Respiratory

Question 1

What condition would show up as a wedge-shape opacity on a CXR?

Answer 1

PE or Lung Infarction
From Vessel Occlusion

Question 2

Who should be immediately admitted to the hospital if a PE is suspected?

Answer 2

Signs of haemodynamic instability - Pallor, tachycardia, hypotension, shock, and collapse).

Pregnant or has given birth within the past 6 weeks.

Question 3

Major Risk Factors for PE?

Answer 3

DVT/ Prev DVT or PE.
Active cancer.
Recent surgery.
Lower limb trauma.
Significant immobility
Pregnancy / 6 weeks’ postpartum.
COCP
HRT
Increasing age >60
Obesity
Long-distance travel

Question 4

What are the clinical features of PE?

Answer 4

SOB
Cough
Haemoptysis
Dizziness
Tachy, pyrexia, Increasing JVP, Hypoxemia,
Pleural rub
Murmurs - Widely split S2, Tricuspid regurg
Gallop rhythm
Hypotension

Question 5

Where is a swallowed FB most likely to go in the lung?

Answer 5

Right Inferior Lobar Bronchus

Question 6

Features of life-threatening asthma?

Answer 6

Peak flow <33 of best-predicted
Silent Chest
Cyanosis
Normal PaCO2 on ABG
Hypoxia on ABG <8 PaO2 or Acidosis

Question 7

Clinical features of severe asthma?

Answer 7

Peak flow 33-50% of best-predicted
RR >25
HR >110bpm
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Question 8

What areas of the body are responsible for breathing?

Answer 8

Pons respiratory centre
Medulla respiratory centre
Pre-botzinger complex

Question 9

Explain steroid-responsiveness when talking about COPD?

Answer 9

A steroid responsiveness is characterised by an increase in the FEV1 by a certain level. This response means that continuing steroid treatments (inhalers, etc…) has a positive response.

Question 10

What is the MRC Grading score used for in COPD +
Explain the different grades?

Answer 10

Describes the degree of breathlessness in a COPD patient.

1 - Not troubled by breathlessness except on vigorous exertion
2 - SOB when hurrying/walking up a hill (inclines)
3 - Walks slower than most people on the level, Stops for a breath when walking at their own pace (15mins)
4 - Stops for a breath after walking about 100m (stops after a few mins walking on the level)
5 -Too breathless to leave the house or breathless while undressing.

Question 11

A. Name 7 Causes for Respiratory Alkolosis

B. What would you expect to see on an ABG?

Answer 11

A - CNS Infection, SAH, Panic Attack, PE, Asprin OD, Anaemia, any cause of hypoxia [Mainly process through hyperventilation]

B - pH (UP), pCO2 (Down), HCO3 (Down if partial comp. or chronic)

Question 12

Obstructive Airway Disease causes?

4 Marks

Answer 12

Asthma
COPD
Bronchiectasis
Cystic Fibrosis

Question 13

Restrictive Airway Disease Causes?

7 Marks

Answer 13

Resp: IPF, ARDS, Pneumoconiosis
Neuro: Myasthenia gravis, MND
Thoracic: Obesity, Kyphosis

Question 14

What do you expect to see on spirometry for?
A - Obstructive disease
B - Restrictive disease

Answer 14

A - FEV1 Lower 0.7, Both FEV1 + FVC decreased proportionally (Both Reduced) - <80% Predicted normal values.

Question 15

Respiratory Failures

A- Types + Pathophysiology
B - ABG Results
C- Primary causes

Answer 15

A - Type 1 - Hypoxia Only, V/Q mismatch leading to volume of air passing in and out of the lungs smaller than blood perfusing the lungs
ABG - PaO2 <8kpa, pCO2 = Normal
Asthma, CCF, PE, Pneumonia, Pneumothorax.
High V/Q areas / Low V/Q Areas

B-Type 2 - Hypercapnia + Hypoxia, Alveolar Hypoventilation leading to being unable to clear enough CO2 out of the lungs leading to build up.
ABG - PaO2 <8kpa + pCO2 >6kpa
Obstructive lung diseases - COPD
Restrictive lung diseases - IFP
Respiratory Depression - Opiate OD
Neuromuscular disease - GBS, MND
Thoracic wall disease/trauma - Rib Fracture

Question 16

Define Pulmonary Hypertension?

Answer 16

Increase in mean pulmonary arterial pressure >15mmhg.

Question 17

Causes of Pulmonary Hypertension?

