Respiratory

Question 1

COPD symptoms and ix findings

Answer 1

Chronic productive cough 
Hyperinflated barrel chest 
JVP 
Central cyanosis
Weight loss
Pursed lip breathing 
SOBOE
 Cor pulmonale 
FEV1:FVC < 0.7 is OBSTRUCTION 
Cxr: Hyperinflation and increased pulmonary vasculature

Question 2

Causes of COPD

Answer 2

Smoking
Air pollution 
Low birthweight and socioeconomic class 
Dust exposure 
Alpha1 antitripsyn

Question 3

Triggers for flare if COPD

Answer 3

Bacterial and viral infection

Smoking

Question 4

Pathophysiology of COPD

Answer 4

Trigger- inflammatory response 
narrow airways 
Increased goblet cells 
Mucous production increases 
Blood vessels change 
Leads to-  damanged elastin, broken alveolar, increased obstruction due to mucus and goblet cells and ciliary dysfunction

Question 5

Exacerbation of COPD SX

Answer 5

Increases SOB
Increased cough and sputum
Chest tightness
Acute confusion

Question 6

Ddx for copd

Answer 6

Heart failure 
Asthma
Bronchiectasis 
Cancer 
ILD

Question 7

Mantoux testing

Answer 7

screening tool for patients w/o BCG vaxx
skin rx >15mm in diameter ==> ACTIVE TB
skin rx 6-15mm in diametter ==> refer for cxr

Question 8

Latent TB

Answer 8

positive mantoux + normal cxr + no clinical findings

tx; 6 months of isoniazid + pyridoxine OR 3 months or isoniazid + rifampicin

Question 9

BCG vaxx

Answer 9

given to Mantoux neg patients

• not received vaxx yet
• 35yr and younger
• 36yr and older and healthcare/lab worker

Question 10

Types of TB

Answer 10

primary : no immunity to tb
post primary : bacterial spread by blood + reactivation of primary tb
miliary: widespread infection via blood steam

Question 11

RF of TB

Answer 11

low income 
homeless
alcohol
HIV + 
immigrants from areas with high tb 
DM 
vit D defiency

Question 12

Causes of TB

Answer 12

BACTERIA: mycobaterium tuberculosis

Question 13

Pathophysiology of PRIMARY TB

Answer 13

GHON complex: a single tubercli in macrophage focus found in the middle/lower zones of lungs
some bacilli travel via the lymphatics to the drainage lymph nodes which undergo caseation
GHON complex and lymph nodes calcify
specific immunity develosp ==> MANTOUX positive

Question 14

Pathophysiology of Post-primary TB

Answer 14

found in LUNGS, BONES, LYMPH NODES

reactivation due reduced host immunity

Question 15

Pathophysiology and sx of Miliary TB

Answer 15

Bacilli travel via blood stream and affect whole body

Usual symptoms + hepatosplenomegaly + choiroidal tubercules

Question 16

Symptoms of TB

Answer 16

persistent cough 
blood in sputum 
pneumonia
weight loss
night sweats
lymphadenopathy 
meningitis
cold abscess

Question 17

Sx of TB in CHILDREN

Answer 17

non-specific : fatigue, poor weight gained, persistent fever

Question 18

DX of TB

Answer 18

CXR: bilateral patchy shadow in upper zones, volume loss, cavitation, fibrosis
3 respiratory samples:
1. AAFB using Ziel neelson/ auramain stain and smear
2. lowenstein jensen medium culture for 6 weeks
3. PCR for tuberculosis DNA
bronchoscopy and lavage
X-rays/US/ECHO/CT/
Aspiration: pleural effusion/
Biopsy: LN/liver

Question 19

Screening of TB

Answer 19

contact with active laryngeal/pulmonary TB
immunocompromised
NHS employees
New entrance to UK from high risk countries
Ptx starting on ant-tumour necrosis -alpha
TESTS: mantoux, IGFR assay

Question 20

Mx of TB -

Answer 20

RIPE 
Rifampicin x 6
Isoniazid x 6
Pyrazinamide  x2 
Ethambutol x 2
second line agents: ethionamde, propionamde, streptomucine, cycloserine 
DOT if poor compliance