CCC - Respiratory

Question 1

If breathlessness has sudden onset what are DDx?

Answer 1

1. pneumothorax
2. PE
3. FB

Question 2

If breathlessness has a mins/hr onset what are DDx?

Answer 2

1. airways (inflammation/obstruction)
2. chest infection (pus)
3. acute heart failure (fluid)

Question 3

If breathlessness has a days/weeks onset what are DDx?

Answer 3

1. above (chronic/non-resolving)
2. ILD
3. Malignancy/large pleural effusion
4. neuromuscular
5. anaemia/thyrotoxicosis

Question 4

What is the management of a pneumothroax primary <2cm?

Answer 4

discharge repeat CXR

Question 5

What is the management of a pneumothroax primary >2cm/SOB?

Answer 5

aspiration, if unsuccessful chest drain - analgesia (regular)

Question 6

What is the management of a pneumothorax secondary <2cm?

Answer 6

aspiration

Question 7

What is the management of a pneumothorax secondary >2cm?

Answer 7

chest drain

Question 8

How do you know if primary or secondary?

Answer 8

• primary: healthy

- secondary: predisposing e.g. COPD

Question 9

How do you know the distance of the pneumothroax?

Answer 9

edge of heart and chest wal

Question 10

Why might you have recurrent SOB after 2 hrs of chest drain?

Answer 10

rexpansion pulmonary oedema

Question 11

What is a quick way to determine the axis?

Answer 11

1. Lead I and II: overall negative?
   - Yes: axis deviation
2. Look at avL: overall positive?
   - Yes: left axis deviation
   - No: right axis deviation

Question 12

What is the inital treatment in PE?

Answer 12

1. LMWH

2. Thrombolysis: if haemodynamic compromise (hypotensive systolic <90 unstable)

Question 13

Why do you not give warfarin as inital PE management?

Answer 13

have a paradoxically pro-thrombotic effect initally

Question 14

How can you see pulmonary oedema on chest x ray?

Answer 14

fluffy shadowing

Question 15

How can you see a PE on x ray?

Answer 15

1. Area of hypovoelamia (PE)
2. Western Mark sign
3. Focus of olgemia
4. Rarely shown as PE usually normal X ray

Question 16

When may you see large bollous (bulla) on xray?

Answer 16

COPD

Question 17

What should you not put in with large bollous?

Answer 17

drain

Question 18

How can you see pulmonary fibrosis on an X ray?

Answer 18

reticular nodular shadowing

Question 19

What are DDx of pulmonary fibrosis?

Answer 19

1. connective tissue disease, RA
2. Drugs
3. Asbestosis (ship builder)

Question 20

What may hyperexpansion with a flat diaphragm on an xray suggest?

Answer 20

COPD

Question 21

What could be a cause of upper lobe consolidation?

Answer 21

TB

Question 22

What would interstitial/alveolar shadowing (fluffy) on CXR suggest?

Answer 22

1. heart failure
2. pneumonia
3. pulmonary oedema

Question 23

What would homogenous shadowing suggest?

Answer 23

pleural effusion

Question 24

What are the different opacities on a CXR you can comment on?

Answer 24

1. Interstitial/alveolar shadowing
2. Reticulo-nodular shadowing
3. Homogenous shadowing
4. Masses/cavitations

Question 25

If you are unsure for a diagnosis what should you state?

Answer 25

1. Infection 2. Inflammation 3. Malignancy

Question 26

If there is cardiomegaly what should you say?

Answer 26

increase cardiac shadow not big heart as may be normal heart but fluid around Cardiomegaly or pericardial effusion (likely latter as globular looking)

Question 27

What are DDx of bilateral hilar lymphadneopathy?

Answer 27

1. infection: TB 2. inflammation: sarcoidosis 3. malignancy: lymphoma

Question 28

When might there be pleural plaques on CXR?

Answer 28

by asbestos (different from asbestosis which is pulmonary fibrosis)

Question 29

What may a blunted costophrenic angle mean?

Answer 29

fluid

Question 30

How should you compare L vs R upper/mid/lower zone?

Answer 30

1. alveolar,intersitital shadowing 2. reticulonodular shadowing 3. homogenous shadowing

Question 31

What should you look at in the peripheray of a CXR?

Answer 31

1. Pneumothroax 2. Plueral thickness 3. Costophrenic angles 4. Diaphragm 5. Heart 6. Mediastinum

Question 32

What is another option for PE management?

Answer 32

CTPA