High Yield points in Respiratory Medicine

1. Next best step after chest x-ray for sarcoidosis is CT chest. More accurate test (diagnostic investigation) => Trans-bronchial biopsy.
2. Pseudomonas in cystic fibrosis is treated by nebulized tobramycin and oral azithromycin 6 monthly.
3. Patient who had history of some bone fracture following RTA, died after 4 days. On autopsy there are petechial hemorrhages in the brain. Probable diagnosis => Fat embolism.
4. HRCT is investigation of choice in idiopathic pulmonary fibrosis showing honey combing.
5. Carbon monoxide transfer factor shows prognosis in => idiopathic pulmonary fibrosis.
6. NIV most common complication=
7. Treatment of Aspergiloma: Surgical resection. Long term itraconazole if not fit for surgery.
8. Bilateral infiltrates on CXR + P02/Fi02 less than 200 + PCWP less than 18 + burn history => PCWP in ARDs is less than 18mmhg while in cardiogenic pulmonary edema it’s more than 18.
9. Progressive breathlessness + large amount of sputum + alveolar walls filled with mucin => bronchoalveolar cell carcinoma.
10. Drugs associated with pulmonary arterial hypertension => appetite suppressants, amphetamine.
11. COPD + respiratory failure type-2 is treated with NIV if there is no contraindication to it. If NIV is contraindicated then go for intubation / invasive ventilation.
12. Pneumonia + high WBC + high inflammatory markers + unilateral consolidation + pigeons exposure => Chlamydia psittaci pneumonia.
13. Spirometry in extrinsic allergic alveolitis shows mixed pattern (obstructive + restrictive).
14. Criteria for exudative pleural effusion: Pleural/serum protein > 5, “OR” pleural/serum LDH > 0.6.
15. Causes of exudative effusion: Think of leaky capillaries (2° to inflammation): malignancy, TB, bacterial or viral infection, PE with infarct, and pancreatitis
16. Causes of Transudative pleural effusion: Think of intact capillaries and ↑ hydrostatic pressure: HF, liver or kidney disease, and protein-losing enteropathy.
17. Treatment for acute asthma exacerbation: β2-agonists and corticosteroids
18. Treatment for acute COPD exacerbation: O2, β2-agonists (albuterol), muscarinic antagonist (ipratropium), corticosteroids, and antibiotics
19. PFTs in obstructive lung disease: ↓ FEV1/FVC (< 7), ↑ TLC
20. PFTs in restrictive lung disease: Normal or ↑ FEV1/FVC, ↓ TLC
21. Acid-base disorder in pulmonary embolism: Respiratory alkalosis with hypoxia and ↓ PaCO₂.
22. Tall white man presents with acute shortness of breath => Spontaneous pneumothorax. Usually regress spontaneously, but supplemental O2 may be helpful.
23. Treatment of tension pneumothorax => immediate needle thoracostomy followed by chest tube placement.
24. ↑ Risk for which infection with silicosis => Mycobacterium tuberculosis
25. Chest radiography findings suggestive of PE => Westermark sign and Hampton hump (although most often CXR is normal).
26. Flow volume loop is the investigation of choice for upper airway compression.
27. Erythema nodosum is associated with a good prognosis in sarcoidosis.
28. Smoking does not increase the risk of
29. Exposure to radiation increase the risk of mesothelioma.
30. Differential Broncho-spirometry is the measurement of functions of each lung separately.
31. The value of tidal volume remain unchanged in obstructive and restrictive lung diseases.
32. Fibrosing alveolitis is the most common pulmonary manifestation of rheumatoid arthritis.
33. Drug induced pneumonitis => methotrexate or amiodarone.
34. Contraindications of lung surgery => FEV < 1.5L, malignant pleural effusion, and metastasis outside lung.
35. Returned from airline flight, TIA = paradoxical embolus, investigation to be done => Trans esophageal echocardiography.
36. Most common cause of community acquired pneumonia => Streptococcus pneumoniae.
37. 1 year old child with history of recurrent chest infections presented with hemoptysis, probable diagnosis =>
38. Best treatment for bronchiectasis => Postural drainage plus antibiotics.
39. Diagnostic test for cystic fibrosis => Sweat chloride test.
40. Lobar pneumonia plus target lesions => Mycoplasma pneumonia.
41. Test used to confirm hemolysis in mycoplasma pneumonia =>
42. True about ARDS: Normal PCWP + interstitial infiltrates.
43. Test used to differentiate ARDS from cardiogenic oedema is =>
44. Correct option regarding diagnosis of ARDS => PaO2: FiO2 < 200.
45. Type-1 respiratory failure: PaO₂ less than 8, PaC0₂ less than 6.6. Treat with high concentration Oxygen (>35% usually 60% high flow 6-8L/min.
46. Type-2 respiratory failure: PaO₂ < 8 and PaC0₂ > 6.6 (hypercapnia). Treat with low concentration (24-28%) Low flow (1-2L/min).
47. Tuberculosis resistant to INH, Rifampicin, quinolone and amikacin => XDR TB.
48. Patient with tuberculosis having serum creatinine =1.2, how he should be treated => Start him on 4 standard drugs (RIPE).
49. 40 years old male patient with arthritis, increased neutrophils and low glucose on pleural fluid R/E: The possible diagnosis could be => Rheumatoid arthritis.
50. Exercise induced Asthma, fall in FEV1 diagnostic after exercise => 15%
51. Regarding COPD, which of the following reduces mortality => Smoking cessation.
52. COPD patient, symptoms not controlled on SABA, his FEV1 is 55%, next management step: Add LABA.
53. Gold standard test for diagnosis of pulmonary embolism => Pulmonary Angiography
54. Patient presented with classical signs and symptoms of pulmonary embolism, BP = 114/70, next best management step => Give LMWH.
55. Patient with signs and symptoms of massive pulmonary embolism (hypotension mentioned in the scenario, alteplase not given in options): Administer Streptokinase.
56. Investigation to be done for legionella pneumonia (Typical features of legionella pneumonia described in scenario) => Legionella serology.
57. ABPA scenario investigation to be done => Sputum for fungal hypae.
58. Patient with chest pain, positive Hamman’s sign (on auscultation a click /sound synchronous with heart sounds was present: Left apical pneumothorax.
59. Lung volume reduction surgery is best in patients with: Predominant upper lobe emphysema.
60. IV drug user failed to respond to ATT: Poor compliance or MDR TB
61. Rheumatoid Arthritis patient presented with shortness of breath that was progressive in nature. Pleural fluid analysis revealed decreased glucose => Bronchiolitis obliterans.
62. Consolidation of pneumonia on Chest X-ray takes 4-6 weeks to resolve.
63. The commonest mutation in patients with cystic fibrosis (CF) is the Delta-F508 mutation.
64. High PEEP low tidal volume respiratory rate up to 35. => Give treatment for ARDS.
65. Talc pleurodesis is best for patient of Mesothelioma with plural effusion.
66. Post-operative fever, cough and crepitation’s

