Respiratory

Question 2

Kartagener syndrome triad

Answer 2

Autosomal recessive ciliary disorder comrpising the triad of

1. Situs inversus
2. Chronic sinusitus
3. Bronchiectasis

Can cause a non-infective otitis media known as myringitis (does not cause pus or fluid in middle ear)

Question 3

Causes of Pulmonary Fibrosis

Answer 3

By location:
Upper: **HART **

Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiotherapy
TB

Lower: **RAIDS **

Rheumatoid arthritis
Asbestosis
Idiopathic
Drugs
Sarcoid

Question 4

2 antifibrotics licenced for IPF

Answer 4

Two antifibrotic drugs are currently licensed for IPF – both slow the progression of fibrosis

Pirfenidone – reduces fibroblast proliferation (anti-tnf b1)

Nintedanib – a tyrosine-kinase inhibitor targeting specific growth factors that contribute to fibrosis

Despite these treatments, the median survival for those with IPF is still 3–3.5 years, with 5000 patients dying every year

Referral to palliative care services should therefore be considered early

Question 5

Features of Severe and Life Threatening Asthma and PMHx conerning features

Answer 5

Signs of a severe attack:

1. Inability to speak in complete sentences
2. Respiratory rate >25 breaths per minute
3. Peak flow 33–50% predicted
4. Heart rate >110 bpm

Signs of a life-threatening attack:

1. Peak flow <33% of predicted
2. Silent chest
3. Altered consciousness: confusion or drowsiness
4. Bradycardia
5. Hypotension
6. Hypoxia
7. Cyanosis
8. Exhaustion

These patients should be urgently escalated to intensive care.

Patients present with acute respiratory distress – difficulty breathing, tachypnoea, wheeze.

High-risk features for a severe attack include:

previous intensive care admission
those on step 3 or higher of the stepwise asthma treatment pathway
hospital admission in the last year

Question 6

Most common causes of HAP

Answer 6

In the United Kingdom, the most common organisms causing HAP are Staphylococcus aureus and Gram-negative bacilli such as Klebsiella pneumoniae and Escherichia coli.

Among them, Staphylococcus aureus is the most common, particularly in patients with severe disease or in those exposed to recent antibiotic use.

Question 7

Most common causes of CAP

Answer 7

Streptococcus pneumonia, which is generally community-acquired

followed by

Haemophilus influenzae

**Mycoplasma pneumonia **

Question 8

Transudate vs Exudate

Answer 8

Transudates are usually bilateral and arise from either increased capillary hydrostatic pressure or decreased oncotic pressure secondary to congestive heart failure, fluid overload, cirrhosis or hypoalbuminemia.

Exudates are usually unilateral and result from increased capillary permeability or** decreased lymphatic resorption** associated with infection, connective tissue disease, pancreatitis or cancer.