Respiratory Medicine 1

Question 1

What is the FEV1/FVC ratio in obstructive lung disease?

Answer 1

Markedly reduced -

Question 2

What are the features of an obstructive lung disease?

Answer 2

Poorly recoiling lung tissue (floppy) so quick to inflate but poor deflation
So TLC is normal or high but FVC is reduced and FEV1 is markedly reduced

Question 3

What defines severity in obstructive lung disease spirometry?

Answer 3

FEV1 % of expected

0. 8-0.5 = mild
1. 3-0.5 = moderate

Question 4

3 examples of obstructive lung disease?

Answer 4

COPD, asthma, Bronchiectasis

Question 5

What is a restrictive lung disease?

Answer 5

‘Stiff’ lungs which are difficult to inflate but quick to deflate
FVC and FEV1 are both reduced

Question 6

What happens to the FEV1/FVC ratio in restrictive lung disease?

Answer 6

Often unaffected

Question 7

2 examples of restrictive lung disease?

Answer 7

Pulmonary fibrosis

Sarcoidosis

Question 8

What is the pathophysiological background of bronchiectasis?

Answer 8

Irreversible dilatation of the bronchi with wall thickening

Increased mucus production, poor trachebronchial clearance and resultant chronic airway infection

Question 9

What sort of things can predispose to bronchiectasis? (4)

Answer 9

Severe childhood asthma
TB
Pertussis
Measles

Question 10

Chronic congenital condition linked with Bronchiectasis?

Answer 10

Cystic fibrosis

Question 11

Enzyme deficiency often implicated in respiratory disease?

Answer 11

a1 antitrypsin deficiency

Question 12

Immunodeficiency syndrome linked to bronchiectasis?

Answer 12

Hypogammaglobulinaemia

Question 13

Describe the sputum associated with bronchiectasis?

Answer 13

Chronic sputum production in large amounts
May be purulent, often dark or green
May be bloodstained

Question 14

2 upper airway conditions linked with bronchiectasis?

Answer 14

Nasal polyps

Chronic sinusitis

Question 15

Management strategies for bronchiectasis?

Answer 15

Bronchodilators, O2, nutritional support
Chest physio - active cycle breathing
Long term azithromycin

Question 16

What Abx can be given long term in bronchiectasis?

Answer 16

Azithromycin

Question 17

Surgical management options for bronchiectasis?

Answer 17

Lung resection
Massive haemoptysis - bronchial artery embolization
Lung transplant

Question 18

Abx for bronchiectasis (and generally infection) confirmed to be with pseudomonas aeruginosa?

Answer 18

Ciprofloxacin

Question 19

Abx for general bronchiectasis management or those colonised with h. Influenzae?

Answer 19

Amoxicillin or clarithromycin

Question 20

3 subtypes of bronchiectasis?

Answer 20

Cylindrical (commonest)
Varicose
Cystic - worst, associated with CF

Question 21

What underlying condition should be considered in bronchiectasis patient with no identifiable pre-infection and/or unusual colonisations?

Answer 21

Immunocompromise/HIV

Question 22

CAPT Kangaroo has Mounier Kuhn of bronchiectasis causes?

Answer 22

Congenital - CF, connective tissue disorders,
Allergic bronchopulmonary aspergillosis
Post-infection - Measles, pneumonia, RSV (bronch), pertussis, flu
TB and other granulomatous disease
Kartagener’s disease (PCD)
Mounier-Kuhn syndrome (tracheobronchomegaly)

Question 23

What is Williams-Campbell syndrome?

Answer 23

Bronchial cartilage deficiency -> congenital cystic bronchiectasis
Deficiency typically from 4th-6th order bronchial cartilage

Question 24

Common findings on auscultation for bronchiectasis?

Answer 24

Course early-inspiratory crackles
Large airway rhonchi (low pitched snore)
Wheeze

Question 25

Gold standard Ix for diagnosing bronchiectasis?

Answer 25

HRCT

Question 26

What is the definition of pneumonia?

Answer 26

Infection of the lung parenchyma with airway consolidation

Question 27

What is the role of air bronchograms in pneumonia CXR?

