Respiratory

Question 1

Management of idiopathic pulmonary fibrosis

Answer 1

Pulmonary rehabilitation

Pirfenidone (an antifibrotic agent)

Nintedanib

Question 2

Antidote for cyanide poisoning.

Answer 2

Hydroxocobalamin

Question 3

Benzodiazepine overdose - treatment

Answer 3

Flumazenil

Question 4

Theophylline - use

Answer 4

Bronchodilator in the management of asthma and COPD

Question 5

BTS guidelines for lung nodules:

Nodule <5mm

Answer 5

Can be discharged

Question 6

BTS guidelines for lung nodules:

Nodule 5-6mm, or =>8mm and low-risk

Answer 6

CT surveillance

Question 7

BTS guidelines for lung nodules:

Nodule =>8mm and high risk

Answer 7

CT-PET, and if CT-PET shows high uptake then biopsy

Question 8

Allergic bronchopulmonary aspergillosis - define + management

Answer 8

Allergy to Aspergillus spores

Oral glucocorticoids

Itraconazole is sometimes introduced as a second-line agent

Question 9

Histoplasmosis - define + treatment

Answer 9

Fungus Histoplasma capsulatum

Amphotericin or Itraconazole

Question 10

Extrinsic allergic alveolitis - define

Answer 10

Hypersensitivity induced lung damage due to a variety of inhaled organic particles

Immune-complex mediated tissue damage (type III hypersensitivity) although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in the chronic phase.

Question 11

Most common infective causes of COPD exacerbations

Answer 11

Haemophilus influenzae (most common cause)

Streptococcus pneumoniae

Moraxella catarrhalis

Question 12

Pulmonary hypertension - define

Answer 12

Sustained elevation in mean pulmonary arterial pressure of greater than 20 mmHg at rest

Question 13

FEV1/FVC ratio < 0.7

Answer 13

Obstructive lung disease

Question 14

COPD - still breathless despite using SABA/SAMA and a LABA + ICS

Answer 14

Add a LAMA

Tiotropium is a long-acting muscarinic antagonist (LAMA)

Question 15

Microscopic polyangiitis

Answer 15

Small-vessel ANCA vasculitis.

Typically positive for p-ANCA, with antibodies against MPO (myeloperoxidase)

Mononeuritis multiplex

Question 16

Exudates have a protein level of

Answer 16

> 30 g/L

Question 17

Transudates have a protein level of

Answer 17

<30 g/L

Question 18

Lung cancer is histologically subdivided as:

Answer 18

Non-small cell carcinoma (NSCLC) - (squamous cell carcinoma, adenocarcinoma, and large cell carcinoma)

Small cell carcinoma (SCLC)

Question 19

Eosinophilic granulomatosis with polyangiitis - define

Answer 19

Churg-Strauss syndrome

ANCA associated small-medium vessel vasculitis.

Question 20

Eosinophilic granulomatosis with polyangiitis - features

Answer 20

Churg-Strauss syndrome

Asthma
Blood eosinophilia (e.g. > 10%)
Mononeuritis multiplex
Renal involvement

pANCA positive in 60%

Question 21

Small cell cancer - paraneoplastic features

Answer 21

ADH

ACTH - hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness

Lambert-Eaton syndrome

Question 22

Squamous cell - paraneoplastic features

Answer 22

Parathyroid hormone-related protein (PTH-rp) secretion

Clubbing

Hypertrophic pulmonary osteoarthropathy (HPOA)

Hyperthyroidism due to ectopic TSH

Question 23

Smokers -> liver enzyme inhibitor or inducer?

Answer 23

Inducer

Question 24

Omalizumab - MOA

Answer 24

Anti-IgE monoclonal antibody

Severe allergic asthma

Question 25

Etanercept - MOA

Answer 25

Anti-TNF antibodies Rheumatoid arthritis

Question 26

Acute respiratory distress syndrome (ARDS) - define

Answer 26

Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli. i.e. non-cardiogenic pulmonary oedema

Question 27

Obstructive - Spirometry

Answer 27

FEV1/FVC < 80%

Question 28

Obstructive - Examples

Answer 28

COPD: Chronic bronchitis Emphysema: including alpha-1 antitrypsin deficiency Asthma Bronchiectasis

Question 29

Restrictive - Spirometry

Answer 29

FEV1/FVC > 80%

Question 30

Restrictive - Examples

Answer 30

Idiopathic pulmonary fibrosis Sarcoidosis Histiocytosis Drug-induced fibrosis: amiodarone, bleomycin, methotrexate Asbestosis Obesity Scoliosis

Question 31

Granulomatosis with polyangiitis

Answer 31

Wegener's granulomatosis Renal Failure Epistaxis / Haemoptysis cANCA Sinusitis, nasal crusting and pulmonary haemorrhage

Question 32

Exudates have a protein level of

Answer 32

>30 g/L

Question 33

Treatment of histoplasmosis

Answer 33

Amphotericin or itraconazole Commonly encountered in the Mississippi and Ohio River valleys

Question 34

Management of Granulomatosis with polyangiitis

Answer 34

Steroids Cyclophosphamide (90% response) Plasma exchange

Question 35

Treatment of choice for allergic bronchopulmonary aspergillosis

Answer 35

Oral Glucocorticoids Oral Itraconazole (2nd line)

Question 36

Allergic bronchopulmonary aspergillosis (ABPA) - define

Answer 36

Hypersensitivity reaction to the fungus Aspergillus causing an eosinophilic pneumonia

Question 37

Salmeterol

Answer 37

LABA Long-acting Beta Agonist

Question 38

Treatment of cystic fibrosis patients who are homozygous for the delta F508 mutation

Answer 38

Lumacaftor/Ivacaftor (Orkambi)

Question 39

? increases susceptibility to tuberculosis

Answer 39

Silicosis

Question 40

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) Antibody?

Answer 40

pANCA positive in 60%

Question 41

Drug to prevent acute mountain sickness

Answer 41

Acetazolamide (carbonic anhydrase inhibitor)

Question 41

Management of HACE

Answer 41

Descent Dexamethasone

Question 42

Management of HAPE

Answer 42

Descent Nifedipine Dexamethasone Acetazolamide, Phosphodiesterase type V inhibitors Oxygen if available

Question 43

? is recommended in COPD where there are >=2 exacerbations per year and FEV1<50%

Answer 43

Roflumilast - Oral PDE-4 inhibitors

Question 44

Causes of lower zone fibrosis

Answer 44

MAID Most connective tissue diseases (e.g. rheumatoid arthritis) Asbestosis Idiopathic pulmonary fibrosis, infection Drugs (e.g. methotrexate, amiodarone, bleomycin)

Question 45

What drug can precipitate Eosinophilic granulomatosis with polyangiitis

Answer 45

Leukotriene receptor antagonists Churg-Strauss syndrome

Question 46

Causes of upper zone fibrosis:

Answer 46

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

Question 47

Indications for corticosteroid treatment for sarcoidosis

Answer 47

Parenchymal lung disease Uveitis Hypercalcaemia Neurological or cardiac involvement

Question 48

How many lobes does the right lung have?

Answer 48

3

Question 49

PR3

Answer 49

c-ANCA

Question 50

MPO

Answer 50

p-ANCA

Question 51

Lung Nodule 5-6mm Nodule >6mm

Answer 51

CT at 1 year CT in 3 months

Question 52

Treatment for MERS

Answer 52

Supportive