Respiratory

Question 1

Light’s Criteria for exudative effusion (3)

Answer 1

Light’s Criteria for exudative effusion requires one of more of the following:
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal
Glucose is not used in Light’s Criteria.

Question 2

bilateral hilar lymphadenopathy common cause (2)

Answer 2

Tuberculosis

Sarcoid

Question 3

Infective exacerbation COPD causes (3)

Answer 3

Haemophilus influenzae (most common cause)
Streptococcus pneumoniae
Moraxella catarrhalis

Question 4

Vital Capacity is..

Answer 4

..maximum volume of air that can be expired after a maximal inspiration

Question 5

Residual volume is…

Answer 5

the volume of air remaining after maximal expiration
increases with age
RV = FRC - ERV
Residual volume (RV) = 1.2L

Question 6

Functional residual capacity is..

Answer 6

the volume in the lungs at the end-expiratory position

FRC = ERV + RV

Question 7

Expiratory reserve volume is..

Answer 7

maximum volume of air that can be expired at the end of a normal tidal expiration
Expiratory reserve volume (ERV) = 750ml

Question 8

Aspergillosis Mx

Answer 8

1st Glucocorticoid (Prednisolone)
2nd Itraconazole

Question 9

COPD General Mx (4)

Answer 9

smoking cessation
annual influenza vaccine
one-off pneumococcal vaccine
Pulmonary rehab

Question 10

COPD Medication Mx

Answer 10

1st - SABA/ SAMA
2nd - a) no asthma - LABA + LAMA
b) + asthma - LABA + Steroid 
3rd - LABA + steroid + LAMA
4th - Oral Theophylline

Question 11

Contraindications to Lung Transplant (4)

Answer 11

SVC obstruction
FEV < 1.5
MALIGNANT pleural effusion
vocal cord paralysis

Question 12

indication for steroids for sarcoidosis (4)

Answer 12

parenchymal lung disease
uveitis
hypercalcaemia
neurological/ cardiac involvement

Question 13

Asthma Mx

Answer 13

1 - SABA
2 - + ICS
3 - + Leukotriene receptor antagonist (eg Montelukast)
4 - + LABA
5 - SABA +/- LTRA + medium-dose ICS Maintenance and Reliever therapy

Question 14

High altitude cerebral oedema Mx

Answer 14

Dexamethasone + Decent

Question 15

High altitude pulmonary oedema Mx

Answer 15

Acetazolamide + decent

Question 16

NIV indications (3)

Answer 16

COPD with respiratory acidosis pH <7.35
type I resp failure - chest wall deformity, neuromuscular disease, OSA
cardiogenic pulmonary oedema

Question 17

COPD LTOT indication

Answer 17

2 measurements of pO2 < 7.3 kPa

Question 18

alpha-1 antitrypsin def Mx (4)

Answer 18

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

Question 19

Transudate pleural effusion causes (4) (< 30g/L protein)

Answer 19

heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

Question 19

Transudate pleural effusion causes (4) (< 30g/L protein)

Answer 19

heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

Question 20

Primary Pneumothorax
definition
Mx

Answer 20

def - <50 yo, no smoking/ lung Hx
Mx - 
1st - <2cm + no SOB - discharge
2nd - needle aspirate
3rd - chest drain

Question 21

Most common Lung Ca in Non smokers

Answer 21

Adenocarcinoma

Question 22

Most common lung Ca in Smokers

Answer 22

Squamous cell Ca (type of non small cell Ca)

Question 23

Secondary Pneumothorax Mx (>1cm)

Answer 23

1st - Aspiration (1-2cm)
2nd - Chest drain for 48 hours (1st line if >2cm or breathless)
3rd - Negative suction