RESPIRATORY

Question 1

What causes psittacosis?

Answer 1

An infection by chlamydia psittaci
Usually from a bird contact

Question 2

What are the causes of upper lobe fibrosis?

Answer 2

CHARTS:
Coal workers pneumoconiosis
Histiocytosis and hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Sarcoidosis and silicosis

Question 3

Pts with pleural effusions will require diagnostic pleural fluid sampling. What from this would indicate that a chest tube should be placed?

Answer 3

If the fluid is clear but pH is <7.2
If the fluid is purulent or turbid/cloudy

These factors suggest likely infection, maybe empyema

Question 4

How should children ages 5-17 be diagnosed with asthma?

Answer 4

Spirometry with a bronchodilator reversibility test - >12%

If normal then FeNo

Question 5

How is a diagnosis of asthma made in a child <5?

Answer 5

Based on clinical judgement

Question 6

Likely diagnosis of an Afro-Caribbean lady with erythema nodosum and hypercalcaemia?

Answer 6

Sarcoidosis

Question 7

What facial rash is seen in sarcoidosis?

Answer 7

Lupus pernio

Question 8

What are indications for long term oxygen therapy in a pt with COPD?

Answer 8

PO2 <7.3kPa

Or those with pO2 of 7.3-8.0 and one of the following:
Secondary polycthemia
Peripheral oedema
Pulmonary hypertension

Question 9

What are the manifestations of Alpha 1 antitrypsin deficinecy?

Answer 9

Panacinar emphysema
Cirrhosis and hepatocellular carcinoma (cholestasis in childen)

Question 10

What is the 4 Centor criteria?

Answer 10

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

Question 11

How does an aspergilloma present?

Answer 11

Episodic haemoptysis which can be severe!
SOB, weight loss
On the background of TB

Question 12

What are the 2 most common causes of B/L hilar lymphadenopathy?

Answer 12

Sarcoidosis and TB

Question 13

What is the triad of Meig’s syndrome?

Answer 13

Benign ovarian tumour
Ascites
Pleural effusion

Question 14

Within what time of a transfusion do symptoms of TRALI occur?

Answer 14

Within 6 hours

Question 15

How to remmeber transudate vs exudate causes of pleural effusions?

Answer 15

TRANSient pressure & EXpert leaks
Transudates protein <30 - caused by increased hydrostatic pressure or reduced oncotic pressure
Exudates protein >30 - caused by leaky capillaries due to infection, inflammation or malignancy

Question 16

What is stage 1 COPD?

Answer 16

Mild COPD
Symptoms present but FEV1 >80%
(And of course FEV1/FVC must be <0.7 showing an obstructive pattern)

Question 17

What is stage 2 COPD?

Answer 17

Moderate COPD
FEV1 50-79% of predicted

Question 18

What is stage 3 COPD?

Answer 18

Severe COPD
30-49% of predicted

Question 19

What is stage 4 COPD?

Answer 19

Very severe COPD
FEV1 <30% of predicted

Question 20

What questionnaire can be used to assess the impact of COPD on wellbeing nd daily life?

Answer 20

The COPD assessment test (CAT)

Question 21

Investigations for COPD?

Answer 21

FBC for anaemia or polycthemia
Post-bronchodilator spirometry to confirm diagnosis by demonstrating FEV1/FVC <0.7
CXR to rule out other causes e.g. ca and to see COPD signs

Others:
If infective -> sputum culture
If any heart symptoms -> ECG and serum BNP for cor pulmonale
If very young or FHx then consider serum alpha-1-anti trypsin

Question 22

CXR findings in COPD?

Answer 22

Hyperinflation
Bullae
Flat hemidiaphragm
Barrel chest - widened AP diameter
Saber-sheath trachea - marked coronal narrowing of intrathoracic trachea with concomitant sagittal widening

Question 23

What is the transfer coefficient ?

Answer 23

KCO
The value of the transfer factor divided by the alvoler volume
It expresses the gas transfer ability per unit volume of lung i.e. its transfer factor corrected for lung volume

Question 24

What is transfer factor?

Answer 24

The rate at which a gas will diffuse from alveoli into the blood
Results given as TLCO or corrected for lung volume as the transfer coefficient (KCO)

Question 25

What can cause a reduced TLCO/transfer factor but an increased KCO/transfer coefficient?

