notes from quesmed

Question 1

how long is PE treatment for

Answer 1

3 months provoked
6 months unprovoked
if ongoing cause eg thrombophilia then treat for life

Question 2

what is the scoring system for PE

Answer 2

wells

Question 3

if wells score is 4 or less

Answer 3

D-dimer should be measured. if low then PE excluded, raised then diagnostic imaging eg CTPA or V/Q scan
if wells score more than 4 then straight to diagnostic imaging

Question 4

diagnostic test of choice for PE

Answer 4

CT pulmonary angiography
need to do U+Es before to assess renal function
use VQ scan is renal impairment, contrast allergy or pregnancy

CXR usually normal in PE but rules out other things
ABG may be normal or show type 1 resp failure
CRP raised

Question 5

management of PE

Answer 5

DOACs- rivaroxaban, apixaban or dabigatran
alteplase in massive PE (haemodynamic instability eg bp <90 for >15mins)

Question 6

management of pleural effusion

Answer 6

conservative (treatment of underlying cause) for small
pleural aspiration for larger
if ongoing cause eg lung cancer then chest drain will stop reocurrence
chest drain for empyema as well (aspiration shows low pH, low glucose and pus)

Question 7

what is acute sarcoidosis called and what are the symptoms

Answer 7

löfgren syndrome
fever
polyarthralgia
erythema nodosum
bilateral hilar lymphadenopathy

Question 8

investigations for sarcoid

Answer 8

ESR raised
raised ACE
rasied calcium
lymphocytes may be reduced
CXR-bilateral hilar lymphadenopathy, peripheral infiltrates

Question 9

what organism causes TB and how can you find it

Answer 9

mycobacterium tuberculosis

resistant to acids used in gram staining procedure- acid fast bacillus

need to use a zeihl neelsen stain- turns bright red against blue background

Question 10

investigations for TB

Answer 10

mantoux test (injecting tuberculin into intradermal space on forearm. induration of 5mm or move is positive)
interferon-gamma release assay (IGRA)
CXR
blood, sputum or lymph node aspiration cultures are taken but take months to come back so treatment starts in meantime
Nucleic acid amplification test NAAT- for HIV or under aged 16

Question 11

findings on TB CXR

Answer 11

primary- pleural effusion, patchy consolidation, hilar lymphadenopathy
cavitation in reactivated and millet seeds in disseminated miliary TB

Question 12

what anti-TNF is linked with TB reactivation

Answer 12

infliximab

Question 13

signs and symptoms of pulmonary fibrosis

Answer 13

cyanosis, clubbing, cachexia, fine end inspiratory crackles that dont clear on coughing

dry cough, SOB, fatigue