Respiratory

Question 1

Bilateral hilar lymphadenopathy causes

Answer 1

Sarcoidosis
Tuberculosis.
Lymphoma/other malignancy
Pneumoconiosis e.g. berylliosis
Fungi e.g. histoplasmosis, coccidioidomycosis

Question 2

Bronchiectasis organisms

Answer 2

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

Question 3

Chest drain contraindications

Answer 3

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

Question 4

Contraindication to lung transplant in CF

Answer 4

Chronic infection with Burkholderia cepacia

Question 5

Eosinophilic granulomatosis with polyangiitis features

Answer 5

asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
renal involvement occurs in around 20%
pANCA positive in 60%

Question 6

Granulomatosis with polyangiitis features

Answer 6

Upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions
cANCA positive in > 90%, pANCA positive in 25%
chest x-ray: wide variety of presentations, including cavitating lesions
renal biopsy: epithelial crescents in Bowman’s capsule

Question 7

Kartagener’s syndrome

Answer 7

dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility

Question 8

Upper zone lung fibrosis causes

Answer 8

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

Question 9

Lower zone lung fibrosis causes

Answer 9

Idiopathic pulmonary fibrosis
Most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
Drug-induced: amiodarone, bleomycin, methotrexate
Asbestosis

Question 10

CURB65

Answer 10

C Confusion (AMT<= 8/10)
U urea > 7 mmol/L
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

Question 11

Obstructive lung disease

Answer 11

FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

Question 12

Restrictive lung disease

Answer 12

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

Question 13

HLA-DR1:
HLA-DR2:
HLA-DR3:
HLA-DR4:
HLA-B27:

Answer 13

HLA-DR1: bronchiectasis
HLA-DR2: systemic lupus erythematous (SLE)
HLA-DR3: autoimmune hepatitis, primary Sjogren syndrome, type 1 diabetes Mellitus, SLE
HLA-DR4: rheumatoid arthritis, type 1 diabetes Mellitus
HLA-B27: ankylosing spondylitis, postgonococcal arthritis, acute anterior uveitis