Corrections 2

Question 1

What type of hypersensitivity reaction is an asthma attack?

Answer 1

IgE type 1

Question 2

What type of asthma attack does an inability to speak in full sentences indicate?

Answer 2

Severe

Question 3

Give features of a life-threatening asthma attack

Answer 3

1) PEFR <33%

2) O2 sats <92%

3) Confusion

4) Silent chest

5) ‘Normal’ PaCO2

6) Exhaustion

7) Cyanosis

8) Bradycardia

9) Hypotension

Question 4

What are some asthmatic features or features suggestive of steroid responsiveness in COPD?

Answer 4

1) previous diagnsois of asthma or atopy
2) diurnal variation in PEFR (>20%)
3) substantial variation in FEV1 (>400 ml)
4) raised eosinophils

Question 5

Target of antibodies in Lambert-Eaton myasthenic syndrome?

Answer 5

It is caused by antibodies against SCLC cells.

These abs also target and damage voltage-gated calcium channels on the PREsynaptic terminals in motor neurones.

Question 6

Referral criteria for 2ww suspected cancer pathway?

Answer 6

1) chest X‑ray findings that suggest lung cancer

2) aged 40 and over with unexplained haemoptysis

Question 7

Which type of lung cancer is most likely to cause a pleural effusion?

Answer 7

Adenocarcinoma (& mesotheliomas)

Question 8

Prior to discharge, following an acute asthma attack, how long must patients be stable for on their discharge medication (i.e. no nebulisers or oxygen)?

Answer 8

12-24h

Question 9

Stepwise diagnostic testing in asthma (age 5-16 y/o)?

Answer 9

1) all children should have spirometry with a bronchodilator reversibility test

2) FeNO test should be requested if there is NORMAL spirometry or obstructive spirometry with a negative bronchodilator reversibility test

Question 10

Stepwise diagnostic testing in asthma (age ≥17 y/o)?

Answer 10

1) patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma

2) ALL patients should have spirometry with a bronchodilator reversibility (BDR) test

3) ALL patients should have a FeNO test

Question 11

Does a negative result on spirometry exclude asthma as a diagnosis?

Answer 11

No - refer for FeNO testing

Question 12

What anaesthetic agents are patients with myasthenia gravis very sensitive to?

Answer 12

Non-depolarising agents e.g. rocuronium

Question 13

Why should you be cautious of using EllaOne (Ulipristal acetate) in severe asthma?

Answer 13

Due to the anti-glucocorticoid effect of ulipristal acetate

Question 14

Describe Light’s criteria for establishing an exudative effusion

Answer 14

1) Fluid protein/serum protein >0.5

2) Fluid LDH/serum LDH >0.6

3) Pleural fluid LDH >2/3 of normal upper limit of serum LDH

Question 15

What 2 medications are licensed that can slow the progression of pulmonary fibrosis

Answer 15

1) Pirfenidone
2) Nintedanib

Question 16

What should be done before prescribing Abx in bronchiectasis?

Answer 16

Sputum culture

Question 17

What is the Abx of choice for bronchiectasis exacerbations caused by Pseudomonas aeruginos?

Answer 17

Ciprofloxacin

Question 18

When is Abx prophylaxis required in COPD patients?

Answer 18

≥4 excacerbations requiring steroids in past year, and 1 requiring hospitalisation

Question 19

Pleural fluid findings of low glucose may indicate what?

Answer 19

1) RA
2) TB

Question 20

Pleural fluid findings of raised amylase may indicate what?

Answer 20

1) pancreatitis
2) oesophageal perforation

Question 21

What does lung abscess most commonly form 2ary to?

Answer 21

Aspiration pneumonia

Question 22

What is silicosis a risk factor for?

Answer 22

Developing TB

Question 23

Is post-exposure prophylaxis for HIV recommended following human bites?

Answer 23

No (even if the individual has known HIV/AIDS) due to low risk of transmission

Question 24

Who is prone to developing endocarditis secondary to Viridans streptococci e.g. Streptococcus sanguinis?

Answer 24

Patients with poor dental hygiene

Question 25

Post-exposure prophylaxis for HIV routine?

Answer 25

Treat within 72h 4 weeks of ART HIV testing at 12 weeks

Question 26

What is the most common cause of death in measles?

Answer 26

Pneumonia

Question 27

How can the risk of oral candidiasis be reduced in inhaled steroid use?

