Respiratory

Question 1

Which micro-organism is most commonly isolated in patients with bronchiectasis?

Answer 1

Haemophilus Influenzae

Question 2

Tx for bronchiectasis?

Answer 2

physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)

Question 3

What is the most common form of asbestos related lung disease?

Answer 3

Pleural plaques- these are benign and do not undergo malignant change.

Question 4

Infective exacerbation of COPD is most likely caused by which organism?

Answer 4

Haemophilus influenzae

Question 5

How may a small cell lung cancer manifest itself?

Answer 5

Paraneoplastic manifestations of small cell lung cancer are produced by their ectopic production of ACTH and ADH. The ACTH production produces a cushing’s syndrome. The ADH production leads to a dilutional hyponatraemia.
ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

Question 6

What type of cells does small cell lung cancer arise from?

Answer 6

APUD cells.
Amine - high amine content
Precursor Uptake - high uptake of amine precursors
Decarboxylase - high content of the enzyme decarboxylase

Question 7

Exacerbations of chronic bronchitis tx?

Answer 7

Amoxicillin or tetracycline or clarithrymycin

Question 8

Uncomplicated community acquired pneumonia tx?

Answer 8

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)

Question 9

NB

Answer 9

After flu (influenza) most likely organism is staph aureus!!!!

Question 10

Atypical pneumonia tx?

Answer 10

Clarithromycin

Question 11

Hospital acquired pneumonia tx?

Answer 11

Within 5 days of admission: co-amoxoclav or cefuroxime. and after that tazocin or ceftazidime or ciprofloxacin.

Question 12

Gingivitis: acute necrotising ulcerative tx?

Answer 12

Metronidazole

Question 13

Clostridium difficile tx

Answer 13

First episode: metronidazole

Second or subsequent episode of infection: Vanc

Question 14

Campylobacter enteritis

Answer 14

Clarithromycin

Question 15

Salmonella (non-typhoid)

Answer 15

Cipro

Question 16

Shigellosis

Answer 16

Cipro

Question 17

Bronchiectasis, obstructive or restrictive?

Answer 17

Obstructive

Question 18

Pleural effusions….

Answer 18

All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling.
If the fluid is purulent or turbid/cloudy a chest tube should be placed to allow drainage
If the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed

Question 19

Which form of ventilation is useful in patients in type 2 respiratory failure?

Answer 19

Bipap

Question 20

How is legionella best diagnosed?

Answer 20

Urinary antigen test

Question 21

Rheumatoid arthritis associations?

Answer 21

pulmonary fibrosis
pleural effusion
pulmonary nodules
bronchiolitis obliterans
complications of drug therapy e.g. methotrexate pneumonitis
pleurisy
Caplan’s syndrome - massive fibrotic nodules with occupational coal dust exposure
infection (possibly atypical) secondary to immunosuppression

Question 22

COPD

Answer 22

FEV1 > 50%
long-acting beta2-agonist (LABA), for example salmeterol, or:
long-acting muscarinic antagonist (LAMA), for example tiotropium

FEV1 < 50%
LABA + inhaled corticosteroid (ICS) in a combination inhaler, or:
LAMA

Question 23

NB

Answer 23

Massive PE + hypotension - thrombolyse

Question 24

NB

Answer 24

CTPA is nephro toxic so in patients who have renal failure and you suspect PE, do a VP perfusion instead.

Question 25

Long term oxygen therapy requirements:

Answer 25

Very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air

Question 26

Which inhaler contains a LABA and a LAMA?

Answer 26

Tiotropium

Question 27

What are the indications for non-invasive ventilation?

Answer 27

COPD with respiratory acidosis pH 7.25-7.35
Type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation