Resp

Question 1

CF: specific test in suspected infection (3)

Answer 1

RATS to aspergillus
pseudomanas precipitants
sputum/cough swab for Burkholderia cepacia

Question 2

CF: management principles

Answer 2

Pulmonary: physio, abx prophylaxis (flucloxacillin/macrolide), chronic pseudomonas (ciprofloxacin 3 wks and colistrin nebs 3m), salbutamol inh, acetylcysteine neb (mucolytic), annual influenza and pneumococcal vaccine
GI: oral acetylcysteine (prophylaxis for obstructions), lactulose
Nutrition: pancreas (creon, ranitidine), calorie supplements, vitamin supplements (fat soluble)

Question 3

CF: clinical features in infancy (2)

Answer 3

meconium ileus

neonatal jaundice

Question 4

CF: clinical features in childhood (4)

Answer 4

nasal polyps
sinusitis
bronchiectasis
rectal prolapse

Question 5

CF: clinical features in adults

Answer 5

psychological symptoms 
aspergilisis, pneumothorax
cirrhosis, portal HTN
Diabetes
distal intestinal obstuction 
male sterility

Question 6

CF: investigations

Answer 6

antenatal screening, neonatal blood spot screening
sweat test-> chloride >60mmol/l
CXR: hyperinflation, inc. AP diameter, bronchial dilatation, cysts
Lung function: obstructive pattern

Question 7

Small cell lung carcinoma: usual spread to

Answer 7

liver 
bones 
bone marrow
brain 
adrenals

Question 8

Endocrine disorders in lunch cancer

Answer 8

non-small cell: hypercalcaema from PTH secretion from adenoma
small cell: SIADH w/ hyponatraemia

Question 9

PET scan: what is it and what does it show?

Answer 9

Position emission tomography scan
uses radiolabelled FDG
metabolically active tissues show increased uptake of radiolabelled FDG
-> local and distant mets detection

Question 10

Pseudomonas cover

Answer 10

Ciproflaxin/ meropenem/ tazocin/ gentamycin/ colistin

Question 11

Pseudomonas: define

Answer 11

gram -ve aerobic bacilli

Question 12

ILD: intersitial pulmonary fibrosis management

Answer 12

supportive management: O2 therapy, pulmonary rehab, opiates, antireflux, withdrawal of steroids and other immunosuppresnants
Prednisolone + azathioprine + N-acestylcsteine trial- some effect
lung transplant if <65yr, no co-morbidities and has advanced/progressive disease

Question 13

ILD: cryptogenic organising pneumonia (COP) features

Answer 13

alveoral spaces with franulation tissue, which backs p to bronchioles

Question 14

ILD: cryptogenic organising pneumonia (COP) management

Answer 14

corticosteroid therapy -> weaning over 6-12 months

Question 15

Connective tissue disease associated ILD

Answer 15

corticostaroids with immunosuppressive agents (except in systemic sclerosis)

Question 16

Long term asthmatics, with control deterioration and CXR changes: suspect what?

Answer 16

Aspergillus

Question 17

Latent TB testing

Answer 17

Montoux test

+ve -> interferon gamma testing (Quantiferon TB Gold)

Question 18

Active TB testing

Answer 18

CXR suggestive of TB

-> 3+ early morning sputum samples -> MC&S for acid fast bacili

Question 19

Non pulmonary TB testing

Answer 19

sputum, pleura, pleural fluid, urine, pus, ascites culture

up to 12 wks to grow

Question 20

TB histology

Answer 20

caseating granuloma

Question 21

Hydatid disease: define

Answer 21

tapeworm infection
ingesion of eggs -> small intestine -> wall penetration and spread to organs via circulation -> usually lungs and liver -> cysts

Question 22

Hydatid disease: ix and rx

Answer 22

Ix: serology or sputum analysis (liver cysts support the Dx)
Ex: excision or albendaole if unfit/disseminated

Question 23

Amoebic life cycle

Answer 23

ingestion of contaminated food/water with Entamoeba histolytica
excystation in small intestine
multiply in large intestine
-> exit in stools or
-> invade the interstitial mucosa -> spread via circulation/direct/lymphatic -> liver, brain, lungs