Resp

Question 1

Classification of airflow limitation

Answer 1

1. Mild: FEV1 >80% - but FEV/FVC 0.7 and syptomatic
2. Mod: FEV1 50-79%
3. Severe : 30-49%
4. Very severe: Fev1

Question 2

BODE index

Answer 2

Define: multidimensional tool to predict mortality in COPD

BMI
Obstruction: FEV1
Dyspnoea: MRC score
Exercise capacity - 6 minute walk

Question 3

Light’s criteria

Answer 3

Used to diagnose of an exudative effusion

Effusion: serum protein ratio > 0.5
Effusion: serum LDH ratio > 0.6
Effusion LDH IS 0.6 time the limit of normal

Question 4

Cause of pleural effusion.

Answer 4

Transudate - less than 25gL

• CCF
• renal failure
• low albumin: nephrotic syndrome, liver failure, enteropathy
• meig syndrome: right sided pleural effusion, ascites and ovarian fibroma

Exudate - protein > 35g/l

• infection: pneumonia, TB
• neoplasm: primary or secondary
• inflammation: RA, SLE
• infarction: PE
• trauma

Question 5

Stages of clubbing

Answer 5

1. Bogginess/increased fluctuate of nail bed
2. Loss of concave nail fold angles
3. Increased longitudinal and transverse curvature
4. Soft tissue expansion of distal phalanx

Question 6

Features of life threatening Asthma

Answer 6

CHEST 
Cyanosis 
Hypotension 
Exhaustion, confusion 
Silent chest, poor resp effort 
Tachyarrhythmia or bradyarrhytmias

PEFR4.6kpa, PaO2

Question 7

Features of severe asthma

Answer 7

PEFR : 33-50%
Can’t complete sentences in one breath
RR>25
HR>110

Question 8

Cause of pulmonary fibrosis

Answer 8

Environmental: asbestosis and silicosis
Drugs: bleomycin, amiodarone, nitrofuratonin, sulfasalazine, methotrexate
Hypersentivity: EAA
Infection: TB, viral,funghi
Associated systemic disease: sarcoid, RA, SLE, Systemic sclerosis, UC, anksponk, sjogrens

Question 9

Kartageners syndrome

Answer 9

Situs inversus
Chronic sinusitis
Bronchiectasis

Question 10

Young syndrome

Answer 10

Bronchiectasis
Rhinosinusitis
Azoospermia

Question 11

mMRC Dyspnoea score

Answer 11

1. SOB only on vigorous exercise
2. SOB only on hurrying or walking up stairs
3. Walks slowly or has to stop for breath
4. Stops for breath after

Question 12

CURB - 65

Answer 12

Confusion - AMTS less than on equal to 8
Urea - 7mM
Resp rate > 30/min
BP = 90/60

0-1 - home
2 - hospital
3 consider ITU

Question 13

SIRS

Answer 13

Inflammatory response to a variety of insults manifest by >=2 of

1. Temp >38 or 90
2. RR> 20
3. WCC >12x10^9 or less than 4

Question 14

Sepsis

Answer 14

SIRS caused by localised infection

Question 15

Severe sepsis

Answer 15

Sepsis with at least 1 organ dysfunction or hypoperfusion

Question 16

Septic shock

Answer 16

Severe sepsis with refractory hypotension

Question 17

MODS

Answer 17

Impairment of >=2 organ system

Homeostasis can not be maintained without therepeutic intervention

Question 18

Complications of pneumonia

Answer 18

Septic Shock and multi organ failure
Para-pneumonic effusions/empyema
Abscess: S. Aureus, klebsiella, anerobes
Resp failure

Question 19

Side effects of TB medication

Answer 19

Rifampacin: hepatitis, orange secretions, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia
Ethambutol - optic neuritis - loss of colour vision first

Question 20

Indication for long term oxygen therapy

Answer 20

Stable non-smokers with Pa02

Question 21

Aim of long term oxygen therapy in COPD

Answer 21

PaO2 8>= for greater than or equal to 15 hours a day

Increase survival by 50%

Question 22

Chronic medial management of Asthma

Answer 22

1. Inhaled short acting B2 agonist prn
2. Inhaled corticosteroids- 200-800 micro gram a day
3. Add long acting b2 agonist and asses response. If inadequate or no response increase steroids to 800mg and consider addition of a leukotrine receptor antagonist
4. Trial of steroids - 2000ug/day - consider addition of other drugs
5. Continuous use of frequent oral steroids

