Respiratory

Question 1

What is atelectasis?

Answer 1

Collapse of lung tissue with loss of lung volume.

Question 2

What is atelectasis caused by?

Answer 2

The partial or complete reversible collapse of the small airways resulting in impaired exchange of O2 and CO2

Question 3

When does atelectasis occur post op?

Answer 3

Within 72h

Question 4

What is seen on CXR in atelectasis?

Answer 4

Platelike, horizontal lines in the area of atelectatic lung tissue

Question 5

How does salicylate poisoning present?

Answer 5

Nausea, vomiting, tinnitus, lethargy or dizziness

Moderate = dehydration, restlessness, sweating, warm extremities w/ bounding pulses, increased RR, hyperventilation and deafness

Question 6

How do we manage salicylate poisoning?

Answer 6

Gastric lavage if within one hour
If plasma levels are high (peak concns at 7hrs), urine alkalinisation and dialysis may be required

Question 7

What are paraneoplastic syndromes?

Answer 7

Rare disorders that are triggered by an abnormal immune response to a neoplasm

Question 8

Give three examples of paraneoplastic syndromes

Answer 8

Cushing syndrome (ACTH)
Lambert-Eaton Syndrome
Myasthenic syndrome
Hypercalcaemia (PTH)
SIADH

Question 9

What is SIADH?

Answer 9

Paraneoplastic syndrome
Cause of hyponatraemia
Linked with SCLC

Question 10

What is Lambert-Eaton Syndrome?

Answer 10

Autoimmune disorder characterised by muscle weakness of the lower limbs. Most commonly linked with SCLC.

Question 11

What is the pathophysiology of Lambert-Eaton Syndrome?

Answer 11

It is the result of antibodies against presynaptic calcium channels in the neuromuscular junction.

Question 12

What is the pathophysiology of myasthenia gravis?

Answer 12

Antibodies that block or destroy nicotinic acetylcholine receptors (AChR) at the neuromuscular junction, leading to varying levels of muscle weakness. Associated with thymomas

Question 13

What is Pancoast’s syndrome?

Answer 13

An apical malignant neoplasm of the lung. It invades surrounding tissues and produces an ipsilateral invasion of the cervical sympathetic plexus leading to Horner’s syndrome. Brachial plexus invasion can cause shoulder & arm pain, wasting of the intrinsic muscles of the hand and paresthesia in the medial aspect of the arm.

Question 14

How does carbon monoxide poisoning present?

Answer 14

Headache
Vertigo
N&V
Alteration in consciousness
Subjective weakness

Cherry red skin colour

Question 15

What is mesothelioma?

Answer 15

Malignant neoplasm originating from pleural or peritoneal surfaces associated with asbestos exposure

Question 16

What is a moderate acute asthma exacerbation?

Answer 16

PEFR >50-75% of maximum
Normal speech
No aspects of severe or life-threatening asthma attack

Question 17

What is a severe acute asthma exacerbation?

Answer 17

PEFT 33-50% predicted, RR >25/min, Tachy, inability to complete sentences in one breath, accessory muscle use

Question 18

What is first-line empirical treatment for non-severe HAP?

Answer 18

Co-amox

Question 19

What is lupus vulgaris?

Answer 19

Painful cutaneous skin lesions with nodular appearance

Are a consequence of:
BCG vaccination
Direct extension of underlying tuberculous foci

Treated with antitubercular regimen

Question 20

How do we treat TB?

Answer 20

Isoniazid 16w
Rifampicin 16w
Pyrazinamide 8w
Ethambutol 8w

Question 21

Which cancer is hypercalcaemia most suggestive of?

Answer 21

Squamous cell carcinoma or multiple myeloma

Question 22

What is first line in IE COPD?

Answer 22

Steroids (obvs)
Amoxi or doxy or clari

Question 23

What is bird-fanciers lung?

Answer 23

Psittacosis - caused by infection by Chlamydophila psittaci
Presents as respiratory tract infection

Question 24

How does oral candidiasis present?

Answer 24

Thick white or cream-coloured deposits
The lesions can be painful and will become tender if rubbed or scraped
Can cause cracking at the corners of the mouth and also cause temporary loss of taste

Question 25

In which gender is OSA more common?

Answer 25

Men by 2x

Question 26

What is the initial mx of suspected asthma?

Answer 26

Trial beta agonist and ICS

Question 27

What is the triad in Goodpasture's syndrome?

Answer 27

Diffuse pulmonary haemorrhage, glomerulonephritis and circulating anti-GBM antibodies Usually occurs in young men

Question 28

What is Wegener's granulomatosis?

Answer 28

Granulomatosis with polyangitis

Question 29

What is the most common cause of CAP?

Answer 29

Strep pneumoniae

Question 30

What are carcinoid tumours?

Answer 30

Most common neuroendocrine tumours, two-thirds of which occur in the GI tract

Question 31

How do carcinoid tumours present?

Answer 31

Often indolent asymptomatic tumours. Can present with non-specific sx. Can cause carcinoid syndrome if secretes various bioactive compounds

Question 32

How does carcinoid syndrome present?

Answer 32

Bronchospasm, diarrhoea, flushing, & R-sided valvular heart lesions

Question 33

How do we dx carcinoid syndrome?

