Respi

Question 1

Diagnostic features of asthma in children

Answer 1

• Frequent wheezing
• Provoked cough
• Intercurrent symptoms eg nocturnal cough
• persistent symptoms >3 yo

Question 2

Diagnostic criteria for asthma in adults

Answer 2

wheeze, SOB, chest tightness, cough

symptoms vary over time + in intensity

symptoms worse at extreme times e.g. late night, early morning ; viral RTI

symptoms triggered by allergens, exercise, cold air

Question 3

investigation workup for asthma

Answer 3

Pulmonary function tests
- spirometry
- bronchial provocation test
- peak expiratory flow
- fractional concentration of exhaled NO

Biochemical
- FBC -> note eosinophil count
- Serum total IgE
- Allergen testing
- U/E/Cr

Imaging
- CXR

Question 4

Investigation workup for COPD

Answer 4

Pulmonary function test
- Spirometry -> post bronchodilator FEV1/FVC < 0.70
- DLCO - for emphysema

Biochemical
- FBC: note Hb (anemia), TW (infection), RBC (polycythemia)
- UECr
- ABG: note pH imbalance
- Septic workup: sputum culture, gram stain, urine

Imaging
- CXR
- 12 lead ECG: note RVH, RA enlargement, RH strain
- 2D echocardiogram

Question 5

Causes of COPD

Answer 5

Exogenous
- Tobacco use
- Air pollution

Endogenous
- Lung growth
- a1-antitrypsin deficiency
- airway hyperresponsiveness
- antibody deficiency syndrome
- primary ciliary dyskinesia

Question 6

Physical signs of acute airway obstruction / respiratory distress

Answer 6

• use of accessory muscles: SCM, scalene anterior, posterior
• chest wall retractions
• rapid, shallow breathing
• tachypnea

Question 8

causes of bronchiectasis

Answer 8

localised
- intraluminal: foreign body, broncholith

• mural: neoplasm (endobronchial lung CA, bronchial carcinoid), bronchial stenosis (bronchial atresia, post-TB, sarcoidosis, irradiation, past bronchial injury)
• extraluminal: enlarged lymph node, displaced airway post lobectomy

generalised
- congenital: cystic fibrosis, alpha-1 antitrypsin deficiency

• acquired: idiopathic, post-infection, autoimmune

Question 9

differentials for coarse crepitations

Answer 9

bronchiectasis, pneumonia, pulmonary oedema, COPD,

Question 10

differentials for fine crepitations

Answer 10

pleural effusion, ILD, atypical pneumonia, atelectasis, bronchiolitis