Delta

Question 1

Buproprion - contraindication

Answer 1

bipolar disorder
but okay in mild depression

Question 2

Varenicline - contraindications

Answer 2

suicidal ideation

Question 3

NRT - contraindications

Answer 3

unstable IHD

Question 4

Smoking cessation: best inverventions

Answer 4

combination NRT (short and long acting) + begavioural intervention

Question 5

Omalizumab target

Answer 5

IgE

Question 6

Mepolizumab targget

Answer 6

IL-5

Question 7

Benralizumab target

Answer 7

IL-5 receptor

Question 8

DUpilimab target

Answer 8

IL4 and IL 13

Question 9

Tezepelumab target

Answer 9

thymic stromal lymphopoietin (TSLP)

Question 10

Severe asthma definition and red flags

Answer 10

requires maximum controller therapy or despite maximal therapy remains uncontrolled
Red flags: poor symptom control, frequent / severe / sudden exacerbations, female, obesity, smoking, elevated peripheral eosinophils

Question 11

How is asthma categorised?
Why does this matter?

Answer 11

High T2 (Allergic / eosinophilic) and low T2 (non-eosinophilic)
Predicts response to MABs to IgE / IL-5 / IL-4/13

Question 12

ILD
- work up

Answer 12

clinical data
HRCT
Pathology / autoimmune screen
BAL / biopsy

Question 13

UIP typical HRCT features

Answer 13

honeycombing
traction bronchiectasis
reticular opacities - peripheral and lower lobe predominant
No atypical features

Question 14

Indications for lung transplant

Answer 14

risk of death >50% within 2 years
likelihood of surviving >90 post TP is >80%
No life-limiting comorbidity in 5 years post
satisfactory supports / psychosocial

Question 15

contraindications for lung transplant

Answer 15

age >65
smoking, alcohol / drug dependence
malignancy
chronic infection
obesity or malnutrition
osteoporosis - severe symptomatic

Question 16

When to refer IPF patient for transplant

Answer 16

DLCO <40% predicted
FVC <80% predicted
Dyspnoe or functional limitation
Decrease in SpO2 to 88% (including on exertion)

Question 17

Antifibrotic therapy for IPF

Answer 17

nintedanib and pirfenidone

Question 18

nintedanib MOA

Answer 18

inhibits multiple tyrosine kinase
slows decline of FVC

Question 19

pirfenidone MOA

Answer 19

inhibits TGF-beta and fibroblast proliferation
slows decline of FVC

Question 20

Nonspecific interstitial pneumonitis imaging features

Answer 20

ground glass opacity
reticular opacity
traction bronchiectasis
diffuse but can have subpleural sparing

Question 21

NSIP - associations

Answer 21

connective dissue disease
HIV
Drugs (amiodarone, MTX, flecainide, nitrofurantoin)
hypersensitivity pneumonitis

Question 22

NSIP - treatment

Answer 22

glucocorticoids
mycophenolate / Azathioprine (second line)
cyclophoxphamide / ?rituximab (third line)
Lung transplantation

Question 23

Precipitins
- role

Answer 23

little use

Question 24

Sarcoidosis pathogenesis

Answer 24

Th1 inflammation
Granuloma formatiuon

Question 25

Sarcoidosis radiological findings on HRCT

Answer 25

bilateral hilar and mediastinal lymphadenopathy
nodular opacities in lung fields

Question 26

Sarcoidosis who requires treatment

Answer 26

usually not required (70%)
treat if:
- progressive pulmonary disease
cardiac or neurologic disease
eye disease not responding to topical therapy
symptomatic hypercalcaemia

Question 27

Sarcoidosis treatment

Answer 27

ICS / oral corticosteroids
Steroid sparing agents:
aza, MMF, ritux, cyclophosphamide

Question 28

Organising pneumonia

Answer 28

idiopathic
connective tissue disease (RA, scleroderma)
medications, radiation, post infective
Covid-19
Usually steroid responsive