Respiratory

Question 1

What score is used to determine the severity of CAP and what are its components?

Answer 1

CURB65 score:
C - confusion
U - urea >7mmol/L
R - respiratory rate >30
B - BP <90/60
65 = age 65+yrs

Question 2

What is SIRS and its components?

Answer 2

2/4 of:

• fever (<36/>39)
• WCC <4/>12
• tachypnoea >20
• tachycardia >90

Question 3

What is sepsis and its diagnostic components?

Answer 3

> 1 of:

• BP <100 systolic
• altered mental status (GCS <15)
• RR >22

Question 4

What is septic shock?

Answer 4

Presence of sepsis criteria and the patient is unresponsive to fluid resuscitation (e.g. hypotensive and not improving with fluids)

Question 5

Name three causative agents of typical pneumonias:

Answer 5

• streptococcus pneumoniae
• haemophilus influenzae
• moraxella catharralis

Question 6

Name three causative agents of atypical pneumonias:

Answer 6

• mycoplasma pneumoniae
• legionella pneumoniae
• chlamydophila psittaci

Question 7

Which type of pneumonia is associated with guillain barre syndrome?

Answer 7

Mycoplasma pneumonia

Question 8

Name two pathologies that would cause the trachea to deviate towards them?

Answer 8

Pneumonectomy

Lobar collapse

Question 9

Name two pathologies that would cause the trachea to deviate away from them?

Answer 9

Large pleural effusion

Tension pneumothorax

Question 10

Name 6 causes of finger clubbing:

Answer 10

Interstitial lung disease (fibrosis)
Cyanotic heart disease
IE
Liver cirrhosis
Inflammatory bowel disease
Idiopathic

Question 11

Describe the following clinical signs of a pleural effusion:

Percussion?
Tactile fremitis?
Auscultation?
Vocal resonance?

Answer 11

Percussion = stony dull (as lungs separated from the chest wall by fluid)
Tactile fremitis = reduced
Auscultation = reduced vesicular breathing
Vocal fremitis = reduced

Question 12

Describe the following clinical signs of a pneumothorax:

Percussion?
Tactile fremitis?
Auscultation?
Vocal resonance?

Answer 12

Percussion = hyper resonant
Tactile fremitis = reduced
Auscultation = diminished vesicular breathing
Vocal fremitis = reduced

Question 13

Describe the following clinical signs of a pneumonectomy:

Percussion?
Tactile fremitis?
Auscultation?
Vocal resonance?

Answer 13

Percussion = dull
Tactile fremitis = none
Auscultation = no breath sounds
Vocal fremitis = none

Question 14

Describe the following clinical signs of consolidation:

Percussion?
Tactile fremitis?
Auscultation?
Vocal resonance?

Answer 14

Percussion = dull
Tactile fremitis = increased
Auscultation = bronchial breathing with fine crackles
Vocal fremitis = increased

Question 15

Describe the following clinical signs of a collapsed lung:

Percussion?
Tactile fremitis?
Auscultation?
Vocal resonance?

Answer 15

Percussion = dull
Tactile fremitis = reduced/absent
Auscultation = absent breathing sounds
Vocal fremitis = reduced/absent

Question 16

Describe the classical examination findings in asthma:

Answer 16

Expiratory polyphonic wheeze
Tachypnoea
Inability to speak in sentences during an exacerbation

Question 17

Describe the classical examination findings in COPD:

Answer 17

Expiratory polyphonic wheeze
Coarse crackles
Lung hyperinflation and use of accessory muscles

Question 18

Describe the spirometry findings in COPD:

Answer 18

FEV1/FVC ratio = <70%
Shows no reversibility
An obstructive airway disorder

FEV1 is <80% of percentage predicted

Question 19

Describe the spirometry findings in asthma:

Answer 19

FEV1/FVC ratio is also <70% but shows reversibility of >15% (at least >400ml air) with 5mg nebulised salbutamol

Question 20

Describe the 4 stages of COPD:

Answer 20

Stage 1 = mild = FEV1% predicted of 80%+
Stage 2 = moderate= FEV1% predicted of 50-79%+
Stage 3 = severe = FEV1% predicted of 30-49%+
Stage 4 = very severe = FEV1% predicted of <30%+