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Question 1

Sx of PE?

Answer 1

Acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope, cyanosis, tachypnoea, tachycardia, hypotension, raised JVP and pleural rub

Question 2

Which score can be used to calculate the risk of PE?

Answer 2

Well’ score

Question 3

Dx and Tx of PE?

Answer 3

CT Pulmonary Angiography
Oxygen, morphine and anti-emetic, IV LMW heparin, thrombolysis with alteplase if haemodynamically unstable
Long term anticogaulation with DOAC e.g. rivaroxiban or warfarin

Question 4

Sx of TB?

Answer 4

Fever, weight loss, night sweats, clubbing, chronic productive cough, chest pain, haemoptysis

Question 5

Dx of TB?

Answer 5

Test for latent TB with the mantoux skin test
Test for active TB with CXR = nodular/patchy shadows in the upper zone, fibrosis and cavitiation. Take a sputum sample and perform a Ziehl-neelsen stain to look for acid-fast bacilli (all mycobacteria are this).

Question 6

Tx of TB? Give SEs of the drugs?

Answer 6

NOTIFY PHE
6 months antibiotic treatment with Rifampicin (makes body secretions orange-red), Isoniazid (causes peripheral neuropathies), Pyrazinamide (causes hepatotoxicity) and Ethambutol (causes colour blindness)

Question 7

What organisms casue TB?

Answer 7

Mycobacteria. Most common = Mycobacterium tuberculosis

Question 8

Sx of pneumonia?

Answer 8

Fever, malaise, dyspnoea, cyanosis, cough with purulent sputum, haemoptysis, pleuritic pain, tachycardia, tachypnoea and hypotension.

Question 9

What will you find on examination in pneumonia?

Answer 9

Consolidation = Reduced chest expansion, dull percussion, increased vocal resonance and bronchial breathing
Pleual rub
CXR = lobar infiltrates, cavitation and pleural effusion

Question 10

How do you calculate pneumonia severity? What does the score mean?

Answer 10

CURB-65
Confusion (1)
Urea >7mmol/L (1)
Resp rate >= 30/min (1)
BP <90 systolic and/or <60 diastolic (1)
65 or over (1)
A score of 2 or more suggests patient should be admitted to hospital

Question 11

What are the most common causative organisms of pneumonia?

Answer 11

CAP = Strep pneumoniae (commonest), haemophilus influenzae
HAP = Pseudomonas aeruginosa, MRSA

Question 12

What is the name of the lung tumour commonly caused by asbestos exposure? How does it present?

Answer 12

Mesothelioma

Chest pain, dyspnoea, weight loss, finger clubbing, reccurrent pleural effusions.

Question 13

What are the main types of bronchial carcinoma?

Answer 13

Small Cell LC = strongly associated with smoking, often metastasized by presentation
Non-Small Cell LC = Squamous or adenocarcinoma are the main ones. Adenocarcinoma = MOST COMMON

Question 14

Sx of lung cancer?

Answer 14

Cough, haemoptysis, dyspnoea, chest pain, clubbing, weight loss and frequent pneumonias.
Can cause consolidation, pleural effusion and lung collapse

Question 15

Sx of pneumothorax?

Answer 15

Sudden onset dyspnoea and pleuritic chest pain. Unilateral decreased chest expansion, hyperresonant percussion, reduced vocal resonance and diminished breath sounds.
Tension pneumothorax = tracheal deviation away from the affected side

Question 16

How can you distinguish transudates and exudates in pleural effusion? What casues each?

Answer 16

Transudates = <25g/L of protien. Caused by HF, fluid overload, cirrhosis, nephrotic syndrome and malabsorption
Exudates = >35g/L of protein. Caused by pneumonia, TB, RA, SLE, malignancy etc.

Question 17

How does pleural effusion appear on examination?

Answer 17

Unilateral reduced chest expansion, stony dull percussion, reduced breath sounds, decreased vocal resonance and broncial breathing above the effusion (if the lung is compressed).
Tracheal deviation away from the affected side.

Question 18

Sx of pleural effusion?

Answer 18

Dyspnoea, pleuritic chest pain, dry cough and orthopnoea

Question 19

Sx of CF? What do you find OE?

