Respiratory

Question 1

ABG in hypoventilation

Answer 1

Respiratory acidosis

Question 2

ABG in APO

Answer 2

Respiratory acidosis

Question 3

ABG in exacerbation of COPD

Answer 3

Respiratory acidosis

Question 4

ABG in pneumonia

Answer 4

Respiratory acidosis

Question 5

ABG in hyperventilation

Answer 5

Respiratory alkalosis

Question 6

ABG in aspirin overdose

Answer 6

Respiratory alkalosis

Question 7

ABG in PE

Answer 7

Respiratory alkalosis

Question 8

ABG in sepsis

Answer 8

Respiratory alkalosis

Question 9

ABG in acute renal/liver failure

Answer 9

Metabolic acidosis

Question 10

ABG in lactic/ketoacidosis

Answer 10

Metabolic acidosis

Question 11

ABG in shock/hypovolaemia

Answer 11

Metabolic acidosis

Question 12

ABG in vomiting

Answer 12

Metabolic alkalosis

Question 13

ABG in chronic diarrhoea

Answer 13

Metabolic acidosis

Question 14

ABG in diuretics

Answer 14

Metabolic alkalosis

Question 15

ABG in hyperaldosteronism

Answer 15

Metabolic alkalosis

Question 16

Causes of high anion gap metabolic acidosis

Answer 16

Methanol
Uraemia (chronic kidney failure)
Diabetic ketoacidosis
Propylene glycol 
Infection/iron/isoniazid/inborn errors of metabolism
Lactic acidosis
Ethylene glycol
Salicylates

Question 17

Spirometry findings for asthma

Answer 17

+ 12% and 200mL in FEV1 with bronchodilator

Question 18

Management of COPD

Answer 18

SABA
LAMA/LABA
ICS

Question 19

Management of asthma

Answer 19

SABA
ICS
LABA + ICS

Question 20

Most common cause of cor pulmonale

Answer 20

COPD

Question 21

Organs involved in cystic fibrosis

Answer 21

Respiratory system
Pancreas
Intestine

Question 22

Management of cystic fibrosis

Answer 22

Respiratory:

• Chest physiotherapy
• Inhaled tobramycin (for chronic Pseudomonas infection)
• Anti-inflammatory agent (azithromycin, ibuprofen, prednisolone)
• Lung transplantation

GI:

• Nutritional supplements
• Pancreatic enzymes + H2 antagonist/PPI + fat soluble vitamins
• Ursodeoxycholic acid (for advanced liver disease)
• Antacid/H2 antagonist/PPI (for GORD)

Question 23

Upper lobe fibrosis

Answer 23

S-CHARTS:

• Silicosis
• Coal workers’ pneumoconiosis
• Histiocytosis, hypersensitivity pneumonitis
• Ankylosing spondylitis
• Radiation
• TB
• Sarcoidosis

Question 24

Lower lobe fibrosis

Answer 24

RASCO:

• RA
• Asbestosis
• Scleroderma
• Cryptogenic fibrosing alveolitis (IPF)
• Other - amiodarone, methotrexate, nitrofurantoin, bleomycin

Question 25

Apnoea-Hypopnoea Index for OSA

Answer 25

≥15 episodes/hour or ≥5 episodes/hour in symptomatic patient

Question 26

Light's criteria

Answer 26

Exudative if ≥1 of: - Pleural:serum protein >0.5 - Pleural:serum LDH >0.6 - Pleural LDH >2/3 of upper limit

Question 27

Causes of community-acquired pneumonia

Answer 27

``` Streptococcus pneumoniae Haemophilus influenzae Moxaxella catarrhalis Influenza RSV ```

Question 28

Management of community-acquired pneumonia

Answer 28

Mild: -Amoxicillin (PO) ± doxycycline (PO) Moderate: - Benzylpenicillin (IV) → amoxicillin (PO) - Doxycycline (PO) Severe: - Ceftriaxone/cefotaxime (IV) - Azithromycin (IV)

Question 29

Management of atypical pneumonia

Answer 29

Azithromycin Doxycycline Clarithromycin

Question 30

Causes of hospital-acquired pneumonia

Answer 30

Staph. aureus Gram-negative bacilli: - Pseudomonas aeruginosa - E. coli - Klebsiella pneumoniae

Question 31

Management of hospital-acquired pneumonia

Answer 31

Mild: -Augmentin (PO) Moderate: -Ceftriaxone/cefotaxine (IV) Severe: -Tazocin (IV)

Question 32

Causes of aspiration pneumonia

Answer 32

Anaerobic oral flora ± aerobes

Question 33

Management of aspiration pneumonia

Answer 33

Mild: -Amoxicillin (PO) Moderate: -Benzylpenicillin (IV) Severe: - Ceftriaxone/cefotaxime (IV) - Metronidazole (IV/PO)

Question 34

Signs of PE on ECG

Answer 34

Sinus tachycardia Right axis deviation S1Q3T3 - deep S wave in lead I, present Q wave in lead III, T wave inversion in lead III

Question 35

Management of PE

Answer 35

LMWH (IV) for 1 week Warfarin (PO) 2-3 days after starting LMWH Thrombolysis - if haemodynamically unstable IVC filter Embolectomy

Question 36

Signs of pulmonary hypertension

Answer 36

``` Split S2 Loud P2 Parasternal heave Signs of right heart failure Tricuspid regurgitation ```

Question 37

Gold standard investigation for pulmonary hypertension

Answer 37

Right heart catheterisation

Question 38

Management of pulmonary hypertension

Answer 38

Treatment of underlying cause Oxygen Vasoactive drugs - sildenafil, bosentan, prostacyclines Lung transplantation

Question 39

Definitive diagnosis of TB

Answer 39

Sputum culture

Question 40

Causes of type 1 respiratory failure (hypoxaemia)

Answer 40

V/Q mismatch - PE, pneumonia, atelectasis Shunt - sepsis, liver failure Diffusion impairment - APO, pulmonary fibrosis High altitude Alveolar hypoventilation - COPD

Question 41

Causes of type 2 respiratory failure

Answer 41

Reduced minute ventilation - opioids, sedatives, head injury, elevated ICP Neuromuscular abnormality - myasthenia gravis, Guillain-Barré syndrome Chest wall abnormality - kyphoscoliosis, ascites Pulmonary disease - COPD, severe asthma, bronchiectasis, OSA

Question 42

Management of PE

Answer 42

LMWH → warfarin | tPA (if haemodynamically compromised)