Respiratory System

Question 1

Give 3 clinical signs of respiratory distress

Answer 1

1. Pursed lip breathing
2. Nasal flaring
3. Intercostal recession

Question 2

What may be heard on auscultation of a patient with COPD?

Answer 2

Polyphonic expiratory wheeze, prolonged expiratory phase

Question 3

Suggest 3 indications of steroid use

Answer 3

1. Purpura
2. Cushingoid appearance
3. Proximal myopathy

Question 4

What are the differential diagnoses for COPD?

Answer 4

1. Cardiac failure with pulmonary oedema
2. Extrinsic allergic alveolitis
3. Interstitial lung disease

Question 5

Outline the components of the MRC dyspnoea scale

Answer 5

Grade 1 - Not trouble by breathlessness except with strenuous exercise
Grade 2 - Troubled with SOB when hurrying on level ground or walking up a slight hill
Grade 3 - Walks slower than people of the same age on level ground due to breathlessness
Grade 4 - Stops for breath after walks about 100m
Grade 5 - Too breathless to leave the house/ breathless when dressing and undressing

Question 6

Which medications are known to interact with theophylline and increase the risk of toxicity as a result

Answer 6

Macrolide and quinolone antibiotics

Question 7

Suggest 5 clinical signs of theophylline toxicity

Answer 7

1. Tremor
2. Vomiting and diarrhoea
3. Confusion
4. Seizures
5. Cardiac arrhythmias

Question 8

What would you offer to complete a respiratory examination in which you suspect a diagnoses of lung cancer?

Answer 8

1. Oxygen saturations and temperature
2. Measure peak flow
3. Examine sputum pot
4. Check for signs of extra-pulmonary involvement by palpating the spine and liver and performing a neurological exam of the arms, legs and cranial nerves

Question 9

What are the typical features of squamous cell ling cancer?

Answer 9

1. Central cavitating lesion
2. Personal smoking Hx
3. Paraneoplastic syndromes e.g. hyperthyroidism (ectopic TSH) and hypercalcemia (ectopic PTH)

Question 10

What are the typical features of adenocarcinoma of the lungs?

Answer 10

1. Peripheral solid lesion
2. Often patient will NOT have a smoking history
3. Seen in association with asbestos exposure

Question 11

What is the characteristic clinical feature of bronchoalveolar carcinoma?

Answer 11

Production of copius amounts of sputum

Question 12

Name the cells from which small cell lung cancers are derived

Answer 12

Endocrine cells - Kulchitsky cells

Question 13

Recall 3 neoplastic phenomena associated with small cell lung cancer

Answer 13

1. SIADH
2. Ectopic ACTH
3. Lamberton-Eaton myasthenia syndrome