hypersensitivity pneumonia * Ankylosing spondylitis * Radiation * Tuberculosis * Silicosis/sarcoidosis

Question 36

Idiopathic pulmonary fibrosis - which lobe?

Answer 36

Lower zones

Question 37

When is bupropion contrindicated

Answer 37

Epilepsy

Question 38

What are the boundaries of the safe triangle?

Answer 38

Latissimus dorsi Pectoralis major Line superior to nipple and apex at the axilla

Question 39

Bupropion mechanism of action?

Answer 39

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.

Question 40

Recognised feature of renal adenocarcinoma?

Answer 40

Polycythaemia