resp pass med 2

Question 1

63 y/o male, to A&E with 5 day history of productive cough, SOB.

resp examination reveals RHS dullness to percussion and increased vocal resonance

CXR shows consolidation of right middle lobe

how would you manage patient?

Answer 1

patient with pneumonia?

work out CURB-65 score

if symptomatic and CURB-65 score low then can be discharged with antibiotics as an outpatient.

Question 2

what is the CURB-65 criteria

Answer 2

C- confusion

U - urea (in hospital)

R - RR

B - Blood pressure

65 - aged 65 years and over

Question 3

how are patients stratified for risk of death in the crb-65b score

Answer 3

0 - low risk (1% mortalilty)

1 or 2 - intermediate (1-10%)

3 or 4 - high risk ( >10%)

Question 4

In conjunciton with clinical judgement, what is the NICE reccomendation for crb-65 score in terms of care

Answer 4

1. home based care for patients with score of 0

2. hospital assessment for those with 2 or more

Question 5

60 y/o with SOB, persistent cough, haemoptysis.

reduced air entry and stony dullness on percussion in the left base

which anatomical landmarks need to be identified to treat patients condition?

Answer 5

signs of pleural effusion

chest drain needs to be inserted!

triangle of safety

1. axilla (superior boundary)
2. lateral edge of pec major (medial boundary)
3. 5th ICS (inf boundary)
4. anterior border or latissimus dorsi

Question 6

surface markers for ascitic drain

Answer 6

• umbilicus

- anterior superior iliac spine

Question 7

emergency aspiration anatomical markers

Answer 7

mid clavicle, 2nd ICS

Question 8

57 y/o farmer, six month hx of increasing SOB and productive cough.

noticed unintential weight loos of 5kg in last 6 months, symptoms improve on holiday.

cxr shows upper and midzone fibrosis

likely diagnosis

Answer 8

extrinsic allergic alveolitis
- gradual onset of SOB and cough work on exposure to allergens

treatment: avoidance of triggers

Question 9

75 y/o male, AED with 2 week history of gradually worsening SOB.

SOB worse on lying down, sleeps with 3 pillows.

sometimes wakes up gasping for breath.

what would you see on CXR?

Answer 9

Heart failure.

A - alveolar oedema 
B - kerly B lines (interstitial oedema)
C - cardiomegaly 
D - dilated prominent upper lobe vessels 
E - effusion (pleural)

Question 10

deviated tachea sign of

Answer 10

tension pneumothorax

Question 11

widened mediastinum sign of

Answer 11

aortic dissection or aneurysm

Question 12

boot shaped heart seen in

Answer 12

TOF

Question 13

Kerley B lines indicate

Answer 13

interstitial oedema

Question 14

murmur present in aortic stenosis

Answer 14

ejection systolic murmur

Question 15

what might be heard in idiopathic pulmonary fibrosis

Answer 15

fine end-inspiratory crepitations

progressive exertional dyspnoea

dry cough

clubbing

Question 16

adult with asthma not controlled by SABA - next step?

Answer 16

add low dose ICS

Question 17

painful skin rash and cough. think?

Answer 17

sarcoidosis

granulomatous inflammatory condition

Question 18

acute exacerbation of COPD should be managed how?

pmh COPD, worsening SOB, cough, wheeze , white sputum , widespread expiratory wheeze

Answer 18

oral prednisolone for 5 days

if pt had purluent sputum or other signs of infectious disease then start oral amoxicillin

Question 19

acute resp distress syndrome causes by:

Answer 19

• increased permability of alveolar capillaries

- leading to fluid accumulation in alveoli

Question 20

what would be expected result of pregnant womans ABG and why?

Answer 20

• there is an increase in tidal volume
• this leads to less co2
• reduced co2 results in alkalosis
• kidneys adapt to this by reducing amount of bicarb
• thus compenated resp alkalosis