Cough

Question 1

Acute Dry cough differentials?

Answer 1

URTIs e.g. laryngitis or pharyngitis

Drugs e.g. ACEi

Question 2

Chronic Dry cough differentials?

Answer 2

Lung cancer
GORD
Mesothelioma

Question 3

Mixed Dry and Productive cough differentials?

Answer 3

Mixed Dry = HF and asthma

Mixed productive = HF and COPD

Question 4

Productive acute cough differentials?

Answer 4

Pneumonia (LRTI) or TB

Question 5

Productive Chronic cough differentials?

Answer 5

Lung cancer, bronchiectasis or CF

Question 6

Most common cause of CAP?

Answer 6

Strep pneumoniae

Question 7

Scoring system for CAP severity?

Answer 7

CURB-65

Question 8

Pneumonia CAP causes?

Answer 8

Strep pneumoniae (gram +ve diplococci), haemophilus influenzae B (gram -ve rod) and Moraxella catarrhalis

Question 9

Atypical Pneumonia causes?

Answer 9

Mycoplasma pneumonia (associated with transverse myelitis)
Legionella pneumophila (Air conditioning, associated with Hyponatraemia and abnormal LFTS)

Chlarmydia psittaci (pet birds)
Chlamydia pneumoniae

Question 10

Hospital acquired pneumonia causes?

Answer 10

Staph aureus (Cavitating lesions)
Pseudomonas aeruginosa
Klebsiella (alcoholic rf, cavitating legions association)

Question 11

Cause of aspiration pneumonia?

Answer 11

Anaerobes from gut flora

Question 12

Symptoms of typical pneumonia?

Answer 12

Typical = fever, SOB, cough (green), pleuritic chest pain and confusion

Atypical = dry cough, headache, diarrhoea, myalgia and hepatitis.

Question 13

Signs of pneumonia?

Answer 13

Inspection = resp distress, cyanosis and increased HR and RR, decreased O2 and BP if septic

Reduced chest expansion an dull percussion over consolidation

Question 14

Auscultation of pneumonia?

Answer 14

Basal crepitation (coarse)
Bronchial breathing and increased vocal resonance

Question 15

Investigations for pneumonia?

Answer 15

Obvs, sputum MCS, bloods, pleural fluid mcs via thoracocentesis ad CXR

Bloods = high wcc, high crp and T1RF on ABG

Question 16

Atypical pneumonia symptoms and organism investigations?

Answer 16

Symptoms = Atypical = dry cough, headache, diarrhoea, myalgia and hepatitis.

Serology, urinary antigens for legionella, blood film of cold agglutins for mycoplasms and LFTs for legionella

Question 17

Types of pneumonia on the XRAY?

Answer 17

Lobar and bronchopneumonia (patchy)

Can see consolidation of air bronchograms

Question 18

Management for pneumonia?

Answer 18

CURB 65 = confusion <8 AMTS, urea >7mmol/L, RR>30, BP<90/60mmHg and Age >65

1 = GP
2= A&E
4+ = admission +-ICU

Question 19

Acute pneumonia management?

Answer 19

Oxygen (sit up)m IV fluid, analgesics and ABx

CPAP if required

Question 20

Causative organism Abx?

Answer 20

CAP = amoxicillin (co-amox)
Atypical = clarithromycin

Staph = flucloxacillin
MRSA = vancomycin
Pseudomonas = tazocin + gentamicin

Aspiration pneumonia = metronidazole

Question 21

Pneumonia complications?

Answer 21

Plural effusion
Empyema
Sepsis
Lung abscess (staph aureus) = swinging fever, persistent pneumonia and foul smelling sputum

Question 22

RFs and Signs/symptoms for TB?

Answer 22

Travel, south asians, immunocompromised

FLAWS, SOB, COugh _ green sputum, HAEMOPTYSIS and lymphadenopathy

Question 23

List of TB complications?

Answer 23

TB pneumonia, pleural effusion, meningitis, erytherma nodosum, clubbing, peritonitis, ascites,

Potts disease and addisions disease

Question 24

TB investigations?

Answer 24

Obvs, sputum MC&S and microscopy with Ziehl-neelsen stain

Bloods and CXR

Lymph node biopsy for caseating granuloma
Mantoux ad IGRA

Question 25

TB CXR features?

Answer 25

Consolidation, bi hilar lymhadenopathy, upper lobe scarring, cavitating lesions and pleural effusions. Miliary TB = nodular shadowing

Question 26

Congenital causes of bronchiectasis?

Answer 26

CF Primary Ciliary dyskinesia (kartageners) = triad of bronchiectasis, sinusitis, situs inversus Youngs syndrome = bronchoectasis, sinusitis, infertility

Question 27

Acquired bronchiectasis causes?

Answer 27

Infection e.g. pneumonia, TB, measles and percussis Lung cancer

Question 28

Symptoms of bronchiectasis?

Answer 28

Chronic cough + green sptum, haemoptysis, SOB, fever and weight loss Signs = clubbing and auscultation (basal crepitations)

Question 29

Resp clubbing causes?

Answer 29

Bronciectasis, IPF, lung cancer and TB

Question 30

Causes of basal crepitations?

Answer 30

HF, pneumonia, bronchiectasis and IPF

Question 31

Bronchiectasis investigations?

Answer 31

Usual bvs, sputum MCS, sweat test for CF and genetic testing Gold standard is High resolution CT . Maybe CXR Classical sign is signet ring sign

Question 32

Bronchiectasis management?

Answer 32

Conservative: exercise, vaccinations (influenza), airway clearance: chest physiotherapy, high frequency oscillation devices, nebulised hypertonic saline Pharmacological: IV ABx (acute infection) or oral Abx (prophylactic e.g. azithromycin) Surgical: localised resection

Question 33

Bronchiectasis complications?

Answer 33

Recurrent infectios, cor pulmonale (RHF) or respiratory failure

Question 34

Lung cancer breakdown and RFs?

Answer 34

Primary = Small cell (15%)?endocrine cells e.g. SIADH, ectopic ACTH Non-small cell cancer: Adenocarcinoma (goblet cells in peripheral). SqCC (Squamous epithelial, PTHrp), Large cell carcinoma (epithelial cells) RFs: Smoking or asbestos (sqcc)

Question 35

Primary tumour symptoms?

Answer 35

Cough dry or productive, Haemoptysis, SOB, weight loss, loss of appetite and night sweats.

Question 36

Local invasion and met symptoms?

Answer 36

Local: nervous (Horners syndrome)(left recurrent laryngeal nerve = bovine cough) Superior Vena Cava (SVC obstruction) Bone = pain/fratures Brain = headaches, blurry vision Liver = hepatomegaly Lymphadenopthy

Question 37

Signs of lung cancer?

Answer 37

Clubbing and lymphadenopathy. Dull percussion Creps and increased vocal resonance

Question 38

Lung Cancer investigations?

Answer 38

Obvs, Bloods e.g. FBC, calcium, ALP or LFTs, Imaging = CXR, CT, CAP, PET Caclium and ALP possibly high. LFTs possible deranged Biospy = bronchoscopy or transthoracic needle

Question 39

CXR for lung cancer?

Answer 39

Primary = consolidatn, bi-hilar lyphadenopathy, pleural effusions, cavitating lesions usually Sqcc Secondary = con shaped lesions e.g. cannonball mets Atelectasis = Sails sign

Question 40

Mesothelioma specifics?

Answer 40

Asbestos exposure Pleural friction rub on auscultation Thoracoscopy and histology are definitive diagnosis

Question 41

Mesothelioma CXR features/

Answer 41

pleural thickening, pleural plaques and pleural effusions