Respiratory Flashcards
1
Q
What are the stages of sarcoid on CXR?
A
1) BHL
2) BHL + infiltrates
3) infiltrates
4) Fibrosis
2
Q
What is the treatment of Chlamydia psittaci?
A
Tetracyclines
3
Q
What treatment can be used to prevent acute mountain sickness
A
acetazolomide (carbonic anhydrase inhibitor)
4
Q
what is the treatment for high altitude pulmonary oedema
A
descent
nifedipine/dexamethasone/acetazolamide/ phosphodiesterase type V inhibitors
5
Q
What is the treatment for EAA
A
oral glucocorticoids
6
Q
what % of recent CXRs are reported as normal in lung ca patients?
A
10%
7
Q
What is the most dangerous form of asbestos?
A
Crocidolite (blue) asbestos
8
Q
What are the indications for steroids in sarcoidosis
A
Parenchymal lung disease, uveitis, hypercalcaemia, neuro/cardiac involvement
9
Q
What is first line treatment for suspected VTE
A
DOAC
10
Q
When should a chest drain be inserted as first treatment for a pneumothorax
A
Secondary PTX in >50yrs with rim >2cm and/or SOB
11
Q
What is management of secondary PTX less than 1cm
A
Oxygen and admit for 24hrs
12
Q
When can discharge be considered in PTX
A
primary PTX <2cm
13
Q
How long after PTX can you fly
A
2 weeks after successful drainage or 1 week post check X-ray
14
Q
What protein level do exudate pleural effusions have
A
> 30
15
Q
What are lights criteria for an exudate
A
Pleural fluid protein divided by serum protein >0.5
16
Q
What is the LDH of an exudate according to lights criteria
A
Pleural fluid LDH >2/3 upper limit of normal serum LDH
17
Q
What are the characteristics of life-threatening asthma
A
PEFR <33% O2 sats <92% Normal pCO2 Silent chest, cyanosis Bradycardia, dysrhythmia, hypotension Exhaustion, confusion, coma
18
Q
What is the PEFR of moderate asthma attack
A
50-75%
19
Q
Which type of hypersensitivity reaction predominates in EAA
A
Type III
20
Q
Which organism causes redcurrant jelly sputum
A
Klebsiella
21
Q
What is seen on brochoscopy in lung carcinoid
A
Cherry red ball lesion
22
Q
What is the most common bacterial organism in IECOPD
A
H. Influenzae
23
Q
What % A1AT function is PiSS
A
50%
24
Q
What condition is caused by a deficiency in a protease inhibitor which normally protects cells from
neutrophil elastase
A
Alpha-1 antitripsin deficiency
25
What FEV1 is a contraindication for lung cancer surgery
FEV1 < 1.5L
26
What is the mechanism of hypercalcaemia in sarcoidosis
Increased activity of 1-alpha hydroxylase causes increased calcitriol
27
What is the most common organism that causes chest infections in teenagers with CF
Pseudomonas
28
What x-ray findings are in keeping with coal pneumoconiosis
Multiple small round opacities in the upper lobes
29
Which dust inhalation is associated with egg-shell calcification of hilar nodes
Silica
30
What condition is at increased risk after silica exposure
TB
31
What condition is associated with 40% of yellow nail syndrome cases
Bronchiectasis
32
Which lung cancer is associated with clubbing and bone pain
Squamous cell lung cancer
33
Which cells are involved in small cell lung cancer
APUD cells (amine, precursor uptake, decarboxylase)
34
Which cancer involves endocrine K cells and has a fluffy/spiked appearance
Bronchial carcinoma
35
What condition produces multiple petechiae in the axilla 1-3 days after a fracture
Fat embolus
36
What condition is associated with crazy paving on HRCT of chest
Pulmonary alveolar proteinosis
37
What is the treatment of pulmonary alveolar proetinosis
Wash alveoli out with salt
38
What FEV1 represents stage 1 COPD
FEV1 > 80%
39
What FEV1 represents stage 3 COPD
30-49%
40
What is a catamenial pneumothorax
Spontaneous PTX in menstruating women
41
What organism causes respiratory symptoms shortly after bird contact
Chlamydia psittaci
42
What are the causes of lower zone pulmonary fibrosis
IPF, asbestos, SLE, Drugs
43
What are the causes of upper lobe pulmonary fibrosis
AS, Sarcoidosis, pneumoconiosis, TB, EAA, Silicosis, radiation, Histiocytosis
44
What condition is diagnosed by pentalaminar X bodies on bronchoalveolar lavage
Histiocytosis X
45
What resting PA pressure is diagnostic of PAH
>25 mmHg
46
What FeNo value is positive in diagnosis of asthma
>40
47
What type of EAA is caused by thermophilic actinomycetes
Mushroom workers lungs
48
What organism is responsible for malt workers lung
Aspergillus Clavatus
49
What does Saccharopolyspora Rectivirgula exposure cause
EAA - Farmer’s lung
50
What factor does smoking increase lung cancer by
10
51
What factor does coal dust increase lung cancer by
0 - it doesn’t
52
Which elements increase risk of lung cancer
Arsenic, radon, nickel, chromate, aromatic hydrocarbon
53
What are the predisposing factors for OSA
Obesity, macroglossia (acromegaly, hypothyroidism, amyloidosis), large tonsils, marfan’s syndrome
54
What FEV1 improvement is considered ‘reversible’
>12%
55
