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1
Q 
31. A boy with well controlled asthma presents with status asthmaticus. He is treated aggressively in Resus and becomes hypotensive and bradycardic. What is the culprit agent?
	A. Magnesium
	B. Aminophylline
	C. Ipratropium
	D. Salbutamol
E. Hydrocortisone
A

IV Magnesium

  • bronchodilator activity in acute asthma, possibly due to inhibition of calcium influx into airway smooth muscle cells
  • causes
  • coronary and systemic vasodilation
  • antiarrhythmic effects
  • slight decrease in heart rate, and prolongs the PR interval
  • decreases the sympathetic tone by causing a sympathetic ganglia blockade
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2
Q

Eosinophilic pneumonia

  • a/w
  • mx
A

strongly a/w new onset or resumption of smoking

very steroid responsive

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3
Q

Where should CVC tip sit

A

SVC - should be seen before carina splaying

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4
Q

Control of respiration

Central - location, chemoreceptors

Peripheral - location, chemoreceptors

A

Central - medulla, pons. Responds to H+ in ECF

Peripheral - Carotid bodies and Aortic bodies
Responds to CO2 and H+

Carotid bodies respond to O2 to some extent

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5
Q

Cause for falsely high SPO2

A

Carboxyhaemoglobin

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6
Q

Elevated A-a gradient that does NOT correct with 100% O2

A

Shunt

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7
Q

Causes of high and normal A-a gradient

A

VQ mismatch
Shunt
ILD

normal - hypoventilation, high altitude

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8
Q

Q82
Pulse oximetry is commonly used as a non-invasive measure of arterial oxygen saturation.
In which of the following situations is pulse oximetry most reliable?

A. Anaemia with a haemoglobin of 80 g/L
B. Carbon monoxide poisoning with a carboxyhaemoglobin of 15%
C. Congenital methaemoglobinaemia with a methaemoglobin of 30%
D. Hypotension with a systolic blood pressure of 80mmHg
E. Hypothermia with a core temperature of 30o

A

A. Anaemia with a haemoglobin of 80 g/L

-usually not significant until Hb <50

Falsely elevated - carboxyhemoglobin

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9
Q

Non cardiogenic cause of APO - ix

A

normal PWP

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10
Q

High fraction of exhaled NO indicates…

A

Asthma
-exhaled NO levels rise in association with acute airway inflammation, sputum eosinophilia, viral upper respiratory infections, and other clinical parameters associated with deteriorating asthma control

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11
Q

CTEPH Imaging

A

VQ Scan

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12
Q

Caffeine effects in lung

A

bronchodilation

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13
Q

Sarcoid predominant white cell

A

Macrophage

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14
Q

Which parameter in the pulmonary function test has the greatest measurement variability?

a) FVC
b) FEV1
c) TLC
d) RV
e) DLCO

A

FEV1

Requires person to maximally exhale - user dependent

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15
Q

A 25-year-old secretary presents with excessive daytime sleepiness, vivid dreams at the onset of sleep and the sensation of her legs “giving way” with laughter or emotional response.

She does not take any medications and has no other medical history. She reports that she has to consume caffeine-containing beverages to maintain alertness at work.

Which of the following investigations would be most likely to provide a diagnosis:

A) MRI of brainstem
B) Maintenance of wakefulness test
C) Mean sleep latency test
D) Overnight polysomnography
E) Sleep deprived EEG

A

Ans: C Mean sleep latency test
To diagnose narcolepsy
Diagnosed by: sleep latency <8minutes and 2 SOREMPs (sleep onset REM periods) - abnormal to have REM sleep straight away but narcoleptics have that
“sensation of giving way” - cataplexy sx

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16
Q

A 60yo patient of yours who is a current smoker has an incidental finding of a 6mm left lung nodule on CT chest. What is your next step?

a. No further investigation required
b. Observe with annual CT
c. Biopsy
d. PET scan
e. Bronchoscopy

A

Ans: B

Consider PET/CT or tissue sampling if >8mm especially if solitary nodule

17
Q
  1. Obstructive sleep apnoea is associated with an increased prevalence of systemic hypertension. What is the predominant mechanism for this?

