KCP

Question 1

1. Define dyspnoea
2. Define orthopnoea
3. Define apnoea
4. What are 3 types of SoB
5. What are 6 causes for SoB

Answer 1

1. Subjective feeling of discomfort when breathing
2. SoB when lying down (supine)
3. Temporary cessation of breathing, where the muscles used for inhalation do not move
4. Acute, subacute, chronic
5. Asthma, COPD, PE, ACS (angina/MI), anaemia, anxiety/hyperventilation, Covid-19, pneumonia, pneumothorax, pleural effusion, upper airway obstruction, cardiac arrhythmia

Question 2

1.What is the pathophysiology of asthma

2. What are 3 types of acute asthma and how can you distinguish between them
3. List 4 signs and symptoms of asthma
4. What are 2 asthma investigations
5. What is the treatment protocol for asthma

Answer 2

1. Bronchoconstriction (in response to stimuli), airway hyper responsiveness (increased histamine from mast cells)
   inflammation (swelling) of mucosa, increased mucus secretion (mucus-producing cells increase in number and size)
2. Moderate - Peak flow > 50-75%
   Severe - Peak flow 33-50%, RR > 25, HR > 110, unable to complete sentences
   Life-threatening - Peak flow < 33%, SpO2 < 92%, PaO2 < 8 kPa, PaCO2 4.6–6.0 kPa, silent chest, cyanotic
3. Wheeze, SoB, worse on exertion, diurnal (worse at morning/night), cough, chest tightness
4. Spirometry (FEV1/FVC <70%), FeNO (>40ppb), bronchodilator reversibility (+ve)
5. Lifestyle modification - stop smoking, weight loss, atopic management, avoid NSAIDs,
   Pharmacological Mx:
6. SABA (salbutamol)
7. SABA + LD ICS (beclometasone, fluticasone, etc.)
8. LD ICS and LABA (salmetarol) and/or LTRA (leukotriene receptor antagonist)
9. LD ICS and LABA and/or LTRA and/or theophylline/muscarinic receptor antagonist or HD ICS
10. Oral steroids

Question 3

1.What is the pathophysiology of COPD

2. List 4 signs and symptoms of COPD
3. What are 3 COPD investigations
4. What are the stages of COPD
5. What is the treatment protocol for COPD

Answer 3

1. Mixed airway reversible obstruction and destructive lung disease (combination of asthma and emphysema). Airflow limitation (narrowing/obstruction due to inflammation, mucus plugging or loss of elastic recoil due to damage to elastic fibers and loss of alveolar surface area), abnormal inflammatory response in lungs, alveolar damage (lung hyperinflation), VQ mismatch
2. > 35 years old, smoker, progressive SoB, SoB on exertion often associated with wheeze/cough/sputum production, ‘winter bronchitis’, hyper inflated chest
3. Spirometry (FEV1/FVC < 0.7), CXR, FBCs, sputum culture
4. GOLD grades:
   Grade 1 - mild - 80+% FEV1 predicted
   Grande 2 - moderate - 50-80%
   Grade 3 - severe 30-50%
   Grade 4 - very severe
5. 0-1 moderate exacerbations (no hospitalisation) - LABA and/or LAMA
   >2 mod exacerbations/1 hospitalisation - LABA + LAMA and/or ICS

Question 4

1. List 6 causes of chest pain
2. List 4 red flag signs/symptoms that require urgent admission with chest pain
3. What Ix can be used to determine cause of chest pain

Answer 4

1. ACS, stable angina, dissecting thoracic aneurysm, cardiac tamponade, acute cardiac failure, arrhythmia, PE, pneumothorax, pneumonia, lung cancer, pleural effusion, GORD, MSK best pain, psychogenic chest pain, herpes zoster
2. Pain at rest, severe/prolonged in last 12 hours, rapidly progressing angina, sudden onset chest pain and/or SoB, tachypnoea, tachycardia, SpO2 ,92%, hypotension, altered consciousness
3. ECG, bloods (glucose, lipids, UE, FBC, TFTs, LFTs, trop-T), CXR

Question 5

1. What are the different types of angina
2. What are 2 causes of angina
3. How is stable angina managed

Answer 5

1. Stable - usually occurs predictably, relieved within minutes of rest or GTN
   Unstable - new onset, or deterioration in previously stable. Often occurring at rest
2. Coronary artery disease, valve disease, HOCM, hypertensive heart disease
3. GTN, beta-blocker or Ca-channel blocker, anti platelets, ACE inhibitor, statin, regular reviews (6-12/12)

Question 6

1. Give 3 PE RFs
2. Give 3 PE Sx
3. Give 3 PE Ix
4. How is a PE managed

Answer 6

1. Immobilisation, recent surgery, cancer, acute medical illness, obesity, prolonged travel, DVT, previous DVT, OCP
2. Acute-onset SoB, pleuritic pain, cough, haemoptysis, tachypnoea, tachycardia, signs of DVT, hypoxia, pyrexia, crackling chest
3. PE Wells criteria - 4+ is +ve for PE, D-dimer, CTPA, CXR, ECG,
4. Admit to hospital, anticoagulants, thrombolysis

Question 7

1. What are the cardinal features of cardiac chest pain
2. What are the cardinal features of non-cardiac chest pain

Answer 7

1. Crushing/squeezing pain, left/centre/right chest, radiating to left arm/jaw/back, lightheaded, dizzy, sweaty, central, heavy, dull/ache
2. Sharp, fleeting, positional, pleuritic, burning, shifting, right-sided, changing with respiration, cough, or position

Question 8

1. What are some lower back pain red flags
2. What are 3 red flag diagnoses for lower back pain
3. What are 3 common causes of lower back pain
4. What is non-specific low back pain
5. What are 3 clinical features of lower back pain
6. What is non-mechanical low back pain

Answer 8

1. Uni/bilateral radicular leg pain, altered nerve sensation/function, incontinence, urinary Sx, severe central spinal pain relieved when supine, gradual onset of symptoms or progressive pain, severe unremitting pain over spine, fatigue, unexplained weight loss, night sweats, claudication, fever
2. Cauda equina syndrome, spinal malignancy, vertebral fracture, or spinal infection
3. Sciatica, injury (MSK), OA, osteoporosis, RA, herpes zoster
4. LBP that cannot be attributed to a cause/diagnosis
5. Generalised/localised pain, burning, ache, tingling/altered sensation, stiffness, weakness, limited activity
6. Pain that’s not caused by physical stress on the spine or movement