Acute respiratory

Question 1

Using which system is PE risk calculated?

Answer 1

Well’s criteria

Question 2

How is Well’s score used in acute SOB patients?

Answer 2

If >4 a PE is likely: admit and do immediate CTPA

If <4 it is less likely: perform a D-DIMER and only do CTPA if this is pos

Question 3

What might an ECG show in PE?

Answer 3

Right axis deviation, RBBB

Question 4

Recall 2 things that may be seen on CXR in PE

Answer 4

Pleural effusion

Elevation of hemidiaphragm

Question 5

Differentiate the management of PE depending on whether the patient is haemodynamically stable or not

Answer 5

Stable: LMWH or fondaparinux until INR>2, warfarin
Unstable: alteplase to thrombolyse

Question 6

How does the chest sound on auscultation in the case of pneumothorax?

Answer 6

Hyperresonant

Question 7

What is the key size of pneumothorax above which there must be medical intervention?

Answer 7

2cm

Question 8

When is it appropriate to aspirate a pneumothorax rather than drain it?

Answer 8

Primary pneumothorax >2cm when pt is <50 yrs

1-2cm pneumothorax when it is a secondary pneumothorax/ pt is >50

Question 9

What should be done to manage larger pneumothoraces?

Answer 9

intercostal drain

Question 10

What would make a pneumothorax an emergency?

Answer 10

If it were a tension pneuothorax

Question 11

What is a tension pneumothorax?

Answer 11

Build up of air in the pleural space due to a one-way valve

Question 12

Recall how a tension pneumothorax appears on examination

Answer 12

Reduced breath sounds
Tachycardia and tachypnoea
Deviation of trachea and displacement of apex beat (as mediastinum pushed out of place)

Question 13

What is the immediate treatment required in tension pneumothorax?

Answer 13

Immediate needle decompression using wide boar needle in 2nd ICS at MCL

Question 14

Define pneumonia

Answer 14

Inflammation of the alveoli caused by an infective pathogen

Results in air sacs filling with fluid/ pus

Question 15

What is the most common community acquired cause of pneumonia?

Answer 15

Streptococcus pneumoniae

Question 16

Which patients are most likely to acquire H. influenzae pneumonia?

Answer 16

COPD

Question 17

Which patients are most likely to acquire klebsiella pneumonia?

Answer 17

HIV

Question 18

What is the most common cause of hospital-acquired pneumonia?

Answer 18

Staphylococcus aureus

Question 19

Recall the classic symptoms of pneumonia

Answer 19

Fever
Rigors
Productive cough
Pleuritic chest pain

Question 20

Recall the 4 key examination findings upon chest examination in pneumonia

Answer 20

Reduced chest expansion
Dull percussion
Increased vocal resonance
Bronchial breathing

Question 21

What are the 2 key things to look for on CXR in pneumonia?

Answer 21

Lobar or multilobar?

Is there conolidation?

Question 22

Recall the medical management of pneumonia depending on severity

Answer 22

Low: oral amoxicillin
Moderate: oral amoxicillin + macrolide
Severe: IV co-amoxiclav + macrolide

Question 23

What score is used to assess pneumonia severity?

Answer 23

CURB 65

Question 24

Recall the CURB 65 criteria

Answer 24

Confusion
Urea >7
Resp rate >30
BP <90/60
>65 (age)

Question 25

What is the name of the disease caused by legionella that is non-pneumonatic?

Answer 25

Pontiac fever

Question 26

What is the first line of medical management of legionnaire’s disease?

Answer 26

IV macrolide (clarithromycin)

Question 27

What investigation confirms a diagnosis of legionella?

Answer 27

Urinary antigen detection

Question 28

Which electrolyte imbalance is caused by legionella?

Answer 28

Hyponatraemia

Question 29

What would be seen on CXR in legionnaire’s diease?

Answer 29

Bibasal consolidation

Question 30

Recall the medical management of staph aureus pneumonia when it is S. aureus and when it is MRSA

Answer 30

S. aureus: flucloxacillin

MRSA: vancomycin

Question 31

Which pathogen causes pneumocystis pneumonia?

Answer 31

Pneumocystic jirovercii (fungus)

Question 32

In which demographic of patients is pneumocystic pneumonia most commonly seen?

Answer 32

HIV+

It is an AIDS-defining illness

Question 33

What is the treatment for pneumocystis pneumonia?

Answer 33

High dose IV co-trimoxazole

Question 34

In which demographic of patients is pseudomonas pneumonia most commonly seen?

Answer 34

Those with bronchiectasis/ cystic fibrosis

Question 35

Recall one unusual symptom of pneumocystis pneumonia?

Answer 35

Purple patches on nose

Question 36

Recall the approach to presenting CXRs

Answer 36

RIPE:
Rotation
Inspiratory effort
Penetration
Exposure
ABCDE:
Airway
Breathing
Circulation
Diaphragms
Everything else (eg foreign bodies, bones)

Question 37

Recall the ABCDE of what you would see on a CXR in heart failure

Answer 37

Alveolar shadowing
Kerley B lines
Cardiomegaly
Upper lobe Diversion
Pleural Effusion