Resp

Question 1

What is Potter’s Rot and what does it cause

Answer 1

Silicosis

Nodular inflammation and scarring of upper lobes

Question 2

Obesity hypoventilation vs OSA

Answer 2

Obesity hypoventilation causes daytime hypercapnia and longer, more continuous hypoventilation overnight

OSA is where there is episodic upper airway collapse during sleep causing daytime sleepiness - measured with Epworth scale

NB. Usually occur together

Question 3

Definition and features of bronchiectasis

Ix of choice?

Answer 3

Permanent and irreversible dilatation of part of the bronchial tree secondary to chronic infection

Sputum ++
Repeat infections
Clubbing

High res CT is Ix of choice

Question 4

Indications for LTOT

Answer 4

PaO2 persistently <7.3kPa
Or 7.3-8.0 AND
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension

Question 5

Asthmatic suffers with runny nose and cough in summer months. Dx?

Answer 5

Post-nasal drip

history of atopy often co-exists

Question 6

Haemoptysis + round apical opacity on CXR + Hx of TB. Dx and Rx?

Answer 6

Aspergilloma

Rx: antifungals limited ie. focus on symptoms
Consider surgery if massive haemoptysis

Question 7

IVDU presents with septic shock
CXR: patchy consolidation
?responsible organism

Answer 7

Staph aureus

Question 8

Gout and arthralgia are SEs of which TB ABx?

Answer 8

Pyrazinamide

Question 9

AIDS patient presents with dry cough, malaise, occasional SOB.
Recent travel to East Europe where exposed to bats

o/e: LNopathy

Dx and RFs?

Answer 9

Histoplasmosis
- causes by inhaling fungus spores
RFs:
- young
- bats
- AIDS
- bird droppings

Question 10

A recreational drug that can cause ARDS

Answer 10

Heroin

Question 11

Cryptococcus presentation, RFs, diagnostic Ix, Rx

Answer 11

Px: meningo-encephalitis or pneumonia

RFs: HIV, Haem malignancy, liver cirrhosis

Diagnostic Ix: cryptococcal antigen titre in CSF

Rx: 3 phases with meds such as amphotericin B, fulctosine, fluconazole

Question 12

Cerebral toxoplasmosis CT findings

Cerebral toxoplasmosis treatment

Answer 12

CT: mass with ring of contrast enhancement

Rx: sulfadiazone, pyrmethiamine

Question 13

Definition and some causes of ARDS

Answer 13

non-cardiogenic pulmonary oedema (secondary to acute alveolar damage) results in acute respiratory failure

Ax:

• pneumonia
• chest trauma
• heroin
• sepsis
• smoke inhalation
• NB. interestingly not asthma!

Question 14

What is farmer’s lung and key organism?

Answer 14

Form of EAA

Organism: Saccharopolyspora rectivirgula

Question 15

What is Bird Fancier’s Lung and key antigen?

Answer 15

Form of EAA

Avian proteins found in feathers/droppings

Question 16

What is Malt Worker’s Lung and key antigen?

Answer 16

Form of EAA

Aspergillusclavatus (in mouldy barley ie. brewery workers)

Question 17

SOB, cough productive of black sputum

CXR: small 1cm pulmonary nodules

Answer 17

Coal worker’s pneumoconiosis -> inflammation + fibrosis

Question 18

What is silicosis? Key exposures?

Answer 18

Form of occupational lung disease causing fibrosis

Pottery, ceramics, glass exposure, sand blasting, icing, quarrying

Question 19

What is Caplan’s syndrome?

Answer 19

RA + Pneumoconiosis due to mining/coal dust

Question 20

What asbestosis worker’s lung?

Answer 20

Chronic inflammation of lungs resulting in restrictive defect ie. lung fibrosis

NB. Asbestosis does not cause EAA

Question 21

Initial management of OSA

Answer 21

Lifestyle advice: lose weight, stop smoking

Routine referral if Epworth >10
(Consider urgent referral if hazardous working situation or comorbidities)

Suggest positional therapy ie. to avoid supine sleeping eg. “tennis ball technique”

Question 22

Steroid therapy in acute asthma, yes or no?

Answer 22

5 days of pred for all acute asthma

Question 23

Patient on SABA + ICS for asthma, still wheezy - next step?

Answer 23

Trial of LTRA for all ages

Question 24

Smoking cessation medications + MOA + important contraindicaitons

Answer 24

Varenicline: partial nicotinic receptor agonist

Bupropion: NA + DA reuptake inhibitor + nicotinic antagonist

Both contraindicated in breastfeeding and pregnancy
Bupropion contraindicated in epilepsy

Question 25

Treatment options for smoking cessation in pregnancy

Answer 25

CBT +/- NRT

Question 26

COPD patient on SAMA still wheezy - next step?

Answer 26

Look for asthma responsive features:

if present: add LABA + ICS

if not present: add LAMA + LABA (and switch SAMA to SABA)

Question 27

Criteria for Azithromycin prophylaxis in COPD

Answer 27

1. Does not smoke
2. On max inhaled therapy + vacs + chest physio
3. One of the following in the previous year:
   - frequent exacerbations
   - prolonged exacerbations
   - exacerbations requiring hospitalisation

Question 28

CURB65 parameters

Answer 28

Confusion: AMT <10
Urea >7
RR >30
BP: SBP <90 or DBP <60
>65yo

Question 29

Pleural aspirate findings that indicate urgent chest drain

Answer 29

Purulent or turbid fluid
+ve Gram stain/culture
pH <7.2

Question 30

Best tests for lung function in long standing rest disease eg. fibrosis

Answer 30

lung diffusion test ~alveolar exchange

Question 31

Best blood test to differentiate bacterial and non-bacterial exam of COPD

Answer 31

procalcitonin (high in bacterial)

NB. WCC/CRP can be raised in non-infective

Question 32

Radiation pneumonitis Rx

Answer 32

roads

Question 33

Common bacteria in CF LRTI

Answer 33

Pseudomonas