Answer 33

Urinary 5-HIAA, or chromogranin A in liver mets

Question 34

How do we mx carcinoid syndrome

Answer 34

Medically - somatostatin analogues or radionuclide therapies Surgically

Question 35

What are the most common causative organisms of HAP?

Answer 35

Pseudomonas aeroginusa, staph A and enterobacteriae (more specifically Klebsiella, E. coli or Enterobacter spp.)

Question 36

How do we diagnose COPD?

Answer 36

Post-bronchodilator spirometry

Question 37

What is haemothorax?

Answer 37

Collection of blood within the pleural cavity

Question 38

How does haemothorax present?

Answer 38

Most common aetiology is blunt or penetrating trauma

Question 39

How does haemothorax differ to pneumothorax OE?

Answer 39

Dull to percussion with haemothorax Hyperresonant in pneumothorax

Question 40

What is bronchiectasis?

Answer 40

Localised, irreversible dilation of part of the bronchial tree

Question 41

What causes bronchiectasis?

Answer 41

Usually necrotising bacterial infections eg. staph, klebsiella or bordetella pertussis

Question 42

What is the most common cause of bronchiectasis, other than encapsulating infection?

Answer 42

CF

Question 43

What is the triad in bronchiectasis?

Answer 43

Chronic cough, excessive sputum production and repeated infections. Sputum is typically mucoid or purulent with a rancid odour

Question 44

How do we confirm dx of bronchiectasis?

Answer 44

HRCT

Question 45

Where do you see barrel chest?

Answer 45

COPD

Question 46

What is the most common lung injury following blunt chest trauma?

Answer 46

Pulmonary contusion

Question 47

What is the first-line mx of sarcoidosis?

Answer 47

Steroid for 6-24/12 + oral bisphosphonate

Question 48

What is Caplan's syndrome?

Answer 48

Pulmonary fibrosis, most commonly seen in coal miners who have RA. CXR shows multiple well-rounded nodules. Tx = steroids

Question 49

How does sarcoidosis present?

Answer 49

Young, black woman 20-40 Some asymptomatic, some constitutional sx On XR you see bilateral hilar lymphadenopathy, or sometimes ILD

Question 50

Why do you see hypercalcaemia in sarcoidosis?

Answer 50

Produced by calcitriol hypersensitivity of macrophages

Question 51

Where do you see reticular infiltrates on CXR?

Answer 51

ILD

Question 52

How do we remove a chest drain?

Answer 52

It should not be removed during inspiration as this creates a pressure gradient which could suck air in and cause a pneumothorax

Question 53

Where do we use Ziehl-Nielsen stain?

Answer 53

Sputum for acid-fast bacilli, such as TB

Question 54

How do we manage poorly controlled asthma in a pt taking SABA and ICS?

Answer 54

From a NICE (ie. cost perspective): add LTRA From a BTS (i.e. effectiveness perspective): add inhaled LABA

Question 55

What is farmers lung?

Answer 55

A form of hypersensitivity pneumonitis or extrinsic allergic alveolitis where there is a hypersensitivity reaction within the lungs to the spores of thermophilic actinomycetes

Question 56

What is bullous myringitis?

Answer 56

Present on ear examination, seen in mycoplasma pneumoniae infection

Question 57

How common is mesothelioma?

Answer 57

Rare - asbestos exposure most commonly causes lung cancer

Question 58

Which organ system in the body is most commonly affected by sarcoidosis?

Answer 58

Pulmonary

Question 59

When pleural effusions are aspirated, what are the commonest cause?

Answer 59

Malignancy. HF is the most common cause of pleural effusions, but these are usually too small to be aspirated

Question 60

Where do you see Reed-Sternberg cells?

Answer 60

Hodgkin's lymphoma

Question 61

How does Hodgkin's lymphoma present?

Answer 61

Asymptomatic lymphadenopathy B symptoms (constitutional sx) Intermittent fevers CP, cough, SOB Alcohol-induced pain at sites of nodal disease

Question 62

How do we stage Hodgkin's lymphoma?

Answer 62

Ann Arbor staging

Question 63

Where does the exhaled air go when using a non-rebreathing mask?

Answer 63

Through the one-way valves, not into the reservoir bag

Question 64

What can be done to reduce the risk of your child developing asthma?

Answer 64

Breast feed!

Question 65

What is Baker's lung?

Answer 65

A form of occupational asthma

Question 66

Where do you see rust-coloured, blood-tinged sputum?

Answer 66

Strep pneumoniae

Question 67

What causes silicosis?

Answer 67

Inhalation of silica particles (e.g. metal mining, sand blasting)

Question 68

How do we treat silicosis?

Answer 68

Only cure is lung transplant

Question 69

Which workers does berylliosis impact?

Answer 69

Aerospace, nuclear, telecommunications, semi-conductor and electrical industries

Question 70

Where do you see "eggshell" calcification of lymph nodes on CT?

Answer 70

Silicosis, alongside lung nodules predominantly in the upper lobes

Question 71

What are theophyllines?

Answer 71

PO/IV medications which inhibit phosphodiesterase and block adenosine receptors. It is used to treat chronic obstructive pulmonary disease and asthma.