• 1^st or 2^nd day = atelectasis
• 3^rd day = Pneumonia.

67. Drug of choice for aspiration pneumonia => clindamycin.
68. Mechanical ventilation causes increase in right atrial pressure.
69. If there is strong suspicion of Tuberculosis, first investigation to do is sputum AFB.
70. DVT Screening / best initial test = Doppler ultrasound. Best (diagnostic) test for DVT = Venography.
71. Patient on ATT become pregnant => stop PZA.
72. Most common manifestation of mediastinal tumor = Pressure effects.
73. Smoker with mucosal gland enlargement => chronic bronchitis.
74. Bronchiectasis: most common organism = Haemophilus influenzae.
75. Light’s criteria: Effusion LDH level greater than 2/3rds the upper limit of serum LDH points to exudative pleural effusion.
76. Asbestosis causes pulmonary fibrosis predominantly affecting the lower zones.
77. PTHrP is a paraneoplastic syndrome associated with squamous cell lung cancer.
78. Symptom control in non-CF bronchiectasis – inspiratory muscle training + postural drainage.
79. Isocyanates are the most common cause of occupational asthma.
80. Confusion in an asthma attack is a feature of life-threatening asthma.
81. Bupropion is contraindicated in epilepsy.
82. NICE only recommend giving oral antibiotics in an acute exacerbation of COPD in the presence of purulent sputum or clinical signs of pneumonia.
83. COPD is the most common cause of secondary pneumothorax.
84. Management of high altitude cerebral edema (HACE) is with descent + dexamethasone.
85. Small cell lung carcinoma secreting ACTH can cause Cushing’s syndrome
86. Lung volume reduction surgery can be used in the treatment of alpha-1 antitrypsin deficiency.
87. Chlamydia psittaci is a cause of pneumonia in bird keepers.
88. Serial peak flow measurements at work and at home are used to detect occupational asthma.
89. Basal atelectasis should be suspected in the presentation of dyspnea and hypoxemia 72 hours post operatively.
90. Supportive treatment for ARDS => Low tidal volume ventilation
91. Patient with chest trauma who was previously stable suddenly dies => Air embolism.
92. Absent breath sounds, dullness to percussion, shock, flat neck veins => Massive hemothorax.
93. Absent breath sounds, tracheal deviation, shock, distended neck veins => Tension pneumothorax.
94. Isoniazid therapy can cause a vitamin B6 deficiency causing peripheral neuropathy.
95. Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics.
96. Before starting azithromycin do an ECG (to rule out prolonged QT interval) and baseline liver function tests.