GP Respiratory

Question 1

What are the boundaries of the ‘safe triangle’ for chest drain insertion?

Answer 1

• Lateral edge of latissimus dorsi,
• Pertoralis major
• Base of axilla
• 5th IC space

Question 2

What is alpha-1-antitryptase deficiency caused by?

Answer 2

A common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver.

The role of A1AT is to protect cells from enzymes such as neutrophil elastase.

Question 3

How do you classify someones allele inheritance with alpha-1-antitryptase deficiency

Answer 3

normal = PiMM

homozygous PiSS (50% normal A1AT levels)

homozygous PiZZ (10% normal A1AT levels)

- the PiZZ patients are usually the ones who manifest disease

Question 4

What is the disease outcomes for patients with alpha-1-antitryptase

Answer 4

lungs: panacinar emphysema, most marked in lower lobes
liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children

Question 5

Managment of patients with Alpha-1-antitrypsin deficiency?

Answer 5

• Smoking cessation
• Supportive: bronchodilators, physiotherapy
• IV alpha-1-antitrypsin
• Surgery: lung volume reduction, lung transplantation

Question 6

Acute symptoms of sarcoidosis?

Insidious symptoms of sarcoidosis?

Skin changes with sarcoidosis?

Answer 6

Acute: erythema nodosum, swinging fever, polyarthralgia, bilateral hilar lymphadenopathy

Insidious: dyspnoea, non-productive cough, malaise, weight loss

Skin: Lupus perinio

Question 7

Why do patients with sarcoidosis get hypercalcaemia?

Answer 7

Because macrophages within the granulomas increase conversion of vitamin D to its active form (1-25 dihydroxycholecalciferol)

Question 8

The most common bacterial organisms that cause infective exacerbations of COPD are:

Answer 8

• Haemophilus influenzae
• Staphylococcus aureus
• Moraxella catarrhalis

Question 9

Asthma may be diagnosed if any of the following criteria are met (in adults)

• An exhaled FeNO of ______
• A post-bronchodilator improvement in lung volume of _____ ml
• A post-bronchodilator improvement in FEV1 of______
• A peak expiratory flow rate variability of_______
• An FEV1/FVC ratio of ______

Answer 9

• An exhaled FeNO of 40 parts per billion
• A post-bronchodilator improvement in lung volume of 200 ml or greater
• A post-bronchodilator improvement in FEV1 of 12%
• A peak expiratory flow rate variability of 20% or more
• An FEV1/FVC ratio of 70% or more

Question 10

what is the underlying pathophysiology of ARDS

Answer 10

increased permeability of the alveolar capillaries.

This causes fluid accumulation in the alveoli and is a non-cardiogenic form of pulmonary oedema.

It is a serious condition that has a mortality of around 40% and is associated with significant morbidity in those who survive.

Question 11

Common causes of Acute Respiratory Distress Syndrome (ARDS)

Answer 11

• infection: sepsis, pneumonia
• massive blood transfusion
• trauma
• smoke inhalation
• pancreatitis
• cardio-pulmonary bypass