Passmedicine

Question 1

How should you investigate pleural effusion?

Answer 1

PA CXR
Ultrasound
Contrast CT (underlying cause)
Diagnostic aspiration

Question 2

Does asbestosis affect upper or lower lobes?

Answer 2

Lower lobes

idiopathic pulmonary fibrosis - lower lobes, EAA - upper lobes

Question 3

Which patients should you avoid varenicline in?

Answer 3

Avoid varenicline in patients with a past history of depression

(varenicline can be given to help stop smoking)

Question 4

What can you offer patients trying to stop smoking?

Answer 4

Nicotine replacement therapy
Bupoprion
Varenicline

Question 5

Adverse effects of nicotine replacement therapy?

Answer 5

Nausea and vomiting, headaches and flu-like symptoms

Question 6

When should you start varenicline

Answer 6

Stope 1 week before target date to stop

Question 7

Recommended length of varenicline treatment?

Answer 7

12 weeks

Question 8

Side effects of varenicline

Answer 8

Nausea, headache, insomnia, abnormal dreams

Question 9

Can you give varenicline in pregnancy/breastfeeding?

Answer 9

No - contraindicated

So is bupoprion

Question 10

When should you take bupoprion?

Answer 10

Take 1-2 weeks before target stop date

Question 11

Weird rare side effect of bupoprion

Answer 11

Seizures

Question 12

When is bupoprion contraindicated?

Answer 12

Contraindicated in epilepsy, pregnancy and breast feeding.

Having an eating disorder is a relative contraindication

Question 13

Treatment of mesothelioma

Answer 13

Platinum chemotherapy (e.g. cisplatin)

Question 14

Which lung is more commonly affected in mesothelioma?

Answer 14

Right lung

Question 15

CXR mesothelioma

Answer 15

Pleural effusion/pleural thickening

Question 16

When should you prescribe antibiotics for someone having an acute exacerbation of COPD?

Answer 16

Prescribe if they have purulent sputum/clinical signs of pneumonia

Question 17

Most common cause of COPD exacerbation?

Answer 17

Haemophilus influenza

Question 18

Bupoprion mechanism of action?

Answer 18

Noradrenaline and dopamine reuptake inhibitor, nicotonic antagonist

Question 19

How does miliary TB spread?

Answer 19

Through the pulmonary venous system

Question 20

What is a ghon focus?

Answer 20

A small lung lesion that develops when a person develops TB for the first time (ghon focus is made of macrophages)

Question 21

What is Potts disease?

Answer 21

When TB spreads to the vertebrae

Question 22

Causes of upper zone fibrosis?

Answer 22

CHARTS
Coal workers pneumoconiosis
Histiocytosis
Ank spon/allergic bronchopulmonary aspergillus
Radiation
Tuberculosis
Silicosis, Sarcoidosis

Question 23

Someone has a CXR and it is suggestive of lung cancer, what investigation should be offered next?

Answer 23

Contrast enhanced CT

Question 24

Epithelial crescents in Bownman’s capsule

Answer 24

Wegeners (granulomatosis with polyangitis)

Question 25

Managment of Wegeners

Answer 25

Steroids Cyclophosphamide (90% response) Plasma exchange

Question 26

Which organism can cause empyema formation?

Answer 26

Klebsiella

Question 27

Which conditions are associated with Klebsiella?

Answer 27

Pneumonia in alcoholics (red jelly sputum - often affects upper lobes) Empyema Ascending cholangitis

Question 28

Addisons disease can be associated with which other disease?

Answer 28

TB

Question 29

Which type of lung cancer would show a cavitating lung lesion on CXR?

Answer 29

Sqaumous cell

Question 30

CPAP or BiPAP for sleep apnoea?

Answer 30

CPAP (keeps airway open)

Question 31

How does varenicline work?

Answer 31

Nicotonic receptor partial agonist

Question 32

Risk factors for aspiration pneumonia?

