Resp

Question 1

What is Tx for PE?

Answer 1

Subcut LMWH (dalteparin) 
Warfarin loading

Question 2

What is the ideal INR for PE Tx?

Answer 2

2-3

Question 3

How long will a pt have to take warfarin for post PE?

Answer 3

3 months

Question 4

Define pancoast tumour

Answer 4

Tumour arising from lung apex - either R or L

Question 5

List Sx of pancoast tumours

Answer 5

Voice hoarseness

Horners syndrome - miosis, ptsois, anhydrosis

Question 6

What is sarcoidosis?

Answer 6

Multisystemic granulomatous disorder of unknown aetiology

Question 7

Who does sarcoidosis primarily affect?

Answer 7

Afro Caribeans

Question 8

List PC of sarcoidosis

Answer 8

20-40% ASYMPTOMATIC
Erythema nodosum, polyarthralgia
Dry cough, SoB, chest pain

Question 9

What are erythema nodosum?

Answer 9

Painful, red, raised lesions on shins

Question 10

What are CXR changes of sarcoidosis?

Answer 10

Bilateral hilar lymphadenopathy

Pulmonary infiltrates or fibrosis

Question 11

List non pulmonary manifestations of sarcoidosis

Answer 11

Lymphadenopathy 
Hepatomegaly 
SPlenomegaly 
Uveitis 
Conjunctivitis 
Lacrimal & parotid enlargement

Question 12

What blood tests indicate sarcoidosis?

Answer 12

Raised ESR
Lymphopenia
Deranged LFTs
Raised ACE / Igs

Question 13

What does biopsy of sarcoidosis show?

Answer 13

Non caseating granulomas

Question 14

What is Tx of sarcoidosis?

Answer 14

Bed rest, NSAIDs, +/- steroids

Question 15

Dyspnoea, fatigue.

O/E cyanosis, tachycardia, raised JVP, RV heave. Dx?

Answer 15

Cor pulmonale

Question 16

What murmur is heard in cor pulmonale?

Answer 16

Graham Steel - early diastolic

Question 17

List categories for causes of cor pulmonale

Answer 17

Lung
Pulm vascular
Thoracic cage
NMD
Hypoventiliation

Question 18

List lung causes of cor pulmonale

Answer 18

asthma, COPD, bronchiectasis, fibrosis, lung resection

Question 19

List pulm BV causes of cor pulmonale

Answer 19

PE, vasculitis, HTN, ARDS, sickle cell

Question 20

List thoracic cage causes of cor pulmonale

Answer 20

kyphosis, scoliosis

Question 21

List NMD causes of cor pulmonale

Answer 21

MG, poliomyelitis, MND

Question 22

List hypoventilation causes of cor pulmonale

Answer 22

sleep apnoea, big adenoids (kids)

Question 23

Bilateral reticulo-nodular shadwoing on CXR. Dx?

Answer 23

Pulmonary fibrosis

Question 24

Why can peripheral pulses be weaker on inspiration in a patient having an acute asthma attack?

Answer 24

Decreased left atrial filling

- this is due to reduced pulmonary venous return to LA due to airway narrowing

Question 25

What is main ABx Tx for pt with CAP?

Answer 25

Amoxicillin

Question 26

What is an empyema?

Answer 26

Pus in pleural space

Question 27

To whom to empyemas happen?

Answer 27

Pts recovering from pneumonia

Question 28

Is protein high or low in empyema?

Answer 28

High - exudate

Question 29

What would pleural fluid with a low pH indicate?

Answer 29

``` Pleural infections Empyema TB Cancer Oesophageal rupture ```

Question 30

Is CF dominant or recessive?

Answer 30

Recessive

Question 31

What is the defect in CF?

Answer 31

XS chloride excretion and Na absoprtion

Question 32

What is a diagnostic result in sweat test for CF?

Answer 32

>60mmol/L NaCl

Question 33

What 3 organisms are most likely to cause LRTI (pneumonia) in pts with CF?

Answer 33

Staoh aureus H. influenzae P. aeruginosa

Question 34

Which lung cancer is associated with asbestos exposure?

Answer 34

Mesothelioma

Question 35

What drugs can cause pulmonary fibrosis if used long term?

Answer 35

Amiodarone Nitrofurantoin Methotrexate Sulfasalazine

Question 36

List 4 jobs that can cause EAA

Answer 36

Mushroom picker Bird keeper Farmer (from mouldy hay) Malt worker (from mouldy barley)

Question 37

List Sx of EAA

Answer 37

Fever, rigors, dry cough, dyspnoea

Question 38

Which jobs can cause infection with Legionella pneumophillia?

Answer 38

Plumber Aircon worker (Anything where water is stored in tanks <60 degrees)

Question 39

What is Tx for aspergilliosus?

Answer 39

Amphotericin B (antifungal NOT ABx)

Question 40

Pt has acute exacerbation of COPD. O2 and CXR ordered. Next best Ix?

Answer 40

ABG - so that O2 and CO2 levels can be assessed

Question 41

Pt has lung cancer with hyponatraemia, haemoptysis. What kind of cancer is it likely to be?

Answer 41

Small cell carcinoma - ectopic ADH production

Question 42

Numerically define mild COPD

Answer 42

FEV1 >80% predicted

Question 43

Numerically define moderate COPD

Answer 43

FEV1 50-79% predicted

Question 44

Numerically define severe COPD

Answer 44

FEV1 30-49% predicted

Question 45

Numerically define very severe COPD

Answer 45

FEV1 <30% predicted OR FEV1 <50% + resp failure

Question 46

Describe NICE COPD Mx

Answer 46

``` 1st = SABA or SAMA 2nd = LABA or LAMA 3rd = + ICS ```

Question 47

Which asthma medication can lead to hypokalaemia?

Answer 47

Salbutamol

Question 48

Pt with haemoptysis has acid fast bacilli on film. Dx?

Answer 48

TB

Question 49

Where in the lungs is TB found?

Answer 49

Apex - more aerobic here

Question 50

Outline Mx of TB

Answer 50

``` 1st = TWO MONTHS of isoniazid, rifampicin, ethambutol, pyrazinamide 2nd = FOUR MONTHS of isoniazid and rifampicin ```

Question 51

Which TB drug can cause peripheral neuropathy?

Answer 51

Isoniazid

Question 52

Why does isoniazid cause peripheral neuropathy?

Answer 52

Depletes vit B6

Question 53

List 2 cardinal features of ARDS

Answer 53

Increased capillary permeability | Non cardiogenic pulmonary oedema

Question 54

List the 4 diagnostic criteria of ARDS

Answer 54

Acute onset Bilateral infiltrates on CXR Pulmonary capillary wedge pressure <19mmHg OR no clinical features of heart failure Refractory hypoxaemia with PaO2:FiO2 <200

Question 55

Patient has aspiration pneumonia. Which ABx are used in Mx?

Answer 55

IV cefuroxime & metronidazole