Acute Resp

Question 1

Features of T1RF?

Answer 1

Hypoxia from ventilation perfusion mismatch.

Focal

Question 2

Features of T2RF?

Answer 2

Hypoxia and Hypercapnia

Global

Question 3

T1RF causes?

Answer 3

Acute asthma, atalectasis, pulmonary oedema, pneumonia, pneumothorax, PE, ARDS

Question 4

T1RF managment?

Answer 4

CPAP as increased airway recruitment (ventilation)

Question 5

T2RF causes?

Answer 5

COPD!!

Acute severe asthma, upper airway obstructions, neuropathies e.g. GBS, MND, Drugs e.g. opiates

Question 6

T2RF management?

Answer 6

BIPAP

Question 7

What is normal intrapleural pressure?

Answer 7

-5 to -8cmH2O

Question 8

types of pneumothorax?

Answer 8

Primary: young healthy and unlikely to have disease
Secondary: older, lung disease, smoking, CF patients

Question 9

Management of primary pneumothorax?

Answer 9

> 2cm or SOB = Needle aspiration
If not discharge and observe
If not successful = chest drain
Succesful = Observation + O2

Question 10

RFs for primary pneumothorax?

Answer 10

Men more than women, smoking, marfans or marinoid habitus

Question 11

What are the features of Tension pneumothorax?

Answer 11

Lung compression = severe dyspnoea, tracheal deviation (away), silent chest, hyperresonance and reduced expansion on lesioned side

Mediastinal shift = hypotension and tachycardia

Question 12

Where for needle aspiration?

Answer 12

2 ICS MCL

orange or grey

Question 13

Secondary pneumothorax management?

Answer 13

> 2cm or SOB = chest drain

1-2cm = needle aspiration. If not successful then Chest drain

Question 14

When to suspect acute massive PE?

Answer 14

Collapse, central crushing pain, severe dyspnoea

Question 15

When to suspect acute submassive and small PE?

Answer 15

Pleuritic chest pain, haemoptysis and dyspnoea

Question 16

When to suspect chronic PE?

Answer 16

Exertional dyspnoea

Question 17

What would PE show on ECG?

Answer 17

S1Q3T3 pattern
RAD
RBBB
Sinus tachycardia

Question 18

What can PE show on CXR?

Answer 18

Westermarks sign

Question 19

RFs for PE mneumonic?

Answer 19

CT S’il vous plait

Question 20

C for PE?

Answer 20

Cancer, chemo, cardiac failure, COPD, factor C deficiency

Question 21

T for PE?

Answer 21

Trauma, time (age), thrombocytosis

Question 22

S for PE?

Answer 22

Stasis, surgery, factor S deficiency

Question 23

V for PE?

Answer 23

Varicose veins, Virchows triad, Factor V leiden

Question 24

P for PE?

Answer 24

Pill (OCP), pregnancy, puerperium, previous VTE, polcythaemia, paraprotein deposition

Question 25

VTE prevention technique?

Answer 25

Mechanical = anti-embolic stockings
Pharamcological = LMWH

Question 26

How to investigate PE?

Answer 26

Wells (4 is cut off for CTPA vs D-dimer)

PE SCORE
Previous DVT or PE
Evidence of DVT

Stasis
Cancer
Opinion is PE
Rate Raised >100
Exsanguination (haemoptysis

Question 27

Stable Management for PE?

Answer 27

Haemodynamically stabble (SBP <90mmHg)

Yes = Resp support and anticoaguation ( Fondaparinux/heparin for 5 days and warfarin for 3 months. Start DOAC)

Question 28

Unstable Management for PE?

Answer 28

Resp support
1st line: thombolysis (alteplase or streptokinase)
2nd line: embolectomy

Question 29

Description of ARDS?

Answer 29

Non-cardiogenic pulmonary oedema

Question 30

ARDS causes?

Answer 30

Drugs, ventilation, nearly drowning, severe bruns, sepsis, pneumonia and transfusion reactions.

COVID-19`

Common in critically ill (ITU)

Question 31

Pathology of ARDS?

Answer 31

Severe inflammation so alveolar oedema so alveolar collapse

Question 32

Berlin criteria for ARDS?

Answer 32

ARDS
Alternative cause (cardiogenics pulmonary oedema)
Rapid onset <1 week
Dyspnoea
Similar on CXR

Question 33

Investigation for ARDS?

Answer 33

ABG, CXR/CT, ECHO, COVID SWAB