Respiratory conditions: diseases

Question 1

Definition of primary vs secondary pneumothorax

Answer 1

Primary = no hx of lung disease
Secondary = hx of lung disease

Question 2

Managing primary pneumothorax

Air rim <2 cm
Aim rim >2 cm

Answer 2

Air rim <2cm, no symptoms = discharge

Air rim <2cm, SOB = aspirate

Air rim >2cm = chest drain

Question 3

Managing secondary pneumothorax

Air rim <1 cm
Aim rim 1-2 cm
Air rim >2cm

Answer 3

Air rim <1 cm = Give oxygen, admit for 24h

Air rim 1-2cm = aspirate

Air rim >2cm = chest drain

Breathless at any point = chest drain

Question 4

Who should get a chest drain if they have a pneumothorax

Answer 4

1. Primary/ secondary pneumothorax, air rim >2cm
2. Secondary pneumothorax, patient >50yo
3. Secondary pneumothorax, patient breathless

Question 5

Contraindication to usage of bupropion for smoking cessation

Answer 5

Epilepsy (risk of reduced seizure control)
Pregnancy
Breastfeeding

Question 6

Where is the safe triangle for chest drain insertion

Answer 6

1. Latissimus dorsi
2. Pec major
3. 4th/5th intercostal space in the mid axillary line

Direct tube high and anteriorly

Question 7

How much oxygen to give in venturi in a COPD CO2 retainer

Answer 7

24percent oxygen

Question 8

Which 2 groups of COPD patients should be put on LTOT

Answer 8

1. PaO2 <7.3 despite maximum treatment

2. Peripheral oedema/ polycythaemia

Question 9

Drugs for long term management of COPD

Answer 9

1. SABA or SAMA
2. • LABA + ICS
3. • LAMA

Question 10

Drugs for long term management of asthma

Answer 10

1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA (continue LTRA depending on response)
5. SABA + LTRA + higher dose ICS

Question 11

Management of suspected pulmonary embolism

Answer 11

LMWH (if normotensive)

Thrombolysis (if hypotensive)

Question 12

Management of recurrent pulmonary embolism

Answer 12

Consider IVC filter

Question 13

What investigation to do in a suspected PE with a LIKELY Wells score

Answer 13

Likely Wells score (>4)

Immediately CTPA

(if can’t do immediately then give anticoagulants first then CTPA)

Question 14

What investigation to do in a suspected PE with an UNLIKELY Wells score

Answer 14

Unlikely Wells score (4 or less)

do D dimer, then if positive do CTPA

Question 15

Most common site of aspiration pneumonia. Why this site?

Answer 15

Apical and posterior segments of the lower lobe of the right lung

Due to larger caliber and more vertical orientation of the right mainstem bronchus

Question 16

What pneumonias can cause dry cough

Answer 16

Legionella (if travel, air con)
Chlamydia psittaci (bird lovers)
PCP (immunocompromised)
Mycoplasma

(Lungs Cant Produce Mucus)

Question 17

What pneumonia causes redcurrant jelly sputum

Answer 17

Klebsiella

Question 18

Risk factors for Klebsiella pneumonia

Answer 18

Elderly
Diabetes mellitus
Alcohol

Question 19

Risk factors for Legionella pneumonia

Answer 19

Travel

Aircon

Question 20

Most common bacterial causes of IECOPD

Answer 20

• Haemophilus influenza (most common)
• Strep pneumoniae
• Moraxella catarhallis

Question 21

Treatment for IECOPD

Answer 21

Prednisolone 30mg for 7-14 days

Abx only if clinical signs of pneumonia

Question 22

Cavitating pneumonia in upper lobes -most likely organism

Answer 22

Klebsiella

Question 23

Most common cause of HAP in patients on ventilator in ITU

Answer 23

Pseudomonas aeruginosa

Question 24

CXR pattern in klebsiella pneumonia

Answer 24

Cavitating pneumonia in upper lobes

Question 25

CXR pattern in mycoplasma

Answer 25

Patchy consolidation of 1 lower lobe | + flu like symptoms

Question 26

CXR pattern in legionella pneumophilia

Answer 26

Bibasal consolidation

Question 27

What pneumonia causes redcurrant jelly sputum

Answer 27

Klebsiella

Question 28

What PEFR levels indicate moderate, severe and life threatening asthma

Answer 28

PEFR: 50-75percent of best/predicted: moderate 33-50 of best/predicted: severe <33 of best/predicted: life threatening

Question 29

Causes of lower zone pulmonary fibrosis

Answer 29

- idiopathic pulmonary fibrosis - most connective tissue disorders (except ankylosing spondylitis) e.g. SLE - drug-induced: amiodarone, bleomycin, methotrexate - asbestosis

Question 30

Causes of upper zone pulmonary fibrosis

Answer 30

Upper zone fibrosis: CHARTS ``` C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis ```

Question 31

Drug induced causes of pulmonary fibrosis

Answer 31

Amiodarone Methotrexate Neomycin

Question 32

Most common cause of spontaneous secondary pneumothorax

Answer 32

COPD

Question 33

Most common chemical cause of occupational asthma

Answer 33

Isocyanates eg spray painting, foam moulding with adhesives

Question 34

What drugs cause pulmonary eosinophilia

Answer 34

Nitrofurantoin | Sulphonamides

Question 35

Which of these causes fibrosis in the upper or lower zones - Silicosis - Coal worker's pneumoconiosis - Asbestosis

Answer 35

UPPER ZONE - Silicosis - Coal worker's pneumoconiosis LOWER ZONE -Asbestosis