ZTF Respiratory not covered

Question 1

What is FEV1 and what is it a measure of

Answer 1

• Forced expiratory volume in 1 second.
• This is the amount of air a person can exhale as fast as they can in 1 second.
• This is a measure of the ability of air to freely flow out of the lungs.

Question 2

in what kind of respiratory conditions is the FEV1 reduced

Answer 2

obstruction to the air flow

Question 3

what is FVC and what is it a measure of

Answer 3

• Forced vital capacity
• total amount of air a person can exhale after a full inhalation
• measure of the total volume of air that the person can take in to their lungs.

Question 4

In what kind of respiratory conditions is the FVC reduced

Answer 4

if there is any restriction on the capacity of the lungs

Question 5

Obstructive lung disease can be diagnosed when then FEV1:FVC ratio is less than

Answer 5

75%

Question 6

name the common obstructive respiratory diseases

Answer 6

asthma

COPD

Question 7

restrictive lung disease can be diagnosed when the FEV1:FVC ratio is

Answer 7

above 75% as both FEV1 and FVC are reduced equally

Question 8

give some causes of restrictive lung disease

Answer 8

Interstitial lung disease
Neurological (i.e. motor neurone disease)
Scoliosis or chest deformity
Obesity

Question 9

give examples of non-invasive ventilation (NIV)

Answer 9

BiPAP or CPAP

Question 10

what does BiPAP involve

Answer 10

cycle of high and low pressure to correspond to the patients inspiration and expiration

Question 11

when is BiPAP used and what is the criteria

Answer 11

when there is type 2 respiratory failure typically due to COPD

respiratory acidosis despite adequate medical treatment

Question 12

what are the indications for CPAP

Answer 12

Obstructive sleep apnoea
Congestive cardiac failure
Acute pulmonary oedema

Question 13

What is interstitial lung disease

Answer 13

an umbrella term to describe conditions that affect the lung tissue (lung parenchyma)

Question 14

how is ILD diagnosed

Answer 14

high resolution CT

shows ground glass appearance

Question 15

what is the general management of ILD

Answer 15

Remove or treat the underlying cause
Home oxygen where they are hypoxic at rest
Stop smoking
Physiotherapy and pulmonary rehabilitation
Pneumococcal and flu vaccine
Advanced care planning and palliative care where appropriate
Lung transplant is an option but the risks and benefits need careful consideration

Question 16

what are the examination findings in idiopathic pulmonary fibrosis

Answer 16

bibasal fine inspiratory crackles and finger clubbing

Question 17

what 2 medications are licensed for idiopathic pulmonary fibrosis to slow the progression of the disease

Answer 17

Pirfenidone is an antifibrotic and anti-inflammatory

Nintedanib is a monoclonal antibody targeting tyrosine kinase

Question 18

name some medications that can cause pulmonary fibrosis

Answer 18

Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin

Question 19

name some conditions of which pulmonary fibrosis can occur secondary to

Answer 19

Alpha-1 antitripsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis

Question 20

what is hypersensitivity pneumonitis also known as

Answer 20

Extrinsic Allergic Alveolitis

Question 21

what does bronchoalveolar lavage show in Extrinsic Allergic Alveolitis

Answer 21

raised lymphocytes and mast cells

Question 22

management of pneumothorax

if there is no SOB and less than 2cm rim of air on CXR then what is the management

Answer 22

no treatment

follow up in 204 weeks

Question 23

management of pneumothorax

if SOB or there is a greater than 2cm rim of air on CXR then what is the management

Answer 23

aspiration and reassessment

Question 24

management of pneumothorax

if aspiration fails twice then what is required

Answer 24

chest drain

Question 25

management of pneumothorax what do unstable patients or bilateral or secondary pneumothorax require

Answer 25

chest drain

Question 26

what is the management of a tension pneumothorax

Answer 26

insert a large bore cannula into the second intercostal space in the midclavicular line

Question 27

chest drains are inserted into the 'triangle of safety' name the boarders

Answer 27

The 5th intercostal space (or the inferior nipple line) The mid axillary line (or the lateral edge of the latissimus dorsi) The anterior axillary line (or the lateral edge of the pectoris major)

Question 28

why is the needle inserted just above the rib

Answer 28

to avoid the neuromuscular bundle

Question 29

what are the main causes of pulmonary hypertension

Answer 29

Group 1 – Primary pulmonary hypertension or connective tissue disease such as systemic lupus erythematous (SLE) Group 2 – Left heart failure usually due to myocardial infarction or systemic hypertension Group 3 – Chronic lung disease such as COPD Group 4 – Pulmonary vascular disease such as pulmonary embolism Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders

Question 30

what is pulmonary hypertension

Answer 30

increased resistance and pressure of blood in the pulmonary arteries. Increasing the pressure and resistance in the pulmonary arteries causes strain on the right side of the heart trying to pump blood through the lungs. This also causes a back pressure of blood into the systemic venous system.

Question 31

what ECG changes are seen in pulmonary hypertension

Answer 31

right ventricular hypertrophy right axis deviation right bundle branch block

Question 32

what CXR changes are seen in pulmonary hypertension

Answer 32

dilated pulmonary arteries | right ventricular hypertrophy

Question 33

what is the treatment off primary pulmonary hypertension

Answer 33

``` IV prostanoids (e.g. epoprostenol) Endothelin receptor antagonists (e.g. macitentan) Phosphodiesterase-5 inhibitors (e.g. sildenafil) ```

Question 34

What is sarcoidosis

Answer 34

granulomatous inflammatory condition. Granulomas are nodules of inflammation full of macrophages.

Question 35

in sarcoidosis what are the two spikes in incidence and who does it affect more

Answer 35

young adulthood and around 60 | black and women are most affected

Question 36

sarcoidosis mainly affects the lungs but name some extra pulmonary symptoms

Answer 36

systemic: fever, fatigue, weight loss Liver: cirrhosis, cholestasis eyes: uveitis, conjunctivitis, optic neuritis skin: erythema nodosum (tender red nodules on shins), Lupus pernio (raised, purple lesions commonly on cheeks and nose)

Question 37

Lofgrens syndrome is a specific presentation of sarcoidosis and is characterised by the triad of

Answer 37

Erythema nodosum Bilateral hilar lymphadenopathy Polyarthralgia (joint pain in multiple joints)

Question 38

name differentials to sarcoidosis

Answer 38

``` Tuberculosis Lymphoma Hypersensitivity pneumonitis HIV Toxoplasmosis Histoplasmosis ```

Question 39

what would be raised in blood tests for sarcoidosis

Answer 39

Raised serum ACE. This is often used as a screening test. Hypercalcaemia (rasied calcium) is a key finding. Raised serum soluble interleukin-2 receptor Raised CRP Raised immunoglobulins

Question 40

what is the gold standard for confirming the diagnosis of sarcoidosis and what does this show

Answer 40

histology from a biopsy non-caveating granulomas with epitheoid cells

Question 41

what is the treatment of sarcoidosis

Answer 41

No treatment is considered as first line in patients with no or mild symptoms as the condition often resolves spontaneously. Oral steroids are usually first line where treatment is required and are given for between 6 and 24 months. Patients should be given bisphosphonates to protect against osteoporosis whilst on such long term steroids. Second line options are methotrexate or azathioprine Lung transplant is rarely required in severe pulmonary disease

Question 42

what is the prognosis of sarcoidosis

Answer 42

Sarcoidosis spontaneously resolves within 6 months in around 60% of patients. In a small number of patients it progresses with pulmonary fibrosis and pulmonary hypertension, potentially requiring a lung transplant. Death in sarcoidosis is usually when it affects the heart (causing arrhythmias) or the central nervous system.

Question 43

what is obstructive sleep apnoea

Answer 43

collapse of the pharyngeal airway during sleep Apnoea episodes are where the person will stop breathing for up to few minutes reported by the patients partner as the patient is unaware of these. episodes

Question 44

what are the risk factors for obstructive sleep apnoea

Answer 44

``` Middle age Male Obesity Alcohol Smoking ```

Question 45

name the features of obstructive sleep apnoea

Answer 45

``` Apnoea episodes during sleep (reported by partner) Snoring Morning headache Waking up unrefreshed from sleep Daytime sleepiness Concentration problems Reduced oxygen saturation during sleep ```

Question 46

what scale is used to assess symptoms associatedwith obstructive sleep apnoea

Answer 46

Epworth sleepiness scale

Question 47

what is the treatment for obstructive sleep apnoea

Answer 47

CPAP