Hint - 3 Main Domains

Answer 17

Parenchymal lung disease - COPD, Chronic Asthma, Interstitial lung disease, Bronchiectasis, CF

Pulmonary vascular disease - PE, Portal HTN, Idiopathic pulmonary hypertension, Pulmonary vasculitis

Hypoventilation - Sleep apneoa, Kyphosis/scoliosis, MG
Left Heart Disease - Mitral stenosis, regurg, LV HF

Question 18

Main clinical features of Pulmonary HTN + ECG findings?

Answer 18

SOB, Fatigue, Syncope

Signs - ++JVP, Parasternal heave, Loud P2, S3 sound, Pansystolic murmur (tricuspid regurg), end-diastolic murmur (pulmonary regurg)

ECG - P pulmonale, RVH, RAD

Question 19

Management of Pulmonary HTN?

Answer 19

Treat underlying condition
Pulmonary vascular resistance reduction- LTOT, CCB (Nifedipine), Sildenafil, Endothelin receptor antagonists, (Bosentan), Prostacyclin analogues
Manage Heart Failure
Heart-lung transplant in extreme cases

Question 20

Define Bilateral Hilar Lymphadenopathy?

Causes?

Answer 20

Bilateral enlargement of lymph nodes of pulmonary hila

Causes- Sarcoidosis, TB, Bronchial Ca, Lymphoma, Interstitial lung disease (Silicosis), Heart Failure, Mycoplasma

Question 21

What are Contraindications for thrombolysis?

Answer 21

Active bleeding
Head injury within the last 3Weeks
Previous Haemorrhagic stroke
CNS Malignancy

Question 22

Define Obstructive Sleep Apnea (OSA)?

Answer 22

Intermittent closure and collapse of the upper airway leading to apnoeic episodes during sleep.

Question 23

What are the risk factors for OSA?

Answer 23

Obesity
Male
Smoker
Alcohol
IPF
Structural airway pathology - Anatomy (Micrognathia)
Neuromuscular disease - MND, etc…

Question 24

What are the main causes of OSA?

Answer 24

Abnormal anatomy and lack of neuromuscular compensatory mechanisms.

Question 25

Clinical Features and Investigations for OSA?

Answer 25

CF - Snoring, choking, gasping, apnoeic episodes, Morning headache, sleepiness (Somnolence)

IX - Polysomnography, SpO2 Overnight

Question 26

Management of OSA?

Answer 26

CPAP via nasal mask during sleep
Weight loss
Smoking Cessation
Alcohol avoidance
Surgery to relieve pharyngeal obstruction - Tonsillectomy, Uvulopalatopharyngoplasty (Removes excess tissue in the throat to make the airway wider. )

Question 27

Where are the most common origin sites for emboli that cause PE?

Answer 27

DVTs - Proximal Leg Veins / Illac Veins

Question 28

Differentials for Haemoptysis?

Answer 28

Category causes - Vascular, Infective, Immunological, Malignant

PE, Pneumonia, TB, Bronchiectasis, Goodpastures, GPA, Lung Ca, Aspergilloma, Mitral stenosis, LRTI, Pulmonary Oedema

Question 29

Define ARDS?

Answer 29

Acute respiratory distress syndrome

Non-cardiogenic pulmonary oedema and diffuse lung inflammation causing pulmonary vascular permeability and leakage.

Histologically - Diffuse alveolar damage + Hyaline membrane formation

Question 30

What Causes ARDS?

Answer 30

Pulmonary Causes - Chest sepsis, aspiration, inhalation injury, pulmonary contusion, tranfusion-related lung injury
Non-Pulmonary - Non-pulmonary sepsis, acute pancreatitits, DIC, drug od

Question 31

Signs and Symptoms of ARDS?

Answer 31

Dyspnoea
Tachypnoea
Retractions
Bilateral crackles
Hypoxemia - Not responding to supportive O2

Question 32

Investigations ARDS?

Answer 32

ABG
PaO2/FiO2 ratio <300mmhg / <100 (Severe)
Or <40kpa(200)
CXR - Bilateral opacities/infiltrates

Question 33

Management of ARDS?

Answer 33

Mechanical ventilation - 6ml/kg + High PEEP to achieve adequate oxygenation.

DVT prophylaxis
Nutritional support - enteral/parenteral
Regular repositioning - pressure ulcer prophylaxis, proning
Mean art. pressure - >60mmhg
Abx - If infection present