Misc

Question 1

Xray signs for pulmonary oedema?

Answer 1

bilateral perihilar alveolar shadowing
upper lobe diversion
bilateral patchy batswing shadowing
fluid in the horizontal fissure

Question 2

difference between lobar and bronchopneumonia on CXR?

Answer 2

lobar - clearly defined

bronchopneumonia - multi-lobular

Question 3

most common cause of lobar pneumonia?

Answer 3

Strep pneumoniae

know at least 3:

-

-

Question 4

what organism is signified by rusty sputum?

Answer 4

Streptococcus pneum

Question 5

what organism is common for pneumonia after influenza?

Answer 5

Staphyloccocus

Question 6

what organism is common for pneumonia in alcoholics/elderly? often red-current jelly sputum

Answer 6

klebsiella

Question 7

what organism is common for pneumonia in COPD/bronchiectasis?

Answer 7

Haemophilus

Question 8

name 3 respiratory causes of clubbing?

Answer 8

Bronchiectasis
Lung cancer
Cystic fibrosis
Lung abscess

Question 9

CT findingds of bronchiectasis?

Answer 9

dialted bronchi - signet ring sing

Question 10

how do we ivx bronchiectasis?

Answer 10

sputum mcs
Imaging; cxr, High res CT
Pulmonary function tests; FEV1

Tests for Specific causes: CFTR, a1-at, chloride sweat test

Question 11

how do we mx bronchiectasis?

Answer 11

Acute exacerbation:
- PO abx Amox (or IV if severe) - or alternatives if allergic

Chronic mx:

• Diet & Lifestyle advice
• Chest physiotherapy
• Inhaled bronchodilator
• Mucolytic agent: n-acetlycysteine

Question 12

how do we decide to do ctpa or ddimer for PE?

Answer 12

WELLS >4:
- ctpa

WELLS<4:
Ddimer, anticoagulate

Question 13

NEW guideline for PE mx?

Answer 13

HAEMODYNAMICALLY STABLE
Treat with DOAC - rivaroxaban

Special groups:
low or v high weight, renal failure cancer:
- lmwh or UFH

Pregnant women: LMWH

HAEMODYNAMICALLY UNSTABLE:
1ST- unfractionated heparin
2nd - alteplase IV

Question 14

stony dull percussion, reduced breath sounds and vocal remitus is indicative of?

Answer 14

pleural effusion

Question 15

difference between exudate and transudate in pleural effusions?

Answer 15

exudate

so must have Higher protein and Higher LDH in
pleural fluid compared to serum

Question 16

causes of exudate and transudate?

Answer 16

Transudate:

• caused by systemic factors (trans for travelling far)
• Congestive cardiac failure, PE
• Cirrhosis, Nephrotic syndrome, low albumin

Exudate:

• Local factors
• Pneumonia, cancer, TB, PE, Autoimmune

Question 17

how do we mx pleural effusions?

Answer 17

Treatment is based on the nature of the effusion and underlying condition.

Congestive heart failure:

1. Diuretics
2. Therapeutic thoracocentesis + O2 (if symptomatic)

Cancer:
1. Therapeutic thoracocentesis + O2
or pleural catheter drainage

Infective:
1. Antibiotics + Thoracocentesis

Question 18

Mx of suspected Pulmonary embolism?

Answer 18

1. Offer apixaban or rivaroxaban first line,

and if these are not suitable;

2. low molecular weight heparin (LMWH) for at least 5 days followed by dabigatran or edoxaban,
   2b. or LMWH concurrently with a vitamin K antagonists for at least 5 days.

Question 19

how does cartageners syndrome present?

Answer 19

Bronchiectasis
Infertility
Sinusitis
Dextrocardia

aka primary ciliary dyskinesia