Respiratory

Question 1

list the bedside tests in respiratory?

Answer 1

Sputum examination

Peak Expiratory Flow

Pulse oximetry

ABG

Spirometry

Question 2

what happens to the FEV1/FVC in restrictive and obstructive airway disease?

Answer 2

Normal, 75-80%

>70% normal

<70% predicted

Question 3

pneumonia can be classified as what?

Answer 3

Community aqcuired

Hospital acquired

Aspiration

immunocomprimised pt

Question 4

clinical features of pneumonia?

Answer 4

Symptoms: fever, rigor, malaise, anorexia, dyspnoea, cough, purulent sputum, pleuritic chest pain

Signs: pyrexia, cyanosis, tachyponeic, tachycardic, signs of consolidation, pleural rub

Question 5

how is severity assessed in pneumonia?

Answer 5

CURB65

Confusion

Urea

Resp rate >30/min

BP <90 systolic +/- 60 diastolic

>65yrs of age

Question 6

how many points does each element of CURB65 score?

Answer 6

1pt for each

0-1, antibiotic/ home treatment

2, hospital therapy

3, severe pneumonia consider ITU

Question 7

complications of pneumonia?

Answer 7

respiratory failure, hypotension, atrial fibrillation, pleural effusion, empyema lung abscess, septiceamia, pericarditis/ myocarditis, jaundice

repeat CXR/CRP in thsoe not responding to treatment to look for complications/progression

Question 8

which is the most common bacterial pneumonia?

Answer 8

pneumococcal pneumonia

Question 9

which pneumonia occurs as an epidemic every 4yrs?

Answer 9

mycoplasma pneumonia- presents insidiously with flu like symtpoms followed by dry cough

complications include skin rash, stevens johnson syndrome,

Question 10

which population goups are more likely to suffer klebsiella pneumonia?

Answer 10

diabetics, alcoholics, elderly

particularly affects upper lobes

Question 11

which pneumonia causes a bilateral cavitating bronchopneumonia?

Answer 11

staphylococcal pneumonia: may complicate influenze infection or occur in elderly/young, IVDU, those with underlying disease

Question 12

hwo is leionella pneumonia diagnosed?

Answer 12

urine antigen/ culture

Question 13

which pneumonia colonizes in water <60C?

Answer 13

legionella pneumonia

(typical in pools/ air conditioning)

Question 14

which respiratory illness is acquired from infected birds (typically parrots)?

Answer 14

chlamydial psittaci

headache, fever, dry cough, patchy consolidation on CXR

Question 15

which pneumonia commonly presents in the imunocompromised patient?

Answer 15

pneumocystitis pneumonia

dry cough, fever, bilateral crepitations, exertional dyspnoea

Question 16

which organsism is responsile for pneumocystis pneumonia?

Answer 16

pneumocystis jiroveci

Question 17

what is empyema?

Answer 17

pus in the pleural space

suspect if a pt with resolving pneumonia presents with recurring fever

Question 18

chronic inflammation of the bronchi and bronchioles resulting in permanent dilation and thinning fo these airways is known as?

Answer 18

bronchiectasis

Question 19

what are the main organisms responsible for bronchiectasis?

Answer 19

H. influenzae, strep pneumoniae, staph aureus, pseudonmonas aeruginosa

Question 20

clinical features of bronchiectasis?

Answer 20

symptoms: persistent cough, purulent sputum, intermittent haemoptysis
signs: figner clubbing, crepitations, wheeze,

Question 21

how do you bronchiectasis?

Answer 21

airway clearance techniques: chest physiotherapy, mucolytics

Antibiotics (consider longterm if >3 exacerbations a year)

bronchodilators/ corticosteroids

Question 22

what is seen on this CT?

Answer 22

Bronchiectasis

Question 23

how many people carry a copy of the faulty gene for Cystic Fibrosis?

Answer 23

1:25 people

Question 24

Cystic fibrosis is caused by a mutation in which gene?

Answer 24

CFTR gene on chromosome 7

(CF transmembrane conductance regulator)

causes defective chloride secretion and increased sodium absoprtion across the airway epithelium

Question 25

CF features in neonates and young children

Answer 25

Neonates: failure to thrive, meconium ileus, rectal prolapse young children: cough/wheeze, recurrent infections, pancreatic insufficiency (DM, steatorrhoea), dital intestinal obstruction syndrome,

Question 26

how is CF diagnosed?

Answer 26

sweat test: sodium and chloride \>60mmol/L genetic screening further tests include: FBC, LFTs, annual glucose tolerance test, sputum cultures, CXR, Abdo US, Spirometry

Question 27

describe the management of CF?

Answer 27

Chest: physiotherapy, drainage, antibiotics, bronchodilatros, annual CXR GI: look for any evidence of malabsoption, GORD, pancreatic dysfunction

Question 28

what are some mutation specific therapies for CF?

Answer 28

Ivacaftor Lumacaftor

Question 29

symptoms of lung tumour?

Answer 29

cough, haemoptysis, dyspnoea, chest pain, lethargy, anorexia, wgt loss

Question 30

how are lung tumours differentiated?

Answer 30

Small cell lung cancer (SCLC) Non-small cell lung cancer (NSCLC): Squamous, adenocarcinoma, large cell

Question 31

SCLC or NSCLC is more likely disseminated at presentation?

Answer 31

SCLC (70%) laready disseminated at presentation

Question 32

complications of lung tumours?

Answer 32

recurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, Horners syndrome, metastases to brain, bone, liver, adrenals

Question 33

describe a bronchial adenoma

Answer 33

rare, slow growing, 90% are carcinoid tumours treat w surgery

Question 34

lung malignancy asocc w asbestos exposure?

Answer 34

mesothelioma: occurs in pleura latent period of up to 45yrs fro time of exposure

Question 35

how is mesothelioma diagnosed?

Answer 35

Pleural thickening, effusion on CXR/CT diagnosed with hisotology

Question 36

how is mesothelioma managed?

Answer 36

pemtrexed + cisplatin therapy can improve survival pleurodesis/ indwelling intra pleural drain may help (overall poor prognosis \<2yrs)

Question 37

differential dagnoses of lung nodule on CXR?

Answer 37

malignancy primary/secondary, abscess, granuloma, carcinoid tumour, AVM, cyst

Question 38

if surgery is being considered with curative intent in lung cancer what should be carried out beforehand?

Answer 38

PET-CT

Question 39

treatment options for NSCLC and SCLC?

Answer 39

NSCLC: lobectomy for localised disease with curative intent. Radical radiotherapy for stage I,II,III. Chemo +/- Radiotherapy for more advanced disease i.e. cetuximab SCLC: surgery if limited stage disease, Chemo +/- Radiotherapy if well enough, palliative radiotherapy/ drainage/drug therapy

Question 40

list the 5 ways aspergillus fungi affects the lungs?

Answer 40

1. Asthma (Type I hypersensitivity) 2. Allergic bronchopulmonary aspergillosis (ABPA, Type I +II hypersensitivity 3. Aspergilloma (mycetoma), fungus ball within pre-existing cavity (i.e. TB/sarcoidosis) 4. Invasive aspergillosis 5. Extrinsic allergic alveolitis

Question 41

what three factors contribute to the airway narrowing seen in asthma?

Answer 41

bronchial muscle contraction, mucosal swelling/inflammation, inc musous production

Question 42

what symtpoms pattern is seen inasthma?

Answer 42

diurnal variation: symtpoms vary throughout the day mornign dip of peak flow is common

Question 43

what are the treatment steps in asthma?