Answer 32

``` Recent intubation Poor dental hygiene Swallowing difficulties Prolonged hospitalisation or surgical procedures Impaired consciousness Impaired mucociliary clearance ```

Question 33

Difference between CRB65 and CURB65?

Answer 33

CRB65 for primary care setting | CURB65 for secondary care setting

Question 34

Why would do you use corticosteroids in COPD?

Answer 34

Reduce exacerbations

Question 35

What interventions improve survival in COPD?

Answer 35

Smoking cessation | Oxygen therapy

Question 36

Emphysema in COPD

Answer 36

At the apices

Question 37

Emphysema in alpha-1 antitrypsin

Answer 37

At the bases

Question 38

What is Meigs syndrome

Answer 38

Ovarian tumour Pleural effusion Ascites

Question 39

What is alpha-1 antitrypsin deficiency commonly misdiagnosed as?

Answer 39

COPD

Question 40

Biggest risk factor for pneumothorax

Answer 40

Stop smoking

Question 41

Treatment of small cell lung cancer

Answer 41

Chemotherapy with adjuvant radiotherapy

Question 42

What can you offer to COPD patients with frequent exacerbations of COPD?

Answer 42

Offer a home supply of prednisolone and an antibiotic

Question 43

Metabolic acidosis with large anion gap

Answer 43

Diabetic ketoacidosis

Question 44

When might you see a high anion gap?

Answer 44

Diabetic ketoacidosis

Question 45

When might you see a low anion gap?

Answer 45

Multiple myeloma

Question 46

"multiple large, round, well-circumscribed masses"

Answer 46

Cannon ball mets | Seen in renal cell carcinoma

Question 47

More common in diabetics and alcoholics?

Answer 47

Klebsiella

Question 48

How might Klebsiella look on CXR?

Answer 48

Consolidation which may cavitate in upper lobe | Commonly causes lung abscesses and empyema

Question 49

If someone develops a cough after recent immunosuppression therapy,, what should you do?

Answer 49

Do a CXR ASAP - could be reactivation of TB or smoething

Question 50

A 35-year-old man is seen due to an extensive petechial rash on his lower legs for the last 2 weeks. He has minimal past medical history other than asthma and surgical removal of nasal polyps aged 23 and 29 years.

Answer 50

Churg Strauss

Question 51

Organism most likely to cause COPD exacerbation

Answer 51

Haemophilus influenzae

Question 52

Treatment of COPD exacerbations?

Answer 52

Amoxicillin or a tetracycline with a prednisolone

Question 53

An ex-smoker with SOB, weight loss and hyponatraemia with a normal CXR?

Answer 53

Urgent referral to the chest clinic

Question 54

Safe triangle for chest drain insertion

Answer 54

5th intercostal space, mid axillary line | borders = latissimus dorsi, lateral border of pectoralis and nipple line

Question 55

How would you control symptoms in non-CF bronchiectasis?

Answer 55

Inspiratory muscle training and postural drainage

Question 56

What is bronchiectasis?

Answer 56

Permanent dilatation of the airways secondary to chronic inflammation or infection

Question 57

How to minimise oral effects of inhaled steroids?

Answer 57

Brushing teeth or rinsing mouth straight after use

Question 58

What is the transfer coefficient?

Answer 58

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

Question 59

Persistent hoarseness in a smoker should raise suspicion of what?

Answer 59

Either lung cancer or laryngeal cancer

Question 60

Tests for occupational asthma

Answer 60

Serial measurements of peak expiratory flow at work and away from work

Question 61

Asthma medications and pregnancy?

Answer 61

Women should have good control of asthma in pregnancy!! Inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast feeding

Question 62

Investigation of choice for asthma?

Answer 62

Peak flow

Question 63

Investigation of choice for COPD?

Answer 63

Spirometry | - a diagnosis of COPD can be made when the FEV/FVC ratio is <0.7

Question 64

What characterises adult respiratory distress syndrome?

Answer 64

Bilateral pulmonary infiltrates and hypoxaemia

Question 65

Sweat test

Answer 65

Cystic fibrosis

Question 66

Epithelioid histiocytes

Answer 66

Tuberculosis

Question 67

Psammoma bodies

Answer 67

Papillary thyroid cancer

Question 68

Owls-eye nucleus

Answer 68

CMV infection

Question 69

Reed-Sternberg cells

Answer 69

Hodgkins lymphoma

Question 70

Histiological finding in patients with granulomas resulting from TB infection?

Answer 70

Epithelioid histiocytes (macrophages which become elongated to look like an epithelial cell)

Question 71

Contraindications to lung cancer surgery

Answer 71

SVC compression FEV <1.5 MALIGNANT pleural effusion Vocal cord paralysis

Question 72

Boot shaped heart

Answer 72

Tetralogy of fallot

Question 73

Deviated trachea

Answer 73

Tension pneumothorax

Question 74

Widened mediastinum

Answer 74

Aortic dissection or aneurysm

Question 75

ABCDE of heart failure

Answer 75

``` Alveolar oedema (bats wings) Kerley B lines Cardiomegaly Dilated prominent upper lobe vessels Effusion (pleural) ```

Question 76

A 24-year-old female presents with facial weakness, fever and painful red eyes. On examination you note a left sided facial palsy and tender swelling of the parotid glands. Laboratory results reveal a calcium level of 2.82 mmol/L.

Answer 76

Sarcoidosis