The Rest

Question 1

what are the risk factors for developing chronic pulmonary infection

Answer 1

Abnormal host response
Abnormal innate host defence
Repeated insult

Question 2

examples of abnormal host response

Answer 2

immunodeficiency

immunosuppression

Question 3

examples of abnormal innate host defence

Answer 3

damaged bronchial mucosa e.g. smoking
abnormal cillia e.g. Hartenager’s Syndrome, Youngs Syndrome
abnormal secretion e.g. CF

Question 4

examples of repeated insult

Answer 4

aspiration e.g. NG feeding

indwelling material e.g. NG tube in wrong place

Question 5

what is a common presentation of intrapulmonary abscess

Answer 5

weight loss, lethargy, cough, weakness, usually a preceding illness

Question 6

what type of pneumonia is likely to cause intrapulmonary abscess and what is the mechanism

Answer 6

Staph Pneumonia -> Cavitating Pneumonia -> Abscess

Question 7

type of poor host immune response that could lead to intrapulmonary abscess

Answer 7

Hypogammaglobulinaemia

Question 8

what is the indicators of a simple parapneumonic effusion

Answer 8

Clear fluid
pH more than 7.2
LDH less than 1000
Glucose more than 2.2

Question 9

what are the indicators of a complicated parapneumonic effusion

Answer 9

pH less than 7.2
LDH more than 1000
Glucose less than 2.2
Requires Chest Tube Drainage

Question 10

what is the definitive signs of a empyema

Answer 10

Frank pus

X-ray - “D sign”

Question 11

what are preferred for ridding an empyema

Answer 11

Small bore seldinger type drains

Question 12

what suggest chronic bronchial sepsis

Answer 12

No bronchiectasis on the HRCT

Confirmed positive sputum results

Question 13

what causes steatorrhoea

Answer 13

exocrine complications of CF

Question 14

what is a headache on wakening suggest

Answer 14

CO2 retention headache

Question 15

what can cause CO2 retention

Answer 15

Snoring due to hyperventilating

Question 16

signs of metabolic acidosis

Answer 16

increased CO2 production
increased resp rate
“breathlessness”

Question 17

what is stridor

Answer 17

predominantly inspiratory wheeze due to large airway obstruction

Question 18

causes of stridor in children

Answer 18

croup, epiglottis, diphtheria,
Foreign body
Anaphylaxis
angioneurotic oedema

Question 19

causes of stridor in adults

Answer 19

neoplasms - larynx, trachea, major bronchi
anaphylaxis
Retrosternal goitre
bilateral vocal cord palsy
Wegener’s granulomatosis

Question 20

what is tracheomalacia

Answer 20

flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded.

Question 21

what investigation should be avoided in acute epiglottis

Answer 21

Laryngoscopy

Question 22

signs of anaphylaxis

Answer 22

Flushing, pruritus, urticaria, 
Angioneurotic oedema
Hypotension leading to shock
Stridor
Wheeze

Question 23

what is OSA

Answer 23

Intermittent upper airway collapse in sleep

Question 24

what is the best treatment of OSA

Answer 24

Remove underlying cause

Continuous positive airway pressure (CPAP)

Question 25

what tool is used to diagnoses OSA

Answer 25

Epworth score

Question 26

what organism may colonise in CF patients

Answer 26

Staph aureus Pseudomonas aeruginosa Burkholderia cepacia Aspergillus

Question 27

what are causes of pulmonary venous hypertension

Answer 27

LVF Mitral regurgitation Mitral Stenosis Cardiomyopathy

Question 28

what are causes of pulmonary arterial hypertension

Answer 28

Hypoxic - COPD, OSA | PE

Question 29

clinical signs of pulmonary hypertension and right heart failure

Answer 29

central cyanosis if hypoxic Raised JVP with V waves RV heave Tricuspid regurgitation

Question 30

risk factors for DVT and PE

Answer 30

``` Thrombophilia Contraceptive pill Pregnancy Surgery Immobility ```

Question 31

what is the 1st line investigation of DVT

Answer 31

Ultrasound Doppler Leg scan

Question 32

what the ABG of a PE

Answer 32

Decreased PaO2 Decreased SaO2 (Type 1 resp failure PaCO2 normal or low)

Question 33

when is a CT pulmonary angiogram used in PE

Answer 33

image pulmonary artery filling defect - only pick up larger clots in proximal vessels

Question 34

when is a leg and pelvic ultrasound used in PE

Answer 34

to detect silent DVT

Question 35

when is gas transfer factor (DCLO) used in PE

Answer 35

to measure perfusion defect

Question 36

what is the first line recommended initial investigation for PE

Answer 36

Computed Tomographic Pulmonary Angiography (CTPA)

Question 37

what is the initial treatment of PE

Answer 37

Low Molecular Weight Heparin (LMWH) And Warfarin

Question 38

when would thrombolyse be used

Answer 38

Massive PE + Hypotension

Question 39

when should heparin be stopped in PE

Answer 39

3-5 days | when INR >2

Question 40

how long is warfarin continued in PE treatment

Answer 40

for 3-6 months

Question 41

how is Warfarin and Heparin reversed

Answer 41

Warfarin - Vit K1 | Heparin - protamine

Question 42

what is the pathology of diffuse pleural thickening

Answer 42

Extensive fibrosis of visceral pleura with adhesion to parietal pleura