Resp

Question 1

Diagnosis
Ghon complex

Answer 1

TB

Question 2

Which area of lungs does TB affect

Answer 2

Apex

Question 3

How to treat active TB

Answer 3

2 months of:
Rifampicine
Isoniazid
Pyrazinamide
Ethambutol

4 months of:
Rifampicin
Isoniazid

Question 4

How to treat latent TB

Answer 4

3 months of rifampicin and isoniazid OR 6 months isoniazid

Question 5

How long to treat meningeal TB

Answer 5

Minimum of 12 months, also use steroids

Question 6

Rifampicin
What does it do
Side effects

Answer 6

Liver enzyme inducer
Orange secretions, hepatitis, flu like sx.

Question 7

Isoniazid
What does it do
Side effects

Answer 7

Inhibit HAN

liver enzyme inhibitor
Hepatitis
Agranulocytosis
Neuropathy (prevent with pyridoxine (Vitamin B6)

Question 8

Pyrazinamide side effects

Answer 8

hyperuricaemia causing gout
arthralgia, myalgia
hepatitis

Question 9

Ethambutol side effects

Answer 9

optic neuritis: check visual acuity before and during treatment
dose needs adjusting in patients with renal impairment

Question 10

‘egg-shell’ calcification of the hilar nodes. Diagnosis

Answer 10

silicosis.

Question 11

Does asbestosis affect upper or lower lobes.

Answer 11

Lower fibrosis

Most others are upper,

Question 12

Common cause of pneumonia after influenza

Answer 12

Staph aureus

Question 13

Features of klebsiella pneumonia

Colour of sputum?
Demographic?
Complications?

Answer 13

Common in alcoholics and diabetics
Common after aspiration
Abscesses and empyema
Bowel flora
redcurrant jelly sputum

Question 14

Features of mycoplasma pneumonia

Answer 14

Dry cough
Can get systemic complications: neuro involvement / pericarditis/ ITP/ anaemia/ hepatitis/ erythema multiforme, erythema nodosum

Mycardium and plasma (ish… ITP & anaemia).

Question 15

Bronchioloitis causative organism,

Answer 15

RSV

Question 16

Croup causative organism

Answer 16

Parainfluenza

Question 17

Most common cause of pneumonia

Answer 17

Strep pneumoniae

Question 18

Difference between asbestosis and mesothelioma

Answer 18

Both caused by asbestos exposure.
Asbestosis = scarring
Mesothelioma = ca of the pleura

Asbestos can also cause pleural plaques - NOT pre-malignant

Question 19

what is mesothelioma

Answer 19

Malignant ca of pleura

Question 20

What is most common form of cancer associated with asbestos exposure

Answer 20

Lung ca (not mesothelioma).

Question 21

What is goodpastures?

Answer 21

When you get haemoptysis (pulmonary haemorrhages), anti-GMB and glomerulonephritis.

Question 22

What is Lambert eaton myasthenic syndrome associated with

Answer 22

Small cell lung ca

Question 23

Which lung ca is associated with hypercalcaemia

Answer 23

Squamous cell

Question 24

What values = Exudative effusion?

Answer 24

Pleural fluid:serum protein ratio >0.5
Pleural fluid: Serum LDH > 0.6
Pleural LDH>2/3 UNL of serum

Question 25

Which cancers does asbestos increase the risk of?

Answer 25

Lung: Mesothelioma, bronchogenic ca, mesothelioma Gastric, colonic, renal adenocarcinoma Gastric lymphoma

Question 26

Which cancer are people mot at risk of after asbestos exposure?

Answer 26

Lung ca - more so than mesothelioma (this is rare)

Question 27

Is alpha 1 antitrypsin obstructive or restrictive

Answer 27

Obstructive

Question 28

COPD stages

Answer 28

All based on FEV1 St1: 80% or more St2: 50-79% St3: 49-30% St4: less than 30

Question 29

What is sarcoidosis characterised by?

Answer 29

Non caseating granulomatous inflammation. Bilateral hilar lymphadenopathy

Question 30

What is silicosis caused by

Answer 30

Inhalation of silica particles e.g. sandblasting/ metal miner

Question 31

What lung pathology can cause Horners and what is this?

Answer 31

Meiosis, ptosis, anhidrosis. Caused by pan coast tumour

Question 32

CURB 65 parameters

Answer 32

Confusioin Urea 7+ RR 30+ Bp 90s/60d + 65 + 0: low risk (less than 1% mortality risk) 1 or 2: intermediate risk (1% to 10% mortality risk) Consider admission esp if 2. 3 or 4: high risk (more than 10% mortality risk). ADMIT

Question 33

What self care does NICE recommend for chest infections

Answer 33

Honey. Pelargonium (a herbal medicine).***!? Over-the-counter cough medicines containing guaifenesin (an expectorant). Over-the-counter cough medicines containing cough suppressants (except codeine) if the person does not have a persistent cough or excessive secretions.

Question 34

Which CRP parameters would tell you to treat chest infection

Answer 34

Less than 20 - no 20-100 - delayed script >100 treat

Question 35

1st line for bronchitis in adults

Answer 35

Doxy Could use amoxicillin (under 18 1st line) Erythromycin if pregnant

Question 36

1st line CAP

Answer 36

Amox

Question 37

CAP trajectory of illness

Answer 37

1 week — fever should have resolved. 4 weeks — chest pain and sputum production should have substantially reduced. 6 weeks — cough and breathlessness should have substantially reduced. 3 months — most symptoms should have resolved but fatigue might still be present. 6 months — symptoms should have fully resolved.

Question 38

How long should you hold breath when using an inhaler How long to wait for 2nd dose

Answer 38

Hold breath for 10s. Wait 30s for next dose.

Question 39

How is bronchiectasis diagnosed

Answer 39

Primary care - Sputum, CXR, Spiro, FBC secondary care - Usually HRCT ** THIS IS GOLD STANDARD** Ix to find the cause e.g. IgE (for allergic bronchopulm aspergillosis)/ CF/ PCD

Question 40

How long to expect sx of the following infections to last Ears Tonsils Common cold Rhinosinusitis Bronchiectasis

Answer 40

Count letters Ears = 4 days Tonsils = 7 Common cold = 10 Rhinosinusitis = 14 (actually about 2.5 weeks) Bronchiectasis is about 3 weeks

Question 41

Duration of abx for exacerbation of bronchiectasis

Answer 41

7-14d

Question 42

How long and when should someone with suspected occupational asthma do peak flow readings

Answer 42

Twice-daily at home and twice-daily at work for three week