Resp

Question 1

Signs of poorly controlled asthma

Answer 1

Beta-2 agonist use >4x/wk
Asthma-related absence from work/school
Exercise induced asthma
Night-time symptoms >1x/wk

Question 2

Prognosis in community acquired pneumonia

Answer 2

CURB-65
Confusion = 1
bUN >7 = 1
RR >30 = 1
BP < 90/60 =1
Age >/= 65 = 1

score = 1 –> tx outpatient
score >1 –> tx inpatient

Question 3

PFT in obstructive disorder

Answer 3

FEV/FVC decreased

Question 4

PFT in restrictive disorder

Answer 4

FEV1/FVC increased

Question 5

Only tx for COPD that has shown to reduce mortality

Answer 5

O2

Question 6

Theophylline

Answer 6

Oral bronchodilator

Can be used for symptoms not adequately relieved by bronchodilators

Question 7

Pulmonary edema CXR findings

Answer 7

++ interstitial markings

Bat wing appearance

Question 8

Percussion on pleural effusion

Answer 8

Dull/flat

Question 9

Percussion on pneumothorax

Answer 9

Hyperresonant

Question 10

Percussion on atelectasis

Answer 10

Dull

Question 11

Fremitus on consolidation

Answer 11

Increased

Question 12

Fremitus on pleural effusion

Answer 12

Absent

Question 13

Fremitus on pneumothorax

Answer 13

Absent

Question 14

Classic histologic signs of squamous cell carcinoma of lung

Answer 14

Keratin pearls

Question 15

Squamous cell carcinoma of lung on CXR

Answer 15

Centrally located tumour

Often causing cavitation

Question 16

Squamous cell carcinoma of lung commonly associated with hypercalcemia via…

Answer 16

Production of Parathyroid-related protein production

Unique peptide produced by tumour that acts on parathyroid with very similar mechanism to endogenous PTH

Question 17

Paraneoplastic syndromes

Answer 17

Most often associated with small cell carcinoma of lung (not squamous cell)
SIADH
Ectopic ACTH secretion
Eaton Lambert Syndrome (Clinical picture similar to that of myasethenia gravis - muscle weakness, diminished reflexes due to antibodies against voltage-gated calcium channels at NMJ)

Question 18

Hyperventilation syndrome causes respiratory alkalosis or acidosis?

Answer 18

Alkalosis

Question 19

Vocal cord dysfunction

Answer 19

Abnormal adduction of vocal cords during respiratory cycle –> airflow obstruction at level of larynx, mostly during inspiration
Idiopathic
Often seen in 15-30yo
Consider in asthma cases that dont respond to tx
May be caused by certain enviro exposures (ie. chlorine in swimmers)
Tx: SPL, breathing techniques, reassurance

Question 20

Alpha-1 antitrypsin deficiency

Answer 20

Autosomal co-dominant genetic d/o 
Lung disease (COPD)
Liver disease (cirrhosis)
Dx: Measurement of serum alpha-1 antitrypsin level

Question 21

Coarse crackles associated with

Answer 21

Bronchiectasis

Question 22

Fine crackles associated with

Answer 22

Interstitial lung disease

Fibrosis

Question 23

Asthma dx on spirometry

Answer 23

FEV1/FVC <0.75-0.8 in adults

<0.8-0.9 in children >6yo AND increase in FEV1 >/= 12% and 200mL in adults after brochodilator therapy

Question 24

Gold standard for asthma diagnosis

Answer 24

Spirometry

Question 25

Asthma test if spirometry and PFM are negative but clinical suspicion remains

Answer 25

Methacholine challenge

Question 26

Severe asthma attack tx

Answer 26

Ventolin neb Atrovent neb Steroid PO Magnesium sulfate IV

Question 27

Mild asthma attack tx

Answer 27

Ventolin neb | Consider steroid MDI

Question 28

Stepwise approach to COPD management

Answer 28

SABA --> SABA + LAMA or LABA --> SABA + LAMA + ICS/LABA --> +/- theophylline

Question 29

Give abx for COPD exacerbation if any 2 of

Answer 29

1. Increased sputum purulence 2. Increased dyspnea 3. Increased sputum volume

Question 30

Most common infectious agent in CF

Answer 30

Pseudomonas aeruginosa