Respiratory 2

Question 1

Pleuritic chest pain, hypoxia, hypotension and no focal chest signs….what next?

Answer 1

Massive PE therefore thrombolysis as danger of cardiac arrest

Question 2

Squamous cell carcinoma

Answer 2

PTH, hypercalaemia

Question 3

The most frequently encountered signs of pneumonia on examination

Answer 3

crepitations

Question 4

Asbestosis on chest x-ray

Answer 4

Lower lobe shadowing

Question 5

Anti-DNA topoisomerase antibodies

Answer 5

Diffuse systemic sclerosis- pulmonary fibrosis and pulmonary vascular disease

Question 6

Is COPD associated with nocturnal desaturation

Answer 6

Yes

Question 7

Eggs of Type 1 Respiratory failure

Answer 7

Pneumonia and pulmonary fibrosis

Question 8

What does the alveolar arterial gradient give an indication of?

Answer 8

Severity of impaired oxygen of the lung

Question 9

Is white asbestos more hazardous than blue?

Answer 9

No

Question 10

Non caseating granuloma

Answer 10

Extrinsic allergic alveolitis

Question 11

Diagnosis of systemic amyloidosis

Answer 11

Abdominal fat pad biopsy, renal biopsy and demonstration of amyloid fibrils

Question 12

Samter’s triad

Answer 12

Asthma, Nasal polyps, aspirin intolerance

Question 13

Ground glass appearance on CT, is it associated with a better prognosis?

Answer 13

Yes, lesser degree than honeycombing and often regresses on treatment

Question 14

Relationship between Interstitial Lung Disease and smoking

Answer 14

Smoking increases risk by 2 fold

Question 15

Treatment for sleep aponea

Answer 15

Nasal CPAP

Question 16

Pulsus paradoxus

Answer 16

Reliable index of asthma severity and describes a greater than normal fall during inspiration

Often produced in PE

Question 17

What drug class can cause a fall in serum potassium?

Answer 17

Beta-2 agonists

Question 18

Which part of the respiratory centre responds to decreases in pH, increases in H+, increased PCO2 and decreased PO2?

Answer 18

Pons

Question 19

Uncomplicated hypoglycaemia

Answer 19

No change in pH

Question 20

Diabetic ketoacidosis

Answer 20

Not the glucose level itself which stimulates pH, but the fall in pH which stimulates respiration

Question 21

Long arm of chromosome 7

Answer 21

CFTR gene

Question 22

What respiratory disease is CF associated with?

Answer 22

Asthma

Question 23

What is the association with DVT and PE?

Answer 23

A DVT can cause a PE but NOT vice versa

Question 24

Loud P2

Answer 24

Pulmonary hypertension

Question 25

Suspected PE treatment

Answer 25

Give heparin, oxygen and alalgesia before obtaining a CTPA or VQ scan

Question 26

Most frequently associated organisms with Bronchiectasis?

Answer 26

H.influenza and Pneumococcus

Question 27

Which Ig subclass is associated with Bronchiectasis?

Answer 27

IgG2 and IgG4

Question 28

Bilateral cavitating bronchopneumonia

Answer 28

Staphylococcal pneumonia

Question 29

Pseudomonas infection

Answer 29

Common in Bronchiectasis and CF and hospital acquired infections

Question 30

Bi basal consolidation

Answer 30

Legionella

Question 31

Hypoxia, hypercapnia and respiratory acidosis before distal limb weakness and sensory loss

Answer 31

Guillian Barre Syndrome

Question 32

Respiratory alkalosis

Answer 32

Common in hypoxia patients

Question 33

Name a risk of using anti-TNF mediation to treat rheumatoid arthritis

Answer 33

Active Pulmonary TB infection

Question 34

Causes of pleural effusion in terms of size: small, medium and large

Answer 34

Small: PE, pneumonia, heart failure, pancreatitis, connective tissue disorder Medium: Pneumonia, heart failure Large: Neoplastic esp lung, heart, breast, mesothelioma, infection (TB), trauma

Question 35

Causes of pleural effusion in terms of protein content: Transudate and Exudate

Answer 35

Transudate: heart failure, liver cirrhosis, nephrotic syndrome Exudate: Maligancy, infection, PE, trauma, rheumatoid arthritis, pancreatitis

Question 36

Hypoxia in area of lung

Answer 36

Vasoconstriction

Question 37

Chronic vasoconstriction

Answer 37

Rise in pulmonary arterial pressure, leading to Cor Pulmonale

Question 38

At what volume can a pleural effusion be detected on an Ultrasound?

Answer 38

500ml

Question 39

Features of severe asthma

Answer 39

Peak flow 110bpm Tachynpoeac >25 respirations/min unable to complete a whole sentence

Question 40

Features of life threatening asthma

Answer 40

Peak flow 6kPa- fatigue and imminent respiratory failure because of hyperventilation A previous ITU admission suggests that the patient is prone to life threatening attacks

Question 41

Polyuria

Answer 41

Hypercalaemia- common feature of active sarcoid

Question 42

Raised JVP, third heart sound gallop rhythm and oedema

Answer 42

Cor Pulmonale

Question 43

Complication of Idiopathic Pulmonary Fibrosis

Answer 43

Cor Pulmonale

Question 44

Treatment for Mycoplasma Pneumonia

Answer 44

Macrolide eg Erythromycin

Question 45

Investigations and treatment for PE

Answer 45

Anticoagulation BEFORE investigations - V/Q scan or CT Pulmonary Angiogram - May be wedge shaped infarct on CXR, likely to be associated with Haemoptysis

Question 46

Calcified Pleural Plaques on both hemidiaphragms and Holly leaf patterns everywhere else

Answer 46

Calcified pleural plaques related to asbestos exposure

Question 47

72 yo Man who previously worked as a dockworker, weight loss, shortness of breath and right sided chest pain. Widespread, right sided pleural thickening with reduced lung volume and exudate pleural effusion

Answer 47

Mesothelioma

Question 48

What drugs should be avoided in Asthma as they can induce bronchoconstriction?

Answer 48

NSAIDs

Question 49

Pulsus paradoxus

Answer 49

Abnormally large decrease in systolic BP and pulse wave amplitude during inspiration Reliable index of asthma severity and describes a greater than normal fall during inspiration Often produced in PE, pericarditis, cardiac tamponade,COPD