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Question 1

Definitive diagnosis of sarcoidosis

Answer 1

Biopsy evidence of a non-caseating granulomatous inflammatory process.

Note: diagnosed is supported by increased serum ACE, increased 24 hr urine Ca excretion and/or increased uptake on gallium 67 scan. Elevated serum Ca while classical is actually very rare

Question 2

Air crescent sign on CXR characteristic of ___

Answer 2

Aspergillosis

Note: tx is voriconazole or ampotericin B

Question 3

A patient with a CURB 65 of 2 is low severity T/F

Answer 3

F -

0-1 = low
2 = moderate
3-5 = severe

Question 4

Common causes of ARDS

Answer 4

sepsis
trauma
direct lung injury
pancreatitis

Note: characterised by sudden onset, bilateral infiltrates on CXR, PaO2:FiO2 ratio of less than 26.7 kPa, Lack of evidence of left atrial hypertension (PAWP <18 mmHg if available)

Question 5

Empiric abx by CURB score

Answer 5

0-1 (mild) : amoxicillin PO TDS
2 (mod): amoxicillin PO TDS + clarithromycin
3-5 (severe) : co-amoxiclav plus clarithromycin

Noye: if high susp for legionella add levofloxacin

Question 6

Asthma obstructive or restrictive pattern

Answer 6

Obstructive

eg FEV1/FVC < 70

Question 7

Obesity obstructive vs restrictive pattern

Answer 7

Restrictive

eg FEV1/FVC > 70

Question 8

Hairdressers are at increased risk of what resp illness?

Answer 8

Asthma

Link between hair bleach/spray and asthma

Question 9

KCO (diffusion capacity for carbon monooxide) is increased in what obstructive lung disease?

Answer 9

Asthma

Note: Patients with extra-pulmonary restrictive defects such as obesity show an elevated KCO with normal TLCO, but the restrictive defect produces a normal or elevated FEV1/FVC and reduced lung volumes.

Question 10

Which types of pleural effusion tend to have the lowest pleural glucose levels

Answer 10

Rheumatoid arthritis cause (rarely > 1.6mmol/L)
Empyema

Question 11

An inability to complete sentences is a feature of life threatening asthma T/F

Answer 11

F - that is a feature of severe asthma

Question 12

Indications for thrombolysis in PE?

Answer 12

Massive PE or
PE with signs of shcok

Question 13

Extra pulm manifestations of mycoplasma pneumonia

Answer 13

Erythema multiforme
Haemolytic anaemia
Hepatitis
Renal failure
Myocarditis
Cerebellar ataxia
Transverse myelitis

Note: about 10% of causes have extra pulm manifestations

Question 14

Residual lung volume and total lung capacity in emphysema

Answer 14

increased residual volume and total lung capacity

Note: due to hyperinflation resultant from air trapping

Question 15

Classic PFTs in extra-pulmonary restrictive disease

Answer 15

Kco is greater than normal
normal/slight reduction in Tlco because of the patient’s inability to achieve a full inspiration.

Note: causes
Pleural disease
Skeletal deformities, or
Respiratory muscle weakness.

Question 16

Hamman’s sign? What pathology?

Answer 16

Left-sided pneumothoraces may be associated with a clicking sound synchronous with the heart-beat and may occasionally be audible to the patient.

Question 17

Mgmt of a spon pneumothorax in a patient who is otherwise well?

Answer 17

If not breathless and the rim of air is less than 2 cm they can be considered for early discharge and repeat chest x ray in two weeks.

If symptomatic or > 2cm needle aspiration

Note: secondary pneuma is if they have any underlying lung disease and this always requires treatment

Question 18

Indications for LTOT in COPD

Answer 18

PaO2 < 7.3 with or without hypercapnia

PaO2 < 8 with pulmonary HTN/cor pulmonate/poylcythaemia

Question 19

In acute asthma, IV aminophylline is likely to result in additional bronchodilation, and should be considered after tx with inhaled bronchodilators and steroids T/F

Answer 19

F - it is not likely to result in any increased bronchodilation

Note: after steroids and inhaler bronchodilators - add IV Mg

Question 20

Tx of pneumothorax of greater than 2 cm or patient breathlessness w/bg lung disease ?

Answer 20

Insertion of a small bore chest drain (8-14 SWG).

There are no advantages in the insertion of a large bore chest drain as it usually more painful and delays discharge.

Note: Needle aspiration is appropriate if the pneumothorax is 1-2 cm a risk group or if patients with symptoms/>2cm but no b/g lung disease

Question 21

A PEF of 35% is criteria for what type of asthma exacerbation?

Answer 21

Severe

Note: 33 - 50%
Other features: RR > 25; HR > 110, inability to complete sentences

Question 22

A PEF of 30% is criteria for what type of asthma exacerbation?

Answer 22

Life threatening

Note: < 33%
Other features: O2 less than 92%; ABG with pO2 < 8 or n pCO2, silent chest, cyanosis, poor response effort, exhaustion, altered mental status, arrythmia

Question 23

A PEF of 55% is criteria for what type of asthma exacerbation?

Answer 23

Moderate

Note: 50 - 75%, increasing symptoms but no other features to fulfil other criteria

Question 24

Management of choice for a second unilateral pneumothorax in a fit individual ?

Answer 24

Referral for bullectomy and pleurectomy

Note: Pleurodesis could be considered in elderly or frail individuals

Question 25

Features of varicella pneumonia

Answer 25

Typically: -Tachypnoea -Cough -Dyspnoea -Fever Cyanosis, pleuritic chest pain and haemoptysis are also common. Note: 20% of adults with chicken pox will develop pneumonia.

Question 26

The pathognomonic radiological changes are hilar eggshell calcification for what disease?

Answer 26

Silicosis

Question 27

Indications for intubation and ventilation in asthma exacerbation?

Answer 27

Fatigue Hyperpcapnia NB: non invasive ventilation is not recommended in acute severe asthma