Dr Clarke

Question 1

What are the signs of Pancoast’s syndrome?

Answer 1

T1 nerve root lesion with sympathetic chain involvment:

Apical carcinoma

Horner’s

Wasting small muscles of hand

Axillary sensation - dermatome

Question 2

4 causes of pleural effusion exudate?

Answer 2

Carcinoma

Infection - lobar pneumonia, TB

Pulmonary emboli

Rheumatoid arthritis

Question 3

How define collapse?

How does this differ clinically from effusion?

Answer 3

Obstruction of a bronchus with loss of aeration of distal lung

Both cause loss of lung volume

Collapse - deviation towards affected side

Effusion - only deviation away if massive, stony dull to percussion

Question 4

what typifies loss of lung volume and give 4 possible causes?

Conditions where the mediastinum deviates away from the lesion?

Answer 4

In loss of volume, trachea is deviated towards the affected side;

Collapse

Pneumonectomy

Unilateral fibrosis

TB/old treatments of TB

Deviation away is rare, but can occur in:

Massive pleural effusion

Pneumothorax with tension

Question 5

6 signs of consolidation?

Answer 5

Reduced expansion

Bronchial breathing

Coarse Crackles

Dull to percussion

reduced air entry

Enhance vocal resonance/TVF

Question 6

CURB-65 criteria?

Answer 6

Confusion - new onset with MMSE score <7

Urea >7

RR > 30

BP diastolic <60, systolic <90

Over 65 years old

Question 7

4 signs of severe asthma?

7 life-threatening features? 33-92-8-N-Chest

Answer 7

Severe:

PEFR <50%, Struggling to complete sentences, RR >25, HR >110

Life -threatening:

PEFR <33%, SaO2 <92%, PaO2 <8, Normocapnia

Cyanosis/Consciousness, Hypotension, Exhaustion and feeble resp effort, Silent chest, Tachycardia/bradycardia

Question 8

How manage acute attack of COPD?

What common organisms cause infective exacerbation?

Question 9

Describe the pathophysiology of:

Pneumoconiosis

Hypersensitivity Pneumonitis

Answer 9

Pneumoconionsis

• Coal dust/Asbestos/Silica engulfed by alveolar macrophages
• Aggregate to form nodules
• Stimulating fibrosis
• This profresses to type 1 RF and pulmonary hypertension
• Eventually cor pulmonale

HP

• immune mediated response to extrinsic allergens including proteins and mould.
• Type III (IC) hypersensitivity enhancing complement activation,
• Type IV delayed hypersensitivy leading to cell-mediated response.
• Result in inflammation and formation of non-caseating granulomas, leading to pulmonary fibrosis.

Question 10

Asbestos

4 consequences in the lung?

What are ferruginous bodies?

Answer 10

1. Pleural Plaques and thickening
2. Asbestosis - fibrotic lung disaese
3. Mesothelioma
4. Carcinoma of bronchus - 5x increased risk, 50X if smoke

Ferruginous bodies - indicative of asbestos inhalation (when the presence of asbestos is verified they are called “asbestos bodies”). In this case they are fibers of asbestos coated with an iron-rich material derived from proteins such as ferritin and hemosiderin

Question 11

What are the features of acute and chronic presentation of sarcoidosis?

Question 12

5 causes of erythema nodosum?