What surgical treatment can be used for A1AT deficiency
Lung volume reduction surgery, lung transplantation
56
What pH is NIV indicated in COPD
7.25-7.35
57
Which lung cancer secretes PTH-rp
Squamous cell lung cancer
58
What is the MOA of varenicline in smoking cessation
Nicotinic receptor partial agonist
59
What is the MOA of bupropion in smoking cessation
Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist
60
What is a contraindication to taking bupropion for smoking cessation
Epilepsy (+pregnancy and breastfeeding)
61
Which smoking cessation should be used with caution in depression
Varenicline
62
Which HLA is associated with bronchiectasis
HLA-DR1
63
What syndrome presents with recurrent sinusitis, bronchiectasis, sub-fertility and dextrocardia
Kartagener’s syndrome (primary ciliary dyskinesia)
64
What is the vital capacity
Maximum volume of air that can be expired after maximal inspiration
4.5L in men, 3.5L in women
VC = inspiratory capacity + ERV
65
How is total lung capacity calculated
TLC = VC + RV
66
What is the tidal volume
Volume inspired or expired with each breath at rest
| 500ml in males, 350ml in females
67
What is the functional residual capacity
ERV + RV
68
When should LTOT be offered in COPD
pO2 <7.3, or pO2 7.3-8 and: polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension
69
Which organism causes red-currant jelly sputum
Klebsiella
70
What is the treatment for COPD with no asthmatic features that is unresponsive to SABA
Add LABA + LAMA
71
What is the management of pleural plaques
No follow-up (benign)
72
Which cancers cause calcification in lung metastases
Chondrosarcoma, osteosarcoma
73
Which cause of pneumonia is commonly associated with cold sores
Streptococcus pneumoniae
74
Which cause of pneumonia is common after influenza infection
Staph aureus
75
What FVC indicates respiratory support in GBS
20ml/kg
76
When should ABPA be excluded
Asthma with raised eosinophil count
77
When is Mg indicated in acute asthma
Severe asthma not responding to inhaled bronchodilator OR life threatening asthma
78
What condition causes hypoxia worse when upright due to vascular dilation of lung bases
Hepatopulmonary syndrome
79
What FEV value is the cut off for pnuemonectomy
>2.0
80
What % of TB pleural effusions stain positive for AAFB
5-10%
81
Which enzyme is activated by macrophages in sarcoidosis
1-alpha hydroxylase
82
Which TB treatment is contraindicated in chronic liver disease
Pyrazinamide
83
Which investigation has the highest positive predictive value for sarcoidosis
Transbronchial biopsy
84
What’s the treatment of chronic pseudomonas infection in CF
6 months oral azithromycin
85
Which jobs increase risk of silicosis
Quarry workers, sand blasters, pottery workers and stonemasons
86
What is the best investigation to monitor prognosis in Guillian Barre Syndrome
FVC
87
What is the best investigation for assessing compression of the upper airway e.g. thyroid goitre
Flow volume loop
88
Which gram negative bacilli is associated with severe worsening of resp symptoms in CF
Burkholderia cepacia
89
What old treatment for TB involved removal of ribs into a collapsed area of lung
Thoracoplasty
90
What is the best investigation for empyema
Pleural fluid pH (<7.2)
91
What is the recommended regime for PJP prophylaxis in patients who are not HIV positive
Co-trimoxazole 160mg/800mg PO three times weekly
92
What is the recommended regime for PJP prophylaxis in patients who are HIV positive with a CD4 count <200
Co-trimoxazole 80mg/400mg PO daily
93
What are absolute indications for intercostal drainage
Identification of organisms on gram staining/culture, frank pus on aspiration
94
Which organism causes pneumonia and is associated with cold sores
Strep pneumoniae (reactivates HSV)
95
What demonstrates an “owls eyes” pattern on histological staining of Transbronchial biopsy
CMV pneumonitis
96
What is responsible for over 50% of deaths after the first year of lung transplant
Bronchiolitis obliterans
97
Which organism can cause severe pneumonia in a pregnant patient
Listeria (immunocompromised) - treat with IV amoxicillin
98
What is the most common manifestation of SLE related lung disease
Pleuritis
99
What is seen on histology of Sarcoid granuloma
Granuloma with prominent epithelioid cells with sparse lymphocytic infiltrate at the margins
100
What FEV1 is associated with peri-operative risk
FEV1 < 0.8
101
What does a click synchronous with the heart sounds on auscultation of the chest signify
Small left apical pneumothorax
102
What presents similarly to cystic fibrosis but with a low calculated globulin fraction
X-linked hypogammaglobulinaemia
103
What can be used to treat severe COPD where symptoms are not controlled on maximal inhaled therapy
Roflumilast (phosphodiesterase type 4 inhibitor)
104
What does a positive 1-3 beta-D-glucan test indicate
PJP infection
