Respiratory

Question 1

Bupropion should not be used with?

Answer 1

Epilepsy as it reduces seizure threshold

Question 2

Smoking cessation options

Answer 2

NRT, Varenicline and Bupropion. All to be offered with no priority

Question 3

Varenicline

Answer 3

Nicotine receptor partial agonist
Nausea is the most common adverse effect
Caution in H/o depression and self harm
Contraindicated in Pregnancy and breast feeding

Question 4

Psittacosis

Answer 4

Chlamydia psittaci
Fever and bird contact
Response to tetracyclines and macrolides (1st and 2nd line respectively)

Question 5

Non-Small cell lung cancer surgery contraindications

Answer 5

SVC obstruction
FEV <1.5
Malignant pleural effusion
Vocal cord paralysis

Question 6

Predisposing factors for OSA

Answer 6

Obesity
Macroglossia - hypothyroidism, amyloidosis, acromegaly

Question 7

Upper zone fibrosis

Answer 7

Remember CHARTS
- Coal workers’ pneumoconiosis
- Histiocytosis
- AS
- Radiation induced
- TB
- Silicosis

Extrinsic allergic alveolitis
Sarcoidosis

Question 8

Lower zone fibrosis

Answer 8

• Asbestosis
• Idiopathic pulmonary fibrosis
• SLE
• Drug induced - Amiodarone, Bleomycin, Methotrexate

Question 9

Allergic Bronchopulmonary Aspergillosis (ABPA)

Answer 9

1. Bloods
   - Raised IgE
   - Raised eosinophils
2. B/L pulmonary infiltrates
3. Treatment
   Oral steroids

Question 10

Primary Pneumothorax

Answer 10

< 2 cms - Discharge
> 2 cms - aspirate, if fails - chest drain

Question 11

Secondary Pneumothorax

Answer 11

< 1 cm - Give oxygen and monitor
1-2 cms - aspirate, if fails - - > chest drain
> 2 cms/> 50 years old - chest drain

Question 12

Most common cause of occupational asthma

Answer 12

Isocyanates

Question 13

Indications for steroids in Sarcoidosis

Answer 13

Parenchymal lung disease
Uveitis
Hypercalcemia
Neurological or cardiac involvement

Question 14

Prevention of Acute mountain sickness

Answer 14

Acetazolamide

Question 15

Churg Strauss (EGPA) criteria

Answer 15

Any 4 among:
Asthma
Eosinophilia
Neuropathy
Sinus abnormalities
Flitting Pulmonary infiltrates
Extravascular eosinophils histologically

pANCA

Question 16

Bronchiectasis causes

Answer 16

Post infective - TB, Measles, pertussis,
Cystic fibrosis
Bronchial obstruction - lung CA, FB
Immune deficiency like IgA
ABPA
Kartagener
Yellow nail syndrome

Question 17

Paraneoplastic features of lung CA

Answer 17

SCC - PTHrp, clubbing, HPOA
Small cell - ADH, ACTH, Lambert - Eaton

Question 18

Most common bacteria in IE COPD

Answer 18

Haemophilus influenzae

Question 19

Which chronic infection is a contraindication for lung transplant in a Cystic fibrosis patient?

Answer 19

Infection with Burkholderia cepacia

Question 20

Alpha 1 AT deficiency

Answer 20

AAT is a protease inhibitor
Autosomal recessive/co-dominant
Heterozygous - PiMZ low risk but can pass to children
Homozygous PiZZ - usually disease

Treatment
No smoking
Bronchodilators and physio
Lung volume reduction surgery

Question 21

COPD management

Answer 21

First line is SABA

Poor control despite SABA :-
- No asthmatic features or negative steroid responsiveness - LABA + LAMA
- Asthmatic features - LABA + ICS. If poor response, LABA + LAMA + ICS

Question 22

Criteria for steroid responsiveness in COPD

Answer 22

• previous diagnosis of asthma
• Higher eosinophil count
• substantial variation in FEV1 over time (atleast 400 ml)
• substantial diurnal variation in PEFR (atleast 20%)

Question 23

Raised TLCO

Answer 23

Asthma
Pulm Hemorrhage
Polycythemia
Left to right shunts

Question 24

Low TLCO

Answer 24

Fibrosis
Pneumonia
PE
Pulm edema
Emphysema
Anemia

Question 25

Investigation for suspected adult asthma

Answer 25

FeNO +Spirometry with reversibility

Question 26

Pulm HTN is Pulm arterial pressure greater than?

Answer 26

25 mm Hg at rest or 30 mm Hg after exercise

Question 27

Most common type of cavitating lung CA

Answer 27

SCC

Question 28

Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Answer 28

Mainly **type III** hypersensitivity damage Farmers lung: **Saccharopolyspora rectivirgula** Malt workers lung: **Aspergillus clavatus** Upper zone fibrosis Oral steroids

Question 29

Oxygen dissociation curve

Answer 29

Left - Lower oxygen delivery, Lower acidity, Low temp, Low 2-3 DPG, HbF Right - Raised oxygen delivery, Raised acidity, Raised temp and raised 2-3 DPG

Question 30

Pulmonary Eosinophilia causes

Answer 30

ABPA Churg Strauss Loeffler's syndrome **Extrinsic allergic alveolitis DOES NOT CAUSE Eosinophilia**

Question 31

Klebsiella risk factors

Answer 31

DM, Alcoholics

Question 32

Cystic fibrosis

Answer 32

Normal function of Cystic fibrosis Transmembrane regulator - **Chloride channel** Chromosome **7**

Question 33

Classic finding in Silicosis

Answer 33

Egg shell calcification and cavitation

Question 34

HLA associations

Answer 34

HLA DR1: Bronchiectasis HLA DR2: SLE HLA DR3: Autoimmune hepatitis, T1DM, SLE HLA DR4: RA, T1DM HLA B27: AS, Acute anterior uveitis