Respiratory

Question 1

Causes of anterior medistinum masses

Answer 1

4 T’s
1)teratoma
2)terrible lymphadenopathy
3)thymic mass
4)thyroid mass

Question 2

Causes of respiratory alkalosis

Answer 2

1)anxiety leading to hyperventilation
2)pulmonary embolism
3)salicylate poisoning*
4)CNS disorders: stroke, 5)subarachnoid haemorrhage, 6)encephalitis
7)altitude
8)pregnancy

NOTE: *salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

Question 3

What are the expected lung function tests in obstructive lung disease?

Answer 3

FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

Question 4

What are the expected lung function tests in restrictive lung disease?

Answer 4

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

Question 5

Examples of obstructive lung disease

Answer 5

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

Question 6

Examples of restrictive lung disease

Answer 6

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

Question 7

What organism is he most common cause of COPD exacerbation?

Answer 7

Haemophilus influenzae

Others less common:
Strep pneumoniae
Mortadella catarrali

Question 8

Parameters for mild , moderate, severe and very severe COPD

Answer 8

Stage 1 - Mild - >80% predicted FEV1
Stage 2 - Moderate- 50-79%
Stage 3- Severe- 30-49%
Stage 4- Very severe- <30%

Question 9

Pulmonary oedema on CXR

Answer 9

Alveolar oedema
Kelley B lines
Cardiomegaly
Dilated prominent upper vessels
Effusions (pleural)

Question 10

Low glucose in pleural fluid

Answer 10

rheumatoid arthritis, tuberculosis

Question 11

Raised amylase in pleural fluid

Answer 11

pancreatitis, oesophageal perforation

Question 12

Heavy blood staining in pleural fluid

Answer 12

mesothelioma, pulmonary embolism, tuberculosis

Question 13

Management of asthma

Answer 13

1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS +LTRA
4) SABA + low dose ICS + LABA (+/- continue LTRA according to response)
5) SABA +/-LTRA +MART (ICS+LABA)
6)SABA +/-LTRA + medium-dose MART (medium dose ICS+LABA)

Question 14

Management of COPD

Answer 14

1) SABA or SAMA
2) LABA +LAMA OR LABA + ICS
3) SABA PRN + LABA + LAMA + ICS

Question 15

Acute exacerbation of asthma management

Answer 15

1) SABA and SAMA
2) IV steroids
3) IV magnesium sulfate
4) IV aminophylline

Question 16

Anaphylaxis management

Answer 16

1) IM adrenaline x2 (5mins apart)
If refractory
2) IV adrenaline infusion + IVI
3)chlorphenamine