Quiz Resp

Front 1

In terms of perfusion, hypoxia causes what in the pulmonary arteries

Back 1

constriction - to divert to well oxygenated areas

Front 2

Which type of respiratory failure with a Ventilatory/Perfusion mismatch

Back 2

Type 1 - <PaO2 but norm CO2

Front 3

4 Symptoms to ask about in Asthma

Back 3

Episodic expiratory wheeze
Cough
Mornings
Sleep

Front 4

Precipitants of Asthma (8!)

Back 4

Exercise
Cold
Allergen (dust mite)
Drug (NSAID, B block)
Occupational
Infection (children)
Pollution
(Psychological)

Front 5

4 measures of a severe athma attack

Back 5

RR >25
Pulse >110
PEFR <50%
>1breath per sentence

Front 6

Asthma Mx Stages (5)

Back 6

1: Salbutamol/Terbutaline
2: Beclomethasone/Fluticasone
3: Salmeterol/Formoterol
4: Oral Theophylline PDEi
5: Oral Steroid

Front 7

Important Ix in Asthma Attack (5)

Back 7

Peak Flow
ABG
CXR (pneumothorax)
K+
Theophylline level

Front 8

Asthma Pathophysiology : 5 bits effected

Back 8

Epithelium: goblet cells>columnar ciliated
BM: thickening
Muscle : hyperplasia, hypercontractable
Nerve derangement
Mucosal Oedema

Front 9

With spirometry what readings would you take to look for obstruction?

Back 9

FEV1/VC <70%

Front 10

Define COPD

Back 10

chronic slowly progressive disorder of fixed or minimally reversible airway obstruction and chronic respiratory failure

Front 11

Four systemic findings of COPD

Back 11

M weakness
Impaired salt excretion (periph oedema)
Altered Fat Metabolism
Osteoarthritis

Front 12

3 Core Symptoms of COPD

Back 12

Persistant PRODUCTIVE cough
Wheeze
SOBOE

Front 13

2 pathological processes of COPD

Back 13

Emphysema
Chronic Bronchitis

Front 14

Define Emphysema (3 key bits)

Back 14

permenant dilatation of air space distal to the terminal bronchiole with destruction of tissue in the absence of scarring

Front 15

What is the mechanism of smoke causing emphysema? (2)

Back 15

Increases protease release
Inactivates a1 antitrypsin

Front 16

Define Chronic Bronchitis

Back 16

Clinically - a productive cough on most days of 3months in 2 consecutive years

Front 17

Histological findings in chronic bronchitis

Back 17

Hypertrophied mucus with lots of goblet cells
Inflammed/Ulcerated bronchi with fibrosis

Front 18

RFs for COPD

Back 18

SMOKING
a1 antitrypsin def
pollution

Front 19

Define Bronchiectasis

Back 19

Abnormal airway dilatation

Front 20

Causes Bronchiectasis (2 groups - 7 examples)

Back 20

Interference of secretion
(tumour, TB, FB, CF viscocity, PCD [AKA Kartagener's])

Persistant Infection
(TB, Immunocompromised)

Front 21

Respiratory causes of clubbing (4)

Back 21

Lung Ca (Large cell/Mesothelioma)
Interstitial Lung Disease (Fibrosis)
Suppurative Lung Disease (Bronchiectasis, Abscess)
Pulmonary Hypertension (LVF, PE, Mitral Stenosis)

Front 22

Talk me through Mx of COPD (6)

Back 22

Salbutamol/ ipratropium bromide
Theophylline
Inhaled Steroid
Oral Steroid
Pulm Rehab
LTOT

Mild = salbuatmol or ipratropium

Moderate = salmeterol or regular ipratropium +/- fluticasone (steroid)

Severe = regualr chosrt acting beta agonist + anticholinergic

NB: guidelines state that to assess for responsiveness to steroids trial of oral and if improvement switch to inhaled. Odd I know, but that's what the guidelines say.

