Resp

Question 1

Management of a PE

haemodynamically unstable

Answer 1

Thrombolysis is now recommended as the first-line treatment for massive PE where there is circulatory failure (e.g. hypotension)

Question 2

VTE management?

Answer 2

DOACs (apixaban or rivaroxaban), instead of LMWH (unless unsuitable).

IF severe renal impairment - LMWH, unfractionated herparin or LMWH followed by a VKA.

Anticoagulate for at least 3 months, continuing after is dependent on whether the VTE was provoked or unprovoked.

Question 3

What is Cor pulmonale?

How to manage it?

Answer 3

Condition resulting from pulmonary hypertension. Effectively is right sided heart failure.

Features: peripheral oedema, raised JVP, parasternal heave, loud P2

Mx: use loop diuretic for oedema, consider long term O2 therapy.

Question 4

Causes of white out on X ray?

How can trachea position help determine cause?

Answer 4

consolidation
pleural effusion
collapse
pneumonectomy
specific lesions e.g. tumours
fluid e.g. pulmonary oedema

Trachea toward the white out - pneumonectomy, complete lung collapse, pulmonary hypoplasia

trachea central - consolidation, pulmonary oedema (usually bilateral), mesothelioma

trachea pushed away from white out - Pleural effusion, diaphragmatic hernia, large thoracic mass

Question 5

Asthma management escalation of meds

Answer 5

Admit
Oxygen
SABA to bronchodilate e.g. salbutamol, terbutaline
- non life threatening: inhaler or o2-driven nebs
- life threatening - nebulised SABA
Corticosteroid
- all pts should be given 40-50mg of pred (to be continued for at least 5 days after attack, along wiht normal corticosteroids)
Ipratropium bromide
- a SAMA given if not responding to above
IV Magnesium sulphate
IV aminophylline (senior led)
ITU

Question 6

What are cannonball metastases and when are they commonly seen?

Answer 6

Multiple round well-defined lung secondaries, commonly seen with renal cell cancer

Also can be secondary to choriocarcinoma and prostate cancer or endometrial cancer

Question 7

What is the difference between primary and secondary pneumothorax

Answer 7

Primary if no underlying lung disease

Secondary if there is an underlying lung disease

Question 8

Mx guidelines for Primary pneumothorax

Answer 8

Rim of air <2cm and no SOB consider discharge

Otherwise - aspirate

If aspiration fails, insert chest drain

Get them to stop smoking

Question 9

Mx guidelines for Secondary pneumothorax

Answer 9

If patient is >50 and rim of air >2cm or patient is SOB - chest drain

Aspiration if rim of air between 1-2cm (if fails, drain)

If pnuemohtorax is <1cm BTS suggests giving oxygen and admitting for 24 hours

Don’t let them scuba dive lol

Question 10

CRB 65 for primary care and CURB 65 for secondary care. what are the parameters?

Answer 10

C = confusion (AMTS <8/10)
(U = Urea > 7mmol/L)
R = RR >30 
B = BP systolic <=90 and/or diastolic <=60
65 = if > - 1 point

Hosp care if 2 or more