Respiratory

Question 1

Alpha-1 antitrypsin deficiency is due to what?

Answer 1

common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver.

Located on Ch 14, PiMM (normal) but patients with PiZZ manifest disease

Question 2

What disease manifestations do you see in alpha-1 antitrypsin

Answer 2

This disease affects the lungs and liver

lungs: panacinar emphysema, most marked in lower lobes
liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children

Question 3

first line broncho dilator Therapy for COPD patients

Answer 3

SAMA or SABA

if the patient is breathless or having increased exacerbations then the additional therapy is decided by the FEV1

Question 4

COPD therapy if FEV1 >50% and the patient is initially on SAMA/SABA???

Answer 4

• long-acting beta2-agonist (LABA), for example salmeterol, or:
• long-acting muscarinic antagonist (LAMA), for example tiotropium

Question 5

Additional COPD therapy if FEV1 >50% and the patient is initially on SAMA/SABA???

Answer 5

• LABA + inhaled corticosteroid (ICS) in a combination inhaler, or:
• LAMA

Question 6

If the patient is STILL having persistent breathlessness despite LABA/LAMA then what do you do?

Answer 6

• LABA + ICS

then LAMA and LABA + ICS

Question 7

Range of severity of asbestos development in patients?

Answer 7

1) Pleural plaques: benign
2) Pleural thickening
3) Asbestosis: LL fibrosis (latent period 15-30y)
4) Mesothelioma: malignant disease of the pleura. Crocidolite (blue) asbestos is the most dangerous form. poor progn.
5) Lung cancer

Question 8

The common cold is due to what organism?

Answer 8

Rhinovirus

Question 9

The most common cause of community acquired pneumonia?

Answer 9

Streptococcus pneumoniae

Question 10

When do you see cannonball metastases in the lung?

Answer 10

Secondary mets to renal cancer

Question 11

Recurrent chest infections + subfertility - think ….??

Answer 11

primary ciliary dyskinesia syndrome / Kartageners Syndrome