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1
Q

What happens in the airway in asthma?

A

Release of inflammatory mediators (Th2 reaction), influx of basophils, mast cells, eosinophils:

  • bronchial smooth muscle contraction
  • increased mucus production
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2
Q

What time of day are asthma symptoms generally worse?

A
  • Morning (PEFR will be reduced)
  • Nocturnal cough
  • After interaction with trigger/exercise.
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3
Q

What type of wheeze can be heard in asthmatics?

A

Audible, widespread, polyphonic wheeze

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4
Q

When is percussion of the chest hyper resonant?

A

Pneumothorax
Emphysema
Asthma
COPD

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5
Q

When is percussion of the chest dull?

A

Consolidation
Fluid
Collapse
Tumour

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6
Q

When is percussion of the chest stony dull?

A

Pleural effusion

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7
Q

What is being unable to speak in full sentences
pulse of greater than 110
RR greater than 25 defined as in asthma?

A

Severe asthma

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8
Q

What are signs of a life threatening asthma attack

A 
Silent chest
Confusion 
Exhaustion 
Cyanosis 
Bradycardia 
PEF<33% expected
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9
Q

What is the progression of asthma medication?

A
  1. Occasional salbutamol (short acting beta 2 agonist)
    • inhaled steroid: beclometasone
    • long acting beta 2 agonist: salmeterol
  4. Trial: increasing beclometasone, theophylline, leukotriene receptor agonist
  5. Once daily dose of oral prednisolone
    REFER
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10
Q

What is the definition of chronic bronchitis?

A

Chronic cough & sputum production on most days for 3 months for two consecutive years.

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11
Q

What is the definition of emphysema?

A

Enlarged airspace with alveolar wall destruction

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12
Q

What is the spirometry definition of COPD?

A

FEV1<80% predicted
FEV1/FVC <0.7
Little/no reversibility

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13
Q

What will the oxygen and co2 look like on an ABG in

a) type 1 resp failure
b) type 2 resp failure?

A

1) O2 low, CO2 normal

2) O2 low, CO2 high

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14
Q

What will lung function tests show in COPD?

A

Obstructive & air trapping

  • increased total lung capacity
  • increased residual volume
  • decreased DLCO
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15
Q

How can bronchial carcinoma present?

A 
Cough (+/- blood)
SOB 
Chest pain 
Recurrent infections 
Lethargy, weight loss 
Anaemia
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16
Q

What can be present on a CXR when there is a bronchial carcinoma?

A
  • Consolidation
  • Collapse
  • Effusion
  • Enlarged hilar
  • Bone mets
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17
Q

Where do mets from bronchial carcinoma tend to spread?

A
  1. Brain
  2. Bone
  3. Liver
  4. Adrenal
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18
Q

What lung cancer secretes ACTH?

A

Small cell

19
Q

What lung cancer secretes PTH?

20
Q

What is the CURB65 score?

A 
Confusion - <8 on AMTS
Urea - >7mmol/L
Respiratory Rate - >30
BP <90, <60
over 65
0-1 = home 
2 = hospital
3+ = ?ITU
21
Q

What is classed as a hospital acquired pneumonia?

A

If it presents 48 hours after admission

22
Q

What condition presents with decreased chest expansion, dull percussion, increased tactile vocal resonance & bronchial breathing?

23
Q

Generally what is the management of pneumonia?

A

IV clarithromycin and co-amoxiclave

24
Q

What treatment is given for aspiration pneumonia?

A

Cephalosporin and metronidazole

25
Which has more protein, transudate or exudate?
Exudate
26
What type of pleural effusion is caused by infection, inflammation, cancer, pneumonia, TB, RA & PE as a result of leaky capillaries?
Exudative
27
What type of pleural effusion is caused by an increase in venous pressure (heart failure), hypoproteinaemia (cirrhosis) & hypothyroidism?
Transudative
28
What happens to the tactile vocal fremitus in pleural effusion?
Decreases (fluid harder for sound to travel through)
29
Differential diagnosis of: Reduced chest expansion and breath sounds on right side. Stony dull to percuss, with decreased tactile vocal fremitus. Some bronchial breathing heard.
Pleural effusion on RHS.
30
What are features of a pleural effusion chest x ray?
Small blunt costophrenic angles. | Water dense shadow with meniscus.
31
Where can a diagnostic aspirate be taken from in a pleural effusion?
Percuss upper border | go 1 - 2 intercostal spaces below where stony dull starts.
32
Management of pleural effusion?
Drain: needle in 5th intercostal space, anterior to mid axillary line
33
What is a subpleural bulla rupture?
A pneumothorax, commonly occurring in young, thin males
34
Differential diagnosis of reduced chest expansion and breath sounds on the right, hyperresonant percussion, decreased tactile vocal fremitus.
Pneumothorax
35
Definition of a tension pneumothorax.
Air is drawn into the pleural space on inspiration and cannot leave on expiration.
36
What is the serious complication of a tension pneumothorax?
Compression of the great veins resulting in cardiac arrest
37
What direction will the trachea move in a) pneumothorax b) pleural effusion c) collapse d) consolidation
a) away b) away c) towards d) towards
38
When would you hear fine end inspiratory crepitations?
Pulmonary fibrosis
39
What are the symptoms and signs of pulmonary fibrosis?
- symptoms: dry cough - SOB on exertion - Malaise - Weight loss - Cyanosis - Clubbing
40
What drug is it important to avoid in pulmonary fibrosis?
Steroids
41
What will spirometry show in pulmonary fibrosis?
``` Low FVC (<80% predicted) Low FEV1 (<80% predicted) Normal FEV1/FVC ```
42
What is FEV1?
The volume of air the patient is able to exhale in the first second of a forced expiration.
43
What is FVC?
The total volume of air the patient can forcibly exhale in one breath.

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