Respiratory Medicine

Question 1

Asthmatic features/features suggesting steroid responsiveness in COPD

Answer 1

• previous diagnosis of asthma or atopy
• a higher blood eosinophil count
• substantial variation in FEV1 over time (at least 400 ml)
• substantial diurnal variation in peak expiratory flow (at least 20%)

Question 2

Causes of a raised TLCO

Answer 2

• asthma
• pulmonary haemorrhage (e.g. granulomatosis with polyangiitis, Goodpasture’s)
• left-to-right cardiac shunts
• polycythaemia
• hyperkinetic states
• male gender, exercise

Question 3

Causes of a lower TLCO

Answer 3

• pulmonary fibrosis
• pneumonia
• pulmonary emboli
• pulmonary oedema
• emphysema
• anaemia
• low cardiac output

Question 4

Indications for corticosteroid treatment for sarcoidosis

Answer 4

• patients with chest x-ray stage 2 or 3 disease who are symptomatic. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment
• hypercalcaemia
• eye, heart or neuro involvement

Question 5

Friedlander’s Pneumonia

Answer 5

• Typically occurs in middle-aged alcoholic men. - - Chest x-ray features may include abscess formation in the middle/upper lobes and empyema.
  -The mortality approaches 30-50%

Question 6

Fibrosis predominately affecting the lower zones

Answer 6

• idiopathic pulmonary fibrosis
• most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
• drug-induced: amiodarone, bleomycin, methotrexate
• asbestosis

Question 7

Fibrosis predominately affecting the upper zones

Answer 7

• hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis)
• coal worker’s pneumoconiosis/progressive massive fibrosis
• silicosis
• sarcoidosis
• ankylosing spondylitis (rare)
• histiocytosis
• tuberculosis
• radiation-induced pulmonary fibrosis
  may develop following radiotherapy for breast or lung cancer
  typically seen between 6 and 12 months following completion of radiotherapy course

Question 8

When to assess COPD patients for LTOT

Answer 8

• very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
• cyanosis
• polycythaemia
• peripheral oedema
• raised jugular venous pressure
• oxygen saturations less than or equal to 92% on room air

Question 9

In patients who are subsequently diagnosed with lung cancer, what percentage of recent chest x-rays were reported as normal?

Answer 9

10%