Respiratory

Question 1

What are the types of lung cancer

Answer 1

Non Small Cell Lung Cancer - Squamous Cell Carcinoma & Adenocarcinoma

Small Cell Lung Cancer

Question 1

Sings and symptoms of lung cancer

Answer 1

SoB
Cough
Haemoptymis
Finger clubing
Pneumonia
Weightloss
Lymphadenopathy

Question 2

How do you investigate for Lung cancer

Answer 2

Chest xray
Staging CT scan - Chest , abdomen and pelvis with contrast
PET CT
Bronchoscopy with biopsy

Question 3

Treatment options for lung cancer

Answer 3

Surgery
Radiotherapy
Chemotherapy

Question 4

What are the extrapulmonary manefistations of lung cancer

Answer 4

Reccurent laryngeal nerve palsy - Hoarse vocie
Phrenic nerve palsy - Diaphram weakness and shortness of breath
Superior vena cava obstruction- facia swelling, distended neck, SOB
SIADH- hyponaturaemia
Cushing syndrome
Hypercalcaemia - ectopic parathyroid hormone

Question 5

What is Lamber-Eaton myasthenic syndrome

Answer 5

Myasthenia Gravis caused by lungcancer auto antibodies. Progressive weakness of small muscles

Question 6

What are the two classifications of pnuemonia

Answer 6

Hopsital aquried penumonia and community aquired pneumonia

Question 8

What will you hear on auscultation in penumonia ?

Answer 8

Bronchial Breath Sounds
Focal Course crackles
Dullness to percussion

Question 8

What is CURB6573

Answer 8

Confusion
Urea >7
resp rate >30
blood pressure <90
AGE >65

Question 8

What are the most common pathogens in pneumonia

Answer 8

Streptococcus pneumoniae 50%
Haemophilus influenzae

Question 8

What is atypical penumonia and how do you treat it?

Answer 8

Atypical penumonia is caused by an organisim which cannot be detected by culture or gram stain. They are penecillin resistant so you need o use clarithromycin, levofloxacin or doxycycline

Question 8

What is special about legionnares disease?

Answer 8

It can cause SIADH

Question 8

What is the usual course for antibiotics

Answer 8

Amoxicilin 5 days

Question 8

What type of pneomnia causes target lesions

Answer 8

mycoplasma pneumoniae

Question 8

What investigations should you do for penumonia?

Answer 8

Chest Xray
FBC
U&E
CRP
Sputum culture
Blood culture

Question 9

What is FEV1?

Answer 9

Volume of air blown out in 1 seconds

Question 9

What are the two common obstructive lung diseases?

Answer 9

Asthma
COPD

Question 9

What is Force vital capactiy

Answer 9

Total volume of volume exhaled after full inspiration

Question 9

What spirometry results do you find in restrictive lung disease?

Answer 9

both FEV1 and FVC are reduced. the FEV1:FVC ratio is maintained

Question 9

What spirometry results would you see in obstructive lung disease

Answer 9

FEV1 is less than 75% of the FVC

Question 10

What are the examples of restrictive lung disease?

Answer 10

Pulmonary fibrosis
Sarcoidosis
Obesity
Motor neuron disease
Scoliosis

Question 11

What questions should you ask in asthma?

Answer 11

Episodic
Diurinal
Dry cough with wheese and SOB
Atopy
family history

Question 12

What is the treatment alogrithim for Asthma

Answer 12

Short action beta 2 agonist
Then
low dose conticosetroid inhaler
then add in eith leukotrine receptor anatgonist or a LABA (Salmetrol)

Question 13

What are the grades of acute asthma exacerbation?

Answer 13

Moderate - PEFR 50-75% Severe - <50% PEFR and unable to complete sentences Life threatening - PEFT <33% Sats <92% NO WHEEZE

Question 14

Treatment for life threatening asthma

Answer 14

Escalate IV aminophyline, IV salbutamol, IV magnessium

Question 15

Treatment for severe asthma

Answer 15

nebulsied salbutamol Nebulised ipratropium bromide prednisolone for 5 days

Question 16

How do you grade breathlessness?

