Respiratory

Question 1

What % FEV predicted is required to be eligible for lung transplant?

Answer 1

<25%

Question 2

Contra-indication to NIV

Answer 2

Massive haemoptysis

Question 3

What does the air-crescent sign mean on high-res chest CT?

Answer 3

Aspergillus (occasionaly pneumocystis pneumonia or neoplasms if necrosis occurs)

Question 4

What does the monad sign mean on high-res chest CT?

Answer 4

Aspergillus (occasionaly pneumocystis pneumonia or neoplasms if necrosis occurs)

Question 5

What causes large pleural effusion and adnexal mass?

Answer 5

Meig’s syndrome

Question 6

Skin manifestations of sarcoidosis

Answer 6

Erythema nodosum
Lupus pernio
Macular or papular sarcoidosis

Question 7

Causes of bilateral hilar enlargement

Answer 7

Sarcoidosis
Tuberculosis
Lymphoma
Lymph node mets

Question 8

Which group of patients are more commonly effected by sarcoidosis?

Answer 8

Black women aged between 20 and 30

Question 9

Causes of erythema nodosum

Answer 9

Tuberculosis
IBD
Streptococcal infections
Sarcoidosis
Drugs (OCP and sulphonamides)

Question 10

What are maximal inspiratory and expiratory pressures used to test for?

Answer 10

Respiratory muscle weakness e.g neuromuscular disorders

Question 11

what is the direction of the external intercostal muscles?

Answer 11

Downwards and medial

Question 12

What FeNO level is indicative of asthma?

Answer 12

Over 40 parts per billion

Question 13

What % improvement of FEV1 post nebulised bronchodilator in indicative of asthma?

Answer 13

12% or higher

Question 14

What volume improvement of FEV1 post nebulised bronchodilator in indicative of asthma?

Answer 14

200ml or greater

Question 15

What % peak flow variability is indicative of asthma?

Answer 15

20% or more

Question 16

Signs of tension pneumothorax

Answer 16

Severe respiratory comprimise, asymmetrical chest movement, tracheal deviation, hyper-resonant hemithorax, absent breath sounds, cardiac arrest

Question 17

Site of emergency decompression for tension pneumothorax

Answer 17

2nd intercostal space mi-clavicular line

Question 18

Lung biopsy sign of preumocystis jirovecii infection

Answer 18

Foamy, vaculoated exudates. Can also effect thyroid, lymph nodes, liver and bone marrow

Question 19

X-ray appearance of preumocystis jirovecii

Answer 19

Bat wing pattern of diffuse infiltrates - can lead to pneumothorax. Usually in IVDU

Question 20

ECG sign of PE

Answer 20

S wave in lead 1, Q wave in lead iii and T wave inversion in lead iii. Most commonly just sinus tachy though

Question 21

Most common type of bacterial organisms causing post asipration pneumonias

Answer 21

Gram negative anaerobes from the oral flora or gastric contents

Question 22

Are anaerobes or aerobes genrally worse smelling?

Answer 22

Anaerobes - produce short chain fatty acids

Question 23

Classical clinical feature of preumocystis jirovecii infection

Answer 23

Desaturation on exercise

Question 24

Symptoms of chemical pneumonitis

Answer 24

Fever, chills, malaise/body aches, along with dyspnoea/wheezing

Question 25

What is Mendelson syndrome?

Answer 25

Chemical pnuemonia/pneumonitis due to aspiration of gastric contents, epcecially under GA - symotoms such as hypoxia and hypertension become evident 2-5 hours aftwe aspiration

Question 26

Exposure to what substance causes Granulomatous reaction of lung parenchyma?

Answer 26

Beryllium. Condition is similar to sarcoidosis.

Question 27

What is Loeffler syndrome?

Answer 27

Eosinophillic infiltraion of lungs in response to parasitic infection

Question 28

In what patients would a V/Q scan be preferable to a CTPA?

Answer 28

Patients with renal impairment, contrast allergies or those who are pregnant

Question 29

What does loud p2 heart sound indicate?

