Respiratory conditions

Question 1

Recurrent chest infections + subfertility

Answer 1

Recurrent chest infections + subfertility - think primary ciliary dyskinesia syndrome (Kartagener’s syndrome)

Question 3

Before starting treatment for TB, what examination should a patient be assessed for?

Answer 3

visual acuity
tuberculosis will need treatment with rifampicin, isoniazid, pyrazinamide and ethambutol.
ethambutol can cause optic neuritis so visual acuity should be assessed

Question 4

most common histological subtype in lung cancer cases in non-smokers

Answer 4

non-small cell lung cancer
adenocarcinoma

Question 5

drugs causing lung fibrosis

Answer 5

• amiodarone
• cytotoxic agents: busulphan, bleomycin
• anti-rheumatoid drugs: methotrexate, sulfasalazine
• nitrofurantoin
• ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 6

IPF spirometry results

Answer 6

spirometry: classically a restrictive picture (FEV1 normal/decreased, FVC decreased, FEV1/FVC increased)

Question 7

Antibiotic for legionella infection

Answer 7

Macrolides such as clarithromycin are used to treat Legionella

Question 8

blood results in lung cancer results

Answer 8

Raised platelets can be an indicator of lung cancer

Question 9

Pleural plaques mamagement

Answer 9

Pleural plaques are benign and do not undergo malignant change. They, therefore don’t require any follow-up.

Question 10

sarcoidosis may cause which biochemical abnormality

Answer 10

Sarcoidosis may cause hypercalcaemia

Question 11

Optic neuritis is common in patients taking which TB treatment?

Answer 11

Optic neuritis is common in patients taking ethambutol

Question 12

Pneumocystis jiroveci pneumonia causes which distinguishable feature

Answer 12

Pneumocystis jiroveci pneumonia causes desaturation on exercise
seen in HIV patients

Question 13

Mesothelioma is

Answer 13

Mesothelioma is a cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure

Question 14

mesothelioma features

Answer 14

• Dyspnoea, weight loss, chest wall pain
• Clubbing
• 30% present as painless pleural effusion
• Only 20% have pre-existing asbestosis
• History of asbestos exposure in 85-90%, latent period of 30-40 years

Question 15

mesothelioma investigation results and management

Answer 15

Question 16

Acute exacerbation of COPD: BiPaP is indicated if

Answer 16

Acute exacerbation of COPD: BiPaP is indicated if type 2 respiratory failure develops despite medical therapy

Question 17

In the step-down treatment of asthma, aim for

Answer 17

In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids

Question 18

In idiopathic pulmonary fibrosis … is the investigation of choice

Answer 18

In idiopathic pulmonary fibrosis, high resolution CT is the investigation of choice

Question 19

Pneumocystis jiroveci penumonia is treated with

Answer 19

Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

Question 20

Pneumonia, peripheral blood smear showing red blood cell agglutination

Answer 20

→ Mycoplasma pneumoniae

Question 21

The features of acute severe asthma are

Answer 21

PEFR 33-50% best or predicted inability to complete full sentences
RR >25/min
pulse >110 bpm

Question 22

Preceding influenza predisposes to….pneumonia

Answer 22

Preceding influenza predisposes to Staphylococcus aureus pneumonia

Question 23

…score is recommended by BTS guidelines to be used to help identify patients with a pulmonary embolism that can be managed as outpatients

Answer 23

The Pulmonary Embolism Severity Index (PESI) score is recommended by BTS guidelines to be used to help identify patients with a pulmonary embolism that can be managed as outpatients

Question 24

which organism causing pneumonia is associated with symmetrical, erythematous rash with ‘target’ lesions over the whole body

Answer 24

Mycoplasma is associated with erythema multiforme

Question 25

which organism causing pneumonia causes neurological signs

Answer 25

Mycoplasma can cause immune-mediated neurological diseases