CCC Respiratory

Question 1

What conditions can make someone breathless in seconds?

Answer 1

Pneumothorax
PE
Foreign bodies

Question 2

What conditions can make someone breathless in hours?

Answer 2

Airway inflammation/obstruction 
Chest infection (pus) 
Acute heart failure (fluid)

Question 3

What conditions can make someone breathless in days/weeks?

Answer 3

Hours answer but chronic
Interstitial lung disease
Malignancy/large pleural effusion
Neuromuscular
Anaemia/thyrotoxicosis

Question 4

How do we manage pneumothorax?

Answer 4

Primary PT
<2cm discharge and repeat CXR (some air can be resorbed)
>2cm aspiration – chest drain if unsuccessful

Secondary to a condition PT
<2cm aspiration
>2cm chest drain

patients may present after with SOB due to reexpansion pulmonary oedema

Question 5

What does this chest XRAY show?

Answer 5

right-sided pneumothorax

Question 6

How do we determine if there is left or right axis deviation on an ECG?

Answer 6

1. Look at I and II, is either of them overall negative? If yes, axis deviation.
2. Look at avL: is it overall position
   Yes? left axis (therefore LBBB)
   No? right axis

Question 7

How would we treat a PE?

Answer 7

LMWH

Thrombolysis is only used if patient is haemodynamic compromise – high bp

(relates to LBBB and RBBB because these may show on ecg in PE)

Question 8

What does this CXR show?

Answer 8

Large PE

Question 9

What does this CXR and CT show?

Answer 9

Large bullae! Shows up in CT

Question 10

What does this CXR show? (has dry cough, clubbing, progressive SOB, FEV1/FVC ratio >70%)

Answer 10

Pulmonary fibrosis – reticular nodular shadowing – the lines and dots present

Could also be asbestosis, connective tissue disease, drugs

(AKA fibrosing alveolitis)

Question 11

What does this CXR show? (chronic sob, sputum, <70% ratio)

Answer 11

COPD, hyperexpansion

Question 12

This patient has a cough, sputum, weight loss and night sweats?

Answer 12

Tuberculosis – consolidation in right upper lobe

Question 13

70 year old with SOB that keeps pigeons, what’s the problem?

Answer 13

Allergic alveolitis! (reticular nodular pulmonary fibrosis again)

Question 14

How to present a CXR?

Answer 14

This is a PA/AP CXR of
Name and DOB
Taken on (DATE)
At (TIME)

Quality of film - rotation, inspiration, penetration

Question 15

Different types of opacities on CXR?

Answer 15

1. Interstitial/alveolar shadowing (fluffy in heart failure or pneumonia)
2. Reticulo-nodular shadowing (lines and dots)
3. Homogenous shadowing (pleural effusion)
4. Masses/cavitations

Question 16

What type of shadowing is this

Answer 16

Interstitial shadowing (heart failure - fluid, pus - pneumonia, blood)

Question 17

What type of shadowing is this?

Answer 17

Homogenous shadowing - pleural effusion

Question 18

What does this show?

Answer 18

Lung collapse (R)

Question 19

Causes of pleural effusion?

Answer 19

Infection
Inflammation
Malignancy

Question 20

What does this show?

Answer 20

Left cavitating lesion e.g. malignancy

Question 21

What is this?

Answer 21

Pericardial effusion

Question 22

What is this?

Answer 22

Bilateral hilar lymphadenopathy (batwing sign)

Question 23

What is this?

Answer 23

Pleural plaques!