Respiratory

Question 1

What respiratory complication can methotrexate give you?

Answer 1

Pneumonitis - presents like a fibrosis

People with RA take this drug

Question 2

Which Gauge do you use for tension pneumothorax? and which

Answer 2

14G

Question 3

Indications for corticosteroid treatment for sarcoidosis are…

Answer 3

Indications are PUNCH

• Parenchymal Lung Disease
• Uveitis
• Neurological involvement or
• Cardiac involvement
• HyperCa

Question 4

In an acute severe asthma management, after 100% oxygen, nebulised salbutamol and ipratropium bromide nebulisers and IV hydrocortisone are given - what do you give?

Answer 4

IV Magnesium sulphate

Question 5

What respiratory presentation does alpha-1 antitrypsin deficiency? obstructive or restrictive picture?

Answer 5

Causes emphysema in patients who are young and non-smokers

• gives obstructive picture
• in lower lobes

Additional info: get cirrhosis and hepatocellular carcinoma in adults

Question 6

COPD management: after Salbutamol inhaler what do you give?

Answer 6

COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features → add a LABA + LAMA

Question 7

What surgery can be used in treatment of alpha-1-antitrypsin?

Answer 7

Lung volume reduction surgery

Question 8

CURB score

Answer 8

C Confusion (abbreviated mental test score <= 8/10)
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

Question 9

What is an emphysematous bullae

Answer 9

Bullae are air spaces in the lung measuring >1cm in diameter when distended. The most common cause of bullae is cigarette smoking and emphysema. Large bullae in COPD can frequently mimic a pneumothorax

Question 10

Causes of a raised TLCO

The transfer factor describes the rate at which a gas will diffuse from alveoli into blood. Carbon monoxide is used to test the rate of diffusion. The problem is not affecting the alveoli directly or gas exchange and so the lungs try to compensate for the problem by improving gas exchange.

Answer 10

asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise

Question 11

Causes of a lower TLCO

Answer 11

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

Question 12

Difference between type 1 and type 2 respiratory failure

Answer 12

type 1 - 1 abnormality (low PaO2)

type 2 - 2 abnormalities (low PaO2 and high PaCO2)

Question 13

Adenocarcinoma

Answer 13

gynaecomastia

hypertrophic pulmonary osteoarthropathy (HPOA)

Question 14

Small cell carcinoma

Answer 14

ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

Question 15

Squamous cell carcinom

Answer 15

parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

Question 16

The causes of upper lobe fibrosis can be remembered with

Answer 16

The mnemonic ‘CHARTS’

Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis

Question 17

mild, mod, severe, very severe COPD classification

Answer 17

FEV1 
> 80%	Stage 1 - Mild**
50-79%	Stage 2 - Moderate
30-49%	Stage 3 - Severe
< 30%	Stage 4 - Very severe

Question 18

Pneumothorax management

Primary and secondary

Answer 18

Primary pneumothorax

if the rim of air is < 2cm and the patient is not short of breath then discharge
otherwise aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

Secondary pneumothorax

Recommendations include:
if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

Question 19

1 pack year =

Answer 19

1 pack year is defined as 20 cigarettes per day for 1 year

Question 20

Asthma
pANCA
Eosinophillia
+ Nasal polyps, vasculitis

Answer 20

Churg-Strauss syndrome

Question 21

What lung cancer is most associated with asbestos exposure? What is the definitive way to diagnose it?

Answer 21

Mesothelioma

Thoracoscopy and histology

Question 22

First line management when you have a CXR of pleural effusion is…

Answer 22

Aspiration

Question 23

Features of sarcoidosis

Answer 23

acute: erythema nodosum, bilateral hilar

lymphadenopathy, swinging fever, polyarthralgia

insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

Question 24

Evidence of lower zone fibrotic shadowing?

Answer 24

DR CIA

Drugs: amiodarone, methotrexate

Rheumatoid arthritis

Connective tissue disease

Idiopathic pulmonary fibrosis

Asbestosis

Question 25

Features of Kartageners

Answer 25

dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

Question 26

Examples of conditions causing FEV1/FVC < 75

Answer 26

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans