RS

Question 1

Pickwickian syndrome

Answer 1

Obesity hypoventilation syndrome
PCO2 >45 mmhg

Question 2

Mesothelioma

Answer 2

Pleural effusion without mediastinal shift

Question 3

Pulmonary alveolar proteinosis

Answer 3

Crazy paving pattern on CT

Question 4

Caplan syndrome

Answer 4

Coal workers

Question 5

Normal anion gap

Answer 5

8-12 meq

Question 6

Severe covid criteria

Answer 6

SpO2<90%
RR > 30/min
Mean Arterial Pressure < 70mmHg

Question 7

Fev1/FVC ratio

Answer 7

Low - <0.7 - obstructive - bronchodilator reversibility (↑Fev1 > 12% after SABA inhalation) -
+ve - Asthma(DLCO↑/n), bronchiectasis
-ve - COPD(↓DLCO-emphysema, (n)DLCO-chronic bronchitis), bronchiectasis

Normal/↑ - >0.7 - restrictive(FVC <80% predicted) -
Intrinsic(↓DLCO) - Fibrosis, ILD, occupational
Extrinsic(DLCO(n))- kyphoscoliosis, Neuromuscular disorders

Question 8

Side effects of ATT

Answer 8

Pyrazinamide - hyperuricemia
Cycloserine - psychosis
Ethionamide/PAS - hypothyroidism
Bedaquiline - QT prolongation
Ethambutol - blindness

Question 9

Fever
Weight loss
LN enlarged
↑ACE

Answer 9

Sarcoidosis

Question 10

Acid base disorder Compensation

Answer 10

Acidosis
Metabolic - CO2 = (1.5 x HCO3) +8 ±2
Respiratory - every ↑10mmhg pco2 → ↓1meq(acute), ↓4meq(chronic) HCO3

Alkalosis
Metabolic - CO2 = HCO3 + 15
Respiratory - every ↓10mmhg pco2 → ↑2meq(acute), ↑4meq(chronic) HCO3

Question 11

Aspiration in bed ridden patients lung segment

Answer 11

RUL posterior and/or RLL superior

Question 12

Central cyanosis

Answer 12

Severe lung disease
Severe heart disease
R→L shunts, pul. AV fistula
High altitude
Abnormal hemoglobin

Question 13

Peripheral cyanosis

Answer 13

Arterial obstruction
Venous obstruction
Cold exposure

Question 14

Alveolar arterial gradient

Answer 14

Hypoxia
(n)P(A-a) - (5-10mmhg) : Hypoventilation

↑P(A-a) - >10mmhg :
Shunt
VQ mismatch
Alveolar membrane disease

Question 15

Pulmonary artery hypertension

Answer 15

Vasoreactive test (Inhale NO →↓mPAP>10mmhg)
+ve - CCBs
-ve-
Low risk (NYHA II,III)- PDE 5 inhibitors(Tadafil), ERA(Ambrisentans)
High risk (NYHA IV) - PDE5i +ERA + inj PGI2(epoprostenol)

Question 16

HAGMA

Answer 16

Ketoacidosis
Lactic acidosis
Renal failure (uremia)
Toxins: methanol, ethylene glycol, paraldehyde, salicylates

Question 17

NAGMA

Answer 17

Panreatic fistula
Ureterosigmoidostomy
Diarrhoea
Carbonic anhydrase
Aldosterone deficiency
Renal Tubular acidosis

Question 18

UIP

Answer 18

Mc ILD overall
Mc in RA
M>F, smoker, elderly, chronic symptoms

Biopsy - fibroblastic foci

CT: honeycombing, traction bronchiectasis

Treatment:
Pirfenidone
Nintedanib
Poor prognosis

Question 19

NSIP

Answer 19

Mc ILD in Connective tissue disease
F>M, non smoker, middle age, subacute symptoms

Biopsy - rare fibroblastic foci

CT - ground glass opacity

Treatment
Steroids
Good prognosis

Question 20

Tension pneumothorax

Answer 20

Tachypnea
Hypotension
Hyperresonant note

Site of needle
5th ICS mid axillary line
2nd ICS mid clavicular line

Site of ICD
5th ICS mid axillary line

Question 21

Mycoplasma pneumonia

Answer 21

Atypical pneumonia
Walking pneumonia
Hemolytic anemia
Lung infiltrates
No cell wall - no response to β lactams
Diagnosis - serology
Treatment
Fluroquinolones
Macrolides
Tetracyclines

Question 22

Legionella pneumonia

Answer 22

Atypical pneumonia
Legionnaires disease
Diarrhoea
Hypomatremia
Confusion
Altered LFT
Lung infiltrates
No cell wall - no response to β lactams
Diagnosis - serology
Treatment
Fluroquinolones
Macrolides
Tetracyclines