Resp

Question 1

what is asthma?

Answer 1

asthma is a chronic respiratory disorder characterised by recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction, which occurs due to hyper-responsiveness to stimuli.

Question 2

What causes airway obstruction in asthma?

Answer 2

acute: bronchial muscle constriction, mucosal inflammation and swellig and an increased production of mucus.
long term: increase in smooth muscle, damaged cilia,

Question 3

what is brittle asthma?

Answer 3

rapid change between being well to having life-threatening asthma, and repeated exacerbations despite treatment.

Question 4

what should you do with patients of intermediate risk of asthma?

Answer 4

BTS guidelines say spirometry with bronchodilator variability testing (>15% chnage or >200ml change). Could also do histamine test or nitric oxide test

Question 5

what is bronchiectasis?

Answer 5

this is the abnormal widening on bronchi or bronchioles which often leads to mucus build up and recurrent infection.

Question 6

what are the causes of bronchiectasis?

Answer 6

congenital (CF, PCD. hypogammaglobunaemia in CVID), infection (measles pertussis, TB, HIV), inflammation (RA, IBD, sarcoid, asthma), other (idiopathic, bronchial obstruction - tumour or FB).

Question 7

what is the gold standard investigation for bronchiectasis?

Answer 7

HRCT - bronchial dilatation and wall thicking, tramlines, small airways near pleura

Question 8

What are the symptoms and signs of bronchiectasis?

Answer 8

chronic mucopurulent cough and intermittent haemoptysis. On examination may have clubbing, wheeze, and bibasal coarse crackles which improve with coughing.

Question 9

What is COPD?

Answer 9

This is a chronic progressive respiratory disorder characterised by airway obstruction with little to no reversibility. The clinical picture includes chronic bronchitis and emphysema.

Question 10

what is the definition of chronic bronchitis?

Answer 10

cough and sputum on most days for 3 months for two successive years.

Question 11

how does A1AT deficiency cause COPD?

Answer 11

A1AT blocks elastase , therefore a deficiency causes excessive elastase, which in turn breaks down elastin in the alveolar wall. this occurs all over the lung (panacinar pattern) unlike in smoking which has a centrilobular pattern.

Question 12

Signs of cor pulmonale>

Answer 12

prominent RV heave and loud pulmonary S2

Question 13

What are the signs of hypercapnia?

Answer 13

Bounding pulse, headache, peripheral vasodilation, tremor, papilloedema, confusion, drowsiness, coma

Question 14

How can interstitial lung disease be classified?

Answer 14

Into 3 groups:
Known cause - occupational, environmental (asbestososis, coal workers lung), drugs (DMARDS, Biologics, SSRIs, chemotherapy, amiodarone), infections (TB, fungal, severe pneumonia), hypersensitivity reactions (EAA)
Associated systemicndisease (RA, sarcoidosis, UC, sjorens, SLE)
Idiopathic (IPF, cryptogenic fibrosing alveolitos)

Question 15

Systems of interstitial lung disease?

Answer 15

Dyspnoea, dry cough, fatigue, end inspiratory crackles (sound like Velcro)

Question 16

Causes of apical lung fibrosis?

Answer 16

BREAST. Borelliosis (Lyme disease) Radiation EAA Ankylosing spondylitis Sarcoidosis TB

Question 17

Causes of basal PF?

Answer 17

DARSI. Drugs (amiodarone, cyclophosphamide), Asbestosis, RA, Systemic sclerosis, IPF

Question 18

What is the bode index?

Answer 18

It is a predictor of survival in COPD. looks at BMI, obstruction (FEV1 % of predicted), Dyspnoea (on the MRC scale - 1-5) , Exercise capacity (6 minute walk distance)

Question 19

What is the management of IPF?

Answer 19

Conservative - MDT including ILD specialist nurse, patient support groups (Action for Pulmonary Fibrosis), patient education, smoking cessation.
Medical - PPI if symptomatic, Pirfenidone (anti-fibrotic drug), NAC is sometimes used
Surgical - lung transplant.

Question 20

what are the CXR signs of IPF?

Answer 20

reticulo-nodular shadowing, ground-glass shadowing, honeycombing in late disease

Question 21

what is EAA caused by?

Answer 21

hypersensitivity to moldy hay, bird shit, moldy barley

Question 22

which paraneoplastic syndromes are associated with small cell lung cancer?

Answer 22

ectopic ACTH, SIADH, Lambet-Eaton syndrome

Question 23

what paraneoplastic syndrome is accoiated with squamous cell lung cancer?

Answer 23

PTHrP

Question 24

how do you stage small cell lung cancer?

Answer 24

limited - in one hemithorax and supraclavicular LN only

extensive - spread beyond the above

Question 25

what causes a bovine cough?

Answer 25

RLN palsy

Question 26

what causes wrist pain in lung cancer?

Answer 26

hypertrophic pulmonary osteoarthropathy

Question 27

what are in the indications for a 2ww CXR?