A . Increased cardiac output.
B . Increased sympathetic tone.
C . Resetting of renal pressure-natriuresis.
D . Upregulation of carotid chemoreceptor sensitivity.
E . Vasoconstriction secondary to intermittent hypercapnia.

A

B. Increased sympathetic tone.

Apnea–>intermittent hypoxemia and ?hypercapnia –>increased sympathetic activity–>hypertension

18
Q

Foetal Hb O2 dissociation curve - left or right?

A

Left

Foetal Hb – Strucurally, foetal haemoglobin (HbF) is made up of two α-subunits and two γ-subunits (instead of two β-subunits)
• This decreases the affinity of HbF for 2,3-DPG
• As 2,3-DPG normally decreases the affinity of hameoglobin for oxygen, in the absence of 2,3-DPG binding the oxyhaemoglobin dissociation curve of HbF is left-shifted
So, baby’s blood will have high affinity to O2 to absorb it from mom’s blood and because there is so much metabolic activity in the fetus, will have no problem with release of O2.

19
Q 
What is the main cause of infertility in patients with Cystic Fibrosis?
A. Medications
B. Gonadal agenesis
C. Obstructive azoospermia
D. Ciliary dysfunction
A

Infertilityin cystic fibrosis—More than 95 percent of men with CF are infertile because of defects in sperm transport, although spermatogenesis is not affected. Most of these men have incompletely developed Wolffian structures, most commonly, absent vas deferens.

20
Q

Pul fibrosis drugs

A

nitrofurantoin, bleomycin, amiodarone, cyclophosphamide, procainamide, penicillamine

21
Q
  1. What is the mechanism of action of inhaled mannitol in the treatment of cystic fibrosis?
    A . Augments action of aminoglycosides.
    B . Augments function of cystic fibrosis transmembrane conductance regulator.
    C . Directly toxic to Gram-negative bacteria.
    D . Increases hydration of airway surface liquid.
    E . Inhibition of the biofilm matrix.
A

D . Increases hydration of airway surface liquid.

Mannitol

  • osmotic agent, draws out water into epithelium
  • need to do Mannitol sens test prior – can cause bronchoconstriction
22
Q 
What is the most common cause of death in patients with mod-severe COPD?
A. Acute exacerbations of COPD
B. Cardiovascular disease
C. Intrathoracic malignancy
D. Pneumonia
E. Progressive respiratory failure
A

C. Intrathoracic malignancy

23
Q

ETT indications for COPD

A

Prediction of need for invasive ventilation - DECAF score and BAP-65

DECAF score
Dyspnea - On a good day, within the last 3 months ?too SOB to leave house, able to do stuff in house, able to leave house
Eosinopenia - <0.5
Consolidation on CXR
Acidemia pH <7.30
atrial Fibrillation – on admission ECG
BAP65 score
BUN > 29 (or 8.9)
Altered Mental Status – GSC <14
Pulse >109
>65 YOA
24
Q

ILD RA Lung pattern

A

UIP

25
Q

28-year-old otherwise healthy woman who is 36/40 pregnant presents with dyspnoea for week and left lower limb swelling for 2 days. Temperature is 37.4 °C, blood pressure is
136/86 mmHg, heart rate 98 beats per minute, oxygen saturations 98% on room air. Her left calf diameter measures 2 cm greater than the right. An ECG and chest radiograph are normal.

Which is the next most appropriate investigation?

A	. CT pulmonary angiogram.
B	. D-dimer.
C	. Echocardiogram.
D	. Lower limb Doppler ultrasound.
E	. Ventilation/perfusion scan.
A

In women with suspected PE who also have symptoms and signs of DVT, compression duplex ultrasound should be performed. If compression ultrasonography confirms the presence of DVT, no further investigation is necessary and treatment for VTE should continue

Respiratory (7 decks)

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