Answer 25

Diseases where there is a decrease in lung volume due to an inability to expand the thorax e.g. lobectomy, scoliosis, neuromuscular disorder or ankylosing spondylitis KCO also increases with age!

Question 26

Which diseases cause an increased TLCO?

Answer 26

Conditions where there is increased exposure of alveolar contents to blood Chronic asthma Pulmonary haemorrhage e.g. GPA Left-to-right cardiac shunts Polycthemia Hyperkinetic states Male gender

Question 27

Which diseases cause an decreased TLCO?

Answer 27

Any cause of reduced capacity for gas exchange in the lungs Pulmonary fibrosis Pneumonia PE Pulmonary oedema Emphysema Anaemia Low CO

Question 28

What can cause iatrogenic pneumothorax?

Answer 28

NIV or lung biopsy Thoracentesis CVC placement

Question 29

In pts with primary spontaneous pneumothorax, what is usually the underlying cause?

Answer 29

Rupture of subpleural blebs or Bullae

Question 30

Why are tall, young men at highest risk for primary spontaneous pneumothoraces?

Answer 30

rapid growth of the chest during growth spurts may increase the likelihood of forming blebs which is the underlyign pathophysiology for a pneumothorax as they can rupture and release air into the pleural space

Question 31

Screening questionnaires available for extent and severity of OSA/

Answer 31

STOP-Bang questionnaire EPWORTH sleepiness scale

Question 32

Investigations for obstructive sleep apnoea?

Answer 32

Epworth sleep scale Multiple sleep latency test - a person is given 4-5 opportunities to sleep every two hours during normal wake times - measures the extent of daytime sleepiness Polysomnography is diagnostic

Question 33

What causes acute respiratory distress syndrome?

Answer 33

Increased per ability of alveolar capillaries leading to fluid accumulation in the alveoli Infections Massive blood transfusions Trauma Smoke inhalation Acute pancreatitis Cardio-pulmonary bypass

Question 34

Criteria for diagnosing ARDS?

Answer 34

Acute onset (within 1 week of risk factor) Pulmonary oedema Non-carcinogenic i.e. not a raised pulmonary artery wedge pressure PO2 or FiO2 <40kPa

Question 35

Clinical features of ARDS?

Answer 35

Dyspnoea Raised RR B/L lung crackles Low oxygen sats

Question 36

Why can acute pancreatitis cause ARDS?

Answer 36

Pancreatitis causes release of key enzymes e.g. amylase, lipase, proteases etc These are released into the blood stream and cause release of cytokines and other inflamamtory mediators -> can cause systemic inflammation -> ARDS

Question 37

Causes of acute mediastinal widening? (5 Ts!!)

Answer 37

Thoracic aortic aneurysm Terrible Lymphoma Thyroid goitre Teratomas Thymus tumours

Question 38

Investigations for ?asthma?

Answer 38

Bedside: Peak flow, ?sputum sample if productive cough Lab: WCC, CRP, eosinophil count, total IgE CXR to rule out lung pathology Diagnostic: Spirometry with bronchodilator reversibility - improvement in FEV1 of 12% of more Fractional exhaled nitric oxide testing of 40ppb or more Variable peak flows if diagnostic uncertainty - more than 20% variability after monitoring at least twice daily for 2-4 weeks = positive Specialist referral: Direct bronchial challenge test if diagnostic uncertainty If they have ?occupation asthma then refer to specialist straight away

Question 39

Presentation of bronchiectasis?

Answer 39

Daily productive cough Haemoptysis in 50% Exertional dyspnoea which may progress to resting dyspnoea Fatigue Rhinosinusitis symptoms due to mucociliary impairment History of childhood LRTI FHx of congenital and autoimmune conditions

Question 40

What can cause a white-out of a hemithorax and the trachea pulled towards the side of the white out?

Answer 40

Pneumonectomy Complete lung collapse Pulmonary hypoplasia

Question 41

What can cause a white-out of a hemithorax and the trachea pulled away from the side of the white out?

Answer 41

Pleural effusions Diaphragmatic hernia Large thoracic mass

Question 42

What can cause a white-out of a hemithorax with a central trachea?

Answer 42

Consolidation Pulmonary oedema Mesothelioma