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Question 1

What some complications of lung ca?

Answer 1

Question 2

What are some causes of lung fibrosis?

Answer 2

Question 3

Simple ix for fibrosis?

Answer 3

Question 4

More complex ix for fibrosis?

Answer 4

Question 5

Difference between coarse and fine crackles?

Answer 5

Coarse = Bubble popping sound - changes with cough (deeper) - found in bronchiectasis, wet cough and may have sputum bottle next to bed

Fine = Velcro pulled apart sound (higher) - found in fibrosis, dry cough

Question 6

What is bronchiectasis?

Answer 6

Chronic dilated airways secondary to prolonged inflammation which become filled with mucus

Question 7

What is Kartageners Syndrome?

Answer 7

This is a congenital cause of bronchiectasis + situs invertus

Question 8

What are some causes of bronchiectasis?

Answer 8

Question 9

Differential for Bronchiectasis?

Answer 9

Could also be fibrosis - however this would present with a dry cough and fine end-inspiratory crackles

Question 10

What are the causes of clubbing - resp, cardio and abdo?

Answer 10

Question 11

Ix of Bronchiectasis?

Answer 11

Bedside:
- Basic obs
- Sputum MCS - screen for infection and colonisation eg H influenza and P aeruginosa

Bloods:
- FBC and CRP - evidence of infection
- ABC - resp failure

Imaging:
- CXR - tramlines and ring shadows
- CT thorax - signet ring sign

Special tests:
- Spirometry - obstructive pattern
- Screen for underlying condition eg RF, immunoglobulins and sweat test for CF

Question 12

Describe the obstructive and restrictive spirometry findings?

Answer 12

Question 13

What does this show?

Answer 13

Signet ring sign as seen in bronchiectasis -> several dialted bronchioles present through lungs

Question 14

Mx of Bronchiectasis?

Answer 14

Question 15

Differentials for COPD?

Answer 15

Question 16

Ix for COPD?

Answer 16

Bedside:
- Basic obs
- Sputum MCS - screen for infection and colonisation eg H influenza and S pneumonia
- ECG - signs of RHF (RBBB and RAD)

Bloods:
- FBC and CRP - evidence of infection
- ABC - type 2 resp failure
- a-1 antitrypsin (protease inhibitor without these protease breaks down the lung tissue)

Imaging:
- CXR - looking for hyperexpansion and signs of infection
- Echo could be needed to check for signs of HF

Special tests:
- Spirometry for obstructive pattern

Question 17

What are the indications of LTOT?

Answer 17

Pulmonary HTN + pO2 <8

pO2 <7.3

Cyanosis, Raised JVP and SpO2 <92% means you should assess the pt for need of LTOT

Question 18

Mx of COPD?

Answer 18

Question 18

Mx of COPD?

Answer 18

Question 19

What techniques were used in the past for TB treatment and what was the rationale behind them?

Answer 19

It was believed that lower PaO2 levels would inhibit TB proliferation

Therefore, techniques used to induce apical collapse were used
a. Apical lobectomy
b. Thoracoplasty (= rib removal to collapse lung)
c. Phrenic nerve crush (= hemi-diaphragm paralysis)
d. Plombage (= insertion of polystyrene balls into thoracic cavity)

Question 20

How can TB be classified?

Answer 20

● Drug-resistant TB
- Resistant to one of the anti-TB therapies

● Multi-drug resistant TB
- Resistant to atleast R&I

● Extremely drug resistant TB
- Resistant to R&I & fluoroquinolone + atleast 1 other agent

Question 21

Ix for pleural effusion

Answer 21