passmed

Question 1

Recent intubation is the most important risk factor for aspiration pneumonia for the following reasons:

Answer 1

Use of neuromuscular agents may lead to an impaired swallow
Intubation itself can cause regurgitation
Intubation may cause damage to the trachea/airway that can inadvertently increase the risk of gastric contents aspirating into the lung

Question 2

most common sites for aspiration penumonia

Answer 2

The right middle and lower lung lobes are the most common sites affected, due to the larger calibre and more vertical orientation of the right main bronchus.

Question 3

The causes of upper lobe fibrosis can be remembered with the mnemonic ‘CHARTS’

Answer 3

Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis

Question 4

Following presentation to hospital the National Institute for Clinical Excellence (NICE) recommends that patients with a suspected exacerbation of COPD should undergo:
Arterial blood gases
Chest X-ray
Electrocardiogram
Full blood count and urea and electrolytes
Theophylline level on admission (if the patient is on theophylline)
Sputum microscopy and culture if purulent
Blood cultures if pyrexial

Patients should then receive medical therapy in the form of:
02 to keep patient within the individualised target range
Nebulised bronchodilators
Steroid therapy
Antibiotics if indicated
Chest physiotherapy
Intravenous theophyllines would be considered if the response to nebulised bronchodilators is poor.

Question 5

All cases of pneumonia should have a repeat chest X-ray at

Answer 5

6 week after clinical resolution

Question 6

Kartagener’s syndrome?

Answer 6

Kartagener’s syndrome (KS) is a subset of a larger group of ciliary motility disorders called primary ciliary dyskinesias (PCDs). It is a genetic condition with an autosomal recessive inheritance,[1,2] comprising a triad of situs inversus, bronchiectasis and sinusitis.

Question 7

features

Answer 7

Features
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

Question 8

another name for Bipap

Answer 8

NIV - non invasive ventilation

Question 9

lung cancer raises what blood product

Answer 9

platelets

Question 10

A 71-year-old man who is being investigated for recurrent collapse during exertion presents with progressive shortness of breath. His pulse is 84 / min and blood pressure 110/90 mmHg.

Answer 10

aortic stenosis

Question 11

What are the boundaries of the ‘safe triangle’ for chest drain insertion?

Answer 11

Bounded by latissimus dorsi, pectoralis major, line superior to the nipple and apex at the axilla

Question 12

what are pleural plaques

Answer 12

Pleural plaques are benign and do not undergo malignant change. They, therefore don’t require any follow-up. They are the most common form of asbestos-related lung disease and generally occur after a latent period of 20-40 years.

Question 13

This image shows pleural thickening indicative of mesothelioma on the right, almost certainly due to asbestos exposure during his shipbuilding or construction work. As a rule of thumb, the pleurae should only be the thickness of a pencil line on a radiograph, whereas here on the right it is diffusely thickened. There is also decreased volume of the right lung as a result, causing

Answer 13

dyspnoea