Front 23

Define Brochiectasis

Back 23

abnormal dilatation

Front 24

Ix for bronchiectasis

Back 24

CT good
Ciliary function Saccharin taste test/biopsy

Front 25

Pathology of CF

Back 25

absent/defective Cl pump in airway and pancreatic epithelium

Front 26

incidence in caucasians

Back 26

1 in 2000

Front 27

CF lung - what do you expect

Back 27

infections
bronchiectasis
haemoptysis
pneumothorax
cor pulmonale

Front 28

talk about the severity score in pneumonia

Back 28

Confusion
Urea >7
Resp rate >30
BP <90/60
>65

Front 29

What organism - all ages, winter, rapid onset, rusty sputum

Back 29

strep pneumonia

Front 30

What organism - young, middle aged, epidemics but self-limiting

Back 30

chlamydia pneumonia

Front 31

what organism - children, young adult, autumn , 3-4yr epidemic, Cx

Back 31

mycoplasma pneumonia

Front 32

what organism - middle old aged, foreign travel, local epidemic

Back 32

legionella pneumonia

Front 33

what organism - coexistant disease, multlobar shadows with cavitation

Back 33

staph aureus

Front 34

what organism - bird contact, hepatosplenomegaly

Back 34

chlamydia psiticca

Front 35

what organism - male, farm worker

Back 35

coxiella burnetti
q fever

Front 36

what organism alcoholic, men, upper lobe

Back 36

klebsiella

Front 37

Mx of TB

Back 37

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Front 38

how long for abx

Back 38

4 for 2/12
2 for 4/12

Front 39

Divide lung Cancers

Back 39

50% Squamous
20% Small-Cell
20% Adenocarcinoma
10% Large Cell

Front 40

Which are linked to smoking

Back 40

Squamous and Small Cell
Not so much Adenocarcinoma

Front 41

Which tend to be peripheral

Back 41

Adenocarcinomas

Front 42

Top 5 presentations of Lung Ca

Back 42

80% cough
70% haemoptysis
60% dyspnoea
40% chest pain
15% wheeze

Front 43

% of patients presenting with mets

Back 43

70%

Front 44

Small cell hormone syndromes (3)

Back 44

inappropriate adh
ectopic acth
hypercalcaemia (pt related)
gynaecomastia (test atrophy)
hyperthyroid

Front 45

pleural effusion differentiators

Back 45

its a transudate if (LIGHT's Criteria)

protein <30
LDH <200

Front 46

Classify restrictive lung disease

Back 46

Acute - ARDS
Chronic - Occupational lung disease, fibrosing alveolitis, extrinsic allergic alveolitis

Front 47

Cases of ARDS (10)

Back 47

pneumonia
contusion - e.g. drowning
sepsis
hypotensive shock
surgery
amniotic fluid embolus
DIC
pancreatitis
liver failure
drugs - heroin, aspirin

Front 48

What is pneumoconiosis

Back 48

Fibrosis in response to an inorganic material (coal/asbestos)

Front 49

Expansion reduced
Percussion dull
Breath sounds - norm/reduced

Differential (3)

Back 49

Pleural effusion (<TVP liq)
Collapse (?trachea towards)
Pleural thickening (>TVP sol)

Front 50

Findings in consolidation

Back 50

Reduced/norm expansion
dull percussion
coarse crackles/bronchiol breathing

Front 51

Findings in fibrosis

Back 51

reduced expansion
dull percussion
fine end expiratory crackles

Front 52

Causes of a transudate (3)

Back 52

Cardiac
Liver (hypoalbuminaemia)
Nephrotic

Front 53

Causes of exudate (5)

Back 53

Pneumonia
TB
Malignancy (mesothelioma)
PE
SLE/RA

Front 54

Which type of COPD go to develop cor pulmonale

Back 54

blue bloaters

Front 55

what criteria to distinguish transudate from exudate

Back 55

LIGHT's CRITERIA

pleural:serum protein >.5
pleural:serum LDH >.6

Front 56

tactile vocal fremitus - increased or decreased in pleural effusion

Back 56

reduced / absent

Front 57

so this lady has fine inspiratory crackles - differential?

Back 57

Cryptogenic fibrosing alveolitis
Extrinsic allergic alveolitis
Connective tissue fibrosing alveolitis (RA, Scleroderma, SLE)
Pneumoconiosis - coal/asbestosis

NB Caplans syndrome : assoc. RA + pneumoconiosis

Front 58

tell me about the immune mediated reactions in extrinsic allergic alveolitis

Back 58

Acute (4-8hr post) Type III (complexes)
Chronic Type IV (cell-mediated) appears like cryptogenic

Front 59

x-ray signs of fibrosis

Back 59

ground glass

Reticulo-nodular appearance

Front 60

expectation in lung function tests with fibrosis

Back 60

FVC fall

FEV1:FVC > 90% (normal = 80%, obstructive < 70%)

Front 61

mx of cryptogenic fibrosing alveolitis (5)

Back 61

prednisolone (acute)
cyclophosphamide
azothioprine (improves 10-20%)
LTOT
lung transplant in young