Respiratory ADDITIONAL

Question 1

pulmonary oedema presentation

Answer 1

• acute, severe shortness of breath.
• elevated JVP is noted and on auscultation
• bilateral basal crackles

Question 2

Nicorandil is contraindicated in patients with acute pulmonary oedema

a. true
b. false

Answer 2

a. true

Nicorandil can cause hypotension and therefore complicate the management of acute pulmonary oedema.

Question 3

An 18-year-old man presents to his GP with fatty stool, recurrent pneumonia and weight loss. A diagnosis of cystic fibrosis is suspected.

What is the likely causative genetic defect of this patient?

Answer 3

Cystic fibrosis is due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR)

Question 4

Decreased FRC:

Answer 4

Pulmonary fibrosis
Laparoscopic surgery
Obesity
Abdominal swelling
Muscle relaxants

Question 5

increases FRC

Answer 5

Increased FRC:
Erect position
Emphysema
Asthma

Question 6

‘Red-currant jelly’ sputum is a feature of Klebsiella pneumoniae

a. true
b. false

Answer 6

a. true

Question 7

most common cause of pneumonia.

Answer 7

Streptococcus pneumoniae

Question 8

A 4-year-old boy is referred to paediatrics following recurrent chest infections and a failure to thrive. His parents explain he also has loose greasy stools and often complains of abdominal pain.

Answer 8

Cystic fibrosis is due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR)

Question 9

where are the peripheral chemoreceptors found

Answer 9

aortic arch and carotid bodies (at the bifurcation of the common carotid artery). They are less sensitive than the central chemoreceptors in the medulla oblongata, which monitors the CSF. There are no peripheral chemoreceptors in veins.

Question 10

Lung cancer can present with ipsilateral elevation of the hemidiaphragm due to

Answer 10

compression of phrenic nerve

Question 11

A 67-year-old man presents with a 2-month history of a productive cough. This is associated with haemoptysis and 10kg of unintentional weight loss. He has no significant past medical history.

An elevated right hemidiaphragm is found on a chest x-ray.

What structure is most likely to be affected?

Answer 11

phrenic nerve

Question 12

Bronchiectasis: most common organism

Answer 12

Haemophilus influenzae is the most common organism associated with bronchiectasis.

Question 13

Paraneoplastic features of lung cancer
(SQUAMOUS)

Answer 13

: PTHrp- hypercalcaemia, clubbing, HPOA

Question 14

Paraneoplastic features of lung cancer
of small cell

Answer 14

ADH, ACTH, Lambert-Eaton syndrome

Question 15

the phrenic nerves lie anterior to the lung

a. true
b. false

Answer 15

a.true

They both lie anterior to the hilum of the lung. The phrenic nerves have both motor and sensory functions. For this reason sub diaphragmatic pathology may cause referred pain to the shoulder.

Question 16

A 79-year-old man presents with shortness of breath. He has a past medical history of rheumatoid arthritis for which he takes methotrexate. On examination, you note fine bibasal crepitations.

What feature on pulmonary function tests would be expected?

Answer 16

Pulmonary fibrosis results in decreased lung compliance

Question 17

Surfactant production begins around week 22 of development

a. true
b. false

Answer 17

a. true and ends around 36 weeks

Question 18

The most common gene causing cystic fibrosis is

Answer 18

Delta F508 deletion

Question 19

Lung collapse causes the trachea to deviate to the affected side, is dull to percuss and has reduced breath sounds
Important for meLess important

a. true
b. false

Answer 19

a. true

Question 20

A 73-year-old woman presents to the Emergency Department with acute shortness of breath following a 5-day febrile illness. On initial assessment, her oxygen saturation is 75% on room air with a PaO2 of 4.5kpa on an arterial blood gas.

Which of the following would be the expected physiological response in this patient?

Answer 20

Pulmonary arteries vasoconstrict in the presence of hypoxia

Question 21

Elevated angiotensin-converting enzyme levels are associated with sarcoidosis

a. true
b. false

Answer 21

a. true

Question 22

Cystic fibrosis can cause diabetes mellitus
a. true
b. false

Answer 22

a.true

Question 23

Cystic fibrosis is associated with an absent vas deferens in men, leading to infertility

a. true
b. false

Answer 23

a. true

Question 24

A 79-year-old man has been referred to the respiratory clinic. He says that he has had a persistent dry cough and hoarse voice for the last 5 months and thinks that he has lost some weight as his clothes feel loose. He does not have any significant past medical history but has a 30-pack-year smoking history. On examination, you note left-sided miosis and ptosis.

