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Respiratory Flashcards

1
Q

What are the stages of sarcoid on CXR?

A

1) BHL
2) BHL + infiltrates
3) infiltrates
4) Fibrosis

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2
Q

What is the treatment of Chlamydia psittaci?

A

Tetracyclines

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3
Q

What treatment can be used to prevent acute mountain sickness

A

acetazolomide (carbonic anhydrase inhibitor)

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4
Q

what is the treatment for high altitude pulmonary oedema

A

descent

nifedipine/dexamethasone/acetazolamide/ phosphodiesterase type V inhibitors

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5
Q

What is the treatment for EAA

A

oral glucocorticoids

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6
Q

what % of recent CXRs are reported as normal in lung ca patients?

A

10%

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7
Q

What is the most dangerous form of asbestos?

A

Crocidolite (blue) asbestos

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8
Q

What are the indications for steroids in sarcoidosis

A

Parenchymal lung disease, uveitis, hypercalcaemia, neuro/cardiac involvement

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9
Q

What is first line treatment for suspected VTE

A

DOAC

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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

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11
Q

What is management of secondary PTX less than 1cm

A

Oxygen and admit for 24hrs

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12
Q

When can discharge be considered in PTX

A

primary PTX <2cm

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13
Q

How long after PTX can you fly

A

2 weeks after successful drainage or 1 week post check X-ray

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14
Q

What protein level do exudate pleural effusions have

A

> 30

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15
Q

What are lights criteria for an exudate

A

Pleural fluid protein divided by serum protein >0.5

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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

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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
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18
Q

What is the PEFR of moderate asthma attack

A

50-75%

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19
Q

Which type of hypersensitivity reaction predominates in EAA

A

Type III

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20
Q

Which organism causes redcurrant jelly sputum

A

Klebsiella

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21
Q

What is seen on brochoscopy in lung carcinoid

A

Cherry red ball lesion

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22
Q

What is the most common bacterial organism in IECOPD

A

H. Influenzae

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23
Q

What % A1AT function is PiSS

A

50%

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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

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25
Q

What FEV1 is a contraindication for lung cancer surgery

A

FEV1 < 1.5L

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26
Q

What is the mechanism of hypercalcaemia in sarcoidosis

A

Increased activity of 1-alpha hydroxylase causes increased calcitriol

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27
Q

What is the most common organism that causes chest infections in teenagers with CF

A

Pseudomonas

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28
Q

What x-ray findings are in keeping with coal pneumoconiosis

A

Multiple small round opacities in the upper lobes

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29
Q

Which dust inhalation is associated with egg-shell calcification of hilar nodes

A

Silica

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30
Q

What condition is at increased risk after silica exposure

A

TB

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31
Q

What condition is associated with 40% of yellow nail syndrome cases

A

Bronchiectasis

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32
Q

Which lung cancer is associated with clubbing and bone pain

A

Squamous cell lung cancer

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33
Q

Which cells are involved in small cell lung cancer

A

APUD cells (amine, precursor uptake, decarboxylase)

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34
Q

Which cancer involves endocrine K cells and has a fluffy/spiked appearance

A

Bronchial carcinoma

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35
Q

What condition produces multiple petechiae in the axilla 1-3 days after a fracture

A

Fat embolus

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36
Q

What condition is associated with crazy paving on HRCT of chest

A

Pulmonary alveolar proteinosis

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37
Q

What is the treatment of pulmonary alveolar proetinosis

A

Wash alveoli out with salt

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38
Q

What FEV1 represents stage 1 COPD

A

FEV1 > 80%

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39
Q

What FEV1 represents stage 3 COPD

A

30-49%

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40
Q

What is a catamenial pneumothorax

A

Spontaneous PTX in menstruating women

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41
Q

What organism causes respiratory symptoms shortly after bird contact

A

Chlamydia psittaci

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42
Q

What are the causes of lower zone pulmonary fibrosis

A

IPF, asbestos, SLE, Drugs

43
Q

What are the causes of upper lobe pulmonary fibrosis

A

AS, Sarcoidosis, pneumoconiosis, TB, EAA, Silicosis, radiation, Histiocytosis

44
Q

What condition is diagnosed by pentalaminar X bodies on bronchoalveolar lavage

A

Histiocytosis X

45
Q

What resting PA pressure is diagnostic of PAH

46
Q

What FeNo value is positive in diagnosis of asthma

47
Q

What type of EAA is caused by thermophilic actinomycetes

A

Mushroom workers lungs

48
Q

What organism is responsible for malt workers lung

A

Aspergillus Clavatus

49
Q

What does Saccharopolyspora Rectivirgula exposure cause

A

EAA - Farmer’s lung

50
Q

What factor does smoking increase lung cancer by

51
Q

What factor does coal dust increase lung cancer by

A

0 - it doesn’t

52
Q

Which elements increase risk of lung cancer

A

Arsenic, radon, nickel, chromate, aromatic hydrocarbon

53
Q

What are the predisposing factors for OSA

A

Obesity, macroglossia (acromegaly, hypothyroidism, amyloidosis), large tonsils, marfan’s syndrome

54
Q

What FEV1 improvement is considered ‘reversible’

