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Question 1

What are the signs of pulmonary oedema?

Answer 1

A-E

alveolar oedema (bat wings)
Kelley B lines
Cardiomegaly
Diversion of blood to upper lobes (where the vessels in the upper zone are larger than in lower zone)
pleural Effusions

Question 2

How to assess adequacy of a plain CXR?

Answer 2

RIPE

Rotation
Inspiration
Projection (AP or PA)
Exposure

OR

PRIM

Projection
Rotation
Inspiration
Markings

Question 3

Assessment of a chest x ray

Answer 3

Airway
Breathing (lungs and pleura)
Cardiac (size and borders)
Diaphragm (incl. costophrenic angles)
Everything else (mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas)

Question 4

CXR findgins of pectus excavatum

Answer 4

7-shaped ribs
missing right heart border
heart displaced to the left

Question 5

What ix should patients with unexplained persistent cough have?

Answer 5

CXR

Question 6

What can increase the reliability of the sweat test?

Answer 6

giving fludrocortisone before

Question 7

Summarise the BTS asthma management ladder

Answer 7

1. Inhaled SABA
2. add ICS
3. Add LABA
4. consider increasing ICS dose and adding 4th drug (LTRA, SR theophylline, b2 agonist tablet)
5. oral steroids and refer to specialist care

Question 8

examination findings in PE

Answer 8

sinus tachycardia
tachypnoea
hypoxaemia
loud s2
elevated JVP
calf swelling/tenderness
haemoptysis

Question 9

3 commonest causes of persistent cough with normal CXR

Answer 9

asthma (50%)
sinusitis with postnasal drip (25%)
GORD (20%)

Question 10

Causes of hypoxaemia (PaO2 <8)

Answer 10

1. hypoventilation
2. V/Q mismatch (shunting vs deadspace)
3. Diffusion impairment
4. high altitude

Question 11

genetic RF for PE

Answer 11

protein C & S deficiency
Factor V leiden
FH

Question 12

Management of haemodinamically unstable with PE

Answer 12

LMWH
thrombolysis
thromectomyn
IV fluids
warfarin
NOAC

Question 13

medication for thrombolysis

Answer 13

alteplase

Question 14

Causes of pulmonary HTN

Answer 14

group 1: PAH (idiopathic, hereditary, drug/toxin, CTD)

group 2: PH secondary to LHF (raised capillary wedge pressure)

group 3: PH secondary to underlying lung disease and hypoxia

group 4: chronic thromboembolic pulmonary HTN

group 5: secondary to conditions with multifactorial mechanisms causing PH

(you don’t come across group 5 that much)

Question 15

sx of pulmonary HTN

Answer 15

breathlessness on exertion
Lower leg swelling

Question 16

signs on examination of pulm HTN

Answer 16

pan systolic murmur (tricuspid regurgitation)
central cyanosis
signs of connective tissue disease

Question 17

features of RHF

Answer 17

peripheral oedema
ascites
raised JVP

Question 18

Management of group 1 pulm HTN

Answer 18

pulmonary vasodilator therapy aimed at decreasing pulmonary vascular resistance

Calcium channel blockers: First-line pulmonary vasodilator therapy for patients with PAH and positive vasoreactivity testing

Question 19

Management of group 2 pulm HTN

Question 20

Management of group 3 pulm HTN

Question 21

Management of group 4 pulm HTN

Answer 21

anticoagulation

pulmonary endarterectomy
…

Question 22

Management of COPD and asthma exacerbation - where do you give more steroids?

Answer 22

asthma

due to very inflammatory nature

Question 23

what does inability to complete sentence indicate in asthma?

Answer 23

severe asthma attack

Question 24

Is NIV a treatment option for asthma exacerbations?

Answer 24

no

but it is for COPD

Question 25

Components of CURB 65

Answer 25

Confusion Urea (>7 mmol/L urea) RR > or = 30 BP (sys <90 or dia or = 65 age

Question 26

Management of CAP based on CURB65 and HAP

Answer 26

1: amoxicillin or tetracycline/macrolide if allergic 2: amoxicillin + macroldie 3 or more: beta lactase (Co-amox) + macrolide HAP: abx covering pseudomonas e.g. tazosin

Question 27

which medications can cause pulmonary fibrosis?

Answer 27

methotrexate chemotherapy amiodarone nitrofurantoin biologics

Question 28

Initial management of infective exacerbation of COPD

Answer 28

oral prednisolone 30mg OD for 5/7 abx (co-amox/amoxicillin/clarithromycin)

Question 29

prevention of COPD exacerbation

Answer 29

stop smoking flu and pneumococcal vaccines mucolytic pulm rehab educatem safety net, rescue pack - steroids and abx annual r/v (6 monthly if severe, <30% predicted) review inhlaers and consider sustainability -> discuss switching from MDI to DPI correct disposal of inhalers, e.g. bring to pharmacy recycle inhalers

Question 30

What is the acronym for causes of upper lobe fibrosis?

Answer 30

CHARTS C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis

Question 31

Does pneumonia predispose to a pneumothorax?

Answer 31

no

Question 32

Which of these conditions predispose to pneumothorax? - lung fibrosis - lung carcinoma - liver biopsy - pneumonia - emphysema - central line insertion - asthma

Answer 32

all except pneumonia

Question 33

Features of moderate acute asthma

Answer 33

- PEF >50-75% expected - worsening sx - no features of acute severe asthma

Question 34

Features of severe acute asthma

Answer 34

- PEF 33-50% expected - RR 25 or above - HR 110 or above - unable to complete sentences in one breath

Question 35

Features of life-threatening acute asthma

Answer 35

- PEF <33% expected - sats <92% - PaO2 < 8kPa - normal PaCO2 (4.6-6.0 kPa) - altered conscious state - exhaustion - arrythmia - hypotension - cyanosis - silent chest - poor respiratory effort

Question 36

Features of near fatal acute asthma

Answer 36

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures