Respiratory

Question 1

causes of transudate pleural effusions

Answer 1

1. heart failure
2. hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
3. hypothyroidism
4. Meigs’ syndrome
   - increased hydrostatic pressure, pleural permeability and decreased oncotic capillary pressure (proteins)

Question 2

causes of exudate pleural effusions

Answer 2

1. infection: pneumonia- most common, TB, subphrenic abscess
2. connective tissue disease: RA, SLE
3. neoplasia: lung cancer, mesothelioma, metastases
4. pancreatitis
5. pul embolism
6. Dressler’s syndrome (form of pericarditis)
7. yellow nail syndrome

• caused by changes of local factors that influence formation and absorption of pleural fluid
  Increase in microcirculation permeability or change in pleural space drainage to lymph nodes

Question 3

at which pH are NG tubes safe?

Answer 3

<5.5

Question 4

where in the lung would coal workers’ pneumoconiosis be shown in a high res CT?

Answer 4

upper zone

Question 5

what are the most common organisms in acute infective COPD?

Answer 5

bacterial:
1. h. influenza (most common)
2. strep. pneumoniae
3. moraxella catarrhalis

viral:
human rhinovirus

Question 6

what are the target o2 sats for someone receiving supplementary o2 in acute asthma?

Answer 6

94-98%

Question 7

what are the target sats in COPD with normal CO2 (ABG)?

Answer 7

94-98%

Question 8

what ABx is used for prophylactic infective COPD exacerbations

Answer 8

azithromycin

Question 9

what investigation can be used to confirm mycobacterium tuberculosis?

Answer 9

Ziehl Neelsen stain identifies presence of acid fast organism

Question 10

why is TB usually in the upper zone of lungs?

Answer 10

due to the effects of gravity on the alveolar ventilation: perfusion ratio, oxygen availability for bacteria is highest in this area (aerobe)

Question 11

what are the first line Abx in infective COPD exacerbation?

Answer 11

amoxicillin, clarithromycin, doxycyline