Respiratory

Question 1

Causes of airflow obstruction

Answer 1

Asthma (reversible)
COPD (fixed)

Obliterative bronchiolitis (fixed obstruction, can be secondary to pollutants or GvHD)

Question 2

Investigations for asthma

Answer 2

PEFR and PEFR diary
Bloods for eosinophil and IgE levels
Spirometry

Question 3

Signs of interstitial lung fibrosis

Answer 3

Finger clubbing
Bilateral fine late inspiratory crackles which do not clear on coughing
May be signs of connective tissue disease (scleroderma, SLE, RA) or AF (amiodarone use)

Question 4

What drugs can cause IPF?

Answer 4

Nitrofurantoin
Sulfasalazine, methotrexate, NSAIDs
Amiodarone
Bleomycin

Question 5

What signs of severity might be seen in a patient with IPF?

Answer 5

Crackles becoming widespread and extending more into expiration
Pulmonary hypertension
Hypoxia, central cyanosis, cor pulmonale

Question 6

What is interstitial pulmonary fibrosis?

Answer 6

The interstitium describes the narrow space between the alveolar epithelium and the capillary endothelium.
The interstitium can become thickened often as a result of the effects of the alveolar transudates or exudates.
This results in fibrosis.

Question 7

What investigations should you request?

Answer 7

FBC, U&Es, CRP/ESR. Look for eosinophilia
ANA/ANCA/RF
Serum ACE
HIV
ABG
CXR
HRCT
Spirometry
Lung biopsy

Question 8

Signs of IPF on CXR

Answer 8

Decreased lung volumes
Subpleural reticular or reticulonodular opacities
Bilateral interstitial shadowing
Peripheral migratory air space shadowing
Mediastinal or hilar lymph node enlargement
It may also help to identify a cause.

Question 9

Causes of apical lung fibrosis

Answer 9

Radiation pneumonitis
ABPA, eosinophilic pneumonia
Pneumonconiosis
Ankylosing spondylitis
Silicosis
TB

Question 10

Causes of basal lung fibrosis

Answer 10

Rheumatoid arthritis
Asbestosis
Scleroderma
IPF

Question 11

Spirometry findings for IPF

Answer 11

Reduced FEV1 and reduced FVC
Intact or raised FEV1:FVC
Reduced transfer factor

Question 12

Features of IPF on HRCT

Answer 12

Ground glass shadowing and honeycombing
Traction bronchiectasis

Question 13

List some eosinophilic lung diseases

Answer 13

Asthma, ABPA
Drug-induced (nitrofurantoin, sulfasalazine, MTX)
Loeffler’s
Eosinophilic pneumonia
Churg-Strauss (eGPA)
Helminth/parasitic infection

Question 14

Lung manifestations of rheumatoid arthritis

Answer 14

Pleural effusions
Pulmonary fibrosis
Drug-induced lung fibrosis
Caplan’s syndrome (dust-exposure and RA)
Lung nodules