Respiratory Station

Question 1

Causes of basal pulmonary fibrosis

Answer 1

Rheumatoid arthritis
Asbestosis
Connective tissue disorders (SS, SLE, PM, DM, MCTD)
Idiopathic pulmonary fibrosis
Other causes: chemicals (lead, mercury, vinylchlorides, paraquat), drugs (MANS)

Question 2

Causes of apical pulmonary fibrosis

Answer 2

Coal worker’s pneumoconiosis
Hypersensitivity pneumonitis
Ankylosing spondylitis
ABPA
Radiation
TB
Sarcoidosis
Silicosis

Question 3

Treatment of pulmonary fibrosis

Answer 3

MDT-approach
Treat underlying cause
Physiotherapy

Steroids
Immunosuppressive agents
Anti-oxidants
Supplemental oxygen
Antifibrotics (pirfenidone, nintedanib)
Lung transplant

Question 4

Differential for bibasal crackles

Answer 4

Idiopathic pulmonary fibrosis
Bronchiectasis
Pulmonary oedema
Bilateral pneumonias

Question 5

Cystic fibrosis genetics

Answer 5

Autosomal recessive
CFTR gene mutations (chromosome 7)
Most common mutation is deltaF508

Prevents chloride from moving out of the cells, resulting in sodium hyper-absorption.

Question 6

Systems affected in CF

Answer 6

Pulmonary: bronchiectasis, pulmonary hypertension, cor pulmonale
GI: pancreatic insufficiency, diabetes mellitus, gallstones, focal biliary cirrhosis, meconium ileus, DIOS
Renal: renal stones
Reproductive: infertility
ENT: sinusitis, nasal polyps
MSK: osteoporosis

Question 7

Treatment of CF bronchiectasis

Answer 7

Daily chest physio
Dornase alpha + hypertonic saline nebs
Inhaled tobramycin or azithromycin for chronic pseudomonas infection
CFTR modulators (ivacaftor, lumacaftor)
Lung transplantation

Question 8

Causes of bronchiectasis

Answer 8

Congenital: CF, Kartagener’s syndrome, Yellow nail syndrome
Childhood infection: Measels, pertussis
Immune over-activity: RA, ABPA, IBD
Immune under-activity: Hypogammaglobinaemia, CVID, HIV
Aspiration: GORD, alcoholics

Post-TB, COPD

Question 9

Indications for lung transplantation

Answer 9

Bronchiectasis (CF)
Pulmonary fibrosis
COPD
Pulmonary arterial hypertension

Question 10

Important late complication of lung transplantation

Answer 10

Bronchiolitis obliterans syndrome

Question 11

Paraneoplastic syndromes in lung cancer

Answer 11

Small cell: SIADH, ACTH secretion, LEMS, cerebellar degeneration (anti-Hu )
Squamous cell: PTHrP secretion, Horner’s syndrome, Pancoast syndrome
Adenocarcinoma: HPOA, Troussea’s syndrome (migratory thrombophlebitis)

Question 12

Treatment of lung cancers

Answer 12

NSLC: surgery or radical radiotherapy, +/- adjuvant chemotherapy in stage 1 and 2, if stage 3 or 4, chemotherapy and radiotherapy
SLC: chemotherapy and radiotherapy

Question 13

Causes of transudative pleural effusions

Answer 13

Cardiac failure
Renal failure
Liver failure
Hypothyroidism
Meig’s syndrome

Question 14

Causes of exudative pleural effusions

Answer 14

Infections: Parapneumomic effusion, TB, empyema

Malignancy

Infarction

Serositis: RA, SS, Sarcoidosis

Question 15

Reasons for a lateral thoracotomy scar

Answer 15

Wedge resection
Lobectomy
Bullectomy
Pneumonectomy

Question 16

Reasons for a VATS scar

Answer 16

Diagnostic: biopsy, cancer staging,
Therapeutic: wedge resection, lobectomy, bullectomy, decortication,
pleurodesis

Question 17

Indications for lobectomy or pneumonectomy

Answer 17

Lung cancer
Localised bronchiectasis
TB (historically)
Aspergilloma
Traumatic lung injury

Question 18

Indications for LTOT in COPD

Answer 18

ph <7.3
pH <8 PLUS pulmonary hypertension, cor pulmonale, polycythaemia, nocturnal hypoxia

Question 19

Classification of COPD

Answer 19

GOLD staging (FEV1 of patient vs predicted)
- mild >80%
- moderate 50-80%
- severe 30-50%
- very severe <30%

Question 20

Work-up for lobectomy or pneumonectomy

Answer 20

FVC >1.5 L or >2 L
Cardiopulmonary exercise testing >15 ml/kg/min
Diffusion capacity >40%