passmed year 5

Question 1

Which of the following options confirms that the chest drain is located in the pleural cavity?

Answer 1

Chest drain swinging: Rises in inspiration, falls in expiration

Question 2

reduced breath sounds and dullness to percussion

Answer 2

pleural effusion

Question 3

Auscultation reveals normal heart sounds, bilateral coarse crackles, and a widespread polyphonic wheeze. She has a past medical history of pertussis as a toddler and recurrent pneumonia as a teenager.

Answer 3

bronchiectasis

Question 4

penumonia caused by aspiration

Answer 4

klebsiella

Question 5

klebsiella normally in what zones of the lung

Answer 5

upper

Question 6

target O2 sats in asthma

Answer 6

94-98%

Question 7

mx of brochiectasis

Answer 7

hysical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)

Question 8

tx in high altitude cerebral oedema

Answer 8

dexamethasone

acetazolamide in prevention

Question 9

COPD standby medication:

Answer 9

NICE recommend offering a short course of oral corticosteroids and oral antibiotics to keep at home

Question 10

30-40 year old with basal emphysema and abnormal LFTs

Answer 10

alpha 1 antitrypsin deficiency

Question 11

Infective exacerbation of COPD

Answer 11

first-line antibiotics are amoxicillin or clarithromycin or doxycycline

Question 12

Bibasal fine end-inspiratory crepitations

Answer 12

PF

Question 13

Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation →

Answer 13

ARDS

Question 14

persistent mouth ulcer

Answer 14

think SCC

Question 15

ramsay hunt syndrome tx

Answer 15

Oral aciclovir and prednisolone

Question 16

dix hallpike manouvre reproduces what

Answer 16

rotatory nsytagmus

Question 17

bird lung is a type of what allevolitis

Answer 17

Extrinsic allergic alveolitis

Question 18

extrinsice allveolitis affects the upper and middle lobes what is the mx

Answer 18

avoid precipitating factors

Question 19

Fine end-inspiratory crepitations are seen in

Answer 19

fibrosis

sudden opening of small airways during inspiration that were held closed in the previous expiration.

Question 20

Coarse crackles heard when

Answer 20

fluid in the lungs

Question 21

klebsiella caused what extra associated signs

Answer 21

lugn abcess or empyema

Question 22

what marker might be raised in chronic copd due to another conditition - 2secondary deu to the copd

Answer 22

hematocrit

polycythaemia

Question 23

what is haematocrit

Answer 23

the ratio of the volume of red blood cells to the total volume of blood.

Question 24

why are high urea levels a poor prognostic sign in CAP

Answer 24

This is because elevated blood urea nitrogen levels indicate dehydration or reduced renal perfusion, both of which can lead to increased mortality

Question 25

two paraneoplastic feature of adenocarcinoma of the lung

Answer 25

gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

Question 26

4 things causing lower zone fibrosis - rest all therefore all upper by default

Answer 26

idiopathic pulmonary fibrosis

most connective tissue disorders (except ankylosing spondylitis) e.g. SLE

drug-induced: amiodarone, bleomycin, methotrexate

asbestosis

Question 27

occupational asthma caused by things such as working in bakery what should GP advise

Answer 27

Advise the patient to keep a diary of peak flow readings both in and out of work

Question 28

treatment of alpha-1 antitrypsin deficiency treatment

Answer 28

Lung volume reduction surgery

removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung.

Question 29

describe brochiectassis presentation or features in an individual

Answer 29

a productive cough with copious amounts of purulent sputum, occasional haemoptysis, wheezing, and is often related to a history of childhood respiratory infections.

Question 30

nasogastric tubes are safe to use under what ph

Answer 30

Nasogastric tubes are safe to use if pH <5.5 on aspirate

Question 31

smoking hx

Answer 31

cancer over tb

Question 32

pancoast tumour dx test

Answer 32

ct if cant see

Question 33

3 stages of churg strauss - pANCA

Answer 33

There are three stages to the presentation of Churg-Strauss disease.

The initial phase is characterised by allergy with many patients having a history of asthma or allergic rhinitis. This inflammation of the nasal passages can lead to the development of nasal polyps.

The second phase is eosinophilia

The third stage is the vasculitis itself which affects small and medium-sized blood vessels and therefore resulting in damage to many organs. Given this patient’s kidney failure, it appears to be affecting his renal blood supply.