Pulmonology

Question 1

What are the possible abnormal sounds on lung auscultation: upper airway

Answer 1

Stridor: high pitched inspiratory sound due to narrowed segment of upper airway –> croup, foreign body, epiglottitis, tracheitis (pseudo-croup) laryngomalacia, subglottic stenosis.

Rhonchi: gurgling noices on inspiration or expiration due to partial obstruction of lower upper airways by secretions, mucosal swelling or tumor. COPD, bronchitis,

Question 2

Abnormal sounds lung auscultation lower airways

Answer 2

Wheezing: high pitched sound on expiration due to narrowed segment of lower airway. Asthma, bronchitis, pneumonia, HF, CF, foreign body

Question 3

What are symptoms of respiratory distress

Answer 3

Tachypnea 
Flaring nostrils 
Use of accessory muscles 
Retraction 
Expiratory grunting
Diaphoresis with eating 
Cyanosis if severe

Question 4

CF

Etiology

Answer 4

• Caucasians
• AR recessive CFTR gene found on chromosome 7 resulting in a dysfunctional chloride channel on the apical membrane of cells.
• leads to relative dehydration of airway secretions, resulting in impaired mucociliary transport and airway obstruction.

Question 5

Clinical presentation of CF

Answer 5

Neonatal: meconium ileus,
Prolonged jaundice, antenatal bowel perforation
Infancy: pancreatic insufficiency with steatorrhea and FTT, anemia, hypoproteinemia, hyponatremia
Childhood; heat intolerance, wheezing, chronic cough, recurrent chest infections (s,aureus, p, aerginosa, H.influenza), hemoptysis, nasal polyp, distal intestinal obstruction syndrome, rectal prolapse, clubbing of fingers.
Older: chronic obstructive pulmonary disease, infertility

Question 6

Investigation in CF

Answer 6

Sweat chloride test x 2 (> 60)

Question 7

Treatment of CF

Answer 7

Nutrition: high caloric diet, pancreatic enzyme replacement, fat soluble vitamin supplements
Chest disease: physiotherapy, postural drainage, bronchodilators, aerolized DNAse and inhaled hypertonic saline. AB. Lung transplantation

Question 8

Complications of CF

Answer 8

Resp failure, pneumothorax, cor pulmonale, pancreatic fibrosis with DM, gallstones, cirrhosis with portal hypertension, infertility, early death

Question 9

Asthma definition

Answer 9

Characterized by recurrent episodes of airway hyperreactivity, bronchospasm and inflammation, reversible airway obstruction. Present most often in early childhood. Asthma is associated with other atopic disease such allergic rhinitis or atopic dermatitis

Question 10

Clinical presentation of asthma

Answer 10

Episodic bouts of wheezing, dyspnea, tachypnea, cough (night/ early morning, with activity or cold exposure)
PE: reveal hyper-resonant chest, prolonged expiration, wheeze

Question 11

Triggers of asthma

Answer 11

URTI
Weather (Cold exposure, humidity changes), allergens (pets), irritants (cigarette smoke), exercise, emotional stress, drugs (aspirin, beta-blockers)

Question 12

Classification

Mild

Answer 12

Occasional attacks of wheezing or coughing (

Question 13

Classification

Moderate asthma

Answer 13

More frequent episodes w symptoms persisting and chronic cough, decreases exercise tolerance, sometimes need PO corticosteroids

Question 14

Severe asthma

Answer 14

Daily and nocturnal symptoms

Frequent ER visit and hospitalisation, need PO corticosteroids

Question 15

Treatment asthma

Answer 15

Acute: O2, fluids, b2 agonist: salbutamol (ventoline)
Ipratropium bromide (atrovent)
Steroids: prednisolone or dexamethasone