Other Respiratory Disorders

Question 1

Features of Kartagener’s syndrome

Answer 1

Subunit of primary ciliary dyskinesia
AR inheritance - 38% mutations DNAI1 and DNAH5. Ciliary dyskinesia/amotility.
Features: situs invertus, infertility, chronic sinus infections and bronchiectasis
Investigations: Ciliary beat pattern analysis via digital high speed video imaging - sensitive and specific. Bronchoscopy - mucosal inflammation and mucopurulent secretions.Nasal biopsy (brush or curettage) samples from inferior surface of turbinates - Electron microscopy reveals the abnormalities in the cilia. High variability in course of lung function - PFTs not particularly helpful

Question 2

Benefits of HFNO vs NIV in acute hypoxaemic respiratory failure

Answer 2

Large reduction in all-cause mortality
Modest reduction in HAP 
Modest reduction in intubations
May increase patient comfort
Insufficient evidence to comment on ICU admission and length of ICU stay

Question 3

Where do inhaled foreign bodies go

Answer 3

Right main bronchus (wider than the left and smaller angle with trachea)

Question 4

Calculation for age-adjusted D dimer cut off in low probability PE

Answer 4

(Age x 10 in patients > 50 years)

Question 5

Factors which might favour use of rivaroxaban over dabiagatran in VTE

Answer 5

History of dyspepsia - lower rates of this in rivaroxaban compared to dabigatran

Question 6

Benefit of catheter directed thrombolysis vs systemic thrombolysis in submassive PE

Answer 6

Reduced risk of major haemorrhage

Question 7

Risk scoring system predictor for need for intensive respiratory and ventilator support in CAP

Answer 7

SMART COP

Question 8

Features of Lofgren’s syndrome:

Answer 8

Type of acute sarcoidosis:

1. Erythema nodosum
2. Arthritis
3. Bilateral hilar adenopathy on CXR

> 90% have disease resolution at 2 years

Question 9

Mechanism of hypercalcaemia in sarcoidosis

Answer 9

High serum calcitriol levels - activated macrophages in lung and lymph nodes produce calcidiol which is converted to calcitriol in proximal tubules of kidney
-> increased calcium absorption from the gut