Respiratory 2

Question 1

Idiopathic pulmonary fibrosis
Age
Gender

Answer 1

50-70yo
M>F

Question 2

IPF spirometry findings
FEV1 =
FVC =
Ratio =
TLCO

Answer 2

Restrictive picture
FEV1 normal/ decreased, FVC decreased
Ratio increased
TLCO - reduced transfer factor

Question 3

CXR IPF (3)

Answer 3

Bilateral interstitial shadowing
Ground glass
Honeycombing

Question 4

IPF gold standard test

Answer 4

high resolution CT

Question 5

What is Kartagener’s syndrome?

Answer 5

Primary ciliary dyskinesia

Question 6

Kartagener’s syndrome features (4)

Answer 6

Dextrocardia
Bronchiectasis
Recurrent sinusitis
Subfertility

Question 7

Name the bacteria:
Typically after aspiration or UTIs
Common in ETOH excess and diabetics
Red currant jelly sputum
Often affects upper lobes
Can cause lung abscess formation and empyema

Answer 7

Klebsiella pneumonia

Question 8

First line investigation lung cancer
Investigation of choice

Answer 8

CXR
CT

Question 9

PET scans are offered in patients with which type of lung cancer?
Why?

Answer 9

Non small cell lung cancer
To establish eligibility for curative treatment

Question 10

Small cell lung cancer paraneoplastic features (2)

Answer 10

SIADH
Lambert Eaton syndrome

Question 11

Squamous cell lung cancer paraneoplastic features (4)

Answer 11

PTH secretion causing raised calcium
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH

Question 12

Adenocarcinoma lung ca paraneoplastic syndrome (2)

Answer 12

Gynaecomastia
HPOA

Question 13

Lung cancer 2ww pathway referral (2)

Answer 13

CXR findings with lung ca
40 and above with unexplained haemoptysis

Question 14

RF for obstructive sleep apnoea (6)

Answer 14

Obesity
Acromegaly
Hypothyroidism
Amyloidosis
Large tonsils
Marfan’s syndrome

Question 15

Gas OSA

Answer 15

Respiratory acidosis

Question 16

Mx OSA (2)

Answer 16

Weight loss
CPAP

Question 17

Point of care CRP test for abx for pneumonia interpretation

Answer 17

CRP <20 - no abx
20-100 delayed prescription
>100 abx

Question 18

CURB65

Answer 18

Confusion AMTS 8/10
Urea >7mmol
RR >30
BP 90/60
65 or more

Question 19

CURB65 interpretation

Answer 19

0 -1 home based care
2 - consider hospital
3 or more = admission

0 - rx at home
1/2 - hospital assessment
3/4 high urgent admission

Question 20

Ix pneumonia in intermediate and high risk patients (4)

Answer 20

Blood and sputum cultures
Pneumococcal and legionella urinary antigen tests

Question 21

Rx pneumonia
low risk
medium risk
high risk

Answer 21

Low risk amoxi
Medium risk double amoxi and clarthro
High risk co-amox or cef or taz

Question 22

Primary pneumothorax mx

Answer 22

<2cm and no SOB –> discharge
>2cm –> aspiration, if still >2cm or SOB still then for drain

Question 23

Secondary pneumothorax mx

Answer 23

All patients should be admitted for at least 24 hours
>50yo and >2cm/ SOB –> chest drain
1-2cm –> aspiration, if fails then chest drain
<1cm –> oxygen

Question 24

Iatrogenic pneumothorax mx

Answer 24

Majority should resolve with observation, if rx is needed then to aspirate unless COPD or requiring ventilation

Question 25

Obstructive or restrictive Pulmonary fibrosis COPD Asthma Asbestosis Sarcoidosis ARDS Bronchiectasis Kyphoscoliosis Bronchiolitis obliterans Neuromuscular disorders

Answer 25

R Pulmonary fibrosis O COPD O Asthma R Asbestosis R Sarcoidosis R ARDS O Bronchiectasis R Kyphoscoliosis O Bronchiolitis obliterans R Neuromuscular disorders

Question 26

Pulmonary function tests Obstructive Restrictive

Answer 26

FEV1 sig reduced FVC reduced or normal Ratio reduced FEV1 reduced FVC sig reduced Ratio normal or increased

Question 27

Who may be considered for an immediate abx prescribing approach? (resp infections) (3) (x2 children cases and centor criteria)

Answer 27

Children <2yo with bilateral acute otitis media Children with otorrhoea with otitis media 3 or more centor criteria

Question 28

CENTOR criteria

Answer 28

Cough absent Exudate Nodes Temperature OR young or old (<15yo +1, >44 -1)

Question 29

Adult immediate prescribing indications with respiratory infections >65 with: >80 with: (4)

Answer 29

acute cough + 2 (>65yo) or +1 (>80yo) of the following - hospitalisation in the last year - on steroids - diabetic - CCF hx

Question 30

Length of symptoms for respiratory infections Otitis media Sore throat/ tonsilitis Cold Rhinosinusitis Bronchitis

Answer 30

acute otitis media: 4 days acute sore throat/acute pharyngitis/acute tonsillitis: 1 week common cold: 1 1/2 weeks acute rhinosinusitis: 2 1/2 weeks acute cough/acute bronchitis: 3 weeks

Question 31

If centor 3 or more then which bacteria is likely to have caused the sore throat?

Answer 31

Group A beta haemolytic Strep

Question 32

RA respiratory manifestations (7) Hint: 6 P's

Answer 32

Pulmonary fibrosis Pleural effusion Pulmonary nodules Pleurisy CaPlan's syndrome Pneumonitis Bronchiolitis obliterans

Question 33

Non caseating granulomas = which condition?

Answer 33

Sarcoidosis

Question 34

Sarcoidosis is common in: Age Ethnicity

Answer 34

Young adults African descent

Question 35

Sarcoidosis features Acute (4)

Answer 35

Swinging fever Erythema nodosum Bilateral hilar lymphadenopathy Polyarthralgia

Question 36

mining slate works foundries potteries Occupations that are at risk of which condition

Answer 36

Silicosis

Question 37

fibrosing lung disease 'egg-shell' calcification of the hilar lymph nodes on CXR = which condition?

Answer 37

Silicosis

Question 38

CXR findings for silicosis

Answer 38

fibrosing lung disease 'egg-shell' calcification of the hilar lymph nodes

Question 39

Smoking cessation options (3)

Answer 39

NRT Varenicline Bupropion

Question 40

NRT adverse effects (3)

Answer 40

N&V Headaches Flu like symptoms

Question 40

NRT prescribing if high level of dependence

Answer 40

combination of patches and one other form

Question 41

Varenicline MOA When should it be started? Length of treatment

Answer 41

Nicotinic receptor partial agonist 1 week prior to STOP date 12 weeks

Question 42

Varenicline adverse effects (3)

Answer 42

Nausea Abnormal dreams Insomnia

Question 43

Bupropion MOA Start date

Answer 43

Norepinephrine and dopamine reuptake inhibitor 1-2 weeks before STOP date

Question 44

Bupropion SE (1)

Answer 44

Increased risk of seizures

Question 45

Smoking cessation mx in pregnancy (4) If on NRT - advice that needs to be given

Answer 45

1. CBT 2. Motivational interviewing 3. Structure self help 4. NRT Take off patches prior to bed