Respiratory

Question 1

Resp signs of granulomatosis with polyangiitis

Answer 1

upper respiratory - epistaxis, sinusisis, nasal crusting;
lower respiratory - dyspnoea, haemoptysis;
Saddle-shape nose deformity

Question 2

Examination findings - pulmonary oedema

Answer 2

bibasal crackles;
S3

Question 3

ABG in chronic CO2 retention

Answer 3

• normal pH
• High pCO2
• High HCO3

Question 4

Step 3 for paeds asthma tx

Answer 4

SABA + paeds low-dose ICS + leukotriene receptor antagonist

Question 5

Step 4 paeds asthma tx

Answer 5

SABA + paeds low-dose ICS + LABA

Question 6

non resp fts of sarcoidosis

Answer 6

• erythema nodosum (painful rash in shin/thigh/forearm)
• hypercalcaemia (kidneys)
• lymphadenopathy (b/l hilar)
• uveitis
• polyarthralgia
• lupus pernio

Question 7

lung Ca heavily associated with smoking

Answer 7

SCC

Question 8

Commonest organism for pneumonia, common fts

Answer 8

streptococcus pneumoniae (pneumococcus)

high fever, rapid onset, herpes labialis

Question 9

Causative organism for pneumonia - COPD pts

Answer 9

Haemophilus influenzae

Question 10

Common presentation of staphylococcus aureus pneumonia

Answer 10

following influenza infection

Question 11

Common fts of mycoplasma pneumonia

Answer 11

Atypical pneumonia

• dry cough
• atypical chest signs/xray
  +/- autoimmune haemolytic anaemia
  +/- erythema multiforme

Question 12

Common fts of legionella pneumophilia pneumonia

Answer 12

Atypical

• hyponatraemia
• lymphopoenia

Classically = infected via air conditioning units (water droplets)

Question 13

Pt group classically affected by klebsiella pneumoniae pneumonia

Answer 13

alcoholics

Question 14

Pt group classically affected by penumocystis jiroveci pneumonia

Answer 14

HIV pts

Question 15

Classic fts of pneumocystis jiroveci pneumonia

Answer 15

• immunosuppressed pts
• dry cough
• exercise-induced desaturation
• absence of chest signs

Question 16

1st step bronchodilator therapy COPD

Answer 16

SABA or SAMA

Question 17

2nd step bronchodilator therapy COPD

Answer 17

asthmatic fts/steroid responsiveness: LABA + ICS

other: LABA + LAMA (if SAMA, stop and swtich to SABA)

Question 18

3rd line bronchodilator therapy COPD w/ asthmatic fts/steroid responsiveness

Answer 18

triple therapy
LAMA + LABA + ICS
(if SAMA prior, discontinue and switch to SABA)

+ phosphodiesterase-4 inhibitor (roflumilast) if 2+ exacerbation in 12mo despite established triple therapy

Question 19

Criteria for asthmatic fts/ steroid responsiveness in COPD pt

Answer 19

• previous, secure diagnosis of asthma or atopy
• higher blood eosinophic count
• substantial variation in FEV1 over time (400mL)
• substantial diurnal variation in PEFR (>20%)

not spirometric reversibility