Respiratory Medicine

Question 1

What is the pathophysiology of asthma?

Answer 1

Type 1 hypersensitivity reaction
Sensitisation: IL-4, 13 > Th2 > IgE in mast cells
Excitation: degranulation of leukotrines, histamine, PGs
Causing: bronchoconstriction, mucosal oedema, mucus hypersecretion, denudation of epithelium

Question 2

What are the four cardinal symptoms of asthma?

Answer 2

SOB, chest tightness, wheeze, cough + sputum

Question 3

What areas should be covered when assessing asthma severity?

Answer 3

Daytime symptoms
Nighttime symptoms
Physical activity
Exacerbations
Number of sick days
Use of reliever
FEV1/FVC
PEF

Question 4

What are the spirometry findings in asthma?

Answer 4

FEV1/FVC 12% (400mL) increase post-BD

Question 5

What are the management steps for chronic asthma?

Answer 5

1. Identify + avoid triggers
2. Reliever: SABA
   +/- Preventor: inhaled corticosteroid (fluticasone)
   +/- LABA: salmeterol
   +/- LTRA: montelukast

Question 6

What are the spirometry findings of COPD?

Answer 6

FEV1/FVC <12% (400mL) reversibility post-BD

FEV1 then used to grade severity

Question 7

What are the GOLD criteria for COPD?

Answer 7

1. Mild: FEV1 >80% predicted
2. Moderate: FEV1 between 50-80% predicted
3. Severe: FEV1 between 30-50% predicted
4. FEV1 <30% predicted

Question 8

What is the pathophysiology of COPD?

Answer 8

Smoking > airway injury >
Chronic bronchitis (chronic inflammation)
Emphysema (destruction of alveoli + fibrosis)

Question 9

Which screening tools are available to assess the severity of CAP?

Answer 9

CURB-65 (easiest)
SMART-COP (endorsed by RAH)
Pneumonia Severity Index (most time consuming)
(used to determine need for hospitalisation)

Question 10

What are the components of SMART-COP?

Answer 10

S - Systolic BP 25
T - HR >125
C - Confusion
O - Oxygen sats <93%
P - pH low (2)
(3+ points = admit to hospital)

Question 11

What is the only treatment proven to extend life in COPD?

Answer 11

Oxygen therapy

Question 12

What are some causes of bronchiectasis?

Answer 12

CF, TB, lung abscess

Question 13

What is the most common cause of haemoptysis?

Answer 13

Bronchiectasis

Question 14

What causes restrictive lung disease?

Answer 14

Interstitial lung disease
Space occupying lesion
Pleural effusions
Multiple sclerosis
SCI

Question 15

What is the most common sign in pulmonary embolism?

Answer 15

Tachycardia

Question 16

What is a Ghon complex?

Answer 16

Calcified TB nodule + lymph nodes

Question 17

What is the most common extrapulmonary location for TB to spread?

Answer 17

?Kidneys (according to DeJa Review)

Question 18

What is Cheyne-Stokes Respiration and in which conditions can it occur?

Answer 18

Breathing that is progressively deeper then shallower an may result in periods of apnoea.
May occur in brainstem lesions, raised ICP, heart failure, pulmonary oedema and altitude sickness.

Question 19

What is Kussmaul breathing and when may it occur?

Answer 19

Deep, laboured hyperventilation associated with metabolic acidosis (especially DKA) and kidney failure.

Question 20

What are the clinical features of carbon dioxide retention?

Answer 20

Asterixis
Myoclonic jerks
Decreased conscious state
Tachypnoea

Question 21

What is Type I respiratory failure?

Answer 21

= low oxygen with normal/low carbon dioxide

underlying problem is with the diffusion membrane, e.g. PE, pulmonary oedema, pneumonia, ARDS

Question 22

What is Type II respiratory failure?

Answer 22

= low oxygen with high carbon dioxide

underlying problem is with decreased ventilation, e.g. COPD, asthma, suffocation

Question 23

What are the causes of clubbing?

Answer 23

Bronchiectasis
Non-small cell lung cancer
Interstitial lung disease (e.g. pulmonary fibrosis, sarcoidosis)
Lung abscess
Cystic fibrosis

Question 24

Which pneumonia-causing organism can be contracted from parrots, pigeons and other birds?

Answer 24

Chlamydia psittaci, causing psittacosis/ornithosis

Question 25

What are the three main causes of chronic cough in otherwise healthy non-smokers with a normal CXR?

Answer 25

Asthma
Sinusitis / Rhinitis with post-nasal drip
GORD

Question 26

What further steps can be taken when a patient’s spirometry results are borderline for asthma?

Answer 26

Peak flow measurement at home (for diurnal variation)
Exercise test (look for drop in peak flow)
Therapeutic trial of inhaled steroids

Question 27

Which antibiotics are most commonly used to treat tuberculosis?

Answer 27

R - Rifampicin
I - Isoniazid
P - Pyrazinamide
E - Ethambutol
S - Streptomycin (may be used instead of ethambutol)

Question 28

What are the two most common causes of typical CAP?

Answer 28

Strep pneumoniae, haemophilus influenzae

Question 29

What are the 3 most common causes of atypical CAP?

Answer 29

Chlamidophila, legionella, mycoplasma

Question 30

What are the 3 most common causes of HAP?

Answer 30

Pseudomonas, staph aureus, enteric gram negative rods

Question 31

What is the most common cause of bacterial pneumonia after influenza?

Answer 31

Staph aureus

Question 32

Which organism that causes pneumonia will produce a positive cold agglutinin test?

Answer 32

Mycoplasma

Question 33

What is the most common cause of pneumonia transmitted by birds?

Answer 33

Pneumonia psittaci

Question 34

What bacteria is typically found in air-conditioning ducts and aerosoled water?

Answer 34

Legionella

Question 35

Which cause of pneumonia can result in a fungal ball?

Answer 35

Aspergillus

Question 36

Which bacteria typically causes rust coloured sputum?

Answer 36

Strep pneumoniae

Question 37

Which bacteria typically causes red currant jelly sputum?

Answer 37

Klebsiella