Resp

Question 1

A failure of ventilation is type…

Answer 1

type 2 respiratory failure

Question 2

What symptoms are associated with hypercapnia

Answer 2

Confusion
Decrease GCS
Asterixis (CO2 flap)
Bounding pulse

Question 3

What is another name for CO2 flap?

Answer 3

Asterixis

Question 4

What are the key history points in a clinical asthma diagnosis? (5)

Answer 4

Recurrent episodes
Variation (worse at extremes of day)
Atopy
FHx
Smoking status

Question 5

What are the clinical signs of life-threatening asthma? (7)

Answer 5

Altered conscious level
Exhaustion 
Arrhythmia
Hypotension 
Cyanosis
Silent chest 
Poor respiratory effort

Question 6

What escalation should be added to Rx of asthma patients who have not had a good initial response to inhaled bronchodilator therapy

Answer 6

Single dose of IV magnesium sulphate

Question 7

What are the initial management steps for acute asthma ?

Answer 7

5mg nebulised salbutamol

0.5mg nebulised ipratropium bromide

100mg IV hydrocortisone OR 40-50mg oral prednisolone

Question 8

What are the three pathological stages of ARDS?

Answer 8

Exudative
Proliferative
Fibrotic

Question 9

How might you distinguish ARDS from heart failure?

Answer 9

BNP <100 pg/mL

Also ECHO?

Question 10

What is the difference between transudate and exudate?

Answer 10

Transudate: protein < 30 g/dl (heart failure)

Exudate : protein > 30 g/dl (bacteria/cancer)

Question 11

What is the most likely causative organism for infective exacerbation of COPD ?

Answer 11

Haemophilus influenzae

Question 12

What is the most likely organism community acquired pneumonia?

Answer 12

Pneumococcus

Question 13

What do you treat Streptococcus pneumoniae with ?

Answer 13

Gram +ve cocci. Benzyl penicillin

Question 14

What do you treat haemophilus influenzae with ?

Answer 14

Amoxicillin

Question 15

FEV1/FVC ratio >70% = restrictive or obstructive pattern?

Answer 15

Restrictive

Question 16

Give 4 DDx of restrictive lung disease

Answer 16

Idiopathic pulmonary fibrosis
Connective tissue disease
Drugs e.g. methotrexate
Asbestosis

Question 17

What type of lung cancer might secrete ACTH?

Answer 17

Small cell lung carcinoma -
History= smoker’s cough and reduced breath sounds over a certain area of the lung. Muscle weakness, hypokalaemia and hyperglycaemia. Blurred vision.

ACTH secretion = paraneoplastic syndrome ie. Cushing’s syndrome. . Patient’s with Cushing’s syndrome due to lung malignancy often don’t present with typical morphological changes you would otherwise expect (e.g. buffalo hump etc.). Her muscle weakness can be explained by hypokalaemia and her blurred vision by hyperglycaemia (both typical symptoms).

Question 18

What are the CXR findings in heart failure ?

Answer 18

ABCDE: 
Alveolar oedema, 
Kerley B lines, 
Cardiomegaly, 
upper lobe Diversion
pleural Effusion