Common Cardio and Resp diseases

Question 1

Asthma aetiology

Answer 1

Atopy - familial, IgE.

Airway hyper responsiveness and intermittent airway obstruction.

Question 2

Signs of Asthma

Answer 2

Tachypnoea
Audible wheeze 
Hyper inflated chest
Hyper resonant percussion. 
Decreased air entry - widespread polyphonic wheeze.

Question 3

Symptoms of Asthma

Answer 3

Intermittent dyspnoea
Wheeze
Cough (nocturnal)
Sputum production

Question 4

Investigations for Asthma

Answer 4

Peak Expiratory Flow on walk before and after dilators
Spirometry
Exercise tolerance test
FBC 
Skin prick for allergen

Question 5

Treatment for Asthma

Answer 5

1. Inhaled short acting B2 agonist
2. Add standard dose of inhaled corticosteroid
3. Add Long acting beta agonist.
4. Consider trials of increasing corticosteroid.

Question 6

What is COPD?

Answer 6

Chronic Obstructive Pulmonary Disease - Bronchitis, Emphysema,.

Question 7

Causes of COPD

Answer 7

Smoking
Air pollution
Occupational exposure

Question 8

Signs of COPD

Answer 8

Use of accessory muscles on expiration 
Decreased chest expansion 
Coarse crackles 
Hyper - resonance 
Clubbing

Question 9

Symptoms of COPD

Answer 9

Morning cough - then constant.
Productive sputum
SOB
Wheeze

Question 10

Investigations for COPD

Answer 10

FBC
Spirometry 
Chest X-ray 
ECG (cor pulmonale)
Arterial Blood Gas

Question 11

Treatment for COPD

Answer 11

Smoking cessation 
Pulmonary rehabilitation 
1. Short-acting beta agonist. 
Systemic corticosteroid 
2. Inhaled corticosteroid 
3. Long acting beta agonist or Long acting muscarinic antagonist.
Oxygen (long term)

Question 12

Lung cancer aetiology

Answer 12

Smoking 
Asbestos 
Environmental 
Occupation 
Air pollution

Question 13

What are the different types of lung cancer?

Answer 13

Squamous cell carcinoma (40%)
Adenocarcinoma (41%)
Small cell carcinoma (15%)
Large cell carcinoma (4%)

Question 14

Signs of Lung cancer

Answer 14

Chest signs 
Finger clubbing
Lymphadenopathy 
Horner's syndrome 
Hepatomegaly

Question 15

Symptoms of lung cancer

Answer 15

Cough 
Haemoptysis
Dyspnoea 
Chest pain 
Recurrent pneumonia 
Unexplained weight loss.

Question 16

Investigations for lung cancer

Answer 16

Chest x-ray 
FBC
LFT 
Spirometry 
CT thorax and abdomen

Question 17

Treatment for Lung cancer

Answer 17

Surgery (lobectomy)
Radiotherapy
Chemotherapy
Immunotherapy

T (tumour) N (nodes) M (metastases) staging used for severity.

Question 18

Tuberculosis aetiology

Answer 18

Mycobacteria species, mainly:
mycobacterium tuberculosis and mycobacterium bovis.
HIV

Question 19

TB signs

Answer 19

Lung consolidation
Bronchial breath sounds
Crackles on auscultation

Question 20

TB symptoms

Answer 20

Presence of risk factors
Cough
weight loss
Fever
Night sweats
Fatigue and malaise

Question 21

TB investigations

Answer 21

3 sputum specimens on successive days (smear, culture and PCR)
Chest X-ray 
CT thorax
Bronchoscopy 
Biopsy

Question 22

TB treatment

Answer 22

Rifampicin 
Isoniazid
Ethambutol
Pyrazinamide
All for 2 months 

Then for 4 months
Rifampicin
Isoniazid

Question 23

Side effects of TB drugs

Answer 23

Rifampin - Orange urine, tears, inactivation of oral contraceptive.

Isoniazid - Hepatitis and peripheral neuropathy

Ethambutol - Optical neuropathy

Pyrazinamide - Gout

Question 24

Stable angina aetiology and risk factors

Answer 24

Atherosclerosis
Thrombosis / Blood clot
Risk factors: Obese, history of heart disease, high cholesterol, hypertension,d diabetes.