What is the most likely site of the lung lesion?

Answer 24

Pancoast tumours can suppress the recurrent laryngeal nerve causing hoarseness of voice

Question 25

Respiratory syncytial virus is the pathogen in the majority of cases of bronchiolitis a. true b.false

Answer 25

a. true

Question 26

lassic presentation of bronchiolitis

Answer 26

coryzal symptoms (common cold) increased work of breathing causing feeding difficulty in a child <1 year. Respiratory syncytial virus is the most common cause of bronchiolitis.

Question 27

Haemophilus influenzae is a common cause of bacterial otitis media a. true b. false

Answer 27

a. true

Question 28

High resolution computed tomograpahy is the investigation of choice to confirm a diagnosis of bronchiectasis a. true b. false

Answer 28

a. true

Question 29

Mesothelioma

Answer 29

is an incurable asbestos-related cancer that affects the mesothelium, the lining of several areas within the body.

Question 30

Asbestosis

Answer 30

non-cancerous form of pulmonary fibrosis where the lung tissue becomes thickened and stiff over a period of time, due to permanent scarring of the alveoli.

Question 31

In the pathophysiology of allergic asthma which cell is found in inappropriately increased numbers?

Answer 31

Increased numbers of circulating eosinophils have been demonstrated in the airways of allergic asthma sufferers. Eosinophil numbers correlate with the severity of asthma and they form a key part of the long-term airway inflammation process by promoting injury, obstruction, and hyperresponsiveness. Mast cell degranulation is responsible for the immediate asthma symptoms following provocation.

Question 32

Tidal volume (TV) = 400 mL. Vital capacity (VC) = 3,300 mL. Inspiratory capacity (IC) = 2,600 mL. FEV1/FVC = 60% Body plethysmography is undertaken, demonstrating a residual volume (RV) of 1,200 mL. What is this patient's total lung capacity (TLC)?

Answer 32

4,500ml

Question 33

Neuromuscular disorders result in a restrictive pattern on pulmonary function tests a. true b. false

Answer 33

a. true

Question 34

Lung cancer can present with ipsilateral elevation of the hemidiaphragm due to compression of phrenic nerve a. true b. false

Answer 34

a.true

Question 35

Bronchiectasis: most common organism = Haemophilus influenzae a. true b. false

Answer 35

a. true

Question 36

Lung collapse causes the trachea to deviate to the affected side a. true\ b/false

Answer 36

a.true it can lead to both dullness and absent breath sounds throughout the lung field on percussion and auscultation respectively, as well as the trachea moving towards the affected side. This is due to the decrease in pressure on the affected side which causes the mediastinum and therefore the trachea to shift towards it.

Question 37

In an acute bacterial infection, neutrophils are likely to be raised. a/ true b/false

Answer 37

a/true

Question 38

The phrenic nerve supplies the pericardium a. true b. false

Answer 38

a. true

Question 39

Alpha-1 antitrypsin is an elastase inhibitor. Smoke inactivates alpha-1 antitrypsin in the lungs, which leads to increased action of elastases and breakdown of elastic tissue. a. true b. false

Answer 39

a. true

Question 40

The commonest cause of empyema is Streptococcus pneumoniae, which is also the commonest cause of pneumonia. a. ture b. false

Answer 40

a. true

Question 41

The empyema is an abscess (collection of puss) in the pleural space. So the antibiotics can't penetrate into this abscess in order to be helpful. a. true b. false

Answer 41

The empyema will need to be drained .

Question 42

pneumonia Classically seen in alcoholics

Answer 42

Klebsiella pneumoniae

Question 43

Because heart failure causes volume overload, she will be more prone to chest and leg infections secondary to pulmonary and peripheral oedema, respectively. a. true b. false

Answer 43

a. true

Question 44

A 35-year-old man presents with fever, malaise, weight loss, dyspnoea, and pain in the shoulder & hip joints. He has raised erythematous lesions present on both legs. Blood tests show raised calcium levels raised serum ACE levels. A chest x-ray shows bilateral hilar lymphadenopathy. most likely diagnosis?

Answer 44

sarcoidosis

Question 45

A silent chest is a life-threatening feature of an asthma attack a, true b. false

Answer 45

a. true