Resp

Question 1

How do diarrhoea and vomiting affect acid base balance?

Answer 1

Diarrhoea –> lose HCO3 –> metabolic acidosis

Vomiting –> lose H –> metabolic alkalosis

Question 2

Causes of resp acidosis and alkalosis

Answer 2

Resp acidosis: type 2 resp failure (COPD, severe asthma)

Resp alkalosis: type 1 resp failure (pneumonia, panic attacks)

Question 3

Causes of metabolic acidosis and alkalosis

Answer 3

Metabolic acidosis: excess acid production e.g. diabetic ketoacidosis or exercise induced lactic acidosis, or diarrhoea so lose HCO3
Metabolic alkalosis: vom so lose H+, or diuretics

Question 4

What is the treatment in acute severe asthma?

Answer 4

Oral prednisolone, nebulised salbutamol.
Then IV ipratropium bromide
THen IV magnesium
Call ICU

Question 5

Define acute severe asthma

Answer 5

RR >25
HR>110
PEF 33-50%
Can’t complete sentences

Question 6

Define life threatening asthma

Answer 6

SpO2 <92%
PEF <33%
Altered conscious level

Question 7

Define near-fatal asthma

Answer 7

High CO2.

Question 8

What is wheeze?

Answer 8

High pitched muscial whistling sound caused by narrowing of bronchial tubes

Question 9

Why is wheeze more pronounced in expiration?

Answer 9

Because airways are narrower in expiration

Question 10

Difference between specific and non-specific triggers of asthma?

Answer 10

Specific are allergens e.g. pollen, house dust mite

Non-specific are irritants e.g. cold weather, exercise

Question 11

Most wheeze is ___piratory but wheeze in ____ is __piratory

Answer 11

Most wheeze expiratory, wheeze in stridor is inspiratory (because upper airway issue)

Question 12

What can cause pink tinged frothy sputum?

Answer 12

LVF

Question 13

What can cause clubbing?

Answer 13

Lung cancer, bronchiectasis, CF, pulmonary fibrosis

Question 14

Why does pursed lip breathing help?

Answer 14

We don’t want to release too much air and make alveoli too small because then its harder to inflate them

Question 15

What lung problems will cause mediastinal shift away from the problem?

Answer 15

Tension pneumothorax and pleural effusion

Question 16

What lung problems will cause mediastinal shift towards the problem?

Answer 16

Lobar collapse, pulmonary fibrosis

Question 17

What is hearing bronchial breath sounds in a vesicular location a sign of?

Answer 17

Pneumonia

Question 18

Name continous and discontinuous lung sounds

Answer 18

Continuous: wheezes and stridors
Discontinuous: pleural friction rubs and crackles

Question 19

What do fine and coarse crackles sound like?

Answer 19

Fine: high and soft
Coarse: loud and low

Question 20

When do fine crackles, coarse cracles, and pleural friction rubs occur?

Answer 20

Fine: pneumonia
Coarse: COPD, bronchiectasis
Pleural friction rubs: pleurisy, PE

Question 21

Do you know where to find the carina, aortic knuckle, hilar points, aorto-pulmonary window

Answer 21

good

Question 22

Identify a CXR pleural effusion

Answer 22

Uniformly white area with concave surface (meniscus sign), costophrenic angles and heart border not visible

Question 23

Identify a CXR tension pneumothorax

Answer 23

Air trapped between lung and chest wall, lung outline visible, air is hyperlucent, in tension there is mediastinal shift away

Question 24

Name 4 TB drugs

Answer 24

Rifampicin, Isoniazide, Pyrazinamide, Ethambutol

Question 25

Describe TB pathology

Answer 25

Caseating granuloma with Langhans giant cells, in pulmonary TB the granuloma calcifies to form a Ghon focus. Consolidation

Question 26

Name a cause of CAP and HAP and treatments

Answer 26

CAP strep pneu treat with amoxicillin (+) | HAP staph aureus treat with co-amoxiclav (+ and -)

Question 27

Describe a COPD CXR

Answer 27

Flattened hemidiaphragms, wider chest diameter, pulmonary arterial HTN, increased retrosternal space

Question 28

How to differentiate latent and active TB?

Answer 28

Latent TB + for IFNy and TST but - for sputum culture

Question 29

Where do TB lesions normally form

Answer 29

Apex of lungs because they're aerobic

Question 30

Difference between miliary and extrapulmonary TB

Answer 30

Miliary (disseminated) TB spreads via blood to anywhere | Extrapulmonary TB can occur in the LNs, GI, peritoneum, bones and joints

Question 31

What should you treat pneumonia from atypical organism with?

Answer 31

Deoxycycline

Question 32

What are the three types of breath sounds and where should you listen for them

Answer 32

Tracheal (neck midline), bronchial (manubrium), vesicular (peripheral lung)

Question 33

What do the three types of breath sounds sound like

Answer 33

Tracheal - even inspiration and expiration, loud, harsh Bronchial - short inspir and long expir, loud, less harsh Vesicular - long inspir short expir, softer

Question 34

A pleural effusion sounds...

Answer 34

Stony dull

Question 35

Name causes of transudate and exudate in pleural effusion

Answer 35

Transudate: change in pressures e.g. HF, hypoalbuminemia. Exudate: infections e.g. pneumonia, TB, bronchial carcinoma

Question 36

Name causes of pneumothorax

Answer 36

Trauma (rib fracture or sharp), spontaneous primary from subpleural bulla (thin young males), secondary spontaneous from COPD, asthma, TB, bronchiectasis, lung cancer

Question 37

What sign do you get from listening to consolidation

Answer 37

Bronchial breath sounds in vesicular location because consolidation solid transmits sounds better than normal air

Question 38

What's a bovine cough and how does it compare to normal

Answer 38

Normal cough involves big inspiration, closing glottis, increasing intrapulmonary pressure and sudden opening of glottis In bovine cough its a non-explosive cough because you can't close glottis

Question 39

Name paraneoplastic syndromes due to lung cancer

Answer 39

SIADH, Cushing's, finger clubbing, Eaton-Lambert syndrome (NMJ autoimmune), Horner's syndrome

Question 40

Which lung cancer is the most common in never smokers

Answer 40

Adenocarcinoma (type of non-small cell)

Question 41

How does treatment differ in small cell and non-small cell lung cancer?

Answer 41

Non-small cell advances slower so if you catch in time surgery, chemo if late but only for symptom control. Small cell advances quicker so no surgery option, chemo or radio only

Question 42

How does staging affect lung cancer treatment

Answer 42

Stages I/II given radical treatment, stage III is inoperable, stage IV is palliative. Beyond N1 is inoperable