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Phase 2a mocks > Resp > Flashcards

Resp Flashcards

1
Q

What is the main target for autoantibodies generated in goodpastures?

A

Type IV collagen

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2
Q

Which of these is NOT a cause of finger clubbing?
A. Empyema
B. Mesothelioma
C. COPD
D. Asthma
E. Cysticfibrosis

A

COPD

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3
Q

What type of hypersensitivity reaction is Goodpasture’s syndrome?

A

Type II

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4
Q

Which of these is not a complication of cystic fibrosis in the body?
A. Type 2 Diabetes Mellitus
B. Infertility in males
C. Mucous retention in the lungs
D. Meconium ileus
E. Reduced sweating

A

E. Reduced sweating

Increased sweating is a complication of cystic fibrosis

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5
Q

22F. SOB on exertion, no other symptoms. Started smoking at same time as symptoms began 2 months ago.
Px liver cirrhosis.
CXR: flattened diaphragm, large lung volumes, basilar predominant emphysema.
LFT shows increased liver enzymes
Most likely diagnosis?

A

Αlpha 1 antitrypsin deficiency

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6
Q

A 35 year old woman presents to the GP with progressive dyspnoea, chest pain and a persistent dry cough. She also complains of eye pain and excruciating pain that radiates from her waist to her groin.

What is the most most likely diagnosis and most appropriate management?

A

Sarcoidosis

Prednisolone

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7
Q

44M. Breathing problems for the last month. Smoker, no exposure to industrial chemicals or asbestos.
Px rheumatoid arthritis (on methotrexate)

Spirometry:

FEV1: 2.1 (normal for height and weight = 2.8)
FVC: 2.21 (normal for height and weight = 3.3)

Most likely diagnosis?

A

Pulmonary fibrosis.

FEV1:FVC = 0.95 … restrictive NOT obstructive disease. Rules out COPD, asthma, bronchiectasis

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8
Q

A man is suffering from a pulmonary embolism.
Which of these is least likely to be seen on examination?
A. Dyspnoea
B. Tearing pain radiating to the back
C. Haemoptysis
D. Tachycardia
E. Loud P2

A

B. Tearing pain radiating to the back

This would indicate AAA

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9
Q

Name 4 antibiotics that can be used to treat TB

A
  • Rifampicin
  • Isoniazid
  • Ethambutol
  • Pyrazinamide
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10
Q

List 4 risk factors for COPD

A
  • smoking
  • asbestos exposure
  • α-1-antitrypsin deficiency
  • occupational exposure
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11
Q

Describe the pathology of cystic fibrosis

A
  • gene mutation in transmembrane conductase regulator (CFTR)
  • dysregulation of salt and fluid movement across cell membranes, causing thickened secretion
  • affects respiratory, GI, reproductive systems
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12
Q

What kind of inheritance is cystic fibrosis?

A

Autosomal recessive

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13
Q

List 4 respiratory features of cystic fibrosis

A
  • wheeze
  • persistent cough, productive of thick mucous
  • exercise intolerance
  • recurrent respiratory infections
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14
Q

List 4 TB drugs and their main side effects

A
  • Rifampicin: red secretion
  • Isoniazid: fever, jaundice, nausea
  • Pyrazinamide: hyperuricaemia (gout), hepatotoxicity
  • Ethambutanol: optic neuritis / eye symptoms including colour blindness
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15
Q

What does tree-in-bud sign on CT indicate?

A

Atypical pneumonia
Bronchialitis
Aspiration pneumonitis

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16
Q

What does a bronchus sign on CT indicate?

A

Bronchogenic malignancy

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17
Q

What does a polo mint sign on CT angiogram indicate?

A

PE

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18
Q

What does a split pleura sign on CT indicate?

A

Emphysema
Malignant effusions

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19
Q

What does a signet ring sign on CT indicate?

A

Bronchiectasis

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20
Q

List 4 obstructive lung diseases

A
  • COPD
  • asthma
  • bronchiectasis
  • bronchiolitis
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21
Q

List 4 restrictive lung diseases

A
  • TB
  • sarcoidosis
  • asbestosis
  • silicosis
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22
Q

What does CURB-65 stand for?

A

Confusion
Urea (>7mmol/L)
Respiratory rate (>30/min)
Blood pressure (<90systolic or <60diastolic)
65 years or older

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23
Q

What are the clinical signs on type 1 respiratory failure ?

A
  • hypoxemia (PaO2 <8kpa)
  • normocapnia (PaCO2 <6kpa)
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24
Q

What are the ABG results expected in type 2 respiratory failure ?

A
  • hypoxemia (PaO2 <8kpa)
  • hypercapnia (PaCO2 >6kpa)
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25
Q

What is the pathology behind type 1 respiratory failure?

A

V/Q mismatch

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26
Q

What is the pathology behind type 2 respiratory failure?

A

Alveolar hypoventilation -> reduced ability to oxygenate blood and eliminate CO2

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27
Q

What is the most common causative organism of hospital acquired pneumonia?

