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Question 1

Tension pneumothorax: signs and symptoms

Answer 1

P-THORAX

Pleuritic pain
Tracheal deviation
Hyperresonance
Onset sudden
Reduced breath sounds (and dyspnea)
Absent fremitus
X-ray shows collapse

Question 2

Asthma management

Answer 2

O SHIT!

Oxygen
Salbutamol nebuliser
Hydrocortisone IV
Ipratropium bromide
Theophylline

Question 3

COPD Assessment Test (CAT)

Answer 3

CAT items: CHEST SEA
To aid memory, think of the chest (or lungs) floating in a sea of yellow sputum, which is commonly seen in COPD.
•	Cough
•	Home-leaving confidence
•	Exercise tolerance (uphill/ 1 flight of stairs)
•	Sputum (phlegm/ mucus)
•	Tightness of chest
•	Sleep
•	Energy level
•	ADL at home

Question 4

Croup symptoms

Answer 4

• 3 S’s:
• Stridor
• Subglottic swelling
• Seal-bark cough

Question 5

Causes of upper zone pulmonary fibrosis

Answer 5

A TEA SHOP
•	ABPA
•	TB
•	Extrinsic allergic alveolitis
•	Ankylosing Spondylitis
•	Sarcoidosis
•	Histiocytosis
•	Occupational (silicosis, berylliosis)
•	Pneumoconiosis (coal-worker’s)

Question 6

Features of a life-threatening asthma attack

Answer 6

A CHEST
• Arrhythmia/Altered conscious level
• Cyanosis, PaCO2 normal
• Hypotension, Hypoxia (PaO2<8kPa, SpO2 <92%)
• Exhaustion
• Silent chest
• Threatening PEF < 33% best or predicted (in those >5yrs old)

Question 7

Pneumonia Complications

Answer 7

SLAP HER

Septicaemia – spread from lung parenchyma, can lead to metastatic infection e.g. endocarditis
Lung abcess – look for swinging fever, foul-smelling sputum, weight loss, haemoptysis, pleuritic chest pain
Atrial fibrilation esp. in elderly, may require beta-blocker
Pericarditis/myocarditis may complicate pneumonia
Hypotension – may be due to dehydration and sepsis-induced vasodilatation
Empyema – if recurrent fever, yellowish pleural effusion aspirated
Respiratory failure – type 1 is common, act if PaCO2 >6kPa

Question 8

Restrictive lung disease causes

Answer 8

SPICE

Space-occupying lesion e.g. tumour, cyst
Pleural disease e.g. effusion, pneumothorax
Interstitial lung disease e.g. fibrosis, oedema
Chest wall disease e.g. kyphosis, neuromuscular disease
Extrathoracic conditions e.g. obesity, ascites, pregnancy

Question 9

hypoxemia causes

Answer 9

LAVISH

Low inspired O2 ( decreased PiO2)
Alveolar hypoventillation
Ventilation/perfusion (V/Q) mismatch
Impaired diffusion
SHunt e.g. pulmonary AV shunt, pneumonia, oedema

Question 10

Life threatening breathing injuries

Answer 10

ATOM FC

Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemorrhage (>1500ml)
Flail chest – abnormal breathing within lung tissue
Cardiac tamponade

Question 11

Fine crackles cause

Answer 11

Fine crackles, the 2 F‘s:

Fibrosis
Failure (cariac)
Coarse crackles may indicate airway pathology e.g. pneumonia/bronchiectasis.

Crackles always occur during inspiration.

Question 12

Sarcoidosis features

Answer 12

SARCOID

Skin – erythema nodosum
Arthritis esp. of feet, hands
Respiratory – bilateral hilar lymphadenopathy, pulmonary infiltrates
Cardiac – heart block, VT, heart failure
Ocular – anterior uveitis, can lead to blindness
Intracranial (brain) – chronic meningitis, seizures, neuropathy
Derangement of liver and renal function – hepatic granuloma (70% patients), hypercalcaemia (can lead to kidney stones and nephrocalcinosis)

Question 13

stridor causes

Answer 13

Stridor is A Very WELSH Condition

Acute epiglotitis (acute stridor)
Vocal cord paralysis (chronic stridor)
Web, laryngeal (chronic)
External compression e.g. vascular ring (chronic)
Laryngomalacia (chronic)
Subglottic stenosis (chronic)
Hypocalcaemia (chronic)
Croup (acute)

Question 14

clubbing–resp causes

Answer 14

Newly Sprouted Fingers

Neoplasia – bronchial carcinoma, mesothelioma
Suppurative lung disease – cystic fibrosis, bronchiectasis, abscess, empyema
Fibrotic lung disease – cryptogenic fibrosing alveolitis, connective tissue disease (e.g. RA, SLE)