resp

Question 1

classic CF of sarcoidosis?

Answer 1

20-40 year old black female with dry cough and SOB. Nodules on their shins (erythema nodosum).
Recent unintentional weight loss and fever.

Question 2

What is another skin CF of sarcoidosis (not erythema nodosum) ?

Answer 2

Lupus pernio (raised, purple skin lesions commonly on nose and cheeks)

Question 3

What are the CFs that make up the Lofgren’s triad?

Answer 3

erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia

Question 4

What is often used as a screening test for sarcoidosis?

Answer 4

ACE levels

Question 5

What electrolyte imbalance commonly occurs in sarcoidosis?

Answer 5

Hypercalcaemia

Question 6

What is the first imaging you would do if suspecting sarcoidosis?

Answer 6

CXR

STaging 
0 = normal 
1 = BHL 
2 = BHL + interstitial infiltrates 
3 = diffuse interstitials infiltrates
4 = diffuse fibrosis

Question 7

What is the gold standard Dx for sarcoidosis ?

Answer 7

biopsy - non- caseating granulomas with epithelioid cells

Question 8

Tx for sarcoidosis?

Answer 8

asymptomatic / mild Sx = no Tx required
Symptomatic + stage 2+ on CXR = long term steroids (6 months min)
Bisphosphonates whilst on long term steroids

Question 9

where should I insert a chest drain?

Answer 9

Triangle of safety

• 5th intercostal space (superior to the nipple)
• Anterior edge of latissimus dorsi (mid axillary line)
• Lateral edge of pectoris major (anterior axillary line)

Just above the rib to avoid the neurovascular bundle

Question 10

A suspicious mass is found on CXR in a pt with 2 month Hx of unintentional weight loss. What is the most appropriate next step?

Answer 10

contrast CT

Bronchoscopy and biopsy can be done for histological Dx

PET scan in NSCLC to establish eligibility for curative Tx

Question 11

What are the features of a moderate asthma attack?

Answer 11

• PEFR 50-75% best or predicted
• normal speech
• RR <25 / min
• Pulse <110 bpm

Question 12

What are the CF of a severe asthma attack?

Answer 12

PEFR 33-50% best or predicted
can’t complete sentences
RR >25/min
P >110 bpm

Question 13

What are the features of a life-threatening asthma attack?

Answer 13

PEFR < 33% best or predicted
Oxygen sats < 92%
'Normal' pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

Question 14

What makes an asthma attack near fatal?

Answer 14

raised pCO2 and/or needed mechanical ventilation