Respiratory

Question 1

What classically causes a ‘wedge shaped infarct’ on a chest x-ray?

Answer 1

Pulmonary embolism (only occurs in 10-15% = of pt’s with PE i.e. minority will show no signs on radiograph)

Question 2

What condition comes to mind in a patient presenting with haemoptysis + glomerulonephritis? What must be screened for to confirm a diagnosis?

Answer 2

Goodpasture’s disease. An autoantibody screen is positive for anti-glomerular basement membrane (anti-GBM) antibodies and MPO-ANCA.

Question 3

What is the most common site for aspiration pneumonia? What would you hear on auscultation?

Answer 3

Right lower lobe; bronchial breathing.

Question 4

What is the cause of a monophonic wheeze?

Answer 4

A monophonic wheeze is caused by a single mass partially obstructing an airway. Typical lesions include bronchial tumours or inhaled foreign bodies.

Question 5

In which direction does the trachea deviate in lobar collapse?

Answer 5

Towards the collapse

Question 6

In an obstructive defect, FEV1/FVC is < ? %

Answer 6

75%

Question 7

Name two common conditions of the airways that are obstructive in nature

Answer 7

COPD and asthma (usually patients have one or the other; not both)

Question 8

What is a normal FEV1/FVC ratio?

Answer 8

75-80%

Question 9

What happens to the FEV1/FVC ratio in restrictive lung disease?

Answer 9

It remains normal or it increases

Question 10

Define type I and type II respiratory failure

Answer 10

• Type I: Hypoxia (O₂ <8kPa) with a normal or low PaCO₂
• Type II: Hypoxia (O₂ <8kPa) with hypercapnia (PaCO₂ >6.0kPa)

Question 11

COPD can lead to secondary polycythaemia. What is this and what causes it?

Answer 11

Polycythaemia is a raised red cell count (causing blood to become thick and less easily circulated). In secondary polycythaemia (caused by conditions such as COPD) chronic hypoxia causes erythropoietin release.

Question 12

What is aspergillosis? What is ABPA?

Answer 12

Aspergillosis is the name of a group of conditions caused by a fungal mould called aspergillus.

Allergic bronchopulmonary aspergillosis (ABPA) is caused by an allergic reaction to the spores of the aspergillus mould. It’s the mildest form of aspergillosis.

ABPA usually affects people with asthma or other respiratory disorders such as CF, TB or COPD.

Question 13

Name some gastrointestinal features of cystic fibrosis

Answer 13

• Pancreatic insufficiency (DM and steatorrhoea)
• Distal intestinal obstruction syndrome
• Gallstones
• Cirrhosis

Question 14

What clinical signs can be found on examination of a patient with CF?

Answer 14

• Cyanosis
• Finger clubbing
• Bilateral coarse crackles
• Cough with purulent sputum
• Wheeze (mainly upper lobes)

Question 15

What is the triad of symtpoms that asthma presents with?

Answer 15

cough, wheeze, breathlessness

Question 16

Genetic associations in asthma?

Answer 16

Increased IgE and Th2 cytokine genes

Question 17

Name two drug triggers for asthma

Answer 17

1) Beta blockers
2) Aspirin

Question 18

Name one short acting B2 agonist used to treat asthma and one long acting B2 agonist

Answer 18

Short acting - salbutamol

Long acting - salmeterol

Question 19

Name some side effects of beta-2 agonsists

Answer 19

Tachycardia, tremor, anxiety, decrease K⁺

Question 20

Name a steroid that is used in step 2 of asthma management (i.e. add a standard dose-inhaled steroid)

Answer 20

Beclometasone

Question 21

What is the most common type of lung cancer in non smokers?

Answer 21

Adenocarcinoma

Question 22

What type of lung cancer is asbestos exposure assoc. w/ ?

Answer 22

Mesothelioma

Question 23

The immediate management of an acute asthma attack can be rembered by the mnemonic “O-SHIT”. What does it stand for?

Answer 23

O- Oxyen 100% through a non-rebreather mask

S- Salbutamol. 5 mg nebulised every 15 mins/10mg continuosuly (monitor ECG for arrhythmias).

H- Hydrocortisone 100mg IV or prednisolone 40-50mg PO

I- Ipratropium bromide 0.5mg nebulised with 0₂

T-Theophylline IV or Aminophylline IV

Question 24

Which calcium channel blockers are contraindicated in heart failure?

Answer 24

First generation calcium channel blockers (e.g. diltiazem, verapamil) are negative inotropes and therefore contraindicated.

Second generation calcium channel blockers (e.g. amlodipine, nifedipine) however are more vasoselective and not contraindicated.