extras

Question 1

flow volume loop not meeting at left side where started to breathe in?

Answer 1

air trapping

Question 2

which aspergillus in ABPA

Answer 2

aspergillus fumigatus

Question 3

Testing what rules out ABPA

Answer 3

if serum IgE total not over 1000 and not on steroids, excludes

Question 4

smoking reduces risk what lung disease

Answer 4

extrinsic allergic alveolitis
AKA
hypersensitivity pneumonitis

Question 5

do you get eosinophilia in EAA/hypersens pneumonitis?

Answer 5

NO!!
look for serum precipitins
obst or restrict LFTs

Question 6

Loeffler syndrome AKA simple pulmonary eosinophilia

Answer 6

over a few weeks onset
not that symptomatic
transient pulmonary infiltrates
no effusion
periph eosinophilia
BAL eosinophilia
check for drugs and parasites
get better on own

Question 7

chronic eosinophilic pneumonia

Answer 7

over weeks to months
often a history of asthma
periph eosinophilia and on BAl
PHOTOGRAPHIC NEGATIVE OF PULMONARY OEDEMA
IgE up but not that high eg no more than 2000
dramatic steroid response

should be a differential for ABPA

Question 8

acute eosinophilic pneumonia

Answer 8

1-5 days onset
looks like pulm oedema on imaging
GET PLEURAL EFFUSIONS ALMOST ALWAYS, with MARKED EOSINOPHILIA
NORMAL periph eosinophils or if there are some then hyeprsegmented
BAL mixed including eosinophils
rapid steroid response
IgE up a bit

could be differential for hypersens pneumonitis (both normal eosinophils)

Question 9

sinusitis in CS vs wegners

Answer 9

destructive in wegners

Question 10

renal disease in CS vs wegeners

Answer 10

CS proteinuria but not normally renal failure

Question 11

ARDS criteria

Answer 11

acute onset
bilat infiltrates
non cardiogenic
pO2/FiO2 under 200

causes

infection
massive transfusion
trauma
stroke
pancreatitis
bypass

Question 12

pneumonia and hyponatraemia think

Answer 12

legionella

Question 13

deranged LFT in pneumonia think

Answer 13

mycoplasma

legionella

Question 14

erythema multiforme with pneumonia think

Answer 14

mycoplasma

Question 15

GBS with pneumonia thnk

Answer 15

mycoplasma

Question 16

myo/pericarditis with pneumonia think

Answer 16

mycoplasma

Question 17

aspergilloma presents how

Answer 17

weight loss, cough, haemoptysis with mass in someone who used to have TB

Question 18

how does lung carcinoid present

Answer 18

40-50 year old non smoker with long history of cough and recurrent haemoptysis
central and often not seen onCXR
cherry red ball on bronch
no carcinoid syndrome unless liver mets

resect
good survival if no mets

Question 19

most common organism in bronchiectasis

Answer 19

haemophilus

good evidence for non CF bronchiectasis doing physical training

Question 20

if aspirate pneumothorax but then still there to under 2cm, what do you do?

Answer 20

Can still discharge home as long as otherwise ok

Question 21

causes of a transudate

there are four

Answer 21

meigs
hypoalbuminaemia
heart failure
hypothyroidism

Question 22

hyponatraemia in lung cancer

Answer 22

small cell

Question 23

CO2 in the blood mostly carried as

Answer 23

BICARBONATE IONS

some of it binds to to haemaglobin as carbamino compound which decreases its affinity for oxygen

Question 24

Diphragmatic paralysis- when is the restriction the most severe

Answer 24

When lying down (gets worst by 30-50%)

Question 25

suspect resp muscle weakness, what should you check

Answer 25

MIP MEP SNIP

Question 26

Sleep changes in old people

Answer 26

increase latency of sleep onset
more arrousals
deepest non REM sleep reduced or absent but REM same

Question 27

MOST cases of familial pulmonary hypertension are a mutation in what

Answer 27

BMPR2
Bone morphogenic protein receptor 2

ALK-1 most common if have coexistent hered haemorrhagic telangiectasia

Question 28

Narcolepsy CSF finding

Answer 28

Reduced hypocretin (a wakefulness protein)

HLA is HLA DQB1 0602

Question 29

Do bronchodilators help CF kids?

Answer 29

30% may help

often paradoxical increase in obstruction

Question 30

poor prognostic markers in mesothelioma

Answer 30

male
anaemia
extensive disease
poor performance status
high PET uptake
increase WCC
high plt
sarcomatoid histo findings
increase COX2 expression
VEGF expression
P16 INK4a gene
Simian virus 40 presence
increase vascularity

Question 31

Major risk factor for Bronchiolitis obliterans after lung transplant

Answer 31

acute cellular rejection
Lymphocytic bronchiolitis

reflux

hard to see on biopsy so use FEV1 as surrogate marker