Respiratory Long

Question 1

FEatures suggesting predominate bronchiectasis

Answer 1

1. Clubbing
2. Suspected COPD, but <10 yr pack Hx
3. Hx of TB or recurrent pneumonia
4. Disadvantaged childhoos
5. Unusual organisms in sputum

Question 2

Cx of Bronchiectasis

Answer 2

Pneumonia
Pleurisy
Empyema
Lung abscess
Cor pulmonale
Cerebral abscess (rare)
Amyloid

Question 3

Suitability for pneumonectomy in cancer

Answer 3

FEV1 >1.5 L

CAn walk up 3 flights of stairs at baseline

Question 4

DDX for daytime sleepiness

Answer 4

Poor sleep hygeine
Poor adjustment to shift work
Use of sedative and stimulant drugs
Depression with or w/o early morning waking
Idiopathic hypersonolence
NAcrolepsy
OSA/CSA
Restless legs

Question 5

Ix for OSA

Answer 5

Sleep study
Home PaO2 measurements
TFTs 
ECG for arrhythmias
TTE for PHTN and CCF

Question 6

Features of Sarcoidosis

Answer 6

Hilar lymphadenopathy
B symptoms
Lymphadenopathy
Cough and dyspnea
Arthralgia 
Erythema nodosum
Eye symptoms: anterior uveitis, dry eyes
Cranial nerve palsies, cardiac arrhythmia, hypercalcemia
Cholestatic LFTs

Question 7

Ix in Sarcoidosis

Answer 7

ESR
ACE level - not elevated in lymphoma
Calcium level
CXR
PFTs - usually restrictive picture, but can be mixed
PET scan
Biopsy
Consider need for cardiac MRI

Question 8

Stages of CXR changes in sarcoid

Answer 8

Stage 1 - Bilateral hilar lymphadenopathy alone (Acute and reversible stage)
Stage 2 - Bialteral hilar lymphadenopathy and pulmonary infiltrate
Stage 3 - Pulmonary infiltration without hilar lymphadenopathy

Question 9

Mx of Sarcoidosis

Answer 9

1. Pred 1 mg/kg for 6 weeks then taper for total 12 months

2. Longer treatment: MTX, AZA, HCQ for skin, inflixamab

Question 10

GOLD Classification

Answer 10

Gold 1 - Mild - FEV1 >80%
Gold 2 - Moderate - FEV1 50-80%
Gold 3 - Severe - FEV1 <50%
Gold 4 - Very Severe - FEV1 <30%

Question 11

Bode index

Answer 11

• multidimensional index incorporating BMI, FEV1, dyspnoea score and exercise capacity (6MWT).

Question 12

Causes of Upper Lung Fibrosis

Answer 12

Upper lobe
	- Coal miners pneumoconiosis
	- Hypersensitivity pneumonitis (extrinsic allergic alveolitis)/ Histiocytosis
	- Ank Spond
	- Radiation
	- TB
Silicosis/Sarcoidosis

Question 13

Varenicline (Champix)

Answer 13

Partial agonist of nicotinic receptors

o Most effective monotherapy
o CIs: Pregnancy, psychiatric disease, CVD, reduce dose in renal disease, SEs: Nausea

Question 14

Bupropion (Zyban)

Answer 14

o Antidepressent with uncertain mechanism

o CI: bipolar, seizures, pregnancy, MAO-I use

Question 15

Pulm HTN Classification

Answer 15

o Group 1: PAH (eg. idiopathic, heritable (BMPR2, ALK1), drugs (eg. Amphetamines, IFN), CTD, HIV
o Group 2: Left heart disease (most common): Elevated LA pressure (mLAP >14mmHg)
o Group 3: Lung disease (+/- hyoxaemia) Eg. COPD, ILD
o Group 4: CTEPH - V/Q best screening test, special phase CTPA gold-standard
o Group 5 – Multifactorial - Eg. Chronic haemolytic anaemia, myeloproliferative disorders, sarcoid, vasculitis

Question 16

Diagnosis of CF

Answer 16

Clinical feature os CF or FHx of CF AND EITHER

• 2 CF causing mutations
• Positive sweat chloride on 2 occasions (60mmol/L)
• Nasal potential difference tracing typical for CF

Question 17

PBS listed treatment for IPF that have shown to slow progression of disease

Answer 17

Pirfenidone

Nintendanib

Question 18

HRCT Findings of UIP pattern

Answer 18

• Subpleural and basal predominance
• Reticular abnormality
• Honeycombing (with or w/o traction bronchiectasis)
• Absence of features listed as inconsistent with UIP (mid or upper zone, peribronchovascular changes, extensive ground glass opacity, profuse micronodules, cysts, mosaic attenuation, consolidation)

Question 19

PHTN Group 1 Tx options

Answer 19

▪ endothelin receptor antagonist
○ Bosentan, ambrisentan and macitentan (PO)
○ SE’s: Liver dysfunction (monthly monitoring), teratogenic and many drug interactions
▪ prostanoid analogues
○ Epoprostenol (IV)
○ Continuous IV infusion via a CVC, which complicates its long-term use
○ Severe rebound pulmonary hypertension and symptoms of vasodilation can occur if therapy is interrupted so it is generally only used for severe disease refractory to other therapies
○ Iloprost (INH 6-9x daily)
○ Requires strict patient adherence, to avoid worsening of symptoms when therapy is interrupted.
▪ phosphodiesterase type 5 (PDE5) inhibitors
○ Sildenafil (PO TDS)
○ tadalafil (PO daily)
○ SE’s: many drug interactions (consult an appropriate text on drug interactions).
▪ soluble guanylate cyclase stimulators
○ Riociguat (PO TDS)
○ SE: multiple drug interactions.
○ Contraindicated with phosphodiesterase 5 inhibitors
○ Indications: in addition to Group 1 also Group 4 CTEPH