Answer 27

If present, suggestive of a pneumonia type consolidation. If absent, indicates more likely a blockage or solid something restricting the airway (e.g. Tumour)

Question 28

In addition to a high CURB65, what other clinical features may make you consider escalation of care in a pneumonia patient?

Answer 28

Hypoxaemia Number of lobes involved Comorbidities

Question 29

What organ abnormality predisposes to pneumococcal pneumonia as well as other capsulated bacterial infection?

Answer 29

Asplenism

Question 30

Lobar vs bronchopneumonia on CXR?

Answer 30

Lobar is consolidation confined to a lobe | Bronchopneumonia is often consolidation of lung bases

Question 31

3 common bacterial causes of atypical pneumonia syndromes?

Answer 31

Mycoplasma pneumoniae Chlamydia pneumoniae Legionella pneumophila

Question 32

What does coxiella burnettii cause?

Answer 32

Q fever

Question 33

Apart from the 3 main bacterial causes what are some other causes of atypical pneumoniae?

Answer 33

Coxiella burnettii - Q fever | Viruses - adenovirus, influenza, RSV etc.

Question 34

Main differentiating factors of mycoplasma pneumonia from pneumococcal pneumonia?

Answer 34

Non-productive, hacking cough Systemic features - erythema multiforme etc. Neurological features - Guillain-Barre, cerebellar ataxia Haematological features - cold agglutinin disease -> haemolytic anaemia GI features - diarrhoea, abdo pain etc.

Question 35

Which is the most severe atypical pneumonia and what is outbreaks of it often associated with?

Answer 35

Legionella pneumophila | Air conditioning system failure or poor maintenance

Question 36

Rx for atypical pneumonia?

Answer 36

Start on amoxicillin as per typical CAP Can also use macrolides Legionella may require Rifampicin

Question 37

3 criteria for diagnosing pneumonia without CXR?

Answer 37

Cough and at least 1 other LRTI Sx or fever New focal signs on chest exam No other better explanation for illness

Question 38

3 criteria for diagnosing pneumonia with CXR?

Answer 38

Cough and at least 1 other LRTI Sx or fever New radiographic infiltrates No better explanation for illness

Question 39

What Ix are required to identify atypical pneumoniae?

Answer 39

Serology (paired sera - Ab and Ag)

Question 40

Rx for CAP of unknown causative organism?

Answer 40

Amoxicillin and clarithromycin - covers pneumococcus as well as atypicals

Question 41

Ix for pulmonary embolism?

Answer 41

WELLS score for probability. Low risk -> D dimer (very sensitive but non-specific) High risk -> V/Q scan and CTPA

Question 42

What does a COPD rescue pack consist of?

Answer 42

``` Oral corticosteroids (7-14 days) Antibiotics if sputum is purulent ```

Question 43

First line management of COPD?

Answer 43

SABA or SAMA

Question 44

What 2 inhaled drugs can't be taken together in COPD long term management?

Answer 44

SAMA and LAMA

Question 45

Which type of lung cancer typically causes clubbing?

Answer 45

Non-small cell

Question 46

If a lung cancer occurs in a non-smoker what type is it likely to be?

Answer 46

NSCLC - adenocarcinoma

Question 47

What type of lung cancer typically presents with metastasis having already occurred?

Answer 47

Small cell

Question 48

4 most common symptoms of lung cancer?

Answer 48

Chronic cough Haemoptysis SOB CP

Question 49

What constitutes a transudate?

Answer 49

Low protein content (

Question 50

3 causes of a transudative pleural effusion?

Answer 50

Heart failure Liver cirrhosis Nephrotic syndrome

Question 51

What constitutes an exudate?

Answer 51

High protein content (>30g/L)

Question 52

3 causes of exudative pleural effusion?

Answer 52

Infection Malignancy Pulmonary embolism

Question 53

3 places to send off pleural tap?

Answer 53

Chemistry (transudate vs exudate) Cytology (cancer) Microbiology (infection)

Question 54

What type of pleural effusions need drainage?

Answer 54

exudates

Question 55

Type of pneumonia which may persist for a while, proving difficult to treat with normal Abx?

Answer 55

Haemophilus