Resp Vivas

Question 1

pulmonary fibrosis o/e

Answer 1

oxygen
dry  cough
tachypnoea
reduced expansion
fine end insp creps

Question 2

pulmonary fibrosis signs of cause

Answer 2

hand deformity (if RA)
clubbing (if idiopathic PF)
sclerodactyly/telengiectasia/microstomia (systemic sclerosis)
butterfly rash (SLE)
kyphosis (ank spond)
lots of drugs cause too 

complications - cushingoid + bruising (steroid use), RVH (pulmHTN)

Question 3

COPD o/e

Answer 3

inhalers/nebs
accessory muscles used
tar stained
tachypnoeic
lip pursing
reduced cricosternal distance <3cm
tracheal tug
indrawing of IC muscles
hyperresonance (lost cardiac and hep dullness)
quiet breath sounds
wheeze
prolonged expiratory phase

Question 4

pneumonectomy o/e

Answer 4

unilateral chest flattening
thoracotomy scar
tracheal deviation towards
reduced expansion
dull percussion
reduced breath sounds
bronchial breathing upper zones

Question 5

lobectomy o/e

Answer 5

thoractomy scar
possibly no other signs as other lobes can expand
possibly some reduced expansion, some dullness, some reduced a/entry

Question 6

pleural effusion o/e

Answer 6

reduced expansion
stony dull percussion
reduced breath sounds
reduced vocal resonance

Question 7

signs of cause of pleural effusion o/e

Answer 7

hands deformed (RA)
clubbing (lung ca)
butterfly rash (SLE)
chronic liver disease signs 
heart failure signs

Question 8

bronchiectasis o/e

Answer 8

productive cough
insp clicks
clubbing
coarse, late expiratory creps

Question 9

signs of causes of bronchiectasis

Answer 9

young+thin = CF
rasied LNs - malignancy
dextrocardia - Kartagener’s

curved yellow nails + lymphoedema = yellow nail syndrome

Question 10

signs of lung cancer o/e

Answer 10

cachexia
clubbing
tar stained fingers
hard irregular raised LNs
radiation marks / tattoo

Question 11

signs of lung ca complications

Answer 11

pain and swelling of wrists = hypertophic pulmonary arthropathy

ptosis/miosis/anhydrosis = HOrner’s

Question 12

lung transplant o/e

Answer 12

mid sternotomy or bilat thoractomy scar

may have signs of COPD, clubbing etc (indication)

Question 13

copd again

Answer 13

signs (flap, bounding pulse, hyper-expanded/res, exp wheeze), CP, CXR may show pneumothorax, ABG – T2RF FBC – low alb if severe spiro – low FEV1, ratio FEV/FVC <0.7 GOLD classification. Cons – stop smoking, physio Med – salbutamol +/- tiotropium +/- ICS, vaccs, carbocisteine mucolytic. LTOT if palliative + non smoker + <7 O2. Can consider lung transplant.

Question 14

classify COPD severity

Answer 14

– mild FEV 80%+, mod 50-80, sev 30-50, v bad <30%. CXR – hyperinflated 8+ ant ribs seen,flat hemidiaphragm, dec lung markings, bullae. 1. SABA or SAMA 2. Add LABA or LAMA 3. Add ICS 4. LABA, LAMA, ICS.

Question 15

ICS + LABA inhalers

Answer 15

– Seretide, Symbicort, Fostair

Question 16

pulmonary fibrosis full summary

Answer 16

lung scarring, progressive hypoxia. Upper zone – coal, ank spond, radiation, TB, EAA Lower zone – more common – conn tissue, asbestos, idiopathic PF, drugs (amiodarone, methotrexate, sulphasalazine). Chronic worsening SOB with dry cough. Reduced expansion, fine creps. Clubbing if idiopathic. Inv – CXR, CT, bloods for cause, PFTs, lung biopsy. Reticulonodular shadowing. HRCT – honeycombing, ground glass. Restrictive spirometry. Steroids, antifibrotics, rehab, stop smoking, LTOT

Question 17

pneumonectomy

Answer 17

– trachea displaced towards removal site, reduced expansion, dull percussion, absent breath sounds CXR organ displacement into cavity.

Question 18

lobectomy

Answer 18

may have no signs, could have signs above. Indications for both incl: lung ca, local bronchiectasis, aspergilloma, large bullectomy. FEV good for op.

Question 19

lung lesion workup

Answer 19

• CT CAP + PET scan, biopsy of lung, PFTs

Question 20

thoracic scars

Answer 20

median sternotomy (open heart surgery – CABG, valve), pacemaker scar (ICD or pacemaker), posterolateral thoracotomy (pneumonecto or lobectomy, oesophageal surg), mini thoracotomy (MVR), axillary (Pthroax), anterolateral thoracotomy (open chest massage)

Question 21

causes of bronchiectasis

Answer 21

genetic CF, syndromes, A1AT def mech malignancy, FB childhood pertussis, measles, TB, pneumonia immune HIV, leukaemia, allergic

Question 22

signs of bronchiectasis

Answer 22

Signs = chronic productive cough, haemoptysis, recurrent inf, clubbing, insp clicks, coarse insp creps, ronchi (gurgling wheeze).

Question 23

imaging signs bronchiectasis

Answer 23

CXR tramlines, ring shadows. HRCT – signet ring sign bronchial wall thickening.

Question 24

investigating bronchiectasis and managing

Answer 24

. Screen cause – Ig, aspergillus IgE, CF sweat test/genetics, HIV, rheum Igs, A1AT, sputum culture
Manage – chest physio, prophylaxis if recurrent inf, trial bronchodil/neb hypertonic saline, vaccines, lung resection if localised disease with poor response.