Respiratory exam

Question 1

What are the indications for a VATs procedure

Answer 1

Decortication, segmentectocmy, bullectomy, lobectomy, treatment for recurrent pneumothoraces

Question 2

benefits of VATs vs. thoracotomy

Answer 2

Reduced pain , wound complicaitons, healing time , reduced length of stay

Question 3

Indications for a lobectomy

Answer 3

Main : Lung Ca
others: TB , Lung Abscess, Aspergilloma

Question 4

What are the diagnostic investigations for a suspected lung cancer

Answer 4

Diagnosis: Chest radiograph , Staging CT, Tissue Diagnosis ( EBUS , Bronchoscopy with direct sampling)

Question 5

What is the work up for lung cancer

Answer 5

1) Full lung function tests including transfer factor assessment.
2) Cardiopulmonary exercise testing

Question 6

What FEV1 for a lobectomy and pneumonectomy

Answer 6

Lobectomy >1.5 or >2.0

Question 7

What is the VO2 Max for good operative outcome for a pneumonectomy

Answer 7

VO2 max of at least 15ml/kg/min.

Question 8

What are the different histological cell types of cancer

Answer 8

Lung cancer be classified into small cell and non-small cell lung cancer.
Non Small cancer is adenocarcinomas, large cell and squamous cell

Question 9

What is good respiratory conservative management plan

Answer 9

Up to date with vaccines
Smoking cessation
Lung rehab

Question 10

What are the treatment options for NSCLC and SCLC

Answer 10

SCLC tends to be aggressive and present late , typical treatment is palliative chemotherapy

Question 11

How would you manage a pneumothroax

Answer 11

Manage with A-E Approach
if primary then aspirate up to 2.5L < if no residual volume and symptom free then consider discharge. If ongoing symptoms or residual volume is large then consider chest drain

Question 12

When would you consider surgical management of a pneumothorax

Answer 12

If ongoing air leak, not resolving with chest drain insertion or if recurrent pneumothoraces then surgical management may be considered.

Question 13

What is the investigations of asthma

Answer 13

if unstable - A- E Approach
PEFR
Eosinophils (FBC) or WCC raised
IgE levels
CXR
reversible airflow obstruction , PEFR / FEV1 in response to a beta agonist - 200ml in FEV1 or 15% change compared to baseline.

Question 14

causes of airway obstruction

Answer 14

typically it is either asthma or chronic obstructive pulmonary disease, rarer causes include Bronchiectasis or obliterative bronchiolitits.`

Question 15

Causes of ILD

Answer 15

1) idiopathic, Sarcoidosis,
2) occupational disorder - asbestosis or silicosis , extrinsic allergic alveolitis (psiticosis),
3) CTD - SLE , Rheumatoid Arthirtis, ANK spond.
4)Medications : Nitrofurantoin , methotrexate , Amiodarone.

Question 16

A patient with IPF , if FVC < 80%

Answer 16

Consider pifernidone or nintenanib

Question 17

Tertiary management of ILD includes

Answer 17

MDT , HRCT review of underlying aetiology of the ILD. MDT approach of the condition

Question 18

Common connective tissue disease that cause ILD

Answer 18

SLE , Systemic sclerosis , Rheumatoid arthritis , ANK spond

Question 19

Ix for ILD

Answer 19

confirmation : Lung Function tests
Cause: HRCT , Avian precipitans, EBUS, Lung Biopsy (last resort) , CTD screen

Question 20

Poor prognostic factors in ILD

Answer 20

IPF has the worse prognosis, median survival is 2-3 years from diagnosis. Poor prognostic factors include older age, dyspnoea, coexisting emphysema , extensive radiographic involvement , exertional desaturation

Question 21

MX for IPF

Answer 21

Lung rehab , Nintenanib, pirfenidone , lung transplant.

Question 22

Mx for Non specific interstitial pneumonia

Answer 22

oral or IV Steroid and steroid sparing agent - Azathioprine or mycophenolate mofetil.

Question 23

Causes of CF

Answer 23

Autosomal recessive condition of the CFTr gene that causes dysfunction in Cl- transport and increased salt excretion , manifests as secretions having increased viscosity affecting the GI tract, respiratory system and the reproductive system

Question 23

Complications of CF

Answer 23

Pancreatic insufficiency and therefore hyperglycaemia
Bronchiectasis
Liver failure
Gallstones / Kidney stones
Osteoporosis
Male infertility
at risk of aspergilloma and pneumothorax

Question 24

Microbiology of cystic fibrosis

Answer 24

Different profile of bacteria, commonly pseudomonas, poor prognosis is conferred by Burkholderria and is a contraindication to lung transplant

Question 24

Management of CF

Answer 24

MDT approach
Physiotherapy
Mucolytics
Prophylactic and targetted long duration abx
Creon tablets
Multivitamin therapy
Nutritional supplementation