Resp conditions

Question 1

What is acute bronchitis?

Answer 1

Infection of the bronchi

Question 2

How is acute bronchitis different to pneumonia?

Answer 2

Infection is of the bronchi not the lung parenchyma

Question 3

What symptoms will someone with acute bronchitis classically present with?

Answer 3

Cough that lasts <30 days
Cough may be productive (clear, white or discoloured sputum)
Cough worse at night and with exercise

Question 4

Who cannot be diagnosed with acute bronchitis?

Answer 4

Those with an underlying respiratory condition eg asthmatics

Question 5

Who is more likely to get acute bronchitis?

Answer 5

Smokers

Those who have been exposed to infectious agents

Question 6

What is the first line investigation of acute bronchitis?

Answer 6

None, diagnosis is clinical

You might want to do a chest x ray to rule out pneumina

Question 7

How is acute bronchitis managed?

Answer 7

Usually it doesn’t need to be treated and the cough will settle in 4 weeks
Anti pyretics eg paracetamol may be used
If there is a wheeze consider giving salbutamol

Question 8

What are some complications of acute bronchitis?

Answer 8

Chronic cough

Pneumonia

Question 9

What is asbestosis?

Answer 9

Diffuse interstitial fibrosis of the lungs due to exposure to asbestos

Question 10

What symptoms will someone with asbestosis classically present with?

Answer 10

Exertional dyspnoea that is progressively getting worse
Cough (non productive/dry)
Crackles on auscultation

Question 11

Who is more likely to get abestosis?

Answer 11

Those with exposure

Smokers

Question 12

How long after exposure to asbestos will someone with asbestosis present?

Answer 12

20 years after

Question 13

What is the first line investigation for asbestosis? What will you see?

Answer 13

Chest x ray- if after 20 years of exposure, you may see evidence of fibrosis and pleural thickening
Pulmonary function tests- usually will show restrictive disease but may also show features of obstructive disease

Question 14

How is asbestosis managed?

Answer 14

First line lifestyle advice of importance of not smoking
May benefit from pulmonary rehabilitation
May need oxygen therapy- if sats are under 89% on room air
Give abx if there is any evidence of infection

Question 15

What advice is it really important to give patients with asbestosis and why?

Answer 15

Don’t smoke- smoking when you have asbestosis increases the risk of lung cancer greatly

Question 16

What are some complications of asbestosis?

Answer 16

Lung cancer

Cor pulmonalae

Question 17

How long after exposure will you see radiographical changes in someone with asbestosis?

Answer 17

20 years

Question 18

What is an LRTI?

Answer 18

An infection of the respiratory tract below the larynx

Question 19

Where must an infection be for it to be an LRTI?

Answer 19

Below the larynx

Question 20

What symptoms will someone with an LRTI classically present with?

Answer 20

Dry cough
Headache
Stuffy or runny nose
Low fever

Question 21

Who is more likely to get LRTI?

Answer 21

Immunocompromised
Under 5 or over 65
Recent cold or flu
Recent surgery

Question 22

What type of organism most commonly causes an LRTI?

Answer 22

Virus

Question 23

What is the first line investigation for LRTI? What will it show

Answer 23

Dont need any, diagnosis can be clinical
Always do oxygen saturation
May do a chest x ray to rule out pneumonia

Question 24

How is LRTI managed?

Answer 24

Usually no medication is needed as its viral but may give abx if bacterial
Tell them to drink lots of water, salt gargle etc
Can take antipyretics and NSAIDs
If they are breathless an inhaler may be prescribed

Question 25

What are some complications of LRTI?

Answer 25

Progression to bronchitis or pneumonia

Question 26

What is fibrotic lung disease?

Answer 26

Fibrosis and scar tissue in the lung with no other obvious cause

Question 27

What symptoms will someone with fibrotic lung disease classically present with?

Answer 27

Exertional dyspnoea Dry non productive cough Crackles (especially in lung bases) They may also have weight loss, malaise and clubbing

Question 28

Who is more likely to get fibrotic lung disease?

Answer 28

Increasing age Smokers Male sex Family hx

Question 29

What are the first line investigations for fibrotic lung disease and what would you expect to see?

Answer 29

Chest x ray- abnormal and evidence of fibrosis CT chest- evidence of fibrosis Lung function tests- show restrictive disease (low forced vital capacity and total lung capacity May do: Anti nuclear antibodies- to rule out collagen vascular disease Rheumatoid factor- to rule out RA as a cause

Question 30

How is fibrotic lung disease managed?

