Respiratory

Question 1

What is asthma

Answer 1

Chronic inflammation of airways secondary to T1 hypersensitivity
reversible bronchospasm - obstructs airway

Question 2

Asthma risk factors

Answer 2

Atopy 
maternal smoking, RSV infection 
low birth weight 
X breast fed
allergens exposure 
air pollution 
hygiene hypothesis

Question 3

IgE mediated atopic conditions

Answer 3

Atopic dermatitis - eczema

Allergic rhinitis - hay fever

Question 4

Asthma symptoms

Answer 4

cough (worse at night)
dyspnea
wheeze
chest tightness

Question 5

Asthma signs

Answer 5

Expiratory wheeze
reduced PEFR
FEV1/FVC <70%

Question 6

Asthma management

Answer 6

1. SABA - salbutamol
2. Inhaled corticosteroids
3. Leukotriene receptor antagonists - montelukast
4. LABA - salmeterol

Question 7

Acute asthma?

Answer 7

worsening dyspnoea, wheeze, cough
not responding to SABA
can be triggered by infection

Question 8

Moderate acute asthma

Answer 8

PEFR 50-75%
normal speech
RR <25
HR <110

Question 9

Severe acute asthma

Answer 9

PEFR 33-50
can’t complete sentences
RR >25
HR >110

Question 10

Life threatening acute asthma

Answer 10

PEFR <33
O2 <92%
silent chest, cyanosis
bad resp effort
Bradycardia
dysrhythmia 
hypotension 
exhausted
confusion 
coma

Question 11

near fatal acute asthma

Answer 11

PCO2 raised!

need mechanical ventilation

Question 12

Acute asthma management

Answer 12

• O2 - 15L, non rebreathe
• 94-98% sats
• salbutamol neb 5mg
• ipratropium neb 0.5mg
• hydrocortisone IV 100mg
  OR 40mg prednisolone oral

Question 13

Acute severe/life threatening asthma management

Answer 13

• magnesium sulfate IV 20mg
• aminophylline, maybe IV salbutamol
• invasive ventilation

Question 14

COPD

Answer 14

chronic obstructive pulmonary disorder

chronic bronchitis, emphysema

Question 15

COPD causes

Answer 15

smoking
alpha 1 antitrypsin deficiency
cadmium, coal, cotton, cement, grain

Question 16

COPD symptoms

Answer 16

cough - productive
dyspnea
wheeze
RH failure - peripheral oedema

Question 17

COPD CXR

Answer 17

hyperinflation
bullae (mimic pneumothorax)
flat hemidiaphragm
exclude lung cancer

Question 18

COPD post-bronchodilator therapy

Answer 18

FEV1/FVC ratio <0.7
and also FEV1
- mild >80%
- mod 50-70
- severe 30-49
- v severe <30

Question 19

COPD management

Answer 19

1. SABA/SAMA
2. if they have asthmatic features - LABA/ICS
3. If not LABA or LAMA

Question 20

COPD triple therapy

Answer 20

if still exacerbations

LAMA, LABA, ICS

Question 21

too many COPD exacerbations?

Answer 21

oral prophylactic AB therapy

azithromycin prophylaxis

Question 22

requirements for starting oral prophylaxis antibiotic therapy

Answer 22

need to quit cigs
CT exclude atypical infection/TB
LFTs, ECG needed to exclude QT prolongation (azi can make it longer)

Question 23

chronic productive cough w COPD?

Answer 23

mucolytics

Carbocysteine

Question 24

long term O2 therapy

Answer 24

15hrs a day 
if severe airflow abs
cyanosis
polycythameia
peripheral oedema 
raised JVP 
O2 <92%
measure w 2 ABGs

Question 25

COPD exacerbation?

Answer 25

increased, dyspnea, cough, wheeze increased sputum hypoxic acute confusion

Question 26

COPD exacerbation organisms

Answer 26

H influenza H rhinovirus S pneumoniae M catarrhalis

Question 27

COPD exacerbation management?

Answer 27

24% O2 Venturi mask 88-92% Nebuliser salbutamol 5mg/4hr Ipratropium 0.5mg/6hr 30mg prednisolone 5 days And hydrocortisone??? oral ABS if sputum purulent/signs of pneumonia - amoxicillin, clarithromycin, doxycycline

Question 28

what is pleural effusion, symptoms

Answer 28

excess fluid between pleura membrane - dyspnea - pleuritic chest pain - non-productive cough

Question 29

pleural effusion transudate

Answer 29

``` <30g/L protein Heart failure Hypoalbuminaemia - liver disease, nephrotic metastases hypothyroidism meigs ew? ```

Question 30

pleural effusion exudate

Answer 30

``` >30g/L infection, pneumonia, TB, abcess RA, SLE lung cancer PE dressers yellow nail ```