Answer 29

Pulmonary hypertension

Question 30

Light's criteria for pleural transudate

Answer 30

Pleural to serum protein ratio of <0.5, pleural to serum LDH of <0.6 and pleural LDH of less than 2/3 upper limit of normal for serum

Question 31

Most common organism causing CAP and its gram stain

Answer 31

Streptococcus pneumoniae (gram positive)

Question 32

Occular manifestation of sarcoidosis

Answer 32

Anterior uveitis

Question 33

Treatment of sarcoidosis

Answer 33

Acute - usually self resolves spontaneously over 2 years | Chronic - steroids and monitor lung function, ESR, CRP and serum ACE levels (all usually raised)

Question 34

Which lung cancer is associated with hypercalcaemia prior to bone mets and its mechanism

Answer 34

Sqaumous cell bronchial carcinoma - produces PTH

Question 35

Which paraneoplastic syndromes can be caused by small cell lung cancer

Answer 35

ACTH and ADH

Question 36

Symptoms of horner's syndrome

Answer 36

Miosis of pupil, ptosis of eyelid and anhidrosis of face

Question 37

3 histological subtypes of mesothelioma

Answer 37

Sarcomatous, epithelial and mixed

Question 38

What is plastic bronchitis?

Answer 38

Formation of gelatinous or rigid casts in airways, and their subsequent coughing out. Can cause lobar collapse due to blockage of airway.

Question 39

What conditions are plastic bronchitis associated with?

Answer 39

Asthma, bronchiectasis, CF and some resp infections.

Question 40

Treatment of plastic bronchitis

Answer 40

Induction of sputum, bronchial washing and prevention of infections. Bronchoscopy is required.

Question 41

What is lofgren's syndrome?

Answer 41

Acute presentation of sarcoidosis with hilar lymphadenopathy and erythema nodosum. Usually self-resolving.

Question 42

What is cardiac asthma?

Answer 42

Acute pulmonary oedema where peribronchial fluid causes bronchoconstriction and wheezing

Question 43

What does rib-notching on CXR indicate?

Answer 43

Dilated upper vessels obscuring ribs in coarctication of aorta

Question 44

Non resp symptom of legionnaire's disease

Answer 44

N&V, diarrhoea, hyponatraemia, elevated transaminases, failure to respond to beta-lactam antibiotics and high CRP (>100mg/L)

Question 45

Histological appearance of malignant mesothelioma

Answer 45

Has sarcomatous (Neoplastic spindle cells) and carcinomatous (tubules or cysts often - the epithelial cells appear like pulm adenocarcinoma but have long thin microvilli) characterisitics

Question 46

Histopathological appearance of pulmonary TB

Answer 46

Caseating granuloma with giant cells

Question 47

Cells found in BAL for sarcoidosis

Answer 47

High CD4 count

Question 48

Cells found in BAL for ILD

Answer 48

High neutrophil count

Question 49

Cells found in BAL for hypersensitivity pneumonitis

Answer 49

Marked lymphocytosis

Question 50

Gold standard imaging for pulmonary fibrosis

Answer 50

High resolution CT scan

Question 51

MRC dyspnoea scale

Answer 51

``` 0 = No breathlessness except strenuous exercise 1 = Breathlessness when hurrying on the level or walking up a slight hill 2 = Walks slower then contemparies on level due to breathlessness, or has to stop for own breath when walking at own pace 3 = Stops for breath after walking about 100m or after a few mins on level ground 4 = Too bretahless to leave house or breathless when getting dressed ```

Question 52

Features of ABPA

Answer 52

High serum IgE Peripheral eosinophilia Positive skin tests for aspergillus protein Recurrent pulmonary infiltrates on x-ray Causes central cystic/varicose brochiectasis in multiple lobes on x-ray

Question 53

What conditions cause middle lobe bronchiectasis

Answer 53

Immotile ciliary syndrome and mycobacterium avium

Question 54

What type of emphysema is related to alpha 1 anti-trypsin deficiency?

Answer 54

Panacinar