passmed qs

Question 1

What is transfer factor

Answer 1

describes the rate at which a gas will diffuse from alveoli into blood

Carbon monoxide is used to test the rate of diffusion.

Question 2

causes of raised transfer factor

Answer 2

asthma
pulmonary haemorrhage (Wegener’s, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise

Question 3

what causes a lower tlco

Answer 3

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

Question 4

what would cor pulmonale show on ecg

Answer 4

peaked p waves

Question 5

allergy related asthma would lead to an increase in what type of immune cell

Answer 5

eosinophills

Question 6

typical spirometry results for asthma

Answer 6

FEV1 - significantly reduced
FVC - normal
FEV1% (FEV1/FVC) < 70%

Question 7

life threatening feature of an asthma attack

Answer 7

silent chest

Question 8

what does IL 4 5 13 do in asthma

Answer 8

IL-4: Facilitates class switching to IgE
IL-5: Facilitates release of eosinophils
IL-13: Stimulates mucus production

Question 9

type 2 resp failure ?

Answer 9

low PaO2 and high PaCO2)

Question 10

feautures of a severe asthma attack

Answer 10

oxygen saturations <90%, peak expiratory flow rate <33% of best, silent chest, bradycardia, hypotension, exhaustion

Question 11

what can be seen on histology for asthma

Answer 11

Curschmann spirals can be seen on histology, which are where shed epithelium becomes whorled mucous plugs

Question 12

a wedge shaped opacification on cxr would indicate

Answer 12

Pulmonary embolism

Question 13

meigs syndrome is characterised by

Answer 13

benign ovarian tumor
pleural effusion
ascites

Question 14

How can marfans cause a spontaneous pneumothorax

Answer 14

• increases rf
• increased stress on the lungs from being tall

Question 15

most common organisms isolated from patients with bronchiectasis

Answer 15

haemophilus influenzae - mc
p aeruginosa
klebs
s pneumoniae

Question 16

patient with recurrent bronchiectasis should be treated with ?

Answer 16

prophylactic abx

Question 17

common finding on auscultation for pneumonia

Answer 17

increased tactile vocal fremitus and dull percussion note

Question 18

flu like illness, dry cough, erythema multiforme and evidence of anaemia would suggest

Answer 18

lower resp tract infection with mycoplasma pneumonia

Question 19

most likely causative organism for patients with pneumonia returning from holiday

Answer 19

Legionella pneumophilia

• inhalation or aspiration of unsanitary water such as in showers supplied by poorly maintained water tanks

Question 20

patients who are allergic to penicillin cant also have ?

Answer 20

co - amixoclav

Question 21

best investigation for atypical pneumonia

Answer 21

polymerase chain reaction

Question 22

infective resp symptoms + alcohol=

Answer 22

klebsiella
upper lobe

Question 23

what stain would you use for pneumocystitis jiroveci

Answer 23

silver stain

Question 24

mechanism of rifampic

Answer 24

inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA

Question 25

Reactivation of tuberculosis is/are most characteristically caused by:

Answer 25

corticosteroids infliximab etanercept

Question 26

Isoniazid mechanism and SE

Answer 26

inhibits mycolic acid synthesis peripheral neuropathy

Question 27

quadruple therapy drugs for tb

Answer 27

ethambutol, isoniazid, pyrazinamide, rifampicin

Question 28

what tb drug can cause visual acuity and color vision difficulties

Answer 28

ethambutamol

Question 29

cavitating lesions are common in what type of lung cancer

Answer 29

squamous cell carcinoma

Question 30

svc obstruction due to small cell lung cancer treatment ?

Answer 30

iv dexamethasone

Question 31

patients with sclc and LEMS would present with

Answer 31

- limb weakness normally lower limbs - dry mouth - impotence - difficulty urinating

Question 32

PTHrp and hypercalcaemia are associated with lung cancer

Answer 32

Squamous cell carcinoma

Question 33

Small cell lung cancer can cause what paraneoplastic syndrome

Answer 33

Cushings Addisons

Question 34

Where does adenocarcinoma arise from

Answer 34

Bronchial glands

Question 35

fine end inspiratory crackles on auscultation and clubbing?

Answer 35

pulmonary fibrosis

Question 36

right sided pleuritic chest pain

Answer 36

pneumonia

Question 37

normal fev1/ fvc ratio

Answer 37

70%

Question 38

does sarcoidosis feature caesating or non caseating granuloma

Answer 38

non caseatign

Question 39

typocal px of sarcoidosis

Answer 39

Black female 20-40 , dry dough, erthema nodosum, worsening dyspnoea

Question 40

raised ACE levels think ?

Answer 40

sarcoidosis

Question 41

Which ECG feature would be most consistent with a diagnosis of pulmonary hypertension?

Answer 41

p pulmonaelae

Question 42

what is bosentan and what should be monitored alongside

Answer 42

endothelin -a receptor agonist liver function tests

Question 43

What bacteria is most likely to cause Otis media

Answer 43

Streptococcus pneumonias Haemophilia influenzas

Question 44

A patient as ptosis, anhydrosis and miosis ?

Answer 44

Horner syndrome Pancoast tumor that affects the apex Ipsilateral

Question 45

Thick and dark green sputum would make you think ?

Answer 45

Bronchiectasis

Question 46

tb on cxr would show

Answer 46

Bilateral hilar lymphadenopahty ghon focus ranke complex

Question 47

what conditions cause finger clubbing

Answer 47

bronchiectasis mesotheliona idopathic pulmonary fibrosis lung abscess

Question 48

tumor marker for liver cancer

Answer 48

ca-19-9