medicine

Question 1

causes of upper zone lung fibrosis (CHARTS)

Answer 1

C - coal worker’s pneumoconiosis
H - histiocytosis/hypersensitivity pneumonitis
A - ankylosing spondylitis
R - radiation
T - tuberculosis
S - silicosis/sarcoidosis

Question 2

causes of lower zone lung fibrosis

Answer 2

• idiopathic
• most connective tissue disorders (except AS)
• drug induced
• asbestosis

Question 3

moderate vs severe vs life-threatening asthma
respiratory rate

Answer 3

moderate <25/min
severe >25/min

Question 4

moderate vs severe vs life-threatening asthma
PEFR

Answer 4

moderate 50-75% best or predicted
severe 33-50% best or predicted
life threatening <33% best or predicted

Question 5

moderate vs severe vs life-threatening asthma
heart rate

Answer 5

moderate <110 bpm
severe >110 bpm
life-threatening - bradycardia

Question 6

markers of life threatening asthma

Answer 6

normal pCO2
O2 sats <92%
silent chest, cyanosis, feeble respiratory effort
bradycardia, dysrhythmia, hypotension
exhaustion, confusion, coma

Question 7

define near fatal asthma

Answer 7

raised pCO2

Question 8

most common organism causing an infective exacerbation of COPD

Answer 8

haemophilus influenzae

Question 9

most likely diagnosis in a patient experiencing respiratory symptoms who is a heavy smoker and experiencing cushingoid symptoms

Answer 9

ACTH secreting small cell lung cancer

Question 10

paraneoplastic syndromes caused by small cell lung cancer

Answer 10

• syndrome of inappropriate ADH secretion (SIADH)
• Lambert-eaton syndrome
• Cushing’s syndrome

Question 11

pleural effusions are classified as transudate vs exudate according to ____ concentration

Answer 11

protein
transudate <30g/L protein
exudate >30g/L protein

Question 12

transudate vs exudate

Answer 12

transudate - occurs due to increased hydrostatic pressure or low plasma oncotic pressure e.g. CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminaemia

exudate - occurs due to inflammation and increased capillary permeability e.g. pneumonia, cancer, TB, viral infection, PE, auoimmune

Question 13

causes of transudate pleural effusion

Answer 13

• heart failure (most common)
• hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
• hypothyroidism
• Meig’s syndrome

Question 14

causes of exudate pleural effusion

Answer 14

• infection
• connective tissue disease
• neoplasia (lung cancer, mesothelioma, metastases)
• pancreatitis
• PE
• Dressler’s syndrome
• yellow nail syndrome

Question 15

most common organism causing acute exacerbation of bronchiectasis

Answer 15

haemophilus influenzae

Question 16

management of primary pneumothorax, no SoB, <2cm in size

Answer 16

discharge and review with outpatient CXR

Question 17

moderate vs severe vs life-threatening asthma
speech

Answer 17

moderate - normal
severe - can’t complete sentences
life-threatening - silent chest, feeble resp effort

Question 18

most common type of lung cancer in non-smokers

Answer 18

adenocarcinoma

Question 19

x-ray findings seen in heart failure (ABCDE)

Answer 19

A - alveolar oedema (bat’s wings)
B - Kerley B lines (interstitial oedema)
C - cardiomegaly
D - dilated prominent upper lobe vessels
E - effusion

Question 20

first line management for a secondary pneumothorax >2cm and/or patient is short of breath

Answer 20

insert chest drain
if it is 1-2cm then aspirate