PACES__Respiratory

Question 1

What phase of respiration is prolonged in COPD?

Answer 1

Expiration

Question 2

What are the 6 key points of COPD management

Answer 2

1. Smoking cessatioN
2. SABA
3. LAMA/LABA
4. Inhaled corticosteroids
5. Pneumococcal and influenza vaccination
6. Pulmonary rehabilitation

Question 3

Name 4 common bacterial causes of pneumonia.

Answer 3

1. Strep pneumoniae
2. Staph aureus
3. Haemophilus influenzae
4. Mycoplasma pneumonia

Question 4

What 3 bacteria are associared with atypical pneumonia?

Answer 4

1. Mycoplasma pneumoniae
2. Chlamydia pneumoniae
3. Legionella

Question 5

What are the 7 respiratory causes of clubbing (A-F)

Answer 5

Abscess and asbestosis
Bronchiectasis
Cystic fibrosis
‘Dirty tumours’
Empyema
Fibrosing alveolitis

Question 6

What are the congenital causes of bronchiectasis? (5)

Answer 6

1. CF
2. Young’s syndrome
3. Kartageners syndrome
4. Yellow nail syndrome
5. Abnormal anatomy

Question 7

What additional feature to bronchiectasis can be elicited to support a diagnosis of Kartageners syndrome?

Answer 7

Dextrocardia/situs invertus

Question 8

What 3 additional featires on exam support a diagnosis of yellow nail syndrome?

Answer 8

1. Yellow nails
2. Pleural effusion
3. Lymphoedema

Question 9

What 3 childhood infections predispose to bronchiectasis?

Answer 9

1. Pertussis
2. Measles
3. TB

Question 10

Give one cause of an overactive immune system and 3 causes of an underactive immune system which may pre-dispose to bronchiectasis.

Answer 10

Overactive- Allergic bronchopulmonary aspergillosis
Underactive- Hypogammaglobulinaemia, HIV, leukaemia

Question 11

What is the pathogenesis of CF?

Answer 11

-Autosomal recessive defect due to mutation in the CFTR gene. Most common cause is dF508.
-This deletion prevents chloride moving out of the cell and leads to thick secretions in the airways

Question 12

What are the 3 major pathogens associated with bronchiectasis?

Answer 12

Pseudomonas aeruginosa
Haemophilus influenza
Steptococcus

Question 13

What are the 4 main pulmonary complications of bronchiectasis?

Answer 13

1. Recurrent infection
2. Haemoptysis
3. Empyema/abscess
4. Cor pulmonale

Question 14

What are the 3 main extrapulmonary complications of bronchiectasis?

Answer 14

1. Anaemia
2. Metastatic infection
3. Secondary amyloidosis

Question 15

What 4 other conditions are known to be associated with bronchiectasis?

Answer 15

1. CTD
2. Chronic sinusitis
3. IBD
4. Marfan’s syndrome

Question 16

TB cause predominantly basal or apical signs?

Answer 16

Apical

Question 17

What staining investigation is indicated in suspected TB?

Answer 17

Ziehl-Neelsen/auramine staining of 3 sputum samples

Question 18

What are the main side effects of TB medications?

Answer 18

Rifampicin: CYP450 Inducer, red discolouration of secretions and urine
Isoniazid: Hepatitis, peripheral neuropathy
Pyrazinamide: Hepatitis, peripheral neuropathy, gout
Ethambutol: Optic neuritis

Question 19

What 5 examination findings are consistent with pulomonary hypertension?

Answer 19

1. Parasternal heave
2. Palpable P2
3. Raised JVP
4. Hepatomegaly
5. Peripheral oedema

Question 20

What are the 8 causes of upper zone pulmonary fibrosis?

Answer 20

1. Coal workers pneumoconiosis
2. Hypersensitivity pneumonitis
3. Ankylosing spondylitis/ABPA
4. Radiation
5. TB
6. Silicosis/Sarcoidosis

Question 21

What is Hamman-Rich syndrome?

Answer 21

An acute rapidly progressive lung fibrosis also known as acute interstitial pneumonia (AIP). It may respond to steroids but has a poor overall outcome.

Question 22

What is the major drawback of high resolution CT?

Answer 22

HRCT is a form of non-continuous cross sectional imaging. Small lesions may be missed between slices.

Question 23

What are the 6 main categories of treatment for pulmonary fibrosis?

Answer 23

1. Corticosteroids
2. Immunosuppressives (cyclophosphamide, azathioprine, methotrexate and ciclosporin)
3. Anti-fibrotics
4. Anti-oxidant (N-acetylcysteine in conjunction with with corticosteroids and azathioprine)
5. Supplemental oxygen (PaO2 7.3kpa or 8kPa with cor pulmonale)
6. Lung transplantation</div>

Question 24

Describe the 5 possible respiratory manifestations of rheumatoid arthritis

Answer 24

1. Pleural effusions/pleurisy
2. Pulmonary nodules
3. Fibrotic lung disease
4. Caplan syndrome (coal worker pneumoconiosis and RA)
5. Obliterative bronchiolitis

Question 25

Give 4 causes of transudative pleural effusion

Answer 25

Congestive cardiac failure Hypoalbuminaemia/hypothyroidism All failures (cardiac, renal, hepatic) Meig's syndrome **Mechanism: Increased Hydrostatic Pressure: Imagine water being pushed through a garden hose with high pressure—fluid leaks out. This is what happens in heart failure where blood pressure builds up in lung vessels. Decreased Oncotic Pressure: Think of oncotic pressure as a sponge keeping fluid inside blood vessels. Low protein levels mean a weaker "sponge," so fluid escapes. Fluid Composition: The fluid is watery and low in proteins.

