Resp

Question 1

Squamous NSCLC paraneoplastic lesions

Answer 1

PTH secretion -> ↑Ca2+, clubbing, HPOA, Hyperthyroid (ectopic TSH), Cavitation lesions

Question 2

Adenocarcinoma SCLC paraneoplastic syndrome

Answer 2

gynaecomastia, HPOA, non smokers

Question 3

SCLC Paraneoplastic syndrome

Answer 3

SIADH + ↑ACTH (cushings)
Lambert Eaton Myasthenic syndrome - muscle weakness, diplopia, dysphagia, speech

Question 4

Mining occupation, upper zone fibrosis, egg shell calcification hilar nodes

dx

Answer 4

silicosis

Question 5

Extertional dyspnea, dry cough, inspiratory crackles
Fine reticular/honeycomb appearance on CXR, lower lobes
Restrictive - ↓ FEV1, ↑FEV1/FVC

dx

Answer 5

asbestosis

Question 6

Mx extrinsic allergic alveoli’s

Answer 6

Avoid + glucocorticoids

Question 7

Clubbing, fine insp crackles
Exertional dyspnea, dry cough, weight loss. Typically men 50-70
Spirometry - FEVR N/ ↓, ↓ TLCO, ground glass-> honeycoming. CT is best for diagnosis
Lif expect 3-4 years

Dx

Answer 7

Idiopathic pulmonary fibrosis

Question 8

Erythema nodosum, plaques on face, cough, ↑Ca, ↑ESR ↑ACEi, LNS. Can cause facial paralysis

dX

Answer 8

Sarcoidosis

Question 9

UPPER ZONE FIBROSIS

Answer 9

Hypersensitivity pneumonitis, coal workers pneumoconciosis, silicosis, sarcoidosis, ankylosing spondylitis, TB,

Question 10

Lower zone fibrosis

Answer 10

Drug induced - amiodarone, methotrexate, asbestosis, idiopathic

Question 11

Symptoms and diagnosis of mesothelioma

Answer 11

Dyspnea, weight loss, chest wall pain, clubbing.
Dx - thoracoscopy and histology for Dx

Question 12

Type pneumonia in bronchiectasis

Answer 12

Haemophilus influenza

Question 13

Type pneumonia in alcohol and DM with caveatting lesions

Answer 13

Klebsiella pneumona

Question 14

Type pneumonia in influenza

Answer 14

Staph aureus

Question 15

hotel air con + ↓Na
type pneumonia

Answer 15

Legionella

Question 16

Pneumonia organism with erythema multiforme

Answer 16

Mycoplasma Pneumoniae

Question 17

Tx HAP vs CAP

Answer 17

HAP - CO-amox
CAP - DOxy

Question 18

CURB65 score and Abx choice

Answer 18

Confusion
Urea >7
RR>/30
BP <90/60
Age >/65

Amoxicillin
Macrolide if mod-severe

Question 19

Surgery type in A1 Antitrypsin def

Answer 19

If bad - surgery - Lung/liver transplant or lung vol reduction surgery

Question 20

COPD MX

Answer 20

SAMA(ipatropium)/SABA
No asthma - LABA/LAMA
Asthma - LABA + ICS..

Question 21

LTOT in COPD - when

Answer 21

LTOT = PaO2 <7.3 or secondary polycythaemia/pulm HTN

Question 22

Tx for exacerbation in COPD

Answer 22

Azithromycin for prophylaxis if lots recurrent exacerbations

Exacerbation -
At home needs prednisolone/inhaler/Abx (doxy for CAP).
Only give Ab if purulent sputum/clinical signs pneumonia.
In hospital - neb bronchs, steroids, Abx

Question 23

Asthma chronic mx

Answer 23

SABA
+ICS
+LABA (if child <12 then LRTA)
Consider others

Question 24

Acute asthma mx

Answer 24

SABA
SABA/Ipatropium bromide neb 5mg
Prednisolone PO or iV hydrocortisone 100mg
MgS04-…

Question 25

Mod, severe and life threatening asthma

Answer 25

Mod = PEFR 50-75% Severe = PEFR 33-50%, RR>25, HR>110,Can't complete sentences Life threatening = silent chest, hypotension…

Question 26

Smoking cess in pregnancy

Answer 26

NRT

Question 27

What pattern spirometery and examples FEV1/FVC ratio N/↑ FVC ↓ ↓ FEV1 ↓

Answer 27

Restrictive FEV1/FVC ratio N/↑ FVC ↓ ↓ FEV1 ↓ Pulm fibrosis, asbestosis, sarcoidosis, ARDS, Kyphoscoliosis, neuromuscular disorders

Question 28

What pattern spirometry and examples FEV1/FVC ratio <75% FEV1 ↓

Answer 28

Question 29

Persistent cough, sputum, exertional breathlessness Coarse crackles + low pitched wheeze High pitched inspiratory squeeks dx

Answer 29

Bronchiectasis

Question 30

Pleural effusion transudative vs exudative

Answer 30

Exudative = ↑ protein (lung cancer/pathologies), protein/serum protein ratio >0.5 Transudative = ↓ protein (congenital HF…) Empyema - ph<7.3, low glucose, ↑ LDH

Question 31

Primary vs secondary mx pneumothorax

Answer 31

primary:No SOB and <2cm = No TxSOB +/- >2cm = Aspiration Secondary: 1-2cm or SOB = aspirate>2cm drain

Question 32

Persistent air leak or recurrent episodes of pneumothorax mx

Answer 32

consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy

Question 33

Sinusitis mx

Answer 33

Intranasal corticosteroids if >10d. If severe then Abx (Pen V)

Question 34

Acute bronchitis vs pneumonia

Answer 34

Differentiating acute bronchitis from pneumonia History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia. Examination: No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.

Question 35

Acute bronchitis symptoms and mx

Answer 35

Cough (may/may not be productive), sore throat, rhinorrhoea, wheeze 18+ = doxy/ <18 = amoxicillin Only Abx if high risk/co-morbidities/systemically unwell or CRP>100. If CRP 20-100 maybe delayed prescription)

Question 36

Epistaxis, sinusitis, dyspnea, haemoptysis, rapidly progressive glomerulonephritis, saddle shape nose, vasculitis rash… dx, ab on bloods and mx

Answer 36

Granulomatosis with polyangitis cANCA Mx - steroids, cyclophosphamide, plasma exchange…

Question 37

In children 5-16 with obstructive spirometry is this enough for asthma dx or need more?

Answer 37

Need bronchodilator reversibility testing with improvement 14%