capsule RESP

Question 1

first line Ix for acute asthma attack (3)

Answer 1

ECG, peak flow, blood gas

Question 2

first line treatment for acute asthma attack (4)

Answer 2

-high dose of O2 until PaO2 normalised
salbutamol and ipratopium bromide administered at once by nebuliser (if not respond then IV aminophyline)
-high dose steroids to reduce inflammation eg IV or oral prednisolone

Question 3

what signs could indicate life threatening asthma (7)

Answer 3

cyanosis, exhaustion and poor resp effort, bradycardia, low BP, ph 7.25 on ABG, pCO2 6kPa, silent chest on auscultation

Question 4

how would you manage asthma attack, after imrpovement (4)

Answer 4

continue O2 at lower dose, commence oral steroids, 4 hourly nebulised salbutamol, monitor peak flow and O2 saturation

Question 5

what is aminophyline

Answer 5

phosphodiesterase inhibitor which can be administered via IV in severe asthma. is may cause low K and cardiac arthymias so heart monitor needed.
Reduce dose in cardiac or liver failure and in patients on certain drugs e.g. Ciprofloxacin, Cimetidine
Omit loading-dose for IV infusion in patients already on oral treatment and, in all cases, monitor drug levels carefully whilst the infusion is ongoing.

Question 6

what can cause consolidation in x ray (3)

Answer 6

aspiration, infection eg pneumonia, haemorrage in lungs
consolidation due to filling of air space with whatever materials.

Question 7

how does lung fibrosis and mesothelioma present in x rays?

Answer 7

Lung fibrosis involves the interstitium rather than the alveoli and causes linear shadows.
Mesothelioma involves the pleura and so does not cause lung consolidation

Question 8

commonest cause of CAP

Answer 8

strep pneumoniae

Question 9

first line treatment for pneumonia (5)

Answer 9

analgesia, continued pulse oximetry, IV ABx, IV fluids, O2 by mask

Question 10

what are some complications of bacterial pneumonia (6)

Answer 10

AF, empyema, jaundice, pericarditis, resp failure, septic shock

Question 11

what are some radiographical changes associated with bronchiectasis (4)

Answer 11

Thickened bronchial walls
Ring shadows (thickened airways seen end-on)
Volume loss secondary to mucous plugging
Air-fluid levels may be visible within dilated bronchi

Question 12

what Abx is choice for uncomplicated CAP

Answer 12

amoxycilin

Question 13

what is drug of choice for suspected pneumocystitis carinii pneumonia

Answer 13

co trimoxazole

Question 14

what are some causes of bronchiectasis?

Answer 14

congenital: CT, marfans, alpha 1 antitrypsin deficiency
post infection: pneumonia, measules, Tb
obstruction: tumour, nodes, foreign body
inhalation/ aspiration
pul fibrosis
immunodeficiency states eg AIDS
rheumatoid arthirtis and sarcoidsosi

Question 15

what are some causes of lymphadenopathy

Answer 15

sarcoidosis, infectious mononucelosides and lymphoma, Tb

Question 16

when would you check for serume ACE

Answer 16

raised in 2/3 pt with sarcoidosis but not specific for this. serum Ca may also be raised for

Question 17

what are some pathology associated with sarcoidosis (4)

Answer 17

hypercalcaemia, lung fibrosis, hepatosplenomegaly, uveitis

Question 18

what conditions associated with erythema nodosum (3)

Answer 18

Tb, corhn’s, oral contraceptives

Question 19

additional treatments for asthma (after ICS and SABA)

Answer 19

long acting beta agonist (Salmererol/ formoterol) adding montelukast

Question 20

side effects of LT steroids (3)

Answer 20

cataracts, weight gain, candida

Question 21

side effect of rifampicin

Answer 21

can cause hepatic and renal impairment. Patients should be warned of red/orange discolouration of urine and mucous membrane secretions.

Question 22

side effect of isoniazid

Answer 22

peripheral neuropathy is a common side effect and is more likely in those with risk factors, e.g. diabetes, alcohol dependence, malnutrition, renal impairment and HIV. These patients should be prescribed prophylactic pyridoxine. Hepatitis is rare but more common in those who are over 35 years old and those who drink alcohol daily.

Question 23

side effect of ethambutol

Answer 23

may lead to colour blindness, loss of visual acuity and restriction of visual fields. Patients should be advised to stop the drug if visual symptoms occur. Ethambutol undergoes renal excretion, therefore, the dose should be reduced in those with renal impairment.

Question 24

side effect of pyrazinamide

Answer 24

may cause hepatotoxicity, particularly in those with pre-existing liver disease.

Question 25

side effect of streptomycin

Answer 25

may cause ototoxicity and nephrotoxicity. Serum concentrations should be monitored in patients with renal impairment.

Question 26

when is strpetomycin used in treatment of TB

Answer 26

Streptomycin is now rarely used in the treatment of TB, unless there is resistance to isoniazid. Treatment duration for pulmonary TB is 6 months

Question 27

what should you check prior to starting Tb treatment?

Answer 27

HIv counselling and testing, LFT, renal function, visual acuity

Question 28

what ECG changes seen on PE

Answer 28

Typical ECG findings are sinus tachycardia and this is commonly the only ECG abnormality. There may be right axis deviation and a SI QIII TIII pattern (deep S in lead I with a Q wave in lead III), although the absence of this pattern would not exclude a PE

Question 29

when do you see prominent u wave

Answer 29

hypokalaemia

Question 30

when do you see delta wave

Answer 30

wolff parkinson white syndrome

Question 31

when do you see LBBB

Answer 31

ischaemic heart disease, signs of ACS

Question 32

factor V leiden

Answer 32

autosomal dominant point mutation in gene, which encodes clotting factor V. inc risk of pro-thrombotic event

Question 33

x ray sign for tb or sarcoidosis

Answer 33

bilateral hilar lymphadenopathy and interstitial lung changes

Question 34

how to test between Tb and sarcoidosis?

Answer 34

mantoux for TB
sarcoidisois: people may make extra vit D and ACE so detect surplus in blood test
biopsy of nodes to exclude malignancy
CT used to evaluate lungs and degree of lymphadenopathy and rule out malignancy