Resp

Question 1

Patient presents with epistaxis, rhinorrhoea. Resent blood tests show decline in renal function

1) Diagnosis
2) Other associated symptoms
3) ANCA status
4) Management .

Answer 1

1) GPA/Wegeners granulosis
2) Epitaxis, cough, haemoptysis, renal involvement = fatigue. Nerve and skin involvement
3) ANCE +
4) cyclophosphamide +/- rituximab

Question 2

CXR/CT presentation of sarcoidosis

Answer 2

Hilar lymphadenopathy 50% of cases

Question 3

Other presentations of sarcoidosis

Answer 3

fatigue 
weight loss
cough
chest pain 
fever

Question 4

skin presentation of sarcoidosis

Answer 4

erythema nodosum

Question 5

Patient presents with cough, low grade fever and chest pain, myalgia and fatigue

1) Most common CXR finding.
2) Diagnosis
3) skin finding
4) Associated eye condition

Answer 5

1) hilar lymphadenopathy
2) Sarcoidosis
3) erythema nodosum
4) Ant uveitis. Conjunctivitis

Question 6

mx of sarcoidosis

Answer 6

6 months should resolve (WAW)

If not –> 30mg pred 6 weeks, then 15mg alt daily for 6 weeks

Question 7

ANCA type in GPA

Answer 7

cANCA

Question 8

pANCA is found in what granulomatous lung disease

Answer 8

Chur-Strauss

Eosinophilic, causes rhinitis and asthma

Question 9

2 common causes of acute bronchitis

Answer 9

S. Pneumoniae

H influenzae

Question 10

3 parts to COPD pathophysiology

Answer 10

Increased mucus cells and mucus production
Interstitial damage and reduced elasticity
squamous cell metaplasia
neutrophil infiltration
increased air space, more dead space

Question 11

type 1 resP failure

Answer 11

Low Oxygen, normal CO2

Question 12

type 2 resp failure

Answer 12

low oxygen, low co2

Question 13

Cause of cor pulmonate

Answer 13

COPD
Increased pulmonary pressure
R sided heart strain 
R sided HF
Peripheral oedema

Question 14

Signs of cor pulmonale

Answer 14

Pulmonary hypertension and RV hypertrophy
Sternal heave
Loud second heart sound

Question 15

First line management of COPD

Answer 15

SABA - salbutamol
or
SAMA - ipratropium

Question 16

second line management of copd

Answer 16

combination of the above

Question 17

third line x of copd

Answer 17

LABA - salmeterol

LAMA - tiotropium, umeclidinium

Question 18

Add on treatments in copd

Answer 18

theophylline
prednisolone in exacerbations only
abx prophylaxis (macrocodes commonly used)

Question 19

Investigations for asthma

Answer 19

PEFR - diurnal variation

Spirometry - 15% improvement on bronchodilator

Question 20

first 3 steps of mx of asthma

Answer 20

1) SABA as and when
2) SABA + low dose ICS (beclo, budesonide). Can add LTRA (especially in children)
3) Add on LABA - salmeterol

Question 21

steps 4-6 of asthma mx

Answer 21

4) High dose ICS + LABA + LTRA or theophylline
5) Regular oral corticosteroids
6) Hospital admission

Question 22

Criteria for moderate asthma exacerbation

Answer 22

PEFR 50-70% predicted. Able to speak normally

Question 23

Criteria for acute-severe asthma attack

Answer 23

30-50% predicted PEFR
RR>25 HR>110 O2 reaching 92%
Unable to talk in full sentences

Question 24

Life threatening asthma attack criteria

Answer 24

<33% predicted PEFR
<92% O2
Altered consciousness
low BP

Question 25

Management of Asthma exacerbation

Answer 25

``` O - Oxygen 24% Venturi mask, 6l/min S - Salbutamol neb 2.5-5mg (10/h) H - hydrocortisone 100mg IV I - Ipratropium bromide T - theophylline 1g M - Magnesium 2g over 20min E - escalate ```

Question 26

Indications for intubation in asthma attack

Answer 26

pH < 7.25

Question 27

Non specific symptoms of pneumonia in elderly

Answer 27

Recurrent falls | Confusion

Question 28

Causes of CAP

Answer 28

S. Pneumoniea | H Influenzea

Question 29

causes of hap

Answer 29

S Aureus Pseudonoms Klebsiella

Question 30

Causes of pneumonia in people with decreased immunity

Answer 30

PCP pneumocystis Jirovecii Candida Aspergileosis

Question 31

Management of Mild cap

Answer 31

Amoxicillin 500mg TDS 5 days | Doxycycline 200mg then 100mg for 5 days OD

Question 32

Management of moderate CAP

Answer 32

Amox + clarithromycin 500mg BD 5 days

Question 33

Management of severe pneumonia or atypical cause

Answer 33

Co-amoxclav 1.2g TDS + clarithromycin BD 500mg both IV

Question 34

DD of pneumonia

Answer 34

PE Atelecactisis Acute respiratory failure

Question 35

Complications of pneumonia

Answer 35

``` Pleural effusions (exudative) Empyma Lung abscess ARDS AF in elderly ```

Question 36

Signs of lung abscess

Answer 36

``` swinging fever (on background of improving pneumonia) foul smelling sputum ```

Question 37

stain used to test for tb

Answer 37

Ziehl-neelson stain

Question 38

2 tests for TB immunity/prev infection

Answer 38

Mantoux test | Interferon gamma test (if mantoux is positive but no active tb)

Question 39

Management of TB

Answer 39

Rifampicin 2 months then 4 months Isoniazid 2 months then 4 months Pyrazinamide 2 months Ethambutol 2 months

Question 40

Side effects of ethambutol

Answer 40

Optic neuritis colour blindness decreased visual acuity

Question 41

side effects of isoniazid

Answer 41

peripheral neuropathy by inhibiting B6 formation

Question 42

Side effects Pyrazinamide

Answer 42

Hepatotoxic | Lower dose if eGFR low

Question 43

side effects of rifampicin

Answer 43

Orange jizz