Question 31

pleural effusion signs

Answer 31

trachea AWAY stony dull less air entry, bronchial breathing reduced expansion/resonance

Question 32

pleural effusion X-ray

Answer 32

Blunt costophrenic angles Dense shadow --> meniscus Mediastinal shift away Coin lesion/cardiomegaly

Question 33

pleural effusion US

Answer 33

guides aspiration, detects fluid

Question 34

pleural effusion CT

Answer 34

underlying causes

Question 35

pleural effusion aspiration

Answer 35

``` percuss border, 1/2 spaces below lignocaine 21g needle send for inspection allow to drain? ```

Question 36

pleural effusion fluid analysis raised amylase, low pH

Answer 36

pancreatitis, oesophageal perforation

Question 37

pleural effusion fluid analysis low glucose, low ph, high protein

Answer 37

RA, TB, SLE

Question 38

pleural effusion fluid analysis blood staining

Answer 38

mesothelioma, PE, TB

Question 39

pneumothorax, symptoms

Answer 39

``` air in pleural space collapse? - sudden - dyspnea - pleuritic chest pain - sweating - tachycardia, tachypnea ```

Question 40

tension pneumothorax, signs

Answer 40

``` one-way valve - air can't escape respiratory distress cardiac arrest mediastinal compression increased JVP increased HR, low BP ```

Question 41

causes of primary pneumothorax

Answer 41

young, thin men | smokers

Question 42

causes of secondary pneumothorax

Answer 42

``` COPD asthma CF lung cancer pneumonia marfans, EDS, pulmonary fibrosis, sarcoidosis ```

Question 43

trauma pneumothorax

Answer 43

penetrating | blunt, rib fractures

Question 44

pneumothorax signs

Answer 44

reduced expansion, breath sounds, VR | resonant percussion

Question 45

tension pneumothorax management

Answer 45

resus no CXR large bore 2nd ICS mid clavicular ICD

Question 46

primary pneumothorax management

Answer 46

<2cm/no SOB --> discharge? larger --> aspirate, if fails chest drain stop smoking!!!

Question 47

secondary pneumothorax management

Answer 47

>50, >2cm, SOB chest drain if not attempt aspiration first

Question 48

sarcoidosis, who?

Answer 48

multisystem non-caveating granulomas young, African, females

Question 49

Acute sarcoidosis presentation

Answer 49

``` erythema nodosum bilateral lymphadenopathy fever - swinging polyarthralgia weight loss fatigue HSM ```

Question 50

sarcoidosis other features

Answer 50

``` SOB, chest pain polyneuropathy renal stones pit dysfunction uveitis restrictive cardiomyopathy pericardial effusion cholestatic LFTS lupus pernio ```

Question 51

sarcoidosis blood results

Answer 51

hypercalcaemia | increased ESR, Ig, LFTs, ACE

Question 52

sarcoidosis investigations

Answer 52

bloods tuberculin neg in 2/3 spirometry - restrictive biopsy - lung, LN, liver

Question 53

sarcoidosis management

Answer 53

``` asymptomatic - nothing acute - bed rest, nsaids chronic - 40mg red 4-6 wks - immunosuppression - methotrexate, ciclosporin ... ```

Question 54

BHL differentials

Answer 54

sarcoidosis TB, mycoplasma lymphoma, carcinoma interstitial disease

Question 55

type 1 resp failure

Answer 55

``` hypoxaemic PaO2 <8 PaCO2 <6 V/Q mismatch damage to lung tissue prevents oxygenation, diffusion failure ```

Question 56

type 2 resp failure

Answer 56

``` hypercapnic PaO2 <8 PaCO2 >6 may have V/Q mismatch alveolar ventilation unable to excrete CO2 ```

Question 57

type 1 resp failure causes

Answer 57

Pneumothorax, PE, pulmonary hypertension , atelectasis, COPD, asthma, bronchiectasis pulmonary fibrosis, oedema,

Question 58

type 2 resp failure causes

Answer 58

``` chest wall, muscle weakness CNS depression severe asthma obesity hypothyroid ```

Question 59

hypoxia acute effects

Answer 59

``` dyspnea, tachypnea agitation confusion cyanosis tachyarrhythmias ```

Question 60

chronic hypoxia effects

Answer 60

polycythemia pulmonary hypertension cor pulmonale

Question 61

hypercapnia effects

Answer 61

``` headache flushing peripheral vasodilation/warm bounding pulse flap confusion, coma ```

Question 62

asthma - spirometry

Answer 62

FEV1 reduced FEV1/FVC <70% obstructive pattern increased 12% w beta agonist

Question 63

asthma investigations

Answer 63

spirometry diurnal variation atopy FeNO (>40ppb positive)

Question 64

Pulmonary embolism?

Answer 64

Blood clot in lungs! - pleuritic chest pain - dyspnea ...