Question 25

Signs of stable angina

Answer 25

Xanthalasma and corneal arcus. Hypertension Tremor Tachycardia

Question 26

Symptoms of stable angina

Answer 26

``` Central chest tightness - often radiation to neck and arms. Aggravated by exertion and stress. Dyspnoea Dizziness Fatigue Sweating Palpitations Claudication ```

Question 27

Investigations for stable angina

Answer 27

Exercise tolerance test Stress ECHO Exercise with ECG Exercise stress test

Question 28

Treatment for stable angina

Answer 28

Relief by stopping activity/ stress. Sublingual nitrate spray (GNT spray) Smoking cessation Treat risk factors - Hypertension, obesity etc

Question 29

Hypertension aetiology

Answer 29

``` Polygenic Age Genetics and Fam history. Environment Weight Alcohol Race - black more at risk. ```

Question 30

Signs of Hypertension

Answer 30

Retinopathy | BP over or equal to 140/90

Question 31

Symptoms of Hypertension

Answer 31

Usually not any Chest pain SOB

Question 32

Investigations for hypertension

Answer 32

BP home monitoring to confirm diagnosis. ECG Echocardiogram Urine analysis

Question 33

Treatment for Hypertension

Answer 33

Step 1: CCB if over 55 and black. If CCB not suitable then thiazide type diuretic. Ace inhibitor if <55yrs, NOT WOMEN OF CHILD BEARING AGE OR BLACK ETHNICITY. Step 2: Thiazide-type diuretic added to CCB or Ace inhibitor. Step 3: Add ACE inhibitor, CCB and diuretic together. Step 4: Resistant hypertension: low dose spironolactone or higher dose diuretic if K over 4.5mmol/l.

Question 34

What are the stages of hypertension?

Answer 34

Stage 1: Clinic BP 140/90 or higher. Stage 2: Clinic BP 160/100mmHg or higher. Severe: Systolic 180 or higher. Diastolic 110mmHg or higher

Question 35

Deep Vein Thrombosis aetiology

Answer 35

``` Many factors: Surgery Lower limb problems Reduced mobility Previous proven venous thromboemboli ```

Question 36

DVT signs

Answer 36

Can be clinically silent. Unilateral pitting oedema. Unilateral limb swelling.

Question 37

DVT symptoms

Answer 37

``` Warmth Erythema (redness) Prominent collateral veins Persisting discomfort Calf tenderness Pigmentation Ulceration (severe) ```

Question 38

DVT investigations

Answer 38

Clinical assessment Pre-test probability score (well's score) Blood test ( D dimer has high sensitivity for VTE) Compression Ultrasound

Question 39

DVT treatment

Answer 39

``` Unfractionated heparin Low molecular weight heparin Warfarin Direct oral anticoagulants Thrombylisis (massive DVT) ```

Question 40

NSTEMI / STEMI aetiology

Answer 40

Thrombosis Atherosclerosis Risk Factors: Age, gender, family history, smoking, diabetes.

Question 41

1. NSTEMI what is it? | 2. STEMI what is it?

Answer 41

1. Partial occlusion of coronary artery. | 2. Complete obstruction of the coronary artery.

Question 42

Signs of 1. NSTEMI 2. STEMI 3. BOTH

Answer 42

1. Common ST-segment depression and T wave inversion. ELEVATED troponin. 2. ST segment elevation in ECG. 3. Distress, anxiety, 4th heart sound, pallor, pan systolic murmur, low grade fever.

Question 43

Symptoms of NSTEMI and STEMI

Answer 43

``` Extreme fatigue Dyspnoea Dizziness Angina Oedema Abdominal swelling Profuse sweating ```

Question 44

NSTEMI and STEMI Investigations

Answer 44

``` ECG Cardiac biomarkers (troponin) ECHO Elevated serum levels FBC CT angiogram ```

Question 45

Treatment for NSTEMI

Answer 45

``` MONAC: Morphine Oxygen Nitro-glycerine Aspirin Clopidiogrel ``` ``` ABAS: Aceinhib Beta blockers Aspirin Statins ```

Question 46

Treatment for STEMI

Answer 46

Primary coronary artery bypass or thrombolysis. Angiography. ``` MONAC: Morphine Oxygen Nitro-glycerine Aspirin Clopidogrel ``` MORE SEVERE

Question 47

Pneumonia aetiology

Answer 47

Strep pneumonia +ve Staph aureus +ve E.coli -ve

Question 48

Pneumonia signs

Answer 48

``` Pyrexia Tachnopnoea Central cyanosis Dullness on percussion of affected lobes. Brachial breathing Increase vocal resonance ```

Question 49

Pneumonia symptoms

Answer 49

``` Malaise Myalgia Fever Chest pain (pleuritic) Cough Rusty sputum SOB ```

Question 50

Pneumonia investigations

Answer 50

``` CRP and FBC Chest X-ray Blood cultures Throat swab HIV test ```

Question 51

Treatment for pneumonia

Answer 51

CURB65 (confusion, blood, Urea > 7, RR >30, diastolic BP<60 age > 65. 1. Amoxycillin, or clarithromycin 2. BOTH 3. Then add amoxiclav Oxygen, IV fluids, intubation.