Respiratory

Question 1

Lung cancer associations. Small cell, squamous cell, Adeno

Answer 1

Small cell = SVC obstruction! Squamous cell = Cavity! Adenocarcinoma = trousseau syndrome and clubbing

Question 2

CI to Lung transplant in malignancy (ROPE)

Answer 2

Reduced FEV1 < 1.5/ Obstruction of SVC/ Paralysis of vocal cord/ Effusion (malignant)

Question 3

HLA associations:
HLA-DR1:

Answer 3

Bronchiectasis

Question 4

HLA-DR2:

Answer 4

Systemic Lupus Erythematous (SLE)

Question 5

HLA-DR3:

Answer 5

Autoimmune hepatitis, primary Sjogen syndrome, T1DM, SLE

Question 6

HLA-DR4:

Answer 6

Rheumatoid arthritis, T1DM

Question 7

HLA-B27:

Answer 7

Ankylosing Spondylitis, Postgonoccocal arthritis, acute anterior uveitis

Question 8

Inhaled pathogen causing Bird fanciers lung?

Answer 8

Avian proteins

Question 9

Inhaled pathogen causing farmers lung?

Answer 9

Saccharopolyspora rectivirgula

Question 10

Inhaled pathogen causing Malt workers lung?

Answer 10

Aspergillus Clavatus

Question 11

Inhaled pathogen causing mushroom workers lung?

Answer 11

Thermophilic actinomycetes

Question 12

Features of Kartageners syndrome (Caused by dynein arm defect immotile cilia)

Answer 12

Dextrocardia, Bronchiectasis, Sinusitis, Subfertility

Question 13

Upper zone lung fibrosis causes?

Answer 13

CHARTS:
Coal Worker Pneumoconiosis
Histiocytosis X (Langerhans cell histiocytosis)
Ankylosing Spondylitis
Radiation
Tuberculosis
Silicosis/Sarcoidosis

Question 14

Lower zone lung fibrosis causes?

Answer 14

BAD RASH:
Bronchiectasis
Asbestosis
Drugs (methotrexate, Amiodarone, Nitrofurantoin)
Rheumatoid Arthritis
Aspiration
Scleroderma/Systemic Sclerosis
Hypersensitivity Pneumonitis

Question 15

Mx of aspiergillus growth post TB?

Answer 15

Surgical Resection

Question 16

What are the causes of a raised Transfer Factor (TLCO)?

Answer 16

Asthma, Haemorrhage, Left to right shunts, Polycythaemia

Question 17

Indication for corticosteroids in sarcoidosis?

Answer 17

PUNCH: Parenchymal lung disease/ Uveitis/ Neurological Involvement/ Cardiac Involvement/ Hypercalcaemia

Question 18

Triad for Meigs syndrome?

Answer 18

Ascites, Pleural Effusion, Benign Ovarian Tumour

Question 19

34 year old women with right sided chest pain, currently mensturating, and a spontaneous pneumothorax?

Answer 19

Catamenial pneumothorax

Question 20

T/F Silica exposure increases incidence of developing TB?

Answer 20

True

Question 21

Paraneoplastic features of squamous cell lung Ca?

Answer 21

PTHrp, Clubbing, HPOA

Question 22

Paraneoplastic features of small cell lung Ca?

Answer 22

ADH, ACTH, Lambert-Eaton Syndrome

Question 23

3 ways to diagnose Asthma in Adults (Assuming symptoms are there)?

Answer 23

1) Eosinophilia
2) FeNO > 50 ppb
3) Spirometry
-FEV1 increases 12% or more after bronchodilator
-FEV1 > 200ml higher after bronchodilator
-FEV1 is 10% or more higher than the predicted FEV1

Question 24

4 ways to diagnose asthma in children aged 5-16?

Answer 24

1) FeNO level above 35 ppb
2) FEV1 increase 12% or higher post bronchodilation
3) 14 days worth of PEF diary demonstrating diurnal variation

Question 25

1st Line management of Asthma for adults aged 12 and over? (2024 guidelines)

Answer 25

Low dose ICS + LABA PRN -Budesonide/Formoterol

Question 26

1st Line management of asthma for adults aged 12 and over who present highly symptomatic? (2024 guidelines)

Answer 26

MART therapy OD -Low dose ICS + Laba -e.g. Budesonide/formoterol

Question 27

Asthma management for adults, where symptoms are no controlled by moderate dose MART (and FeNo2 and eosinophils are not raised)?

Answer 27

MART + LRTA (Montelukast) OR LAMA (Tiotropium)

Question 28

MOI Montelukast?

Answer 28

blocks leukotriene receptors (specifically, the cysteinyl leukotriene receptor CysLT1) to prevent bronchoconstriction, inflammation, and mucus production associated with asthma

Question 29

MOI Lama Tiotropium?

Answer 29

Tiotropium blocks muscarinic receptors (M3 subtype) in the airway smooth muscle, preventing acetylcholine-induced bronchoconstriction and promoting bronchodilation

Question 30

Alpha-1 Antitrypsin deficiency -Spirometry -Transfer factor for carbon monoxide -Pathophysiology -Most severe phenotype

Answer 30

-Obstructive -Low -Deficiency of AAT (protease inhibitor) leads to unchecked elastase activity and alveolar damage -PiZZ phenotype

Question 31

Central Chemoreceptor 1) Location 2) Stimulus

Answer 31

1) Medulla Oblongata 2) Primarily increase in PaCO2

Question 32

Peripheral Chemoreceptor 1) Location 2) Stimulus

Answer 32

1) Carotid bodies (Carotid bifurcation) and Aortic bodies (Aortic arch) 2) Hypoxia

Question 33

Explain the Bohr affect?

Answer 33

Increasing acidity means oxygen binds less well to Hb

Question 34

Explain the Haldine affect?

Answer 34

Increasing oxygen means CO2 binds less well to HB

Question 35

Definition of lung compliance?

Answer 35

Change in lung volume per unit change in airway pressure

Question 36

What is the transfer factor?

Answer 36

Measurement of the rate at which a gas will diffuse from alveoli into blood

Question 37

How do pulmonary arteries respond to hypoxia?

Answer 37

Vasoconstrict

Question 38

Why should the dose of oral theophylline be reduced when co-prescirbed with macrolides of fluroquinolone?

Answer 38

Macrolides inhibit CYP3A4 which inhibits metabolism of theophylline and increases risk of toxicity

Question 39

Atypical pneumonia associated with erythema multiforme (target lesions) and cold autoimmune haemolytic anaemia. Does not respond to penicillins or cephalosporins.

Answer 39

Mycoplasma Pneumoniae

Question 40

What are the four indications for commencing steroids in Sarcoidosis?

Answer 40

1) Hypercalcaemia 2) Worsening restrictive pattern on lung function tests 3) Eye involvement 4) Cardiac/Neuro Involvement

Question 41

Tx for healthcare workers exposed to TB with a positive tuberculin skin test?

Answer 41

1) Isoniazid and Rifampicin for 3 months OR 2) Isoniazid monotherapy for 6 months