Answer 30

First line antifibrinotics eg pirfenidone or nintedanib Pulmonary rehabilitation and oxygen therapy if needed Prescribe PPI as an adjunct as it has been shown to increase survival rates

Question 31

What should you prescribe as an adjunct in fibrotic lung disease and why

Answer 31

PPI as it has been shown to increase survival and patients with fibrotic lung disease have a high risk of developing GORD

Question 32

What are some complications of fibrotic lung disease?

Answer 32

GORD | Pumonary hypertension

Question 33

What is obstructive sleep apnoea?

Answer 33

Episodes of apnoea due to complete or partial airway blockages at night

Question 34

What symptoms will someone with obstructive sleep apnoea classcially present with?

Answer 34

``` Chronic snoring Episodes of apnoea- waking up due to loud snore in attempt to open airway Gasping Unrefreshing sleep Insomnia Fatigue during the daytime ```

Question 35

Who is more likely to develop obstructive sleep apnoea?

Answer 35

``` Male sex Post menopausal females Wide neck circumference Structural abnormalities of the mandible Down's syndrome Increased soft tissue in mouth and neck eg large tonsils, macroglossia Obesity Increasing age Smokers PCOS Family history Hypothyroidisim ```

Question 36

What is the first line investigation of OSA? How does it work and what do you see?

Answer 36

Polysomnography- patient comes in for a night and apnoea: hypopnoea is measured, if over 15 and hour or over 5 an hour with symptoms and comorbities a diagnosis can be made

Question 37

What is polysomnography used for and what does it measure?

Answer 37

It is a test used to diagnose obstructive sleep apnoea and it measure apnoea: hypopnoea

Question 38

How is OSA managed?

Answer 38

First line CPAP- required titration to set If not tolerated oral devices or implanted hypoglossal neurostimulation If obese give lifestyle advice/ consider bariatric surgery

Question 39

What are some complications of OSA?

Answer 39

``` Depression Cardiovascular disease Motor vehicle accident Cognitive dysfunction Impaired glucose metabolism Mortality ```

Question 40

What is pulmonary hypertension?

Answer 40

Increased blood pressure in the pulmonary vessels

Question 41

What symptoms will someone with pulmonary hypertension classically present with?

Answer 41

``` Chest pain Dyspnoea- initially exertional but also on rest as disease progresses Cyanosis Fatigue Dizziness or syncope Oedema (as a result of heart failure) ```

Question 42

What are the 5 causes of pulmonary hypertension?

Answer 42

``` PAH (pulmonary arterial hypertension) Due to lung disease Due to left sided heart disease (failure or valvular disease) Vascular obstruction (clots etc) Other/ multifactorial disease ```

Question 43

What are the first line investigations for pulmonary hypertension? What would expect to see?

Answer 43

Echocardiogram- pressure in pulmonary arteries greater than 25 mmHg Right heart catheterisation- catheter passed into right side of heart and then pulmonary vessels to confirm high pressure ``` May also do ECG- to rule our arrhythmia Bloods Chest x ray Cardiac MRI LFTs Serology- HIV screen etc ```

Question 44

How is pulmonary hypertension managed?

Answer 44

Treat the underlying cause If in heart failure give diuretics to offload them Digoxin may be given to reduce heart rate and increase strength of contractions Anticoagulate them if due to blood clots Surgical interventions include pulmonary endartectomy (to remove old blood clots) to balloon angioplasty

Question 45

What are some complications of pulmonary hypertension?

Answer 45

Heart failure- cor pulmonalae when right sided Blood clots Arrhythmia Increased risk in pregnancy

Question 46

What is ARDS?

Answer 46

Acute respiratory failure causing inflammation of the lungs without any evidence

Question 47

How is tension pneumothorax managed?

Answer 47

High flow oxygen with non rebreather mask Analgesia Insert a large bore needle (14 gauge IV catheter) into the 2nd ICS MCL Aspirate air or fluid

Question 48

What is a primary pneumothorax and who is more likely to get one?

Answer 48

It is spontaneous and usually occurs in tall thin males

Question 49

How is primary pneumothorax managed?

Answer 49

Advise them to stop smoking If <2cm and patient isn't SOB discharge If over 2cm and/or patient is SOB aspirate with a 16-18 g cannula If this fails insert a chest drain

Question 50

How is a secondary pneumothorax managed?

Answer 50

<1cm then give oxygen and admit to monitor If 1-2cm then aspirate If >2cm or SOB then insert chest drain

Question 51

What is secondary pneumothorax?

Answer 51

Pneumothorax in someone with existing lung disease