Respiratory

Question 1

What are the physiological causes of pulmonary oedema?

Answer 1

Increased capillary permeability
Increased capillary pressure
Decreased oncotic pressure
Lymphatic obstruction

Question 2

Symptoms of pulmonary oedema?

Answer 2

SOB - orthopnoea, exercise dyspnoea, paroxysmal nocturnal dyspnoea
Tachypnoea
Cough - pink frothy sputum

Question 3

Investigations for pulmonary oedema?

Answer 3

Bloods - FBC, U+Es, BNP, blood gas
CXR
ECG
Lung function tests - restrictive pattern

Question 4

How can you divide up the causes of pulmonary oedema?

Answer 4

Cardiogenic

Non-cardiogenic

Question 5

What non-cariogenic conditions can cause pulmonary oedema?

Answer 5

Non-cardiogenic

• volume overload (increased cap pressure)
• renal - AKI, CKD, renal artery stenosis (increased cap pressure)
• ARDS (increased cap permeability)
• lung transplant (may cause lymphatic insufficiency)

Question 6

What cardiogenic conditions can cause pulmonary oedema?

Answer 6

All cause increased capillary pressure:

• MI
• Valve problem - aortic regurg/stenosis, mitral regurg
• PE
• Cardiomyopathy
• Cardiac tamponade

Question 7

Management of pulmonary oedema?

Answer 7

Varies with cause

1) Sit patient up + oxygen
2) Nitrates (vasodilators) if Syst BP >90
3) Furosemide
4) Opiates (not if heart failure) - decrease anxiety but may suppress respiratory drive
5) ?ACEi long term

Question 8

RFs for a PE? (Name 5)

Answer 8

Post-surgery
Long-haul flight
cOCP
Malignancy
Pregnancy

Question 9

What is the pathophysiology of CF?

Answer 9

Defects if the CFTR protein, who’s gene is on the long arm of Chr 7
Most commonly ∆508
Causes high conc of Na and low conc Cl in secretions

Question 10

How do babies with CF normally present? (if not picked up of Guthrie screening)

Answer 10

Meconium ileus
Respiratory infections
Failure to thrive

Question 11

Respiratory presentations of CF?

Answer 11

Recurrent infections esp with Pseudomonas
If aspergilloma, may have haemoptysis
Bronchiectasis
Nasal polyps
Pulmonary HTN + fibrosis may cause cor pulmonale

Question 12

GI manifestations of CF?

Answer 12

Pancreatic insufficiency -> malabsorption, steatorrhoea, DM
Thickening of bile -> portal HTN
Liver cirrhosis/CLD -> gynaecomastia
Gallstones, cholecystitis
Acute pancreatitis
Intussusception

Question 13

Other manifestations of CF?

Answer 13

Infertility for males (failure of vas deferens and epididymis to develop)
DM

Question 14

Ix for CF

Answer 14

Immunoreactive trypsinogen in heel prick
Sweat test - >Na, >Cl
Nasal potential difference testing
Genetic testing

Question 15

Management of pulmonary manifestations in CF?

Answer 15

Vigorous daily physiotherapy - with manual percussion, forced expiratory manoeuvres and vibration
May also be a role for postural drainage - lying in various positions
Prophylactic or responsive abx

Question 16

Management of nutrition in CF?

Answer 16

Enteric coated pancreatic enzymes
KADE vitamin replacement
120% normal diet intake - high calorie, high fat

Question 17

Respiratory causes of clubbing?

Answer 17

Bronchus carcinoma, mesothelioma, bronchiectasis, abscess, empyema, fibrosing alveoli’s, CF
NOT COPD or asthma

Question 18

Which abx treats MRSA?

Answer 18

Vancomycin

Question 19

Which abx treats Legionella?

Answer 19

Clarithromycin

Question 20

Which organs does sarcoidosis affect?

Answer 20

Lungs, eyes, skin

Heart, kidney, CNS

Question 21

Investigations for sarcoidosis?

Answer 21

Bloods - Raised serum ACE, Ca, ESR and Ig
Urine - raised Ca
CXR/CT - hilar lymphadenopathy
Tissue biopsy - non-caseating granulomata with epithelioid cells

Question 22

Management of sarcoidosis?

Answer 22

Bilateral hilar lymphadenopathy alone - no Tx needed
Acute - bed rest + NSAIDs
Consider prednisolone 6-12 months

Question 23

What are the symptoms of idiopathic pulmonary fibrosis?

Answer 23

Dry cough, exertion dyspnoea, malaise, WL, arthralgia

Question 24

What are the signs of IPF?

Answer 24

SOB/cyanosis, clubbing, fine end-inspiratory creps

Question 25

Investigations for IPF?

Answer 25

Reduced transfer factor (TLCO) ANA +ve in 30% CXR - ground glass to honeycomb lung CT - Ix of choice

Question 26

Management for IPF?

Answer 26

Best supportive care - O2, pulmonary rehab, opiates, palliative care

Question 27

How much does peak flow readings need to change by to diagnose asthma?

Answer 27

After bronchodilator reversibility test: improvement of FEV1 >12% and increase in volume of >200ml

Question 28

What is the side effect of salbutamol?

Answer 28

Tremor

Question 29

What is the side effect of ICS (beclometasone)?

Answer 29

stunted growth in children oral candida

Question 30

Asthma treatment?

Answer 30

SABA (salbutamol) - for symptomatic relief, relaxes SM of the airways If asthma not controlled/new Dx + symptoms ≥3 times/wk or night-time waking: ICS (beclometasone) - taken every day regardless of symptoms Add a LTRA, continue if responsive LTRA (Montelukast) - oral LABA (salmeterol) - taken every day regardless of symptoms MART (maintenance + reliever therapy) is now an option for patients with poorly controlled asthma – contains ICS + LABA in a single inhaler

Question 31

Main investigation for asthma after spirometry?

Answer 31

FeNO test

Question 32

Examples of T1 and T2 respiratory failure?

Answer 32

T1: Pneumonia, Pulmonary Oedema, PE, Asthma, Emphysema, Pulmonary fibrosis T2: - Pulmonary disease – asthma, COPD, pneumonia, end-stage pulmonary fibrosis etc - Reduced respiratory drive – sedative drugs, CNS tumour or trauma - Neuromuscular disease – cervical cord lesion, myasthenia gravis, GBS - Thoracic wall disease – flail chest, kyphoscoliosis

Question 33

Symptoms of hypoxia?

Answer 33

SOB, agitation, central cyanosis, confusion

Question 34

Symptoms of hypercapnia?

Answer 34

headache, peripheral vasodilatation, tachycardia, tremor/flap, papilloedema

Question 35

Causes of pneumothorax?

Answer 35

Often spontaneous Chronic disease - asthma, COPD, CF, Ca Infectious - TB, pneumonia Trauma

Question 36

When might you need surgical advice for a pneumothorax?

Answer 36

``` If: •bilateral pneumothoraxes •Failure of IC drain insertion •2+ previous pneumothoraxes on same side •Hx of pneumothorax on the opposite side ```

Question 37

What causes transudates in pleural effusions?

Answer 37

D/t increased hydrostatic pressure Too much fluid - CCF, fluid overload Hypoproteinaemia - cirrhosis, malabsorption

Question 38

What causes exudates in pleural effusions?

Answer 38

The gap between the endothelial cells widen and fluids and proteins leak out, therefore there is a high protein content found in exudates e.g. caused by infection, Ca, PE, RA, SLE etc