Resp 2

Question 1

Management of allergic bronchopulmonary aspergillosis (ABPA).

2. sometimes introduced..

Answer 1

1. oral glucocorticoids
2. itraconazole is sometimes introduced as a second-line agent

Question 2

or
-
-
-
-

Answer 2

pO2 of < 7.3 kPa

oe

pO2 of 7.3 - 8 kPa AND one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

Question 3

What must be ruled out before diagnosing ARDS?

Answer 3

can only be diagnosed in the absence of a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised)

Question 4

how do you make definitive diagnosis of mesothelioma?

Answer 4

histology, following a thoracoscopy

Question 5

patient info for CAP treatment
week 1:
week 4:
week 6:
month 3:
month 6:

CXR when?

Answer 5

week 1: fever should resolve
week 4: chest pain and sputum should have significantly reduced
week 6: cough and shortness of breath should have significantly reduced
month 3: most symptoms should have resolved, except for tiredness
month 6: should be returned to normal

CXR at 6 weeks

Question 6

Infective exacerbation of COPD: first-line antibiotics are (3)

Answer 6

amoxicillin or clarithromycin or doxycycline

Question 7

COPD O2 target sats should be 88-92% unless

Answer 7

on ABG they are seen to not be chronic CO2 retainers (normal CO2 and Bicarb normal) therefore they would just be the same as everyone else 94-98% target

Question 8

Diagnostic criteria for ARDS

Answer 8

Clinical + CXR + pO2/fiO2 < 40kPa (300 mmHg)

NORMAL pulmonary capillary wedge pressure

Question 9

Smoking Cessation:
- What can only be used in preg?

Answer 9

Nicotine Replacement Therapy- could try CBT first

Question 10

Smoking Cessation:

Bupriopion

Start before deignated quit day and continue until several weeks after

CI:
1 drug
2 condition
3. Social (3)

Answer 10

CI:
1. aviod SSRI as lower seizure threshold?
2. Seizure history
3. preg, <18yo or breastbeeding

Question 11

Smoking Cessation:

Varenicline

Start before deignated quit day and continue for 12 weeks

avoid in who/ PM of?

Answer 11

Psych illness!

CI also < 18yo, Preg or breastfeeding

Question 12

Paeds Athma severity

Mod
HR
1-5yo -
>5yo -

RR
1-5yo -
>5yo-

Severe
HR
1-5yo -
>5yo -

RR
1-5yo -
>5yo-

Answer 12

Mod
HR
1-5yo - <140
>5yo - <125

RR
1-5yo < 40
>5yo < 30

Severe

HR
1-5yo - >140
>5yo - >125

RR
1-5yo > 40
>5yo > 30

Question 13

Bronchiectasis: most common organism =

Answer 13

Haemophilus influenzae

Question 14

Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes → ?

Answer 14

silicosis

Question 15

In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids
Important for meLess important

Question 16

Alpha anti-trypsin deficiency

Background:
- Lack of…
- Produced in the…

• What is the role of Alph 1 antitrypsin?

Classic STEM-

Chromsome-
Genetic pattern-
Most who develop have the genotype…

Answer 16

Background:
- Lack of… protease inhibitor (Pi) produced by the liver

Role- Protects cells from enzymes such as neutrophil elastae

STEM: Young guy with COPD or emphysema non-smoker

Chromsome- 14
Genetic pattern- autosomal dominant/ co-dominant
Most who develop have the genotype… PiZZ

Question 17

Alpha anti-trypsin deficiency

where in the lungs does it affect?

other manifestations (2 adults, 1 children)

-

Management
1. Conservative (2)
2. Medical (2)
3. surgical (2)

Answer 17

panacinar emphysema, most marked in lower lobes

adult
- Liver cirrhosis
- Hepatocellular carcinoma

kid
- cholestasis

Investigation
- A1AT concentration
- Spirometry; OBSTRUCTUVE!

Management
1. Conservative- non-smoker
2. physio
3. Med- bronchodilator
4. IV alpha1-antitrypsin protein concentrates
5. lung volume reduction surgery, lung transplantation

Question 18

gauge needle for tension pneumothorax?
and where do you put it?

Answer 18

14 G- tension pneumoFOURax you use a FOURteen gauge needle

ATLS guidelines changed and the ideal place for tension pneumothorax
- decompression is at the 5th intercostal space anterior to the MAL. (triangle of safety)

Question 19

Normal/raisedTLCO with raised transfer coefficient think (2)

Answer 19

1. Asthma- will show OBSTRUCTIVE picture too

or

2. pulmonary haemorrhage
   (GoodPastures)
   - falsely raised due to the CO binding to the haemoglobin in the RBC’s inside the alveoli

Question 20

Sarcoidosis

Indications for treatment (6)
* rogue one in there

What do you treat with?

Answer 20

Indications for treatment
1. hepatic/ splenic/ cardiac / renal involvement
2. lupus pernio (cutaneous manifestation presents, blue red to violet smooth shiny nodules and plaques on the head and neck- predominantly nose, ears, lips, and cheeks.)
3. hypercalcemia
4. eye/CNS involvement
5. deteriorating pulmonary function tests
6. deteriorating chest x-ray changes

What do you treat with?
1. Oral prednisolone
2.

Question 21

White out CXR look at the trachea for deviation which can give differentials

Trachea pulled towards

Trachea central

Trachea pushed away from white out

Answer 21

Trachea pulled towards
- pneumonectomy
- complete lung collapse e.g. endobronchial intubation
- pul hypoplasia

Trachea central
- Consolidation
- Pulmonary oedema (usually bilateral)
- Mesothelioma

Trachea pushed away from white out
- Pleural effusion
- Diaphragmatic hernia
- Large thoracic mass