Clinical

Question 1

Upper respiratory tract infections

Answer 1

Common cold
Pharyngitis
Sinusitis
Epiglottitis

Question 2

Lower respiratory tract infections

Answer 2

Acute bronchitis
Acute exacerbation of chronic bronchitis/ COPD
Pneumonia
Influenza
Fungal infection

Question 3

Coryza

Answer 3

Acute viral infection of the nasal passages
Often accompanied by sore throat
Sometimes mild fever
Spread by droplets and fomites

Question 4

Viruses causing coryza

Answer 4

Adenovirus
Rhinovirus
Respiratory syncytial virus

Question 5

Acute sinusitis

Answer 5

Preceded by common cold
Frontal headache, 
Retro-orbital pain, 
Maxillary sinus pain, 
Tooth ache, 
Discharge

Question 6

Diphteria

Answer 6

Bacterial infection
Produces toxin
Life threatening

Question 7

Acute bronchitis

Answer 7

Productive cough
Fever – minority of cases
Normal chest examination
Normal chest X-ray
May have a transient wheeze

Question 8

Rhinovirus incubation time

Answer 8

1-5 days

Question 9

Group A streptococci incubation time

Answer 9

1-5 days

Question 10

Influenza and para influenza virus incubation time

Answer 10

1-4 days

Question 11

RSV virus incubation time

Answer 11

7 days

Question 12

Pertussis incubation time

Answer 12

7-21 days

Question 13

Diphtheria incubation time

Answer 13

1-10 days

Question 14

Epstein-Barr Virus incubation time

Answer 14

4-6 weeks

Question 15

Pneumonia

Answer 15

Signs and symptoms of a lower respiratory tract infection, with a new infiltrate on a CXR

Question 16

CURB 65 Severity Score

Answer 16

C new onset of Confusion
U Urea >7
R Respiratory rate >30/min
B Blood pressure Systolic <90,Diastolic <61
65 Aged 65 or older

Score 1 point for each above
Only applies to community acquired pneumonia

Question 17

Other severity markers for pneumonia

Answer 17

Temperature <35 or >40
Cyanosis PaO2 <8kPa
WBC <4 or>30
Multi-lobar involvement

Question 18

Complications of pneumonia

Answer 18

Respiratory failure
Pleural effusion
Empyema
Death

Question 19

Cases of pneumonia (4)

Answer 19

Community acquired
Hospital acquired
Aspiration pneumonia
Legionella

Question 20

Aetiology of classical flu

Answer 20

Influenza A virus

Influenza B virus

Question 21

Aetiology of flu-like illnesses

Answer 21

Parainfluenza viruses

many others

Question 22

Aetiology of Haemophilus influenzae

Answer 22

Bacterium

Question 23

‘Flu complications

Answer 23

Primary influenzal pneumonia
Secondary bacterial pneumonia
Bronchitis
Otitis media
Pregnancy complications

Question 24

Causes of community acquired pneumonia (other than flu)

Answer 24

Microbiological causes:
Mycoplasma pneumoniae
Coxiella burnetii
Chlamydia

Question 25

What are most cases of bronchiolitis caused by?

Answer 25

Respiratory syncytial virus

Question 26

Empyema

Answer 26

Pus in the pleural space

Question 27

Signs of complicated effusion

Answer 27

``` +ve gram stain pH <7.2 low glucose septations loculations ```

Question 28

Stridor

Answer 28

Inspiratory wheeze due to large airway obstruction

Question 29

Possible causes of stridor in the supraglottis/larynx

Answer 29

Laryngomalacia Supraglottic mass Glottic lesion Vocal cord paralysis

Question 30

Main causes of stridor in children

Answer 30

Infection Foreign Body Anaphylaxis/ Angioneurotic oedema Other (eg burns)

Question 31

Main causes of stridor in adults

Answer 31

``` Neoplasms Anaphylaxis Goitre Trauma (burns, strangulation, irritant gases) Bilateral vocal cord palsy Cricoarytenoid arthritis Tracheopathia ```

Question 32

Infections causing stridor in children

Answer 32

``` Epiglottitis Croup/ Pseudomembranous croup Retropharyngeal abscess Diphtheria Infectious mononucleosis ```

Question 33

Tracheomalacia

Answer 33

Inflammatory condition which causes destruction of cartilage

Question 34

Investigation in stridor

Answer 34

``` Laryngoscopy (beware in acute epiglottitis) Bronchoscopy Flow volume loop Chest X ray Other imaging ```

Question 35

Treatment of laryngeal obstruction

Answer 35

Treat underlying cause eg foreign body removal, Mask bag ventilation with high flow O2 Cricothyroidotomy Tracheostomy

Question 36

Treatment of malignant airway obstruction

Answer 36

Tumour removal (laser; photodynamic therapy; cryotherapy; diathermy; surgical resection) Tumour compression Radiotherapy Chemotherapy

Question 37

Acute anaphylaxis

Answer 37

``` Type 1 Hypersensitivity (IE) Flushing, pruritus, urticaria Angioneurotic oedema Abdominal pain, vomiting Hypotension Stridor, wheeze and respiratory failure ```

Question 38

Treatment of anaphylaxis

Answer 38

``` IM Adrenaline IV antihistamine IV corticosteroid High flow O2 Nebulised bronchodilators Endotracheal intubation ```

Question 39

Snoring

Answer 39

Relaxation of pharyngeal dilator muscles during sleep Upper airway narrowing Turbulent airflow Vibration of soft palate and tongue base

Question 40

Obstructive sleep apnoea

Answer 40

Intermittent upper airway collapse in sleep Hypoxia Sleep fragmentation

Question 41

Risk factors for sleep apnoea

Answer 41

``` Enlarged tonsils Obesity Retrognathia Acromegaly Oropharyngeal deformity Neurological Drugs/alcohol Post-operative period ```

Question 42

Clinical presentation of sleep apnoea

Answer 42

Excessive daytime sleepiness Personality change Cognitive / functional impairment Major impact on daytime function

Question 43

Consequences of sleep apnoea

Answer 43

``` Hypertension Activated sympathetic system Raised CRP Impaired endothelial function Impaired glucose tolerance Increased CDV risk ```

Question 44

Diagnosis of sleep apnoea

Answer 44

``` Snoring & EDS (raised Epworth score) Overnight sleep study - oximetry - domicillary recording - full polysomnography ```

Question 45

Treatment for obstructive sleep apnoea

Answer 45

Remove underlying cause Continuous Positive Airway Pressure (CPAP) Mandibular Advancement Device Surgery