Passmed - Resp

Question 1

Causes of upper zone fibrosis?

Answer 1

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

Question 2

Causes of lower zone fibrosis?

Answer 2

idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis

Question 3

CO2 retention in COPD

Answer 3

Bad part of the lung (emphysema, COPD, alveoli broken down) -> lung constricts blood flow to that part of lung and perfused other part (ventilation-perfusion mismatch) = physiological shunt (blood diverted to good part of lung).
If put on high flow oxygen, mismatch is off and oxygen goes to bad parts of lungs so blood goes to bad parts of lung so is physiologically bad to give O2

Question 4

ROME ABG

Answer 4

Respiratory = Opposite
low pH + high PaCO2 i.e. acidosis, or
high pH + low PaCO2 i.e. alkalosis

Metabolic = Equal
low pH + low bicarbonate i.e. acidosis, or
high pH + high bicarbonate i.e. akalosis

Question 5

Moderate asthma?

Answer 5

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

Question 6

Severe asthma?

Answer 6

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

Question 7

Life-threatening asthma?

Answer 7

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

Question 8

Obstructive sleep apnoea management

Answer 8

Following weight loss, CPAP is the first-line treatment for moderate/severe obstructive sleep apnoea

Question 9

Obstructive sleep apnoea predisposing factors

Answer 9

obesity
macroglossia: acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s syndrome

Question 10

Obstructive sleep apnoea sleep assessment and diagnosis?

Answer 10

Assessment of sleepiness
Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)

Diagnostic tests
sleep studies (polysomnography) - from monitoring of pulse oximetry at night to full polysomnography, measure EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry

Question 11

first-line pharmacological treatment of COPD

Answer 11

A SABA or SAMA

Question 12

Risk factors for the development of aspiration pneumonia include:

Answer 12

Poor dental hygiene
Swallowing difficulties
Prolonged hospitalization or surgical procedures
Impaired consciousness
Impaired mucociliary clearance

Question 13

The features of acute severe asthma

Answer 13

PEFR 33-50% best or predicted, inability to complete full sentences, RR >25/min and pulse >110 bpm

Question 14

Tracheal deviation, resonant to percussion and absent breath sounds in the context of respiratory distress and shock

Answer 14

think a tension pneumothorax

Question 15

most common cause of occupational asthma

Answer 15

Isocyanates

Question 16

Hypercalcaemia + bilateral hilar lymphadenopathy → ?

Answer 16

sarcoidosis

Question 17

Tuberculosis typically causes x zone pulmonary fibrosis

Answer 17

upper

Question 18

x is recommended for 5 days in acute exacerbations of COPD

Answer 18

Oral prednisolone

Question 19

Following weight loss, x is the first-line treatment for moderate/severe obstructive sleep apnoea

Answer 19

CPAP

Question 20

Pulmonary hypertension is a cause of a (heart sound)

Answer 20

loud S2 (due to a loud P2)

Question 21

Patients diagnosed with pneumonia who have COPD should be given x even if no evidence of the COPD being exacerbated

Answer 21

corticosteroids

Question 22

Symptom control in non-CF bronchiectasis -

Answer 22

inspiratory muscle training + postural drainage

Question 23

Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems →

Answer 23

?bronchiectasis

Question 24

x prophylaxis is recommended in COPD patients who meet certain criteria and who continue to have exacerbations

Answer 24

Azithromycin

Question 25

If eosinophil count/FeNO do not confirm suspected asthma, and spirometry is not available then measure x

Answer 25

peak expiratory flow (PEF) twice daily for 2 weeks

Question 26

Asthma: adults and children ≥ 12 years first-line treatment → x

Answer 26

low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler as required

Question 27

Adults with asthma who are poorly controlled on SABA prn + regularly ICS → x

Answer 27

regular low-dose regular ICS/formoterol combination inhaler (MART therapy)

Question 28

If a patient cannot complete sentences, they have x

Answer 28

severe asthma

Question 29

Target saturations in COPD are 94-98% if x

Answer 29

CO2 is normal on ABG

Question 30

Gynaecomastia - associated with x of the lung

Answer 30

adenocarcinoma

Question 31

For adults with suspected asthma, if the eosinophil is above the reference range OR FeNO is x then asthma can be diagnosed

Answer 31

>= 50 ppb

Question 32

Cavitating lesions are more common with X than other types of lung cancer

Answer 32

squamous cell

Question 33

DVT/PE pregnancy management?

Answer 33

warfarin contraindicated S/C low-molecular weight heparin preferred to IV heparin (less bleeding and thrombocytopenia)

Question 34

x are used to detect occupational asthma

Answer 34

Serial peak flow measurements at work and at home

Question 35

A x is the first-line pharmacological treatment of COPD

Answer 35

SABA or SAMA