Answer 27

``` >40 and 2 of: - previous moker cough fatigue sob chest pain weight loss LoA or any age and unexplained: clubbing recurrent chest infection supraclav or cervical LN chest signs suggestive of lung cancer thrombocytosis. ```

Question 28

what is a raised hemidiaphragm suggestive of on CXR?

Answer 28

phrenic nerve damage or lobar collapse (in lung cancer)

Question 29

Pancoast's tumour can invade which structures?

Answer 29

sympathetic chain (Horner's), brachial plexus (hand pain and paralysis), RLN (hoarseness), subclavian artery, brachicephalic vein, phrenic nerve.

Question 30

where is the air in a pneumothorax?

Answer 30

in the pleural space

Question 31

what are the borders of the area in which a chest drain can be safley inserted?

Answer 31

lat border of pec major, lateral edge of lat dorsi, 5th IC space and base of axilla

Question 32

when can someone with a pneumothorax fly?

Answer 32

2w after clear CXR

Question 33

what drugs are used in chemical pleurodesis?

Answer 33

minocycline or talc via chest drain

Question 34

what investigations would you do in allergic bronchopulmonary aspergillosis?

Answer 34

sputum: aspergillus Bloods: FBC (eosinophilia), serum precipitants (igG asperigullus), aspergilus igE RAST test, aspergillus skin test

Question 35

who gets invasive aspergillosis?

Answer 35

immunocompromised or those exposed to massive amount of spores

Question 36

what is treatment for invasive aspergillosis?

Answer 36

IV Voriconazole

Question 37

who gets chronic pulmonary aspergillosis?

Answer 37

those patients with underlying lung diseases

Question 38

how does chronic pulmonary aspergillosis present?

Answer 38

it sort of mimics caner - weight loss, haemoptysis, LoA, chronic productive cough, sweats, malaise

Question 39

how do you investigate suspected chronic pulmonary aspergillosis?

Answer 39

sputum culture, aspergillus-specific serum precipitins, CXR

Question 40

what does an asperigilloma look like on CXR?

Answer 40

round opacity in pre-existing cavity (secondary to TB, sarcoid)

Question 41

what is the treatment for aspergilloma?

Answer 41

only treat if symptomatic - transexamic acid, surgical exicision

Question 42

who gets bronchopneumonia, what is it and what causes it?

Answer 42

bronchopneumonia occurs surroudning airways. It tends to affect elderly patients or those with COPD. assoiacted with low virulence pathogen like staph / strep.

Question 43

what causes lobar pneumonia in past cases?

Answer 43

strep pneumoniae (90%)

Question 44

what are the symptoms of an atypical CAP?

Answer 44

1st: fever, malaise, myalgia 2nd: dyspnoea, dry cough, D&V, hepatitis

Question 45

weird symptoms of legionella?

Answer 45

hyponatraemia, LFT derrangement

Question 46

what is first-line drug for Tx of legionella?

Answer 46

fluoroquinolone

Question 47

chlamydia psittaci is associated with which animal?

Answer 47

birds

Question 48

Klebsiella is seen most commonly in which patient population?

Answer 48

alcoholics

Question 49

what colour is the sputum in klebsiella?

Answer 49

it's like red-current jelly. haemoptysis is also seen.

Question 50

in which pneumonia is hypoxia usually sene to be disproportionate to CXR changes?

Answer 50

Pneumocystis jiroveci

Question 51

what are the causative bacteria in HAP?

Answer 51

S. aureus, Pseudomas aeruinosa, eneterobacteria

Question 52

what pneumonia is associated with rapid deterioration, lung cavitation and MOF?

Answer 52

Panton-Valentine Leukocidin S aureus

Question 53

there is bilateral cavitating lesions with fluid levels on the CXR, what is the most likely causative organism?

Answer 53

Staph aureus

Question 54

viral causes of pneumonia?

Answer 54

adenovirus, coronavirus, flu.

Question 55

what are the signs on chest examination of consolidation?

Answer 55

reduced expansion, dull to percussion, increased vocal fremitus, bronchial breathing

Question 56

what can CURB-65 score be used for?

Answer 56

prognosis as well as determining severity, as well as what antibiotics to give and how long for.

Question 57

what media is TB cultured on?

Answer 57

Lowenstein-Jensen medium

Question 58

what is the drug treatment regime for standard TB?

Answer 58

6 months of rifampacin, isoniazid and pyridoxdine, 2 months of pyraziamide and ethmabutol

Question 59

what is the treatment for latent TB?

Answer 59

9m of isoniazid monotherapy.

Question 60

what are the side effects of rifampacin?

Answer 60

orange secretions (R - Red-orange secretions / youll be picin colours) , hepatotoxicity, resistance to OCP

Question 61

which TB drugs can cause sidedroblastic anaemia?

Answer 61

Isoniazid and pyrazinamide (the ones with the Zs in)

Question 62

what side effects does isoniazid have?

Answer 62

peripheral neuropathy, rash, hepatotoxicty, CNS effects, sideroblastic anaemia

Question 63

what are the side effects of Pyrazinamide?

Answer 63

arthralgia, hyperuricaemia, gout, hepatotoxicty, rash, sideroblastic anaemia

Question 64

what are the side effects of ethambutol?

Answer 64

E is for eyes - optic neuritis, Red-green colour blindness, vertical nystagmus. also peripheral neuropathy. avoid in renal disease!

Question 65

what does the pulmonary artery pressure have to be above in order to classify as pulmonary hypertension?

Answer 65

>25mmHg

Question 66

what's the tretament for pulmonary hypertension?

Answer 66

conservative - use POCO (pregnancy is high risk), pulmonary rehab, annual flu vaccination, monitor for heart failure of valve disease (TR and PR) medical - high dose CCBs (diltiazem, nifedipine), prostaglandins (prostacyclin), sildenafil), anticoagulation for all (warfarin)