Respiratory

Question 1

COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features –>

Answer 1

add a LABA + ICS

Question 2

COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features –>

Answer 2

A LAMA/LABA inhaler would be a suitable option if the patient has no asthmatic features, or features suggesting steroid responsiveness. However, the diurnal variation with raised eosinophil count does suggest this may be the case.

Question 3

patients with asthma who are not controlled with a SABA + ICS should first have a… added

Answer 3

Leukotriene receptor antagonist added, not a LABA (due to cost-effectiveness)

Question 4

How do we dx pulmonary fibrosis?

Answer 4

HR CT

Question 5

How does idiopathic pulmonary fibrosis present?

Answer 5

a male patient aged 50-70 years presenting with progressive exertional dyspnoea associated with clubbing and a restrictive picture on spirometry,

Question 6

What are Light’s criteria?

Answer 6

Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH
Pleural fluid LDH divided by serum LDH >0.6
Pleural fluid protein divided by serum protein >0.5

Question 7

When do we use Light’s criteria?

Answer 7

In the assessment of a pleural effusion, it is important to ascertain whether the effusion is a transudate or exudate. This can sometimes be ascertained quite easily by looking at the protein content of the pleural fluid (transudate protein content < 25g/L and exudate protein content > 35g/L). However, in some cases (i.e. protein content 25-35g/L) Light’s criteria need to be applied.

Question 8

What is aspergilloma?

Answer 8

Aspergilloma is a fungal growth affecting immunocompromised patients or those with underlying cavitating lung disease such as tuberculosis or emphysema. Symptoms of include fever, cough and haemoptysis. Treatment is with anti fungal medications such as itraconazole.

Question 9

What is the most common organism causing IE COPD?

Answer 9

The most common organism causing infective exacerbations of COPD is Haemophilus influenzae

Question 10

Where do you see parallel-line shadows?

Answer 10

Bronchiectasis

Question 11

What is the most common organism causing IECOPD?

Answer 11

The most common organism causing infective exacerbations of COPD is Haemophilus influenzae

Question 12

What is seen on CXR in HF?

Answer 12

Alveolar oedema (bat’s wings), Kerley B lines (interstitial oedema), Cardiomegaly, Dilated prominent upper lobe vessels, Effusion (pleural) are features of heart failure on a chest x-ray

Question 13

What is budesonide

Answer 13

ICS inhaler

Question 14

What ix do we do in suspected lung ca?

Answer 14

CT w/ contrast

Question 15

Do we give NIV in acute severe asthma?

Answer 15

No - IV mag sulph

Question 16

Which abx prophylaxis can be given in COPD?

Answer 16

Azithromycin

Question 17

What is the first-line mx in COPD?

Answer 17

A SABA or SAMA is the first-line pharmacological treatment of COPD

Question 18

What is the Mantoux test for?

Answer 18

TB

Question 19

Give a RF for mesothelioma

Answer 19

Asbestos exposure

Question 20

What are the four commonest causes of anterior mediastinal mass

Answer 20

teratoma, terrible lymphadenopathy, thymic mass and thyroid mass

Question 21

Which CT scan would you request in myasthenia gravis

Answer 21

In cases of myasthenia gravis, it is important to perform a CT chest in order to look for a thymoma. Removal of a thymoma may improve the condition in certain patients and prevents malignant transformation.