Question 26

Give 5 causes of exudative pleural effusion

Answer 26

Think PINTS of eggs Pneumonia Infarction Neoplasm TB Sarcoidosis/Scleroderma **Mechanism: Inflammation damages the blood vessel walls, making them more permeable, like a net with big holes. This lets proteins and immune cells leak out with fluid. Fluid Composition: The fluid is thick, cloudy, and high in proteins and cells.

Question 27

What is Light's criteria?

Answer 27

Light's Criteria help distinguish between transudative and exudative effusions by analyzing the pleural fluid and comparing it to blood. If any one of the following is true, it’s considered exudative: 1. Pleural fluid protein/serum protein ratio > 0.5 (Is the pleural fluid protein significantly higher than expected? In exudates, yes.) 2. Pleural fluid LDH/serum LDH ratio > 0.6 (LDH is an enzyme released with tissue damage; higher ratios indicate exudative effusion.) 3. Pleural fluid LDH > two-thirds the upper limit of normal serum LDH

Question 28

Outline 5 major processes that lead to pleural effusions.

Answer 28

1. Increased hydrostatic pressure or decreased oncotic pressure (transudates) 2. Increased capillary permeability (exudates) 3. Disruption of lymphatic duct (chylothorax) 4. Infection of pleural space (empyema) 5. Bleeding into pleural space (haemothorax)

Question 29

Are there weaknesses of Light's criteria in differentiating transudates and exudates?

Answer 29

Yes, 25% of patients with transudates are mistakenly identified as having exudates by Light's criteria.

Question 30

What is the triad of Horner's syndrome?

Answer 30

1. Unilateral ptosis: Drooping of the upper eyelid due to weakness of the muscle that lifts the eyelid (Müller's muscle). 2. Unilateral miosis: Constricted pupil due to unopposed parasympathetic activity. 3. Anhidrosis: Loss of sweating on the affected side of the face (sometimes only in a part of the face, depending on the site of nerve damage).

Question 31

What 2 MSK paraneoplastic syndromes are associated with lung malignancy?

Answer 31

1. Hypertrophic pulmonary osteoarthropathy (clubbing and pain and swelling at wrists and ankles) 2. Polymyositis

Question 32

Name 4 neurological paraneoplastic syndromes associated with lung cancer

Answer 32

1. Lambert-Eaton syndrome 2. Proximal myopathy 3. Peripheral neuropathy 4. Cerebellar syndrome

Question 33

Name 4 endocrine paraneoplastic syndromes associated with lung cancer

Answer 33

1. SIADH 2. Hypercalcaemia 3. Cushing's syndrome (Ectopic ACTH release) 4. Gynaecomastia (HCG secreting tumour)

Question 34

Name 4 dermatological paraneoplastic conditions in lung cancer.

Answer 34

1. Thrombophlebitis migrans 2. Acanthosis nigrans 3. Erythema gyratum repens 4. Dermatomyositis

Question 35

Name 4 procedures which may leave someone with a thoracotomy scar

Answer 35

1. Pneumonectomy 2. Lobectomy 3. Open lung biopsy 4. Oesophagectomy

Question 36

What is post-pneumonectomy syndrome? How is it treated?

Answer 36

-Post-pneumonectomy syndrome occurs to extrinsic compression of the distal trachea due to mediastinal shifting and hyperinflation of the remaining lung. -Treatment involves surgical repositioning of the mediastinum. -Condition can be fatal if left untreated.

Question 37

Is there a discrepancy in morbidity/mortality between right and left sided pneumonectomies?

Answer 37

Yes. Right sided pneumonectomies are associated with much higher rates of complication. The cause for this is unclear.

Question 38

What is the definition of pulmonary hypertension?

Answer 38

Mean pulmonary arterial pressure >25mmHg with a pulmonary capillary or left atrial pressure <15mmHg

Question 39

Name 4 common causes of cor pulmonale

Answer 39

1. COPD 2. Interstitial lung disease 3. OSA 4. Hypoventilation disorders (obesity related, neuromuscular disorders, kyphoscoliosis)

Question 40

What are the 5 subtypes of pulmonary hypertension?

Answer 40

1. Pulmonary arterial hypertension 2. Pulmonary venous hypertension 3. Pulmonary hypertension associated with hypoxaemia 4. Pulmonary hypertension due to chronic thrombotic or embolic disease 5. Pulmonary hypertension associated with miscellaneous disorders such as sarcoidosis and Langerhans cell histiocytosis

Question 41

The combination of chronic shortness of breath + pleuritic chest pain and features of right sided heart failure should make you think of what condition?

Answer 41

Pulmonary hypertension