55
Q

What surgical treatment can be used for A1AT deficiency

A

Lung volume reduction surgery, lung transplantation

56
Q

What pH is NIV indicated in COPD

57
Q

Which lung cancer secretes PTH-rp

A

Squamous cell lung cancer

58
Q

What is the MOA of varenicline in smoking cessation

A

Nicotinic receptor partial agonist

59
Q

What is the MOA of bupropion in smoking cessation

A

Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist

60
Q

What is a contraindication to taking bupropion for smoking cessation

A

Epilepsy (+pregnancy and breastfeeding)

61
Q

Which smoking cessation should be used with caution in depression

A

Varenicline

62
Q

Which HLA is associated with bronchiectasis

63
Q

What syndrome presents with recurrent sinusitis, bronchiectasis, sub-fertility and dextrocardia

A

Kartagener’s syndrome (primary ciliary dyskinesia)

64
Q

What is the vital capacity

A

Maximum volume of air that can be expired after maximal inspiration
4.5L in men, 3.5L in women
VC = inspiratory capacity + ERV

65
Q

How is total lung capacity calculated

A

TLC = VC + RV

66
Q

What is the tidal volume

A

Volume inspired or expired with each breath at rest

500ml in males, 350ml in females

67
Q

What is the functional residual capacity

68
Q

When should LTOT be offered in COPD

A

pO2 <7.3, or pO2 7.3-8 and: polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension

69
Q

Which organism causes red-currant jelly sputum

A

Klebsiella

70
Q

What is the treatment for COPD with no asthmatic features that is unresponsive to SABA

A

Add LABA + LAMA

71
Q

What is the management of pleural plaques

A

No follow-up (benign)

72
Q

Which cancers cause calcification in lung metastases

A

Chondrosarcoma, osteosarcoma

73
Q

Which cause of pneumonia is commonly associated with cold sores

A

Streptococcus pneumoniae

74
Q

Which cause of pneumonia is common after influenza infection

A

Staph aureus

75
Q

What FVC indicates respiratory support in GBS

76
Q

When should ABPA be excluded

A

Asthma with raised eosinophil count

77
Q

When is Mg indicated in acute asthma

A

Severe asthma not responding to inhaled bronchodilator OR life threatening asthma

78
Q

What condition causes hypoxia worse when upright due to vascular dilation of lung bases

A

Hepatopulmonary syndrome

79
Q

What FEV value is the cut off for pnuemonectomy

80
Q

What % of TB pleural effusions stain positive for AAFB

81
Q

Which enzyme is activated by macrophages in sarcoidosis

A

1-alpha hydroxylase

82
Q

Which TB treatment is contraindicated in chronic liver disease

A

Pyrazinamide

83
Q

Which investigation has the highest positive predictive value for sarcoidosis

A

Transbronchial biopsy

84
Q

What’s the treatment of chronic pseudomonas infection in CF

A

6 months oral azithromycin

85
Q

Which jobs increase risk of silicosis

A

Quarry workers, sand blasters, pottery workers and stonemasons

86
Q

What is the best investigation to monitor prognosis in Guillian Barre Syndrome

87
Q

What is the best investigation for assessing compression of the upper airway e.g. thyroid goitre

A

Flow volume loop

88
Q

Which gram negative bacilli is associated with severe worsening of resp symptoms in CF

A

Burkholderia cepacia

89
Q

What old treatment for TB involved removal of ribs into a collapsed area of lung

A

Thoracoplasty

90
Q

What is the best investigation for empyema

A

Pleural fluid pH (<7.2)

91
Q

What is the recommended regime for PJP prophylaxis in patients who are not HIV positive

A

Co-trimoxazole 160mg/800mg PO three times weekly

92
Q

What is the recommended regime for PJP prophylaxis in patients who are HIV positive with a CD4 count <200

A

Co-trimoxazole 80mg/400mg PO daily

93
Q

What are absolute indications for intercostal drainage

A

Identification of organisms on gram staining/culture, frank pus on aspiration

94
Q

Which organism causes pneumonia and is associated with cold sores

A

Strep pneumoniae (reactivates HSV)

95
Q

What demonstrates an “owls eyes” pattern on histological staining of Transbronchial biopsy

A

CMV pneumonitis

96
Q

What is responsible for over 50% of deaths after the first year of lung transplant

A

Bronchiolitis obliterans

97
Q

Which organism can cause severe pneumonia in a pregnant patient

A

Listeria (immunocompromised) - treat with IV amoxicillin

98
Q

What is the most common manifestation of SLE related lung disease

99
Q

What is seen on histology of Sarcoid granuloma

A

Granuloma with prominent epithelioid cells with sparse lymphocytic infiltrate at the margins

100
Q

What FEV1 is associated with peri-operative risk

A

FEV1 < 0.8

101
Q

What does a click synchronous with the heart sounds on auscultation of the chest signify

A

Small left apical pneumothorax

102
Q

What presents similarly to cystic fibrosis but with a low calculated globulin fraction

A

X-linked hypogammaglobulinaemia

103
Q

What can be used to treat severe COPD where symptoms are not controlled on maximal inhaled therapy

A

Roflumilast (phosphodiesterase type 4 inhibitor)

104
Q

What does a positive 1-3 beta-D-glucan test indicate

A

PJP infection

MRCP (16 decks)

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