Respiratory Review Flashcards
Dysregulated activation of which cell type is most associated with interstitial lung disease?
* Alveolar type II cells
* Alveolar macrophages
* T cells
* Fibroblasts
Fibroblasts
A 67-year old man with COPD is admitted to hospital with an exacerbation. They have had a fever and coughing for 2 days, and their lung function has declined. What is the most likely cause?
* Streptococcus pneumoniae
* Allergen exposure
* Rhinovirus
* Influenza A virus
Rhinovirus
Monoclonal antibodies targeting immunological signalling is used in the treatment of a range of atopic diseases including allergic asthma. The table below shows 4 immune signalling molecules known to be involved in type-2 responses.
Targeting of which of these molecules do you think would be the most effective to target in individuals with allergic asthma?
* IL-5Ra
* IL-4Ra
* IgE
* TSLP
TSLP
What class of drugs is commonly used in the treatment of chronic hypersensitivity pneumonitis but harmful in idiopathic pulmonary fibrosis?
* Corticosteroids (e.g. prednisone)
* Anti-fibrotics (e.g. nintedanib)
* Non-steroidal immunosuppressants (e.g. azathioprine)
* Immune modulators (e.g. Tocilizumab/anti-IL6R)
Corticosteroids (e.g. prednisone)
Mr PJ is a 72-year old retired plumber and ex smoker. He visits his GP, as he’s felt lethargic and had a persistent cough for the last 6 weeks. He is sent for imaging which shows the following signs of lung cancer:
Assuming there are no signs of metastatic disease what is the staging of this disease
* T2bN1aM0
* T1cN0M0
* T2aN0M0
* T3N1bM1b
T2aN0M0
A Ct-guided lung biopsy of Mr PJ is carried out to diagnose the cancer histologically. What is the likely histological diagnosis?
* Squamous cell carcinoma
* Adenocarcinoma
* Large cell lung cancer
* Small cell lung cancer
Adenocarcinoma
Mrs GF is 87 with dementia. She has carers 3 times a day, walks with a zimmer, and needs help with personal care and has poor short term memory. She has hyperthyroidism and hypertension, and is an ex smoker. She has reduced appetite, weight loss over the last 6 weeks and worsening confusion. She is admitted with a fall, and chest x-ray shows a mass. A CT indicates mediastinal lymph node involvement and sclerotic foci suspicious of metastatic disease. The diagnosis is like stage 4 lung cancer. What course of treatment do you think would be most appropriate?
* Cytotoxic chemotherapy
* A lobectomy with lymphadectenectomy
* Stereotactic ablative body radiotherapy
* Palliative care
Palliative care
Mr DE is a 68-year old with an existing diagnosis of idiopathic pulmonary fibrosis. They have developed a fever, persistent cough and are breathless. Mr DE’s wife take him to see their GP complaining that Mr DE has also had difficulty remembering things for the last few days, The GP is concerned they may have pneumonia. Mr DE’s breathing rate is 28 breaths per minute, his pulse is 64 beats per minute, his temperature is 38.5 degrees C, systolic pressure is 100 mm Hg, diastolic pressure is 55 mm Hg. After assessment the GP refers Mr DE direclty to hospital. How would you grade Mr DE’s pneumonia?
* 1
* 2
* 3
* 4
3
After admission, even with antibiotics, Mr DE continues to decline. Tests come back positive for Influenza A virus and streptoccous pneumoniae. 2 days after admission Mr DE has a PaCO2 of 48 mm Hg (normal range 38-42 mm Hg) and a PaO2 of 66 mm Hg (normal range 75-100 mm Hg). How would you best describe their respiratory failure?
* Acute, type I respiratory failure
* Acute on chronic type I respiratory failure
* Chronic type II respiratory failure
* Acute on chronic type II respiratory failure
Acute on chronic type II respiratory failure
A novel zoonotic influenza A virus originating in birds begins to circulate in humans. It has a unique H10N7, where the hemogluttinin can bind alpha-2,6 sialic acid. Defects in which part of the immune response would you be most concerned would results in more severe disease in individuals infected with this novel virus?
* Interferons
* T cells
* Antibodies
* Neutrophils
Interferons
The annual influenza vaccine is modified to incorporate the new H10N7 strain of influenza A virus, and the population is vaccinated. In the context of a vaccinated population, defects in what part of the immune response would you be most concerned might result in more severe disease?
* Interferons
* T cells
* Antibodies
* Neutrophils
Antibodies
A 6 year old child with a history of wheezing and bronchiolitis in infancy visits their GP after their parents notice they are coughing more frequently and they have periods of wheezing, where they complain of chest tightness. They are investigated for signs of asthma. They have signs of airflow obstructions but they are unable to complete a bronchodilator reversibility test. Which of the follow readings in the child could be used to confirm a diagnosis of asthma?
* Exhaled nitric oxide (FeNO) of 40 ppb.
* Serum IgE of 1600 IU/mL
* sputum eosinophil of 4%
* A blood eosinophil count of 400 cells/microL
Exhaled nitric oxide (FeNO) of 40 ppb