Answer 19

Neonate = failure to thrive and rectal prolapse
Older = cough, wheeze, recurrent chest infections, bronchiectasis, haemoptysis, pancreatic insufficiency, male infertitility
OE = cyanosis, finger clubbing and bilateral coarse crackles

Question 20

Dx and Tx of CF?

Answer 20

Sweat test (measures the amount of sodium and chloride in the sweat - will be high in CF)
Genetic screening (look for mutation in CFTR gene on chromosome 7)
Chest physio, mucolytics, bronchodilators etc.

Question 21

Sx of bronchiectasis? What is seen OE?

Answer 21

Persistent cough, lots of purulent sputum, intermittent haemoptysis, wheeze
Clubbing, coarse biphasic crackles

Question 22

Causes of bronchiectasis?

Answer 22

CF

H.influnezae, Strep. pneumoniae, Staph. aureus, Pseudomonas aeruginosa

Question 23

Tx of bronchiectasis?

Answer 23

Chest physio and mucolytics, antibiotics, bronchodilators e.g. salbutamol and corticosteroids e.g. prednisolone

Question 24

What is Empyema?

Answer 24

A build up of pus in the pleural space. It often occurs as a complication of pneumonia and should be suspected in any patient whith resolved pneumonia who develops a recurrent fever

Question 25

Sx of lung abscess?

Answer 25

Swinging fever, cough, purulent foul-smelling sputum, pleuritic chest pain, haemoptysis, weight loss, clubbing

Question 26

Causes of lung abscess?

Answer 26

Poorly treated pneumonia, aspiration (often seen in alcoholics) and broncial obstruction e.g. malinancy

Question 27

Sx of Idiopathic Pulmonary Fibrosis? What is seen OE?

Answer 27

Dry cough, exertional dyspnoea, weight loss, cyanosis, arthralgia Finger clubbing, fine end-inspiratory crackles

Question 28

Dx and Tx of IPF?

Answer 28

``` CXR = decreased lung volume and honeycombing of the lung Spiromitery = restirctive lung disease (FEV1 <80%, FEV1:FVC >70%) Tx = oxygen, pulmonary rehabilitation, opiates, palliative care ```

Question 29

What Sx are seen in all Intersitial Lung Diseases (ILD)

Answer 29

Dyspnoea on exertion, non-productive paroxysmal cough, abnormal breath sounds and restrictive spirometry.

Question 30

Sx of sarcoidosis?

Answer 30

Granulomas develop throughout the body! Fever, dry cough, progressive dyspnoea, decreased exercise tolerance, chest pain, hepatosplenomegaly, uveitis/conjunctivitis, erythema nodosum, cardiomyopathy, arrhythmias and renal stones

Question 31

What is BHL? How does it appear on X-ray and what may it indicate?

Answer 31

Bilateral Hilar Lymphadenopathy. Enlargement of the mediastinal lymphnodes (in the hila) Indicates sarcoidosis, infection e.g. TB, malignancy or hypersensitivity pneumonitits

Question 32

What is hypersensitivity pneumonitis?

Answer 32

A type III hypersensitivity reaction leading to inflammation of the lungs. Common casues = farmers lung and pigeon fanciers lung

Question 33

Sx of acute and chronic hypersensitivity pneumonitis?

Answer 33

``` Acute = fever, dry cough, dyspnoea, chest-tightness and pulmonary crackles Chronic = cough, increasing dyspnoea, cyanosis, weight loss, clubbing and type 1 respiratory failure ```

Question 34

Tx of hypersensitivity pneumonitis?