Answer 27

Take ICS using a large volume spacer --> less drug deposition in mouth

Question 28

Why are dry powder asthma inhalers better for the environment than metered dose inhalers?

Answer 28

Metered dose inhalers use hydrofluorocarbon propellant (a greenhouse gas). Dry powder inhalers do not use propellants.

Question 29

Location of consolidation if it is above the R horizontal fissure?

Answer 29

R upper lobe

Question 30

Mx of persistent air leak or recurrent episodes in pneumothorax?

Answer 30

consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy

Question 31

Symptom control in non-CF bronchiectasis?

Answer 31

Physiotherapy for inspiratory muscle training and postural drainage

Question 32

Why are combination inhalers recommended where possible?

Answer 32

to increase medication compliance

Question 33

Gold standard for diagnosis of mesothelioma?

Answer 33

Thoracoscopy & histology

Question 34

What should be considered if a lung abscess is not improving with intravenous antibiotics?

Answer 34

Percutaneous drainage

Question 35

When draining a pneumothorax, if after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand, what should you do?

Answer 35

Seek a thoracic surgical opinion

Question 36

Spirometry results in idiopathic pulmonary fibrosis?

Answer 36

- restrictive picture - reduced transfer factor - reduced coefficient

Question 37

What is transfer factor?

Answer 37

The transfer factor describes the rate at which a gas will diffuse from alveoli into blood.

Question 38

How can results for transfer factor be given?

Answer 38

a) as the total gas transfer (TLCO) or b) that corrected for lung volume (transfer coefficient, KCO)

Question 39

Causes of a raised TLCO?

Answer 39

- asthma - polycythaemia - male gender, exercise - pulmonary haemorrhage

Question 40

Causes of a lower TLCO?

Answer 40

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

Question 41

Pleural fluid results in an empyema?

Answer 41

- low pH - low glucose - high LDH

Question 42

TLCO in pulmonary fibrosis?

Answer 42

Reduced

Question 43

What type of shock can tension pneumothorax cause?

Answer 43

Obstructive shock

Question 44

Patients with COPD with a pH in the range of what will achieve the most benefit of BiPAP?

Answer 44

pH 7.25-7.35 If pH is <7.25 then invasive ventilation should be considered if appropriate

Question 45

What is the p/f ratio?

Answer 45

PaO2 / FiO2

Question 46

What can the p/f ratio be useful for?

Answer 46

Checking if the patient's O2 has responded adequately to the supplemental oxygen.

Question 47

What is the normal P/F ratio?

Answer 47

55kPa or 400mmHg (depending on whether PaO2 is measured in kPa or mmHg).

Question 48

What is myasthenic crisis?

Answer 48

An acute respiratory failure characterised by: a) FVC <1 b) negative inspiratory force ≤20cm H20 c) the need for ventilatory support

Question 49

What is the most appropriate test to monitor respiratory function in a myasthenic crisis?

Answer 49

FVC

Question 50

When should all cases of pneumonia have a repeat CXR?

Answer 50

6 weeks after clinical resolution

Question 51

What variation in FEV1 over time indicates steroid responsiveness in COPD?

Answer 51

At least 400ml

Question 52

What picture does asbestosis given on pulmonary function testing?

Answer 52

Restrictive

Question 53

What are the indications for steroid treatment in sarcoidosis?

Answer 53

1) hypercalcaemia 2) parenchymal lung disease 3) uveitis 4) neurological or cardiac involvement

Question 54

In bacterial infections, does the WCC or CRP return to normal first?

Answer 54

White cells back into normal ranges faster than the CRP as the CRP response ‘lags.’

Question 55

How is assessment for LTOT done?

Answer 55

Measuring ABG on 2 separate occasions at least 3 weeks apart in patients with stable COPD on optimal mx.

Question 56

Define a substantial diurnal variation in peak flow

Answer 56

≥20%

Question 57

What type of lung cancer are cavitating lesions more common in?

Answer 57

Squamous cell

Question 58

WHat does a raised pulmonary wedge pressure indicate?

Answer 58

Cardiogenic pulmonary oedema

Question 59

Can sarcoidosis cause enlargement of the parotid glands?

Answer 59

Yes - Mikulicz syndrome

Question 60

Prior to the availability of blood gases, which venturi mask should be used in COPD patients who are known retainers?

Answer 60

28% venturi mask 4L/min