Respiratory

Question 1

2 typical organism for CAP and 3 atypical organisms for CAP

Answer 1

Typical: Haemophilus influenza, Streptococcus pneumonia

Atypical: Legionella pneumophilia, Chlamydia pneumoniae, Mycoplasma pneumoniae

Question 2

3 organisms for Hospital-Acquired Pneumonia

Answer 2

Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Klebsiella pneumoniae

Question 3

Define Type 1 Respiratory Failure; give the underlying cause and provide some examples of conditions.

Answer 3

Definition: Hypoxia PO2<8kPa with normal or low CO2

Underying cause: Ventilation/Perfusion Mismatch

Examples: Pneumonia, pulmonary oedema, PE, asthma, emphysema, fibrosing alveolitis, ARDS

Question 4

Define Type 2 Respiratory Failure; give the underlying cause and some examples of conditions.

Answer 4

Definition: Hypoxia PO2<8kPa, Hypercapnia PCO2>6.6kPa with or without V/Q mismatch

Underlying cause: Alveolar hypoventilation

Examples:

• Pulmonary disease (pneumonia, COPD, asthma, obstructive sleep apnoea)
• Reduced Respiratory drive (sedatives, CNS tumour, trauma)
• Neuromuscular disease (cervical cord lesion, diaphragmatic paralysis, myasthenia gravis, Guillain-Barre Syndrome)
• Thoracic Wall defect (kyphoscoliosis, flail chest)

Question 5

Pathophysiology: Guillain-Barre Syndrome

Answer 5

Autoimmune reaction to the self antigens of myelin sheath of nerve cells leading to reduced nerve conduction and muscle weakness (symmetrical parasthesia and weakness from legs up)

Question 6

Describe the 5-step management of chronic asthma as by the BTS.

Answer 6

1) SABA mild intermittent asthma (salbutamol)
2) ICS if pt is using SABA 3 or more times a week OR symptomatic OR has used oral steroids in last two years (400 mcg beclamethasone)
3) Add-on LABA and increase ICS does if still symptomatic (salmeterol)
4) Leukotriene Receptor antagonists (montelukast) theophyllines or slow-release BA used if poor control
5) Oral low dose steroids

Question 7

What ECG disturbance would you see in a patient with PE?

Answer 7

S1Q3T3 and sinus tachycardia (and RBBB)

Deep S wave in I, pathological Q-wave in III, inverted T in III

Question 8

Define Primary Ciliary Dyskinesia (Kartagener’s Syndrome) and name the triad.

Answer 8

Definition: Autosomal recessive condition characterised by abnormal ciliary structure or function leading to impaired ciliary clearance.

Triad: Situs inversus, Bronchiectasis, chronic sinusitis (and infertility)

Question 9

Define the subtypes of bronchogenic carcinomas

Answer 9

1. Small Cell Carcinoma
2. Non-Small Cell Lung Carcinoma (NSCLC)
   - Squamous cell
   - Adenocarcinoma (presents in non-smokers)
   - Large cell
   - Carcinoid and unspecified

Question 10

List clinical presentation and signs of sarcoidosis.

Answer 10

Weight loss
Bilateral Hilary lymphadenopathy
Cervical lymphadenopathy (non-tender)
Raised Ca and ACE
Erethyma Nodosum
Lupus pernio

Question 11

List some causes of pneumothorax.

Answer 11

COPD
TB
Pneumonia
Connective tissue disorders (Marfan’s, Elher-Danlos)
Trauma
Iatrogenic (biopsy, pleural aspiration)
Spontaneous in young men - subpleural bullae rupture

Question 12

On examination, you find a patient is stoney-full on percussion. What does this suggest?

Answer 12

Pleural Effusion