Respiratory for PACEs

Question 1

What p02 to be centrally cyanosed?

Answer 1

<6`

Question 2

Resp causes of clubbing

Answer 2

Infection
Fibrosis
Cancer

Question 3

Obstructive breathing pattern

Answer 3

fastest exhalation lasts 6 seconds

Question 4

What chest deformity in long term T2 resp failure

Answer 4

Kyphosis

Question 5

How to discuss percussion>

Answer 5

Symmetrical or asymmetrical

then resonant/hyperresonant

dull/stony dull

Question 6

Breathing on auscultation - spectrum of findings

Answer 6

decreased resonance - consolidation (less air due to pus)

no resonance - pleural effusion (acts as dampener)

Question 7

What does increased vocal resonance mean?

Answer 7

More solid pathology

Question 8

When auscultating - what is bronchial breathing

Answer 8

Seen in collapsed or consolidated lung

Timing of ins and exp similar with a gap in the middle

Question 9

Causes of monophonic wheeze

Answer 9

mucus or narrowing

or listening over the trachea

Question 10

What types of crackles are there?

Answer 10

Coarse or fine

Question 11

Coarse

Answer 11

bubbles sound

bronchiectasis or pulm oedema

Question 12

Fine crackles

Answer 12

Like velcro

opening of fibrosed alveoli

Question 13

Why check the ankles and sacrum

Answer 13

Look for complications

pHT and RHF
Shins for Erythema Nodosum

Question 14

reduced air entry
Dull percussion
reduced VR

Answer 14

Effusion

Question 15

Effusion - signs

Answer 15

reduced air entry
Dull percussion
reduced VR

Question 16

Bronchial breathing
dull percussion
increased VR

Answer 16

Collapse or consolidation

Question 17

Collapse or consolidation

Answer 17

Bronchial breathing
dull percussion
increased VR

Question 18

Fine crackles, clubbed, sputum

Answer 18

Bronchiectasis

Question 19

What are the common resp investigations?

Answer 19

Bloods
Sputum culture
CXR
Spirometry
Echo - pHT and cardiac failure
CT - difference between HRCT and Volime CT

Question 20

Lung function: Gas Transfer - what does it measure

Answer 20

Uptake of CO

Lower lung surface area and decreased transfer factor

Question 21

Volume CT

Answer 21

3mm slices for nodules and cancer

Question 22

HRCT

Answer 22

10-15mm slices

lower amount of radiation

interstitial lung disease

Question 23

Resp MDT

Answer 23

SMOKING CESSATION

Dietician
Physio
NIV
Surgery
Psych
Palliative

Question 24

Asthma on resp examination

Answer 24

If well controlled can be completely normal

Question 25

Invesitigations in Asthma

Answer 25

Spirometry (obstructive with reversibility) Exhaled NO - if increased then asthmatic and should be on steroids Histamine challenge Peak flow diary for variability Skin tests/ IgE / Eosinophils

Question 26

Asthma Rx

Answer 26

INhaled steroids + Montelukast + LABA Writeen asthma plan involving the nursing team

Question 27

Bronchiectasis complications

Answer 27

``` Pulm HTN Cachexia Lobar collapse Massive haemoptysis T2 RF / asterixis Situs inversus / Kartaageners (Swapped liver and heart on wrong side) ```

Question 28

Causes of Bronchiectesis

Answer 28

``` Idiopathic Post infective (measles, pertussis, TB) Immunodeficency (hypogammaglobulinaemia / CVID (low IgG) / Spec polysaccharide ad deficiency CF PCD, Youngs, Kartageners ABPA Obstruction / foreign body / tumour RheumA, IBD ```

Question 29

ix in bronchiectasis

Answer 29

``` Volume CT / HRCT - shows ring shadows and tram lines Immunoglobulins CF testing Spirometry Cultures ```

Question 30

Management for bronchiectasis

Answer 30

``` Airway Clearance through PHYSIO Smoking cessation Abx more than 3 infection/year Rx any cause Pulm Rehab Bronchodilaters ```

Question 31

Complications of lung cancer

Answer 31

SVCO, Horners

Question 32

Example of non-small cell

Answer 32

adenocarcino,ma and squamous

Question 33

Lung cancer Ix

Answer 33

Volume CT Lung function for rx ability and resectability PET CT Biopsy lymph and liver

Question 34

Rx of small cell lung cancer

Answer 34

Rarely resection mostly chemo and radiation

Question 35

Non-small cell cancer

Answer 35

Resection Radiotherapy Chemo Palliative

Question 36

Sign of COPD

Answer 36

Airflow obstruction - prolonged exp phase pursed lip breathing wheeze/inhalers Hyperexpansion - reduced cricosternal distance Loss of cardiac dullness Displaced liver Causes signs - Tar staining!

Question 37

Cx of COPD

Answer 37

Bruising/steroid therapy pHT Co2 retention Hyperinflation - loss of cardiac dullness and displaced liver edge. Reduced cricosternal distance)

Question 38

Ix in COPD

Answer 38

``` FBC - polycythaemia A1AT Lung function ABG CT Echo for pHT ```

Question 39

What is the modified MRC for breathlessness

Answer 39

``` 0 - hard exercise 1 - moderate exercise 2 - slow 3 - rest after minuetes 4- on dressing ```

Question 40

Mx of COPD

Answer 40

``` Bronchodilaters Pulm Rehab Dietician SMOKING CESSATION Steroids/Abx oxygen if pO2 is less than 7.8 ```

Question 41

Signs in Effusion

Answer 41

Decreased expansion decreased air entry decreased Vocal resonance

Question 42

Ax conditions to effusion

Answer 42

Transudative - liver and cardiac pathology Exudative - malignancy, infection TB, RA, yellow nail use lights criteria

Question 43

Ix in effusion

Answer 43

CXR CT later on US guided drain send to lab Chemistry Micriscopy Immunology

Question 44

Ax conditions to Fibrosis

Answer 44

RA

Question 45

Sign of fibrosis

Answer 45

fine late inspiratory crackles

Question 46

causes of fibrosis

Answer 46

idiopathic connective tissue associated - scleroderma, RA, SLE Sarcoid increased sensitivity pneumonitis drugs - amioderone, nitrofurantoin, bleomycin, methatrexate

Question 47

Ix in Fibrosis

Answer 47

``` FBC, complement, autoimmune screen, preceptins CXR, HRCT Lung function Echo BAL ABG ```

Question 48

Mx of Fibrosis

Answer 48

Physio/rehab nurse specialist anti-tussive smokingcessation Profenidone?

Question 49

Lung surgery normally for?

Answer 49

Cancer TB Bronchiectasis

Question 50

Signs of penumonectomy

Answer 50

``` Scar Chest wall deformity shifted trachea decreased expansion no breath sounds (in lobectomy will be decreased) ```

Question 51

Signs in penuomonia/collapse

Answer 51

decreased expansion dull reduced or no air entry increased vocal resonance