Respiratory

Question 1

Pulmonary fibrosis ix

Answer 1

Bloods - ANA, ANCA, RF, dsDNA, ESR, alpha-1 antitrypsin
ABG
CXR
PFTs - restrictive, reduced TLco + Kco
Broncheolar lavage
HRCT - honeycombing or ground glass (steroid responsive)
Lung biopsy
Echo - RHF

Question 2

Pulmonary fibrosis rx

Answer 2

Conservative - pulmonary rehab, smoking cessation
If inflammatory / ground glass changes- steroids
If IPF - referral for antifibrotic - pirfenidone
If CTD - DMARD
Single lung transplant

Question 3

ILD causes

Answer 3

IPF - over 50 and clubbed
Occupational - silicosis, asbestosis
AI - RF, scleroderma, SLE, polymyositis
Medication - nitrofurantoin, methotrexate, amiodarone, chemotherapy
Allergen - extrinsic allergic alveolitis
Idiopathic
Radiotherapy
Sarcoid

Question 4

Apical vs basal fibrosis causes

Answer 4

Basal - UIP, asbestosis, connective tissue disease
Apical - sarcoid, TB, hypersensitivity pneumonitis

Question 5

Bronchiectasis ix

Answer 5

Sputum culture and cytology
Bloods - immunoglobulins, aspergillus testing
CXR
HRCT - signet ring
Genetic screening - cystic fibrosis if < 40

Question 6

Bronchiectasis mx

Answer 6

Physio and postural drainage
Neb hypertonic saline
Long term azithromycin
2/52 course abx
Nebulised abx (pseudomonas)
Surgical - lung transplant (for localised)

Question 7

Bronchiectasis causes

Answer 7

Idiopathic
Yellow nail - (lymphoedema)
Immunodeficiency
RA
IBD
Primary ciliary dyskinesia
Lobar pneumonia
TB
ABPA - mould exposure

Question 8

Bad bacteria in CF / bronchiectasis etc

Answer 8

Pseudomonas aeruginosa
Bukholderia Cepacia

Question 9

COPD medications

Answer 9

SABA
SAMA - ipratropium
LABA - salmeterol
LAMA - tiotropium

Question 10

Pleural effusion

Question 11

Pneumonectomy

Question 12

Kyphoscoliosis

Question 13

Asthma

Question 14

Asthma ix

Answer 14

Obs + pulse ox
ABG if acute
Peak flow + diary
Bloods and IgE
Skin prick test
CXR
Spirometry

Question 15

Reversibility criteria asthma

Answer 15

> 200ml or 15% change

Question 16

Asthma management

Answer 16

ICS
LKTRA
LABA
Specialist

Question 17

Lung transplant - single. Indications.

Answer 17

COPD
Pulmonary fibrosis

Question 18

Lung transplant - double. Indications.

Answer 18

“Wet” lung conditions
CF
Bronchiectasis
Pulmonary hypertension

Question 19

Immunosupression in lung transplants

Answer 19

Tacrolimus
MMF
Steroids
Prophylactic antibiotics

Question 20

Lung transplant

Answer 20

Acute rejection
Opportunistic infections
Bronchiolitis obliterans (terminal)
Malignancy - skin + haematological

Question 21

Lung transplant contraindications

Answer 21

BMI
Cancer
Smoking
Serious MH disorders
Colonisation with mycobacterium abscesses

Question 22

VATS indications

Answer 22

Wedge resection
Lobectomy - often smoking related disease
Pleurectomy
Bullectomy
Lung biospy

Question 23

VATS vs open thoracotomy

Answer 23

Reduced pain, wound complications, healing time and length of stay

Question 24

Lobectomy indications

Answer 24

Lung cancer = main

Other - localised bronchiectasis, abscess, aspergilloma, TB, (historical)

Question 25

Work up of lung malignancy

Answer 25

Staging CT - CAP Tissue diagnosis - bronchoscopy, bronchoscopy + EBUS or CT guided biopsy If curative - PETCT Work up for surgery - Full lung function tests including transfer factor - Cardiopulmonary exercise testing

Question 26

Lung cancer - non respiratory physical complications

Answer 26

SVCO Recurrent laryngeal nerve palsy - hoarse. Bovine cough. Horners - small muscle hand wasting. Pancoast's. Endocrine - gynaecomastia (B-HCG). Neuro - LEMS, peripheral neuropathy, proximal myopathy. Derm - dermatomyositis, acanthosis nigricans.

Question 27

FEV1 minimum for lobectomy and pneumonectomy

Answer 27

Lobectomy - 1.5 Pneumonectomy - 2

Question 28

Types of lung cancer

Answer 28

Small cell NSCLC (80%) - adenocarcinoma, squamous (smoking), - Rare - large cell, neuroendocrine

Question 29

Examination difference between Lobectomy and Pneumonectomy

Answer 29

Trachea - may be deviated in lobectomy, will be for pneumonectomy Breath sounds - reduced in lobectomy, absent in pneumonectomy Percussion - dull percussion note

Question 30

Respiratory causes clubbing

Answer 30

Lung cancer CF and bronchiectasis ILD

Question 31

Pneumothorax - surgical indications and options

Answer 31

Ongoing air leak Recurrent pneumothoraces Pleurodesis or pleurectomy Bullectomy VATS - greater risk of recurrence

Question 32

Cystic fibrosis cause

Answer 32

Autosomal recessive CFTR gene Increased salt excretion Thick mucus Respiratory, pancreatic insufficiency, reproductive

Question 33

Cystic fibrosis

Answer 33

Respiratory - bronchiectasis Pancreatic insufficiency - croon + fat soluble vitamins Diabetes Gallstones and kidney stones Reproductive Osteoporosis

Question 34

Cystic fibrosis management

Answer 34

Physio - positional drainage, mucous clearance. Dieticians. Nebulised mucolytics and prophylactic antibiotics Regular azithromycin Creon + vitamin therapy. +/- nutritional supplementation. Double lung transplant

Question 35

Bad bacteria in CF

Answer 35

Pseudomonas aeruginosa - common coloniser Burkholderia cepacia or mycobacterium abscesses - contraindication to lung transplant