__Y6 Resp

Question 1

Resp causes of clubbing

Answer 1

Supparative - Bronchiectasis, abscess, empyema, CF
Malignancy - Lung cancer, mesothelioma
Pulmonary fibrosis

Question 2

Differentiating between pulm fibrosis crackles and mucus plugging?

Answer 2

Get patient to cough

If sounds clear (or change) with coughing then likely related to broncheictasis or mucus plugging

Question 3

↓air entry, dull perc, ↓vocal res

Answer 3

Effusion

Question 4

Bronchial breathing (±crackles), dull perc, ↑vocal res

Answer 4

Consolidation

Question 5

Fine crackles, clubbed

Answer 5

Pulmonary fiboriss

Question 6

Coarse crackles, clubbed, ++phlegm

Answer 6

Bronchiectasis

Question 7

Spirometry

Obstructive vs restrictive
+ examples of each

Answer 7

FEV1/FEV ration <70% = obstruction (fixed: COPD, reversible: asthma)

FEV1/FVC ratio >70% = restrictive or normal (fibrosis, ILD, thoracic restriction)

Question 8

Different types of CT and indication for each?

Answer 8

High resolution - more detail, bigger slices
eg. bronchiectasis or IPF

Volume CT - lower quality but thinner slices
eg. nodules, lung cancer
can give contrast (vasc)

Question 9

CXRshows ring shadows and tramlines?

Answer 9

Bronchiectasis

Question 10

Bronchiectasis on CXR?

Answer 10

Ring shadows and tram lines

Question 11

Cardinal signs of hyperinflation x3

Answer 11

Reduced cricosternal distance
Loss of cardiac dullness
Displaced liver edge

Question 12

COPD classification system?

Answer 12

GOLD

Question 13

Name of criteria for pulm effusion transudate/exudate

Answer 13

Light’s criteria

includes serum/pleural fliud protein, serum/pleural fluid LDH

Question 14

Diagnosis?

Pink face, fine tremor, tar staining
Symmetrical hyperinflate chest expansion
Widespread polyphonic expiratory wheeze

Answer 14

COPD

pink face with secondary polycythaemia vera

Question 15

COPD vs asthma x5

Answer 15

Airway reversiblity
Diurnal variation in asthma, variable breathlessness
COPD almost all smokers
COPD rare

Question 16

Grading of SOB

Answer 16

MRC scale 1-5

1: SOB strenuous exercise
2: hurrying or hill
3: walks slower than contemporaries
4: stops after walking 100m or few mins
5: SOB on ADLs/too breathless to leave house

Question 17

When to give long term O2 threapy?

Answer 17

1. non smoker and PaO2 <7.3 despite max tx
2. PaO2 7.3-8 + PPPP: Peripheral oedema, pulm HTN, PCV, Poor O2 at night
3. Terminally ill pt

Question 18

Define bronchiectasis?

Answer 18

Chronic permanent dilatation of the bronchi

Caused by repeated cycles of airway infection and inflammation

Question 19

Causes of bronchiectasis

Answer 19

Infections - bacterial pneumonia, TB, viruses
Congenital - CF, A1-AT, Kartegner’s
Rheumatic

Question 20

Clubbing + crackles

Answer 20

Bronchiectasis, malignancy, fibrosis, abscess

Question 21

Clubbing, fine end inspiratory crackles

+ rheumatoid hands

Answer 21

Pulmonary fibrosis

Question 22

Pulmonary fibrosis on CT?

Answer 22

Ground glass shadowing

Bibasal reticulonodular shadowing on CXR
If advanced – honeycombing of the lung

Question 23

Causes of pulmonary fiboriss

Answer 23

Specific - occupational (/environmental pollutants), hypersensitivity pneumonitis (bacterial/fungal), drugs (methotrexate, steroids, amiodarone, chemo, isoniazid), infection
Systemic (CTD) - RA, SLE, sarcoid, UC
Other - idiopathic PF

Question 24

Pleural effusion

Transudate vs. exudate?

protein level and causes?

Answer 24

Transudate (<25g/L albumin) → cardiac failure, renal failure, liver failure (low alb)

Transudate more likely if bialteral

Exudate → infection, malignancy, autoimmune, infarction (PE), inflammation, iatrogenic (drugs e.g. nitrofurantoin)

Use Light’s criteria - includes pleural fluid protein:serum protein, pleura LDH:serum LDH

Question 25

Consolidation on x-ray where you cannot see the R heart border?

Answer 25

Middle lobe

Question 26

Score for pneumonia severity

Answer 26

``` Confusion Urea >7 RR >30 BP <90/60 >65 years ```

Question 27

Mode of death in tension pneumothorax

Answer 27

IVC compression

Question 28

Signs of CO2 retention (x5)

Answer 28

``` Flap/asterixis Bounding pulse Vasodilatation (warm hands) Papilloedema (late sign) Mental changes - confusion, drowsiness, LOC ```

Question 29

Life threatening acute asthma exacerbation signs

Answer 29

OH PAACCES Any one of: O2 <92% Hypotension ``` PEFR <33%, Arrythmia Altered consciousness Cyanosis Confusion Exhaustion/poor resp effort Silent chest ```

Question 30

Acute severe asthma exacerbation signs

Answer 30

Any of: PEFR 33-50% RR>25 HR >110 Inability to complete full sentences Accessory muscle use

Question 31

Management of acute COPD exacerbation

Answer 31

* Salbutamol 5mg/4h and Ipratropium 0.5mg/6hr nebs * Hydrocortisone 200mg IV AND Prednisolone 30mg PO (continue for 7-14 days) * Abx if evidence of infection (amoxicillin, alt. clarithro/doxy) * Physiotherapy for sputum expectoration Controlled oxygen therapy if SaO2 <88% or PaO2 <7 kPa

Question 32

Features of Pancoast's syndrome (x3)

Answer 32

L sided apical lung tumour Horner's syndrome Wasting of small muscles of hand

Question 33

Endocrine manifestations of lung cancer

Answer 33

Ectopic ACTH → Cushing’s syndrome SIADH → hypernatraemic PTHrP → hypercalcaemia