general resp

Question 1

what is the appropriate treatment to start for a person with an exacerbation of asthma - currently only on salbutamol 2 puffs prn

Answer 1

Prescribe prednisolone 40mg od for 5 days (with a stat dose now) + a beclometasone inhaler 200mcg bd

Question 2

state the criteria for the Wells score for a DVT

Answer 2

Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3
An alternative diagnosis is less likely than PE 3
Heart rate > 100 beats per minute 1.5
Immobilisation for more than 3 days or surgery in the previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1
Malignancy (on treatment, treated in the last 6 months, or palliative) 1

Question 3

what Wells score makes a PE likely and what score makes a PE unlikley

Answer 3

likely - 4+

unlikely - 4 or less

Question 4

if a PE is likely according to the Wells score - what test should you arrange?

Answer 4

CTPA

or V/Q scan if Renally impaired

Question 5

what is the most common ecg change in a PE?

Answer 5

sinus tachycardia

Question 6

if a PE is unlikely according to the Wells score - what should you do?

Answer 6

D-dimer test. If negative, excludes PE

Question 7

if you suspect PE, but CTPA is delayed - what should you do?

Answer 7

If there is a delay in getting the CTPA then give low-molecular-weight heparin until the scan is performed.

Question 8

what are the common causes of exudative pleural effusions?

Answer 8

think what causes capillary leakiness…?
(infection / inflammation / malignancy )
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome

Question 9

what are the causes of a transudative Pleural effusion.

Answer 9

Transudate (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

Question 10

what might be the presenting symptoms of a pleural effusion

Answer 10

ASX

or dyspnoea / pleuritic chest pain / non-productive cough

Question 11

how would you manage a pleural effusion?

Answer 11

treat the underlying cause
DRAIN IT IF ITS SYMPTOMATIC - slowly at about 1L/24hr
can aspirate it in the same way as a diagnostic tap - ie percuss to the upper border of the PE, then choose a sit 1-2 IC spaces below…
if recurrent - pleurodesis with tetracycline / talc