Question 23

CURB - 65

Answer 23

Confusion - AMTS 7mM
Resp rate > 30/min
BP = 3 consider ITU

Question 24

SIRS

Answer 24

Inflammatory response to a variety of insults manifest by >=2 of

1. Temp >38 or 90
2. RR> 20
3. WCC >12x10^9 or less than 4

Question 25

Sepsis

Answer 25

SIRS caused by localised infection

Question 26

Severe sepsis

Answer 26

Sepsis with at least 1 organ dysfunction or hypoperfusion

Question 27

Septic shock

Answer 27

Severe sepsis with refractory hypotension

Question 28

MODS

Answer 28

Impairment of >=2 organ system | Homeostasis can not be maintained without therepeutic intervention

Question 29

Complications of pneumonia

Answer 29

Septic Shock and multi organ failure Para-pneumonic effusions/empyema Abscess: S. Aureus, klebsiella, anerobes Resp failure

Question 30

Side effects of TB medication

Answer 30

Rifampacin: hepatitis, orange secretions, enzyme induction Isoniazid: peripheral sensory neuropathy Pyrazinamide: hepatitis, arthralgia Ethambutol - optic neuritis - loss of colour vision first

Question 31

Indication for long term oxygen therapy

Answer 31

Stable non-smokers Oxygen less than 7.3 Oxygen 7.3 - 8 and evidence of any of the following: secondary polycythemia, nocturnal hypoxemia, peripherals odema and pulmonary HTN

Question 32

Aim of long term oxygen therapy in COPD

Answer 32

PaO2 8>= for greater than or equal to 15 hours a day Increase survival by 50%

Question 33

Definition of chronic bronchitis

Answer 33

Cough and sputum production on most days for 3 months of 2 successive year

Question 34

Definition of emphysema

Answer 34

Histopathalogical diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

Question 35

Wells score

Answer 35

Clinical signs and symptoms of a DVT - 3 Alternative diagnois is less likely than a PE - 3 HR>100 bpm -1.5 Immobilisation or surgery in previous 4 weeks - 1.5 Previous DVT/PE - 1.5 Heamoptysis - 1 Malignancy - 1

Question 36

Complications of COPD

Answer 36

``` Acute/infective excaerbations Pulmonary HTN pneumothorax Polycythemia Lung cancer ```

Question 37

Parameters used in the gold classification

Answer 37

mMRC dyspnoea score Airflow limitation Numbers of excaerbations a year

Question 38

Complication of pneumonia

Answer 38

``` Resp failure Hypotension AF Pleural effusion - exudative Empyema Lung abcess Sepsis Jaundice - can be due to sepsis, drugs or bacteria specific ```

Question 39

Detention of asthma

Answer 39

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli

Question 40

Complication of lung cancer

Answer 40

``` Local - bronchial obstruction: collapse of distal airway and increased infection risk - invasion of local structures: SVC, oseophagus( dysphagia) nerves - recurrent laryngeal, sympathetic( Horners) phrenic - AF -lymphatic carcinomoatosis Parenoplastic - SIADH - cushings - serotonin - PTHrp - dermtomyositis - cerebellar degeneration Metastatic - pathological fracture - hepatic failure - confusion fits, focal Neuro - Addisons ```

Question 41

Assessment of risk in lung cancer surgery

Answer 41

Thoroscore - based on cardiorepsitiory function and co- morbidities

Question 42

Definition of pulmonary hypertension

Answer 42

Pulmonary aterial pressure >25mmHg

Question 43

Cause of pulmonary hypertension

Answer 43

Left heart disease e.g. MS, MR lung parenchymal disease e.g. COPD, interstitial lung disease Pulmonary vascular disease e.g. Idopathic pulmonary HTN, PE Hypoventillation: OSA, thoracic cage abnormality, neuromuscular

Question 44

Gold standard for diagnosis of pulmonary HTN

Answer 44

Right heart catheterisation

Question 45

Complication of pulmonary HTN

Answer 45

Cor pulmoanle | Supraventricular tachyarrhythmia

Question 46

Definition of cor pulmonale

Answer 46

RHF due to chronic pulmonary hypertension

Question 47

Signs of cor pulmonale

Answer 47

``` Increased JVP with prominent a waves Left parasternal heave Loud P2 and S3 Graham steel Tricuspid regurgitation ```

Question 48

Cause of apical fibrosis

Answer 48

``` Aspergillosis ABPA Pneumoconiosis - coal and silica Extrinsic allergic alveoltitis Ankylosis spondylitis TB ```