resp

Question 1

lung Ca causing SIADH

Answer 1

small cell carcinoma

Question 2

mx of person with frequent IECOPD

Answer 2

home Abx (if purulent or clinical signs of pneumonia) and prednisolone 30mg (plus bronchodilator frequency increased)

Question 3

mx COPD

Answer 3

SABA/SAMA
LABA +ICS
LAMA LABA ICS

Question 4

pneumoconiosis where are opcaities

Answer 4

upper zones

Question 5

Small cell cancer special features

Answer 5

ADH → hyponatraemia
ACTH → Cushing’s syndrome
ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

Question 6

phases of churg strauss

Answer 6

1 allergy rhinitis asthma
2eosinophilia
3 vasculitis pANCA

Question 7

severe asthma

Answer 7

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

Question 8

buproprion contraindicated in

Answer 8

epilepsy

Question 9

fev1 in moderate (stage 2 copd)

Answer 9

50-79% (very severe <30%)

Question 10

sleep apnoea scale

Answer 10

epworth

Question 11

Facial rash plus lymphadenopathy

Answer 11

sarcoidosis

Question 12

causes ARDS

Answer 12

infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
cardio-pulmonary bypass

Question 13

lung mets caused by

Answer 13

breast cancer
colorectal cancer
renal cell cancer
bladder cancer
prostate cancer
(before computers people read books)

Question 14

smoking cessation in preggo

Answer 14

none or nicotine replacement patch

Question 15

long term o2 therapy if

Answer 15

pO2<7.3 twice

Question 16

asbestos causes

Answer 16

benign pleural plaques
asbestosis- lower lobe fibrosis
mesothelioma- blue asbestos
pleural thickening
lung Ca

Question 17

mx sarcoidosis

Answer 17

if asymptomatic nothing

first line prednisolone (hyper calcaemia etc)

Question 18

features of steroid responsiveness in COPD

Answer 18

previous diagnosis of asthma or atopy
a higher blood eosinophil count
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)

Question 19

mx of atelectasis

Answer 19

chest physiotherapy

Question 20

Asthma may be diagnosed if any of the following criteria are met (in adults)

Answer 20

An exhaled FeNO of 40 parts per billion or greater (hence option 1 is incorrect)
A post-bronchodilator improvement in lung volume of 200 ml (hence option 2 is incorrect)
A post-bronchodilator improvement in FEV1 of 12% or more (hence option 3 is CORRECT)
A peak expiratory flow rate variability of 20% or more (hence option 4 is incorrect)
An FEV1/FVC ratio <70% (it is an obstructive lung disease) - hence option 5 is incorrect

Question 21

haemoptysis for the past two weeks. Clinical examination reveals a loud first heart sound, a diastolic murmur and new-onset atrial fibrillation.

Answer 21

Haemoptysis in mitral stenosis is thought to occur secondary to rupture of the bronchial veins caused by raised left atrial pressure.

Question 22

Fibrosis predominately affecting the lower zones

Answer 22

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

Question 23

upper zone fibrosis charts

Answer 23

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

Question 24

COPD mx after SABA/SAMA in asthma feature pictue

Answer 24

LABA ICS

Question 25

Surgery contraindications

Answer 25

stage IIIb or IV (i.e. metastases present) FEV1 < 1.5 litres is considered a general cut-off point* malignant pleural effusion tumour near hilum vocal cord paralysis SVC obstruction

Question 26

mx ptx

Answer 26

primary less than 2 discharge more than 2 drain 2dary drain/ admit

Question 27

pH to intubate in acute asthma

Answer 27

less than 7.35 likely represents carbon dioxide retention in a tiring patient

Question 28

azithromycin ix before starting

Answer 28

ECG and LFTs

Question 29

when to use NIV in COPD

Answer 29

The evidence surrounding the use of NIV in COPD shows that patients with a pH in the range of 7.25-7.35 achieve the most benefit. If the pH is < 7.25 then invasive ventilation should be considered if appropriate

Question 30

mx A1AT deficiency (obstructive)

Answer 30

no smoking supportive: bronchodilators, physiotherapy intravenous alpha1-antitrypsin protein concentrates surgery: lung volume reduction surgery, lung transplantation

Question 31

first-line treatment for moderate/severe obstructive sleep apnoea

Answer 31

Following weight loss, CPAP

Question 32

tx in COPD that helps with exercise tolerance

Answer 32

pulmonary rehab

Question 33

causes of exudative pleural effusion

Answer 33

``` Exudate (> 30g/L protein) infection: pneumonia (most common exudate cause), TB, subphrenic abscess connective tissue disease: RA, SLE neoplasia: lung cancer, mesothelioma, metastases pancreatitis pulmonary embolism Dressler's syndrome yellow nail syndrome ```

Question 34

causes of transudate effusion

Answer 34

heart failure (most common transudate cause) hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption) hypothyroidism Meigs' syndrome

Question 35

sleep apnoea ix

Answer 35

polysomnography

Question 36

varencicline moa

Answer 36

nicotinic partial agonist

Question 37

ank psond lung changes

Answer 37

restrictive- apical fibrosis and kyphosis

Question 38

haemoptysis in valvulopathy

Answer 38

Haemoptysis in mitral stenosis is thought to occur secondary to rupture of the bronchial veins caused by raised left atrial pressure.

Question 39

breathlessness after effusion drained

Answer 39

reexpansion pulmonary oedema

Question 40

Bilateral interstitial shadowing in RA pt

Answer 40

methotrexate pneumonitis

Question 41

tx and prevention of high altitude cerebral oedema

Answer 41

dexamethosone | acetazolamide

Question 42

when to assess for LTOT

Answer 42

very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be 'considered' for patients with severe airflow obstruction (FEV1 30-49% predicted) cyanosis polycythaemia peripheral oedema raised jugular venous pressure oxygen saturations less than or equal to 92% on room air

Question 43

mediastinal mass ddx

Answer 43

4 T's: teratoma, terrible lymphadenopathy, thymic mass and thyroid mass

Question 44

KCO vs TLCO

Answer 44

KCO is TLCO divided by the alveolar volume, which makes it a measure of how efficient gas exchange is in relation to the alveolar-capillary surface to volume ratio. In asthma, this is increased because there is increased pulmonary blood flow which increases the number of cells which come into contact with the gas.

Question 45

causes of a rasied TLCO

Answer 45

``` asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise ```

Question 46

how to ascend safely

Answer 46

less than 500m a day, rest every 3rd day

Question 47

empyema features

Answer 47

turbid effusion with pH<7.2, Low glucose, High LDH

Question 48

Low total gas transfer with normal/ increased transfer coefficient

Answer 48

Extrapulmonary restrictive defect, or pneumonectomy

Question 49

causes of bronchiectasis

Answer 49

post-infective: tuberculosis, measles, pertussis, pneumonia cystic fibrosis bronchial obstruction e.g. lung cancer/foreign body immune deficiency: selective IgA, hypogammaglobulinaemia allergic bronchopulmonary aspergillosis (ABPA) ciliary dyskinetic syndromes: Kartagener's syndrome, Young's syndrome yellow nail syndrome

Question 50

indications for chest drain from aspirate info

Answer 50

Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage. The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage. Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.

Question 51

when is surgery an optioin in bronchiectasis

Answer 51

localised disease only

Question 52

problem with CRP in pneumonia monitoring

Answer 52

it lags behind actual infection (2 types of error)