Respiratory

Question 1

Moderate Asthma

Answer 1

PEF 50-75% of predicted

No features of severe asthma

Question 2

Severe Asthma

Answer 2

Any one of:

PEF 33-50%
RR > 25
HR > 110
Unable to complete sentences

Question 3

Life Threatening Asthma

Answer 3

Any one of:

PEF < 33%
SpO2 < 92%
PO2 < 8kPa
Normal PCO2 (4.6 - 6)
Silent chest
Cyanosis
Reduced GCS
Exhaustion from breathing 
Hypotensive

Question 4

Emergency asthma treatment

Answer 4

Salbutamol nebs 
Ipratropium nebs 
Steroids 
Oxygen 
IV Mg Sulphate 
ITU referral

Question 5

Antibody in allergic asthma

Answer 5

IgE

Question 6

Asthma treatment (non-acute)

Answer 6

ICS + SABA
+ LABA
+ Higher dose ICS
+ Oral steroids

Question 7

Acute pulmonary oedema symptoms

Answer 7

SOB
Dyspnoea 
Orthopnoea 
Tachycardia
Gallop rhythm
Bilateral basal crackles 
Haemoptysis

Question 8

Valve defects associated with pulmonary oedema

Answer 8

Mitral Regurgitation

Aortic Regurgitation

Question 9

Causes of acute pulmonary oedema

Answer 9

Decompensated HF 
Hypertensive crisis 
PE
Negative pressure 
Acute lung injury 
ARDS

Question 10

ARDS symptoms

Answer 10

Hypoxaemia
Dyspnoea
Respiratory failure

Question 11

Bronchiectasis on auscultation

Answer 11

Course crackles
High pitched squeak
Rhonchi
Wheeze

Question 12

Differentiating between COPD and Bronchiectasis

Answer 12

High resolution CT will show structural changes in bronchiectasis
Doesn’t have to be associated with smoking or asthma

Question 13

Complications of bronchiectasis

Answer 13

Massive haemoptysis 
Pleural effusion
Pneumothorax 
Empyema 
Right sided HF

Question 14

Diagnosing bronchiectasis

Answer 14

High res CT
Sputum cultures
Alpha-1-antitrypsin

Question 15

Complications of COPD

Answer 15

Cor Pulmonale - RHF
Pneumothorax
ARF

Question 16

CXR features of COPD

Answer 16

Hyperinflation of lungs
Flattened diaphragm
Cardiomegaly
Pulmonary blebs or bullae

Question 17

Causes of transudative pleural effusion

Answer 17

CHF
Portal hypertension
Nephrotic syndrome
Hypoalbuminaemia

Question 18

Causes of exudative pleural effusion

Answer 18

Malignancy
Infection
Pulmonary embolus

Question 19

Clinical features of effusion

Answer 19

Breathless
Pleuritic chest pain 
Dull percussion 
Decreased chest wall movement 
Diminished breath sounds 
Quiet vocal fremitus
Tracheal deviation away from affected side

Question 20

Diagnosing empyema

Answer 20

Blood Cultures

Culture of pleuritic fluid via thorancentesis

Question 21

Treating empyema

Answer 21

Chest drain
Empirical antibiotics
Fluid resuscitation if required

Question 22

Diagnosing pleural effusion

Answer 22

CXR
US
Thoracic CT
Pleural tap if cause not obvious

Question 23

Pleural fluid protein levels in transudate

Answer 23

< 30 g/L

Question 24

Pleural fluid protein levels in exudate

Answer 24

> 30 g/L

Question 25

Types of lung cancer

Answer 25

Small cell (epithelial cell) NSC Squamous cell NSC Adenocarcinoma Less common: Large cell, Carcionoid, Bronchialveolar

Question 26

Complications of lung cancer

Answer 26

Superior Vena Cava Syndrome - facial swelling, upper arm oedema, breathlessness, vein distortion etc. Post-obstructive pneumonia Cerebellar degeneration Hypercalcaemia

Question 27

Common mets sites for lung cancer

Answer 27

Brain Bone Liver Adrenal glands

Question 28

Common pathogens in CAP

Answer 28

Streptococcus Pneumonia Haemophilus Influenzae Post-viral Staphylococcus Aureus/MRSA Less common: Mycoplasma Legionella Chlamydia

Question 29

Common pathogens in HAP

Answer 29

``` Enterobacteria Pseudomonas Strep Pneumonia Haemophilus Influenzae Staphylococcus Aureus/MRSA ```

Question 30

Common cause of lobar pneumonia

Answer 30

Klebsiella

Question 31

Treatment of pneumonia in hospital

Answer 31

``` Antibiotics O2 Fluids Vasopressors if hypotensive Analgesia Chest physio ```

Question 32

Septic shock

Answer 32

Sepsis (end organ dysfunction) + Raised lactate + Refractory hypotension requiring vasopressin

Question 33

Main cause of mesothelioma

Answer 33

Asbestos

Question 34

Clinical signs of restrictive lung disease

Answer 34

Reduced FEV1 and FVC leading to a normal FEV1/FVC ratio T2RF or compensated RF on ABG Honeycombing on CT Biopsy

Question 35

Pulmonary causes of restricted lung function

Answer 35

``` Obstructive lung pathologies Fibrosis Occupational exposure to pathogens Allergic response TB Lung surgery ```

Question 36

Non-pulmonary causes of restricted lung function

Answer 36

Kyphoscoliosis Obesity Pregnancy Neuromuscular disease

Question 37

Causes of focal PF

Answer 37

Occupational hazards

Question 38

Causes of interstitial PF

Answer 38

Allergic response

Question 39

Replacement PF

Answer 39

Autoimmune conditions such as RA and connective tissue disorders TB

Question 40

CXR findings for TB

Answer 40

Nodular opacities in upper lobes Cavitations Hilar adenopathy

Question 41

Best test for detecting mycobacterium tuberculosis

Answer 41

Acid Fast Bacilli smear from early morning sputum samples

Question 42

Locations of non-pulmonary TB

Answer 42

``` Kidneys Larynx Pleura Meninges Spine Pericardium Adrenal glands Peritoneum ```