Other

Question 1

What is Wegeners granulomatosis

Answer 1

Granulomatous with polyangia (autoimmune inflammatory condition affecting endothelial cells)

Question 2

Pathophysiology of Wegeners granulomatosis

Answer 2

Unknown.
Vasculitis.
Thought to be an attack on endothelial cells

Question 3

Classification of Wegeners granulomatosis

Answer 3

ELK classification depending on if it affects ENT, Lungs and/or Kidneys

Question 4

Clinical presentation of Wegeners granulomatosis

Answer 4

Multisystem: range of signs and symptoms.

Fatigue, fever, pleural pain, rhinorrhea, haemoptysis, haematuria.

Question 5

Epidemiology of Wegeners granulomatosis

Answer 5

6/1,000,000

Question 6

Diagnosis of Wegeners granulomatosis

Answer 6

FBC
U and E
ESR
C-ANCA an p-ANCA (very suggestive)

Question 7

Treatment of Wegeners granulomatosis

Answer 7

Prednisolone

Cyclophosphamide (immunosuppressant) with Rituximab (monoclonal antibody)

Question 8

Complications of Wegeners granulomatosis

Answer 8

Acute Kidney Injury

Resp failure

Question 9

What is Pulmonary Thromboembolus and infarct

Answer 9

Where thromboembolus blocks right ventricular outflow, pulmonary arteries and branches
DVT embolism

Question 10

Types of Pulmonary Thromboembolus and infarct

Answer 10

Small-medium (can be clinically silent)

Massive (medical emergency)

Question 11

Risk factor for DVT embolism

Answer 11

Long periods of immobility (usually sat down) such as a long flight or surgery

Question 12

Clinical presentation of small-medium pulmonary thromboembolus and infarct

Answer 12

Breathlessness
Pleuritic chest pain
Haemoptysis if infarction
Tachypnoea
Pleural rub
Exudative pleural effusion

Question 13

Clinical presentation of massive pulmonary thromboembolus and infarct

Answer 13

Severe central chest pain
Shock
Pale
Sweaty
Tachypnoea
Tachycardia
Cyanosis
Increased JVP
2nd heart sound and gallop

Question 14

Diagnosis of pulmonary thromboembolus and infarct

Answer 14

Revised Geneva score to predict probability of PE.
CXR (decreased vascular markings, raised hemi diaphragm) ECG may exclude differentials eg MI.
D-dimers, spiral CT.
ECHO diagnostic and can be performed at bedside, good for massive.

Question 15

Treatment of pulmonary thromboembolus and infarct

Answer 15

Initial therapy: Oxygen.
Thrombolysis, LMWH, warfarin.
High risk of recurrence: Vena cava filter

Question 16

Complications of massive pulmonary thromboembolus and infarct

Answer 16

Acute right heart failure
Syncope
Death

Question 17

What is a pulmonary embolism

Answer 17

Occlusion of the pulmonary vasculature by a clot
Often it occurs from a deep vein thrombosis (DVT) that has become dislodged and forms an embolus that lodges in the pulmonary arterial vasculature, blocking the vessels

Question 18

Signs and symptoms of Pulmonary Embolism

Answer 18

Breathlessness (may be of sudden onset or progressive)
Tachypnoea
Pleuritic chest pain
Cyanosis
Haemoptysis

(Symptom correlation depends on where the pulmonary circulation is occluded)

Question 19

Causes of pulmonary embolism

Answer 19

DVT
Air embolus
Fat embolus
Amniotic fluid embolus
Foreign material introduced via IV drug

Question 20

3 pathways involved in pathophysiology of pulmonary embolism

Answer 20

• Platelet factor release: serotonin and thromboxane A2 cause vasoconstriction
• Decreased alveolar perfusion: lung is underperfused and this leads to diminished gas exchange
• Decreased surfactant: this leads to ventilation/perfusion mismatch, hypoxaemia and dyspnoea

Question 21

Complications of pulmonary embolism

Answer 21

SAPPPP
Sudden death
Arrhythmia
Pulmonary infarction
Pleural effusion
Paradoxical embolism
Pulmonary hypertension

Question 22

Investigations of pulmonary embolism

Answer 22

D-dimer (sensitive, but not specific - negative result used to rule out PE)
Thrombophilia screening
CXR (usually normal)
ECG
ABG
CT, Pulmonary Angiography
V/Q scan

Question 23

How could you calculate risk of pulmonary embolism

Answer 23

Wells score

Question 24

D-dimer test for pulmonary embolism is SENSITIVE but not specific - what is meant by this

Answer 24

Sensitivity is the ability of a test to correctly identify those with the disease (true positive rate)
Specificity is the ability of the test to correctly identify those without the disease (true negative rate)

Question 25

What test is used to rule out pulmonary embolism

Answer 25

D-dimer

Negative test result rules out PE

Question 26

When is Thrombophilia screening used

Answer 26

In patients <50 years with recurrent PE

Question 27

PE - what would you see on an ABG

Answer 27

Hypoxaemia

Question 28

PE - what is seen on an ECG

Answer 28

Sinus tachycardia

S1Q3T3 pattern is classical but rare (excludes MI)

Question 29

Treatment of Acute PE

Answer 29

Oxygen
IV fluids
Thrombolysis therapy if indicated e.g. alteplase if massive PE or haemodynamically unstable
LMWH

Question 30

Long-term management of PE

Answer 30

Anticoagulation

Inferior vena cava filter

Question 31

Side effects of anticoagulants

Answer 31

passing blood in your urine
passing blood when you poo or having black poo
severe bruising
prolonged nosebleeds
bleeding gums
vomiting blood or coughing up blood
heavy periods in women

Question 32

Examples of anticoagulants

Answer 32

Warfarin
Rivaroxaban
Heparin

Question 33

Other examples (except PE) of when anticoagulants are used

Answer 33

strokes or transient ischaemic attacks
heart attacks
deep vein thrombosis (DVT)