A

Pseudomonas aeruginosa

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28
Q

Give two common causative organisms of community acquired pneumonia

A

Streptococcus neumoniae
Staphylococcus aureus

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29
Q

What group is most at risk of spontaneous PE?

A

Young men with low BMI
Marfans syndrome

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30
Q

What signs on XR would confirm a diagnosis of TB?

A
  • Ghon focus
  • Ghon complex
  • dense homogenous opacity
  • lymphadenopathy
  • pleural effusion
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31
Q

What type of lesion is usually present in TB?

A

Caseating granuloma

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32
Q

Give 3 risk factors for asbestosis

A
  • boiler workers
  • electrician
  • miner
  • living in a house built prior to 1980 / older pts that are likely to have lived in a house that used asbestos in the insulation
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33
Q

Give 4 DD for asbestosis

A
  • mesothelioma
  • silicosis
  • idiopathic pulmonary fibrosis
  • coal workers pneumoconiosis
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34
Q

Which type of cancer has a strong association with asbestosis?

A

Mesothelioma

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35
Q

In a pt presenting with ptosis, miosis, and anhydrosis of one side, what is your likely diagnosis?

What is this group of symptoms called?

A

Pancoast tumour.

Horners syndrome

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36
Q

Where are Pancoast tumour located?

A

Lung apex

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37
Q

What symptoms are associated with Pancoast tumour?

A
  • horners syndrome (ptosis, miosis, anhydrosis)
  • arm pain / weakness
  • shoulder blade pain
  • fatigue
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38
Q

Describe the Pathophysiology of Pancoast tumours symptoms?

A

Pancoast tumour invades the apical chest wall, and as it grows, it affects surround structures. This included the brachial plexus, causing arm pain, shoulder blade pain, etc. Also affects the sympathetic pathway, causing Horners syndrome.

39
Q

What is the Pathophysiology of asthma?

A

Narrowing of the airway due to:
- smooth muscle contraction
- thickening of the airway wall by cellular infiltration and inflammation
- secretions in the airway lumen

40
Q

List 9 precipitations of asthma

A
  • cold air
  • exercise
  • smoking
  • second hand / passive smoking
  • allergens
  • infections
  • pollution
  • β blockers
  • NSAIDs
41
Q

Give 3 drug classes used in asthma and an example of each

A
  • SABA (short acting β 2 agonist) : salbutamol
  • LABA (long acting β 2 agonist) : salmeterol
  • ICS (inhaled corticosteroid) : beclomethasone diproprionate
42
Q

What investigation can be used first to diagnose squamous cell lung cancer?

A

Chest X ray

43
Q

Give 4 examples of sites that lung cancer is likely to metastasise from

A
  • breast cancer
  • colon cancer
  • prostate cancer
  • bladder cancer
  • sarcoma
  • neuroblastoma
  • wilms tumour
44
Q

What are the DD of bilateral hilar lymphadenopathy?

A
  • sarcoidosis
  • TB
  • lymphoma
  • heart failure
  • silicosis
45
Q

What kind of lesions does sarcoidosis form?

A

Non caseating granuloma

46
Q

Describe the epidemiology of sarcoidosis

A
  • young adults
  • African descent
47
Q

Give 3 extra pulmonary signs of sarcoidosis

A
  • erythema nodosum
  • lupus pernio
  • polyarthritis
  • uveitis
  • arrhythmia
48
Q

Name 3 potential causes of bronchiectasis

A
  • post infection e.g. TB
  • cystic fibrosis
  • idiopathic
  • bronchial obstruction e.g. mass / foreign object
  • immunodeficiency
49
Q

Name 2 clinical sign seen on examination in bronchiectasis

A
  • course crackles on inspiration, especially in the lower zones
  • wheeze
  • clubbing
50
Q

Give 2 potential complications of bronchiectasis

A
  • respiratory failire
  • repeated respiratory infection
  • pneumothorax
  • emphysema
51
Q

List 3 non-pharmacological management options for bronchiectasis

A
  • smoking cessation
  • physical exercise
  • immunisation against influenza
52
Q

Name 2 DD for COPD

A
  • asthma
  • α1 antitrypsin deficiency
  • bronchiectasis
  • cystic fibrosis
53
Q

What initial investigations are appropriate in COPD (except spirometry)

A
  • Chest X ray
  • FBC
  • BMI
  • ABG
54
Q

Name 3 causative organisms of CAP

A
  • streptococcus pneumoniae (most common)
  • haemophilus influenzae
  • staphylococcus aureus (post influenza infection)
55
Q

Gram negative coccobicilli causing CAP … ?

A

Haemophilus influenzae

56
Q

Name 3 RF for pneumothorax

A
  • COPD
  • smoking
  • trauma
  • previous pneumothorax
57
Q

Name 2 symptoms on pneumothorax

A
  • pain (chest pain, often pleuritic)
  • dyspnoea
58
Q

Name 3 symptoms of pulmonary embolism

A
  • shortness of breath
  • sweating
  • palpitation
59
Q

Name an objective risk assessment score for calculating PE risk

A

Well’s score

60
Q

Describe how a pneumothorax and pleural effusion could be differentiated on a respiratory examination

A

Pleural effusion = dullness on percussion

Pneumothorax = hyperresonant on percussion

61
Q

Describe how a pneumothorax and pleural effusion could be differentiated through a history

A

Pleural effusion: slow onset, Px of congestive heart failure, cancer, pneumonia,

Pneumothorax: rapid onset, Px of trauma, smoking,

62
Q

What are the 3 typical characteristics of asthma?