Answer 16

1 - breathless on stenuous exercise 2 - breathless on walking up a hill 3 - breathless slow walking on flat 4- stop to catch breath after 100 meters on flat 5- unable to leave house due to breathlessness

Question 17

What do people with COPD show on spiromentry?

Answer 17

obstructive picture FEV1/FVC ration < 70%

Question 18

What are the drug treatments for COPD

Answer 18

1 - Salbutamol or Ipratropium 2- if not asthma like then combined LABA and LAMA If asthma like then LABA and steroid (Fostair or Seretide)

Question 19

What is ipratropium?

Answer 19

short acting antimuscarinic

Question 20

What are the two types of respiratory failure?

Answer 20

Normal pCO2 and low pO2 = Type 1 Raised pCO2 low pO2 = Type 2

Question 21

How do you know if the target sats should be >95% or should be 88-92%?

Answer 21

Do an ABG, if there is a very high bicarbonate this suggests they retain CO2 so you should aim for 88-92% to avoid depressing respiratory drive

Question 22

What is the typical treatment of an exacerbation of COPD?

Answer 22

Prednisolone 30mg OD for 2 weeks Regular inhaler usage ABX if infection

Question 23

What ABX do you use in exacerbation of COPD?

Answer 23

Amoxicillin 500mg tds for 5 days (or doxycycline)

Question 24

What is intersitial lung disease?

Answer 24

Conditions which cause inflamation and fibrosis to the lung parenchyma

Question 25

What does intersitial lung disease look like on CT?

Answer 25

ground glass

Question 26

What are the two types of pleural effusion?

Answer 26

Exudative - high protein transudative - low protein

Question 27

What causes exudative pleural effusions?

Answer 27

inflammation causing protein to leak into pleural space Lung cancer Pneumonia Rheuamtoid Arthritis TB

Question 28

What causes transudative pleural effusions?

Answer 28

Fluid shifiting into the pleural space Congestive heart failure low albumin hypothyrodisim

Question 29

What would you see on Xray in a pleural effusion?

Answer 29

blunting of costrophrenic angle fluid in lung fissures

Question 30

What is Empyema?

Answer 30

infected pleural effusion

Question 31

What lab findings are there in empyema?

Answer 31

acidic low glucose high LDH

Question 32

What is the treatment of penumothorax?

Answer 32

if no SOB and less than 2cm rim then leave If SOB or >2cm then aspiration if aspiration fails then chest drain

Question 33

What is the managment of tension pneumothorax

Answer 33

Insert a large bore cannula into the second costal space in the midclavicular line of the affected side then insert a chest drain

Question 34

Where do you insert a chest drain?

Answer 34

just above the rib in the Triangle of saftey then xray it 5th intercostal space (below nipple) border of pec major mid axillary line (latissumus dorsi)

Question 35

Risk factors for PE

Answer 35

Stationary Surgery Pregnancy or Oestrogen malignancy polycythemia lupus thrombophilia

Question 36

What do you do if there is a risk of PE?

Answer 36

prohpylaxis with enoxapaarin (LMWH)

Question 37

How do you score for risk of PE?

Answer 37

Wells score

Question 38

What is D Dimer useful for?

Answer 38

it rules out a DVT

Question 39

How do you definativley diagnose a PE

Answer 39

CT pulmonary angiogram or Ventelation perfusion scan

Question 40

What do you see in ABG for pulmonry embolisim?

Answer 40

Respiratory alkalosis

Question 41

What is the inital managment of PE

Answer 41

Oxygen and analgesia LMWH Enoxaparin or Dalterparin

Question 42

What is the longer term management for PE

Answer 42

anticoagulation Warfarin, or DOAC

Question 43

What do you do if the patient is in real trouble with a PE or LMWH isnt working?

Answer 43

thrombolysis with streptokinase