Respiratory

Question 1

What would a CT of idiopathic pulmonary fibrosis show

Answer 1

Honeycombing
thickened interstitial walls

Question 2

What would spirometry of idiopathic pulmonary fibrosis show

Answer 2

Reduced FVC and FEV1
Normal or high FEV1:FVC ratio

ANA positive in 30%, rheumatoid factor positive in 10% but this does not necessarily mean that the fibrosis is secondary to a connective tissue disease. Titres are usually low

Question 3

What is mesothelioma

Answer 3

Cancer of epithelial lining, usually in lungs/pleural lining

Associated w asbestos

Question 4

The most common organism causing infective exacerbations of COPD is ?

Answer 4

Haemophilus influenzae

then
Streptococcus pneumoniae
Moraxella catarrhalis

Question 5

What happens in sarcoidosis

Answer 5

Immune system triggered in the absence of a pathogen

Causes formation of nodules/granolomas filled with immune cells

Question 6

Risk factors for sarcoidosis

Answer 6

African american
FHx of sarcoidosis

Triggers: mycobacterium TB, borrelia burdorferi

Question 7

Where are you most likely to find nodules/granulomas in sarcoidosis

Answer 7

Mainly in the lymphnodes (hilar lymphadenopathy) , but can form elswhere in the body (erythema nodosum, uveitis, cardiac muscle)

Question 8

How do you test for sarcoidosis

Answer 8

CT showing bilateral hilar lymphadenopathy
high Ca (due to excess vit D from macrophages)
Bronchoalveolar lavage: excess T cells

Question 9

How do you treat sarcoidosis

Answer 9

Steroids if sx are severe, otherwise supportive as disease is usually self limiting

Question 10

Symptoms of myasthenia gravis

Answer 10

People with myasthenia gravis might wake up feeling fine, but get progressively weaker as the day goes on and by the end of the day they might feel very weak, sometimes even getting weaker with repetitive movements like chopping vegetables.

affects the extraocular muscles, which control movement of the eye as well as the eyelids, so individuals might have diplopia or double vision, as well as ptosis, or drooping eyelids.

Question 11

secondary cause of myasthenia gravis

Answer 11

Thymoma can produce anti acetylcholine receptor antibodies (paraneoplastic) which can lead to MG

Question 12

The symptoms of Legionella pneumophila

Answer 12

Fever, cough, chest pain, shortness of breath and diarrhoea

occurs more commonly in warmer months

Question 13

Legionella pneumophila can be diagnosed by

Answer 13

rapid urinary antigen
sputum PCR
sputum culture
serology.

Question 14

Legionella pneumophila incubation period is

Answer 14

2-10 days

Question 15

Legionella pneumophila

Answer 15

urinary antigens
macrolide abx

Via inhalation of water containing the organism (spas, air conditioning or ice machines)

worse in warm months
GI symptoms more predominant then other pneumonias