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Question 1

IPF Ix

Answer 1

High res CT gold standard - ground glass then honeycombing later stage
Spirometry restrictive picture with reduced gas transfer

Question 2

IPF Mx

Answer 2

Mostly pulmonary rehab
Pirfenidone in some pts
Supplementary O2 and lung transplant
Prognosis 3-4yrs life expectancy

Question 3

COPD stages

Answer 3

All stages should have post-bronchodilator FEV1/FVC<0.7
Stage 1 - FEV1 >80% of predicted (with sx) Mild
2 - 50-79% Moderate
3 - 30-49% Severe
4 - <30% Very severe

Question 4

Granulomatosis with polyangiitis features

Answer 4

Renal impairment (rapidly progressive GN)
Haemoptysis
Flat/saddle nose

Question 5

What is sarcoidosis

Answer 5

Multisystem disorder with unknown cause
Multiple caseating granulomas

Question 6

Sarcoidosis presentation

Answer 6

Acute - b/l hilar lymphadenopathy, swinging fever, polyarthralgia, erythema nodosum
Chronic - Dyspnoea, chronic cough, weight loss
Uveitis
Lupus pernio, b/l parotid enlargement, facial nerve palsy
Hypercalcaemia (macrophages in granulomas increase conversion of vit D to active)

Question 7

What is Lofgren’s syndrome

Answer 7

Sarcoidosis form with:
BHL, fever, erythema nodosum, polyarthralgia
Very good prognosis

Question 8

What is Heerfordt’s syndrome

Answer 8

Oveoparotid fever
Parotid enlargement, fever and uveitis 2ry to sarcoidosis

Question 9

Indications for chest tube in pleural effusion

Answer 9

Turbid/purulent
pH<7.2 with suspected infection
Pleural culture +ve

Question 10

Pleural fluid low glucose causes

Answer 10

TB
RA

Question 11

Pleural fluid raised amylase

Answer 11

Pancreatitis
Oesophageal perf

Question 12

Low C3/C4 in pleural fluid

Answer 12

SLE

Question 13

Pleural fluid heavily blood stained

Answer 13

Mesothelioma
PE
TB

Question 14

Recurrent pleural effusions Mx

Answer 14

Repeated aspiration
Indwelling catheter
Pleurodesis
Medications for sx e.g. opioids dyspnoea

Question 15

Pleural fluid transudate vs exudate

Answer 15

Protein <25 is trans, >35 is ex

25-35, Light’s criteria (if 1 met then exudate):
Pleural fluid protein >0.5x serum
Pleural LDH >0.6x serum
Pleural LDH >2/3 upper limit of normal serum

Question 16

Lung Ca 2ww indications

Answer 16

> 40yrs and ever smoked +1 or 2 from below:
Cough
Fatigue
SOB
Chest pain
Weight loss
Appetite loss

> 40yrs +:
Persistent/recurrent chest infection
Clubbing
Supraclavicular lymphadenopathy/persistent cervical
Thrombocytosis
Chest signs of lung Ca

Question 17

OSA diagnosis

Answer 17

Polysomnography

Question 18

OSA Mx

Answer 18

Weight loss
CPAP for moderate-severe
Intraoral devices e.g. mandibular advancement if not tolerating CPAP

Question 19

Inhaled ICS benefit in COPD

Answer 19

Reduced frequency of exacerbations

Question 20

COPD steroid responsiveness features

Answer 20

Asthma/atopy
Higher eosinophil count
400ml FEV1 variation
20% diurnal PEF variation

Question 21

COPD Abx prophylaxis prerequisites

Answer 21

Azithromycin if >3 exacerbations in year with 1 hospital

Non-smoker
CT thorax r/o bronchiectasis
Sputum culture r/o atypicals/TB
LFTs
ECG for QT

Question 22

COPD improved prognosis

Answer 22

Stop smoking
Lung volume reduction surgery
LTOT

Question 23

LTOT indications

Answer 23

pH<7.3
pH7.3-8 with:
2ry polycythaemia
Peripheral oedema
Pulmonary HTN

Question 24

How long per day for LTOT

Answer 24

> 15hrs

Question 25

Obstructive lung disease

Answer 25

COPD Asthma Bronchiectasis Bronchiolitis obliterans

Question 26

Restrictive lung disease

Answer 26

NM disorders Fibrosis Asbestosis Sarcoidosis Severe obesity ARDS Infant RDS Kyphoscoliosis

Question 27

NIV indications

Answer 27

pH 7.25-7.35 T2RF 2ry to NM disease, chest wall deformity or OSA Cardiogenic pulmonary oedema unresponsive to CPAP Weaning from trachy

Question 28

Pneumothorax Mx

Answer 28

Asymptomatic - conservative Symptomatic no high risk - conservative vs ambulatory vs needle aspiration Symptomatic high risk -> chest drain

Question 29

Pneumothorax safe to intervene criteria

Answer 29

CXR 2cm apical/lateral margin CT showing radiologically guided needle margin

Question 30

Pneumothorax conservative mx

Answer 30

1ry spontaneous - OP every 2-4d 2ry spontaneous - IP monitoring 2-4wks OP appt following

Question 31

Persistent/recurrent pneumothorax mx

Answer 31

Video assisted thoracoscopic surgery for pleurodesis +/- bullectomy

Question 32

Flying post-pneumothorax

Answer 32

2wks after successful drainage 1wk post-check CXR

Question 33

A1AT genetics

Answer 33

Chromosome 14, AR

Question 34

A1AT mx

Answer 34

Bronchodilators, physio IV a1at protein concentrate Lung volume reduction surgery Lung transplant

Question 35

Asthma severe criteria

Answer 35

RR>25 HR>110 Can't complete sentences PEFR 33-50%

Question 36

Life-threatening asthma

Answer 36

Normal pCO2 PEFR<33% Sats <92% Silent chest Bradycardia/hypotension/dysrhythmia Exhaustion/confusion

Question 37

Asthma d/c criteria

Answer 37

Stable for 12-24h Inhaler technique checked PEFR >75% best

Question 38

Asthma when to admit

Answer 38

Life-threatening Pregnant Previous near-fatal Attack despite steroids At night Severe not responding initially

Question 39

Bronchiectasis long-term mx

Answer 39

Inspiratory muscle training Postural drainage Abx for acute infections Bronchodilators Imms Surgery in localised disease

Question 40

Acute bronchitis mx

Answer 40

Abx only if: Co-morbidities Systemically very unwell CRP 20-100 delayed px, >100 abx

Question 41

Silicosis features

Answer 41

Exertional dyspnoea + dry cough CXR showing upper zone fibrosis and egg-cell calcification of hilar nodes Hx of mining/slate worker/pottery/foundry Pre-disposition to TB as silica toxic to macrophages

Question 42

Step down asthma Rx

Answer 42

Consider every 3/12 Steroids reduce by 25-50% dose

Question 43

Anterior mediastinal most common masses

Answer 43

Thymoma Terrible lymphadenopathy Thyroid Teratoma

Question 44

Bronchiectasis lung volume reduction indications

Answer 44

Localised disease Uncontrolled haemoptysis

Question 45

SCLC Mx

Answer 45

Usually chemo+radio if curative Chemo if palliative Surgery rarely, if T1-2a N0M0 disease