Answer 34

``` Acute = remove allergen, give oxygen and oral prednisolone Chronic = avoid allergen exposure, long term prednisolone ```

Question 35

Sx of GPA (Wegener's granulomatosis)?

Answer 35

Saddle nose deformity, epistaxis, nasal obstruction Renal involvement = proteinuria and haematuria Lung involvement = cough and haemoptysis

Question 36

Dx and Tx of GPA (Wegener's granulomatosis)?

Answer 36

ANCA positive - it is a form of vasculitis | Tx = corticosteroids and cyclophosphamide

Question 37

Sx of Goodpastures syndrome?

Answer 37

This is a type II hypersensitivity reaction caused by anti-GBM antibodies Oliguria, haematuria, dyspnoea and haemoptysis. It also causes anaemia = fatigue and pale skin

Question 38

Sx of asthma?

Answer 38

Episodic polyphonic expiratory wheeze, cough, dyspnoea, diurnal variation, chest hyperinflation

Question 39

Dx of asthma?

Answer 39

FeNO test. Reduced peak expiratory flow | Obstructive disese = PEF1 <80%, PEF1:FVC <70%

Question 40

Tx of asthma?

Answer 40

SABA (e.g. salbutamol) or SAMA (e.g. tiotropium) ADD inhaled corticosteroids ADD LABA/LAMA. In severe eosinophilic disease consider monoclonal antibodies e.g. omalizumab

Question 41

How do you treat an asthma attack?

Answer 41

40-60% oxygen, salbutamol (nebulised with oxygen), IV hydrocortisone, IV magnesuim sulfate if severe attack

Question 42

Sx of COPD?

Answer 42

Chronic cough, progressive dyspnoea (worse on exertion), sputum production, wheeze, cyanosis, chest hyperinflation, use of acessory muscles, frequent LRT infections

Question 43

Dx of COPD? How is this used to stage COPD?

Answer 43

FEV1 <80%, FEV1:FVC <70% Stage 1 = FEV1 >80%, chronic cough and no-mild breathlessness Stage 2 = FEV1 50-79%, breathlessness on exertion Stage 3 = FEV1 30-49%, breathlessness on low exertion Stage 4 = FEV1 <30%, breathless at rest

Question 44

Tx of COPD?

Answer 44

Smoking cessation, SABA/SAMAs (e.g. salbutamol or ipatropium) ADD LABA/LAMA, ADD inhaled corticosteroids. Oxygen in acute exacerbations (consider NIV) These patients are at risk of developing type 2 respiratory failure!

Question 45

Define the two types of respiratory failure?

Answer 45

Type 1 = hypoxia with normal/low carbon dioxide levels | Type 2 = hypoxia with hypercapnia

Question 46

Causes of Type 1 respiratory failure?

Answer 46

Ventilation/perfusion mismatch = pneumonia, pulmonary oedema, PE, asthma, ephysema and pulmonary fibrosis. Also due to hypoventilation, abnormal diffusion, R to L cardiac shunts and ARDS e.g. due to opiate OD

Question 47

Causes of Type 2 respiratory failure?

Answer 47

Alveolar hypoventialtion with or without V/Q mismatch. Pulmonary disease = asthma, COPD, obstructive sleep apnoea, pnumonia Reduced respiratory drive = opiates and CNS injury Neuromuscular disease = myasthenia gravis, Guillain-Barre syndrome and C spine injury Thoracic wall diseas = flail chest

Question 48

Sx of hypoxia?

Answer 48

dyspnoea, restlessness, agitation, confusion, central cyanosis. If chronic = polycythaemia, pulmonary hypertension and cor pulmonale

Question 49

Sx of hypercapnia?

Answer 49

Headache, peripheral vasodilation, tachycardia, bounding pulse, tremour/asterixis, papilloedema, confusion, drowsiness and coma

Question 50

Sx of pharyngitis/tonsillitis?

Answer 50

Sore throat, tender cervical lymph nodes/glands in the neck, fever, enlarged tonsils with exudate in tonsilitis

Question 51

Sx of sinusitis?

Answer 51

Fever, facial pain, pain in the ears/teeth, purulent nasal discharge, cold-like symptoms

Question 52

Sx of acute epiglottitis?

Answer 52

Fever, sore throat, severe airway obstruction, odonphagia, fatigue, weight loss, diarrhoea, oral thrush, inspiratory stridor

Question 53

Sx of whooping cough?

Answer 53

Chronic cough with coughing spasms that end in vomiting, clear lungs, subconjunctival haemorrhage, fever. VACCINATE CHILDREN

Question 54

Tx of acute epiglottitis?

Answer 54

Urgent endotracheal intubation, IV ceftazidime

Question 55

What is coup?

Answer 55

A complication of URT infection causing oedema of teh vocal cords and epiglottis = a barking cough (like a seal), inspiratory stidor and cyanosis

Question 56

Sx of glandular fever (infective mononucleosis)

Answer 56

Fever, lymphadenopathy, severe sore throat, tonsilar enlargement, anorexia, fatigue, hepatosplenomegaly which can lead to jaundice

Question 57

Tx of coup?

Answer 57

Nebulised adrenaline, oxygen, fluids, oral/IM dexamethasone