A

Airflow limitation, airway hyper-responsiveness, bronchial inflammation

63
Q

Give 2 RFs for asthma

A
  • personal history of atopy
  • family history of atopy
  • obesity
  • premature birth
  • living in an inner city environment
64
Q

Name 2 lung function tests used to diagnose asthma

A
  • spirometry
  • peak expiratory flow rate
65
Q

Name 3 classes of bronchodilator

A
  • beta 2 agonists
  • muscarinic antagonists
  • methyxanthines
66
Q

Give 2 features of a life threatening asthma attach

A
  • silent chest
  • confusion
  • exhaustion
  • cyanosis
  • bradycardia
    PEFR <33%
67
Q

Pneumonia

Upon culturing the patients sputum it is found that the bacteria is resistant to optochin. Name what bacteria this is and what it would look like upon staining and microscopy.

A

Streptococcus pneumoniae- gram positive bacilli chains

68
Q

What is the first line treatment for pneumonia?

A

Oxygen

69
Q

CURB65 score of 2.
Where should they be treated?

A

In hospital

70
Q

What is bronchiectasis?

A

Permanent dilation of the airways due to chronic inflammation and an inability to clear secretions

71
Q

Give a congenital cause of bronchiectasis

A

Cystic fibrosis

72
Q

How can infection cause bronchiectasis?

A

Infection causes release on inflammatory mediators which impair ciliary action, allowing bacterial proliferation and ciliary damage

73
Q

Give 2 possible treatments of bronchiectasis

A
  • antibiotics
  • bronchodilators
  • corticosteroids
  • sputum drainage
74
Q

HAP.
Culture: gram positive cocci, found in clusters
Positive coagulase test
Organism?

A

Staph aureus

75
Q

What substance causes βeta haemolysis on blood agar?

A

Biliverdin

76
Q

What kind of airway disease is COPD?

A

Irreversible and obstructive

77
Q

Give an example of when long term oxygen therapy can be given for COPD.

A
  • Clinically stable non-smokers with PaO2 <7.3kPa
  • If PaO2 7.3-8.0kPa and pulmonary hypertension
  • For terminally ill patients
78
Q

How are severe asthma attacks and life threatening asthma attacks clinically differentiated?

A

Severe:
- PEF 33-50% predicted
- can’t talk/feed
- use of accessory muscles

Life threatening
- PEF <33%
- silent chest
- cyanosis
- altered consciousness

79
Q

Describe the MOA of Ipatropium bromide

A

Muscarinic acetylcholine receptor antagonist -> bronchodilator

80
Q

Pt presents with vasculitis, sinusitis, and dyspnoea.

What investigation will allow you to differentiate between granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis ?

A

Bloods: antibodies

If cANCA positive = granulomatosis with polyangiitis
If pANCA positive = eosinophilic granulomatosis with polyangiitis

81
Q

How does asthma cause airway hypertrophic?

A

Chronic inflammation of the airway causes remodelling to have a greater smooth muscle content, therefore causing hypertrophy

82
Q

How does COPD cause polycythaemia?

A

Chronic hypoxia

83
Q

What 2 conditions make up COPD? Briefly describe their Pathophysiology

A

Emphysema: inflammation causes loss of elastic recoil of alveoli, causing air trapping and lower gas transfer

Chronic bronchitis: inflammation causes mucociliary dysfunction, leading to lower ventilation

84
Q

How does COPD cause peripheral oedema?

A

hypoxia of the kidney, reduced kidney perfusion, lack of excretion of sodium and water

85
Q

List 4 signs of COPD on examination

A
  • barrel chest
  • intercostal recession
  • wheeze
  • tachycardia
86
Q

What is shown on X-RAY in COPD?

A
  • hyperinflation
  • air gaps
  • flat diaphragm
87
Q

Give the three cardinal symptoms of COPD

A
  • productive cough
  • dyspnoea
  • chronic cough
88
Q

What two signs found through lung function tests indicate COPD?

A

FEV1/FVC < 0.7
FEV1 < 80% of predicted value

89
Q

What type of hypersensitivity is hypersensitivity pneumonitis?

A

Type III

90
Q

Hypersensitivity symptoms?

A

Increasing dyspnoea, weight loss, exertional dyspnoea

91
Q

Signs of hypersensitivity pneumonitis

A

Finger clubbing, type 1 respiratory failure, cor pulmonary

92
Q

Define granuloma

A

Aggregate of epithelioid histiocytes

93
Q

Asthma: 3 tests and their results

A

Spirometry: FEV1/FVC <0.7
Reversibility testing: increase of FEV1 by >15%
Peak flow: diurnal variation

94
Q

Which two pathological features of asthma are caused by histamine?

A

Bronchoconstriction and mucus production

Phase 2a mocks (11 decks)

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