Respiratory

Question 1

Lung cancer associations. Small cell, squamous cell, Adeno

Answer 1

Small cell = SVC obstruction! Squamous cell = Cavity! Adenocarcinoma = trousseau syndrome and clubbing

Question 2

CI to Lung transplant in malignancy (ROPE)

Answer 2

Reduced FEV1 < 1.5/ Obstruction of SVC/ Paralysis of vocal cord/ Effusion (malignant)

Question 3

HLA associations:
HLA-DR1:

Answer 3

Bronchiectasis

Question 4

HLA-DR2:

Answer 4

Systemic Lupus Erythematous (SLE)

Question 5

HLA-DR3:

Answer 5

Autoimmune hepatitis, primary Sjogen syndrome, T1DM, SLE

Question 6

HLA-DR4:

Answer 6

Rheumatoid arthritis, T1DM

Question 7

HLA-B27:

Answer 7

Ankylosing Spondylitis, Postgonoccocal arthritis, acute anterior uveitis

Question 8

Mx of asymptomatic primary pneumothorax

Answer 8

Discharge + F/U outpatient

Question 9

Mx of asymptomatic secondary pneumothorax

Answer 9

Monitor IP

Question 10

Mx of Symptomatic pneumothorax with high risk features?

Answer 10

Chest drain

Question 11

Mx of symptomatic pneumothorax with no high-risk features?

Answer 11

Conservative care, Needle aspiration, Ambulator device

Question 12

Inhaled pathogen causing Bird fanciers lung?

Answer 12

Avian proteins

Question 13

Inhaled pathogen causing farmers lung?

Answer 13

Saccharopolyspora rectivirgula

Question 14

Inhaled pathogen causing Malt workers lung?

Answer 14

Aspergillus Clavatus

Question 15

Inhaled pathogen causing mushroom workers lung?

Answer 15

Thermophilic actinomycetes

Question 16

Features of Kartageners syndrome (Caused by dynein arm defect immotile cilia)

Answer 16

Dextrocardia, Bronchiectasis, Sinusitis, Subfertility

Question 17

Upper zone lung fibrosis causes?

Answer 17

CHARTS:
Coal Worker Pneumoconiosis
Histiocytosis X (Langerhans cell histiocytosis)
Ankylosing Spondylitis
Radiation
Tuberculosis
Silicosis/Sarcoidosis

Question 18

Lower zone lung fibrosis causes?

Answer 18

BAD RASH:
Bronchiectasis
Asbestosis
Drugs (methotrexate, Amiodarone, Nitrofurantoin)
Rheumatoid Arthritis
Aspiration
Scleroderma/Systemic Sclerosis
Hypersensitivity Pneumonitis

Question 19

Mx of aspiergillus growth post TB?

Answer 19

Surgical Resection

Question 20

What are the causes of a raised Transfer Factor (TLCO)?

Answer 20

Asthma, Haemorrhage, Left to right shunts, Polycythaemia

Question 21

Indication for corticosteroids in sarcoidosis?

Answer 21

PUNCH: Parenchymal lung disease/ Uveitis/ Neurological Involvement/ Cardiac Involvement/ Hypercalcaemia

Question 22

Triad for Meigs syndrome?

Answer 22

Ascites, Pleural Effusion, Benign Ovarian Tumour

Question 23

34 year old women with right sided chest pain, currently mensturating, and a spontaneous pneumothorax?

Answer 23

Catamenial pneumothorax

Question 24

T/F Silica exposure increases incidence of developing TB?

Answer 24

True

Question 25

Paraneoplastic features of squamous cell lung Ca?

Answer 25

PTHrp, Clubbing, HPOA

Question 26

Paraneoplastic features of small cell lung Ca?

Answer 26

ADH, ACTH, Lambert-Eaton Syndrome

Question 27

3 ways to diagnose Asthma in Adults (Assuming symptoms are there)?

Answer 27

1) Eosinophilia 2) FeNO > 50 ppb 3) Spirometry -FEV1 increases 12% or more after bronchodilator -FEV1 > 200ml higher after bronchodilator -FEV1 is 10% or more higher than the predicted FEV1

Question 28

4 ways to diagnose asthma in children aged 5-16?

Answer 28

1) FeNO level above 35 ppb 2) FEV1 increase 12% or higher post bronchodilation 3) 14 days worth of PEF diary demonstrating diurnal variation

Question 29

1st Line management of Asthma for adults aged 12 and over? (2024 guidelines)

Answer 29

Low dose ICS + LABA PRN -Budesonide/Formoterol

Question 30

1st Line management of asthma for adults aged 12 and over who present highly symptomatic? (2024 guidelines)

Answer 30

MART therapy OD -Low dose ICS + Laba -e.g. Budesonide/formoterol

Question 31

Asthma management for adults, where symptoms are no controlled by moderate dose MART (and FeNo2 and eosinophils are not raised)?

Answer 31

MART + LRTA (Montelukast) OR LAMA (Tiotropium)

Question 32

MOI Montelukast?

Answer 32

blocks leukotriene receptors (specifically, the cysteinyl leukotriene receptor CysLT1) to prevent bronchoconstriction, inflammation, and mucus production associated with asthma

Question 33

MOI Lama Tiotropium?

Answer 33

Tiotropium blocks muscarinic receptors (M3 subtype) in the airway smooth muscle, preventing acetylcholine-induced bronchoconstriction and promoting bronchodilation

Question 34

Alpha-1 Antitrypsin deficiency -Spirometry -Transfer factor for carbon monoxide -Pathophysiology -Most severe phenotype

Answer 34

-Obstructive -Low -Deficiency of AAT (protease inhibitor) leads to unchecked elastase activity and alveolar damage -PiZZ phenotype