Pulmonology

Question 1

What are the indications for tracheostomy?

Answer 1

Upper airway narrow (stenosis, webs, atresia)
Tracheo broncho malacia
Weakness
Trauma to head and neck

Question 2

What are the features of OSA?

Answer 2

Snoring, apnea, restless sleep
Complications - excessive daytime sleepiness, learning problems, cardiorespiratory acute events, PHT
Mostly from adenotonsillar hypertrophy
But any cause of hypotonia and stenosis
Rx - overnight oximetry then adenotonsillar excision
Long term overnight ventilation with CPAP or BIPAP

Question 3

What are the causes of bronchiectasis?

Answer 3

CF, primary ciliary dyskinesia, immunodeficiency, chronic aspiration, HIV, TB
Severe pneumonia, FB, congenital lung anomaly

Question 4

What are the features of primary ciliary dyskinesia?

Answer 4

Chronic productive cough, pus nasal discharge, chronic otitis media, Kartagener syndrome
Rx-chest physiotherapy, Abx for infection, ENT referral

Question 5

What are the features of cystic fibrosis?

Answer 5

AR defective CFTR on Chromosome 7
Reduced life expectancy
Multisystem due to channelopathy
In lungs-chronic infection with Pseudomonas
GIT- thick meconium ileus, pancreatic exocrine failure, FTT, growth failure, chronic diarrhoea malabsorption
Neonatal jaundice
lung hyperinflation, coarse crepts, expiratory wheeze, clubbing
Lack of amylase, lipase, protease causes steatorrhea FTT
low elastase in feces
Nasal polyp, rectal prolapse, sterility, sinusitis, DM, CLD
Dx- sweat test to screen, genes to confirm
1/4 chance for next baby

Question 6

What is the management of CF?

Answer 6

Prevent progressive disease
Maintain nutrition and growth
Monitor lung function, daily physiotherapy
Abx prophylaxis with flucloxacillin
IV Abx for 14 days if infection
If Pseudomonas, daily nebulised antipseudomonal
Daily saline nebulisation
Lung transplant
High calorie diet, overnight feeding, pancreatic enzymes

Question 7

What are the causes of persistent cough?

Answer 7

RSV, Mycoplasma, pertussis
TB
Asthma
Bronchiectasis (CF, PCD)
Chronic aspiration (GERD)
FB
TEF, TBM

Question 8

What are the organisms causing RTI?

Answer 8

RSV, influenza, parainfluenza, metapneumovirus, adenovirus, coronavirus, rhinovirus
Strep, Morax, Bordetella, Hib, Mycoplasma, TB

Question 9

What are the risk factors for RTI?

Answer 9

Passive smoking
Poor socioeconomic status
Poor nutrition
Chronic lung disease
CHD
Immunodeficiency

Question 10

What are the types of RTI?

Answer 10

URTI (coryza, pharyngitis, AOM, sinusitis, tonsillitis)
Larungeotracheal
Bronchitis
Bronchiolitis
Pneumonia

Question 11

What are the causes of tonsillitis?

Answer 11

GABHS, EBV IMN (never give amoxicillin for tonsillitis)

Question 12

What are the features of AOM?

Answer 12

Infants and toddlers have a short horizontal eustachian tube
Ear pain with fever - do otoscopy
Viral or bacterial
Can cause meningitis, effusion OM,
Rx- PCM for pain. Amoxicillin if persistent
Abx do not prevent deafness
H2 or decongestants useless

Question 13

What is the commonest cause of conductive hearing loss?

Answer 13

OM with effusion

Insert grommet, adenoidectomy

Question 14

What are the indications for tonsillectomy?

Answer 14

Recurrent tonsillitis
Peritonsillar abscess
OSA
Recurrent AOM

Question 15

What are the causes of upper airway obstruction?

stridor, hoarseness, barking cough, dyspnea

Answer 15

Croup
FB
Epiglottitis
Anaphylaxis
Hypocalcemia
IMN

Question 16

How to manage acute upper airway obstruction?

Answer 16

Dont examine throat
Nebulize adrenaline with oxygen
Call seniors
Intubate

Question 17

What are the features of croup?

Answer 17

Fever and coryza, then upper airway obstruction signs
Paraninfluenza virus, other viruses
6 months to 6 years
Rx - nebulize budesonide (pulmicort)
DDx - bacterial croup, give IV abs staph aureus

Question 18

What are the features of epiglottitis?

Answer 18

Acute onset high fever without coryza
Very painful throat with drooling
No cough, soft stridor
Upright with open mouth for easing work of breathing
Rx - secure airway first, then IV Abx after BCx
Cause is Hib, give prophylaxis with rifampicin to family

Question 19

What are the features of pertussis?

Answer 19

Highly contagious
Week of coryza, then paroxysmal cough and whoop
Tussive vomiting
FBC lymphocytosis
Vaccinate, erythromycin Rx and prophylaxis

Question 20

What are the features of bronchiolitis?

Answer 20

Disease of infants
Caused by RSV and other viruses
Coryza, dry cough, dyspnea, feeding difficulty, apnea
Risk high in CHD, lung anomalies, CF
Sharp dry cough, tachypnea, recessions, hyperinflation
Fine end crackles, biphasic wheeze, tachycardia, cyanosis or pallor
Mx - humidified oxygen, IV fluids, isolation
AVOID Abx, steroids, bronchodilators

Question 21

What are the features of pneumonia?

Answer 21

Young children viral , older children bacterial
Neonate - GBS, GNB
Infants - viruses, Strep, Hib, Bordetella, Chlamydia
Children - Mycoplasma, Strep, Chlamydia
TB for all
Fever, cough, dyspnea, malaise, chest pain, poor feed
Tachypnea, recessions, flaring, hypoxia, crackles
Lobar pneumonia on CXR = Strep
Mx - Oxygen, IV fluids, analgesia, IV Abx/PO Abx
Complications - effusion, empyema, collapse