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

What are the signs of Pulmonary oedema on CXR?

Answer 9

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

Question 10

What would cause low glucose in pleural fluid?

Answer 10

rheumatoid arthritis, tuberculosis

Question 11

What would cause raised amylase in pleural fluid?

Answer 11

pancreatitis, oesophageal perforation

Question 12

What would cause heavy blood staining in pleural fluid?

Answer 12

mesothelioma, pulmonary embolism, tuberculosis

Question 13

What is the 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

What is the management of COPD?

Answer 14

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

Question 15

What is the management of acute exacerbation of asthma?

Answer 15

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

Question 16

What is the management of anaphylaxis?

Answer 16

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

Question 17

What is the management of Alpha-1 antitrypsin deficiency ?

Answer 17

1) no smoking
2) supportive: bronchodilators, physiotherapy
3) intravenous alpha1-antitrypsin protein concentrates
4) surgery: lung volume reduction surgery, lung transplantation

Question 18

What are the features of Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)?

Answer 18

asthma
Eosinophilia
paranasal sinusitis
pANCA

Question 19

What is the managment of Extrinsic allergic alveolitis (AKA hypersensitivity pneumonitis)?

Answer 19

• avoid precipitating factors
• oral glucocorticoids

Question 20

What are the features of

Answer 20

Renal failure
Epistaxis/haemoptysis
cANCA
saddle-shape nose deformity

Question 21

What is the management of idiopathic pulmonary fibrosis?

Answer 21

Pulmonary rehabilitation

many patients will require supplementary oxygen and eventually a lung transplant

Question 22

What are risk factors for Klebsiella?

Answer 22

more common in alcoholic and diabetics

Question 23

What are features of Klebsiella pneumoniae?

Answer 23

• may occur following aspiration
• ‘red-currant jelly’ sputum
• often affects upper lobes
• commonly causes lung abscess formation and empyema

Question 24

What are the different types of lung cancer?

Answer 24

Small cell

Non-small cell:
1) adenocarcinoma
2) squamous
3) large cell
4) alveolar cell carcinoma
5) bronchial adenoma

Question 25

What is the most common type of lung cancer?

Answer 25

Adenocarcinoma

Question 26

What are the paraneoplastic features of small cell lung Ca?

Answer 26

ADH-> hyponatraemia
ACTH-> Cushing’s
Lambert-Eaton syndrome

Question 27

What are the paraneoplastic features of squamous cell lung Ca?

Answer 27

1) parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
2) clubbing
3) hypertrophic pulmonary osteoarthropathy (HPOA)
4) hyperthyroidism due to ectopic TSH

Question 28

What are the paraneoplastic features of adenocarcinoma?

Answer 28

1) gynaecomastia
2) hypertrophic pulmonary osteoarthropathy (HPOA)

Question 29

What is the management of pneumothorax?

Answer 29

1) Assess if symptomatic-> if asymptomatic then no intervention regardless of size

2) Assess for high-risk characteristics

If high risk characteristics and safe to intervene-> chest drain

If none-> conservative, ambulatory or needle aspiration

Question 30

What is done for patients with persistent or recurrent pneumothorax?

Answer 30

video-assisted thoracoscopic surgery (VATS) should be considered to allow for mechanical/chemical pleurodesis +/- bullectomy.

Question 31

When can you fly and dive after pneumothorax?

Answer 31

Fly: after 2 weeks if no residual air

Scuba diving: never (unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively)

Question 32

What are the features of silicosis on CXR?

Answer 32

1) upper zone fibrosing lung disease
2) ‘egg-shell’ calcification of the hilar lymph nodes