sessions 8+

Question 1

AP or PA

Answer 1

AP = scapula further medial

Question 2

AP or PA

Answer 2

PA = scapular further lateral

Question 3

Most common lung cancer in non smokers

Answer 3

Bronchogenic adenocarcinoma

Question 4

Common lung cancers in smokers

Answer 4

small cell carcinoma, squamous cell carcinoma

Question 5

abnormality on CXR of active TB

Answer 5

Ghon’s complex

Ghon foci + enlarged hilar lymph nodes

Question 6

Risk factors for TB

Answer 6

HIV, immunosuppressive drugs, non Uk born, poorly controlled T2DM, homeless, drug user

Question 7

Symptoms of adrenal insufficiency

Answer 7

Fatigue, weakness, poor appetite, salt craving, weight loss, dizziness, hypotension, hyper pigmentation

Question 8

SIADH is most commonly caused by

Answer 8

Small cell carcinoma of the lung- causes electrolyte disturbance on Us and Es

Question 9

muscle weakness causes what type of respiratory failure

Answer 9

Type 2 respiratory failure

Question 10

some causes of respiratory failure T2

Answer 10

opioid OD, brainstem injury, muscular dystrophy, severe kyphoscoliosis

Question 11

Increased 2,3 DPG results in

Answer 11

decreased Hb Oxygen affinity, curve shifted to right

Right = easier RRRRelease off oxygen

Question 12

cough reflex muscles

Answer 12

internal intercostal muscles and abdominal muscles

Question 13

30 cigarettes a day for 42 years pack years

Answer 13

42 x 1.5 packs = 63 pack years

Question 14

CXR features of pneumothorax

Answer 14

more radiolucent area beyond collapsed lung

Edge of collapsed lung is seen

Decreased lung markings

Question 15

Hyperventilating plus PE will cause

Answer 15

Type 1 respiratory failure with low oxygen and co2

Question 16

Why is a patient with tension pneumothorax cyanosed

Answer 16

hypoxaemia

Question 17

Why does trachea deviate away from pathology in pneumothorax

Answer 17

higher pressure in pleural cavity due to tension pneumothorax pushes trachea and mediastinum away to other side

Question 18

Why is the chest hyper resonant on tension pneumothorax

Answer 18

air in pleural space, lung deflated

Question 19

Why are breath sounds absent in pneumothorax

Answer 19

collapsed lung = presence of air between chest wall and lung further reduces the intensity of breath sounds

Question 20

why is blood pressure low in tension pneumothorax

Answer 20

• One way valve system at site of breach in pleural membrane
• Air can enter pleural cavity but not leave during expiration
• Increased in intrapleural pressure
• Venous return impaired
• Drop in CO
• Hypoxaemia from impaired ventilation may directly impair cardiac function

Question 21

Emergency treatment for pneumothorax

Answer 21

needle decompression, insert needle into pleural cavity, 2nd ICS in MCL

Cannula introduced over the needle

Question 22

Conditions which will cause mediastinal displacement away from affected side

Answer 22

pleural effusion- volume displacement
Pneumothorax

Question 23

conditions which cause mediastinal displacement towards the affected side

Answer 23

Pulmonary fibrosis (healed TB), as fibrous tissue shrinks, it pulls the mediastinum towards the affected side

Lung collapse secondary to obstructive atelectasis

Question 24

visceral pain

Answer 24

generalised, vague

Question 25

shoulder tip pain

Answer 25

suggests diaphragmatic pleura not cardiac referred pain

Question 26

Typical features of cardiac pain

Answer 26

central, tight, radiates to arms and neck, angina brought on by exertion, pericardial = sharp

Question 27

Pleuritic pain

Answer 27

sharp, over affected area

Question 28

Important features of DVT history

Answer 28

long haul flights, medications, COCP, history of blood clots, calf pain/swellling

Question 29

PE presentation

Answer 29

acute onset, sharp, pleuritic, risk factor of long haul flight haemoptysis/cough

Question 30

What is important to state in ABG interpretation

Answer 30

alkalosis/acidosis respiratory/metabolic Type of failure if respiratory

Question 31

Which mechanism explains hypoxaemia in PE

Answer 31

V/Q mismatch

Question 32

questions to explore cough complaint

Answer 32

mucous, PMH, smoker, trigger factors, URTI, atopy ,FH

Question 33

Bronchitis (acute viral) vs asthma

Answer 33

Bronchitis; symptoms don't vary with time of day, no significant PMH, infective symptoms such as fever, coloured sputum Asthma: symptoms worse at night and early morning, atopy

Question 34

How to tell between asthma and COPD with spirometry

Answer 34

pre and post bronchodilator treatment would differentiate- 12% or greater improvement if asthma

Question 35

when is there a one way valve in pneumothorax

Answer 35

only in tension (mediastinal shift and cardiovascular collapse) NOT IN SIMPLE