Data - Respiratory

Question 1

Common causes of respiratory acidosis?

Answer 1

Acute ventilatory failure from:
Severe acute asthma
Exacerbation of COPD
Thoracic skeletal abnormality
Neuromuscular disorders (eg muscular dystrophy)

Question 2

Common causes of respiratory alkalosis?

Answer 2

Hyperventilation (anxiety/panic)
CNS causes - stroke, SAH
Salicylate poisoning *early stage

Question 3

Common causes of metabolic acidosis?

Answer 3

Increased production of acids:
- DKA
- Poisoning (ETOH)
- Acute renal failure
- Lactic acidosis, shock, post cardiac arrest
Loss of bicarbonate:
- Renal tubular acidosis
- Severe diarrhoea
- Addison's

Question 4

Common causes of metabolic alkalosis?

Answer 4

Loss of acid:
- Severe vomiting; nasogastric suction
Loss of potassium:
- Excess diuretic therapy
- Hyperaldosteronism
- Cushings
- Liquorice ingestion(!??!?!?!)

Question 5

Dull percussion note chest wall causes

Answer 5

Pulmonary consolidation
Pulmonary collapse
Severe pulmonary fibrosis

Question 6

Stony dull percussion note chest wall causes

Answer 6

Pleural effusion

Haemothorax

Question 7

Hyperresonant percussion note chest wall causes

Answer 7

Pneumothorax

Question 8

Hot potato voice?

Answer 8

Stertor - often due to quinsy

Question 9

Breathlessness in different positions?

Answer 9

Lying - orthopnoea
Upright - platypnoea
Lying on one side - trepopnoea

Question 10

CURB-65?

Answer 10

Confusion
Urea > 7mmol/L
Respiratory rate > 30
BP (systolic) <90mmHg  (diastolic) < 60mmHg
Age > 65yrs

Question 11

Red nodules on shins?

Answer 11

Erythema nodosum
Streptococcal infection
Sarcoidosis
TB

Question 12

Respiratory causes of clubbing?

Answer 12

Bronchiectasis
Lung cancer
Interstitial lung disease

Question 13

Coarse flapping tremor?

Answer 13

Asterixis

CO2 retention

Question 14

Cor pulmonale?

Answer 14

Chronic hypoxia in COPD –> pulmonary arterial vasoconstriction–> pulmonary hypertension –> right heart dilatation –> raised JVP

Question 15

Cause of pectus carinatum?

Answer 15

Poorly controlled (severe) childhood asthma
Osteomalacia
Rickets

Question 16

Pectus excavatum cause?

Answer 16

Developmental deformity

Question 17

Tracheal deviation sides and causes?

Answer 17

Toward abnormality
Lung collapse
Upper lobe fibrosis
Pneumonectomy

Away from abnormality
Tension pneumothorax
Massive effusion

Question 18

Tenderness over costal cartilages?

Answer 18

Costochondritis of Tietze syndrome

Question 19

Score used for determining PE risk?

Answer 19

Well’s score

Question 20

Crackles causes?

Answer 20

Early inspiratory: small airways disease (bronchiolitis)
Mid - inspiratory: Pulmonary oedema
Fine late inspiratory: pulmonary fibrosis; oedema, bronchial secretions (COPD, pneumonia etc)
Inspiration and expiration: bronchiectasis

Question 21

cANCA positive in?

Answer 21

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

Question 22

pANCA positive in?

Answer 22

Microscopic polyangiitis

Churg-Strauss syndrome

Question 23

Borders for insertion of chest drain?

Answer 23

Lateral border of pec major
5th IC space
Anterior border lat dorsi

Question 24

Signs of severe acute asthma?

Answer 24

Peak flow 33%-50% of best
Inability to complete full sentences
Resp rate >25
Heart rate > 110

Question 25

Signs of life threatening acute asthma?

Answer 25

Peak flow <33% of best
SpO2 < 92%
PaO2 < 8
PaCO2 normal!
Silent chest
Poor respiratory effort
Exhaustion

Question 26

When to admit acute asthma?

Answer 26

Admit all life-threatening or near fatal attacks

Admit severe asthma if persisting after initial treatment

Question 27

Management of acute asthma attack?

Answer 27

Oxygen! Get sats between 94-98%
High dose inhaled beta 2-agonists
Steroid therapy
Nebulised ipratropium bromide if severe/life threatening
MgSO4 if not responsive to initial inhaled bronchodilators

Question 28

Management of COPD?

Answer 28

1. SABA or SAMA
   2
   a) if FEV1 > 50% then LABA or LAMA
   b)if FEV1 < 50% then LABA + ICS OR LAMA