Respiratory

Question 1

What are the signs and symptoms of Asthma?

Answer 1

Symptoms - Wheeze, dyspnoea, chest tightness, diurnal variation, cough.
Signs - Tachypnoea, tachycardia (>110 = severe attack), hyperinflated chest, hyper resonant and wheeze.

Question 2

Describe the management of an acute asthma attack

Answer 2

1. Ensure patient has patent airway with O2 sats >94%.
2. Nebulisers - Salbutamol or ipratropium
3. Steroids; oral prednisolone or IV hydrocortisone

Question 3

What is the management of chronic asthma?

Answer 3

1. Short acting beta agonist,
2. Low dose inhaled steroid,
3. Long acting beta agonist

Question 4

What is bronchiectasis?

Answer 4

Permanent dilation of the bronchi/bronchioles due to chronic inflammation

Question 5

What are the subsets of COPD and the symptoms?

Answer 5

• Bronchitis or emphysema.
  Symptoms - Productive cough, wheeze, dyspnoea, reduced exercise tolerance.
  Signs - Accessory muscles for breathing, tachypnoea, hyperinflation, reduced cricosternal angle, wheeze, cyanosis, cor pulmonale

Question 6

What are the investigations and management for COPD?

Answer 6

Spirometry, 
Bloods,
ECG,
Chest X ray
Management - Short acting beta agonist/muscarinic antagonist

Question 7

What is cystic fibrosis?

Answer 7

Autosomal recessive condition which causes abnormal chloride secretion and increased sodium absorption in epithelial cells, resulting in thicker mucus which impairs cilia function.

Question 8

What are the differentials for haemoptysis?

Answer 8

• PE,
• Pneumonia,
• TB
• Bronchiectasis,
• Lung cancer,
• Goodpastures syndrome

Question 9

What are the signs and symptoms of pleural effusions, and the management?

Answer 9

Signs - Trachea deviated away, reduced chest expansion, dull percussion, decreased/absent breath sounds
Symptoms - Dyspnoea, chest pain, reduced exercise tolerance.
Management - Plural aspiration or intercostal drain

Question 10

What are the signs and symptoms of pneumonia?

Answer 10

Most common cause - streptococcus pneumoniae.
Signs - Tachypnoea, tachycardia, hypertension, cyanosis, pyrexia, dull percussion, increased vocal resonance, bronchial breathing, plural rub.
Symptoms - fever, malaise, rigors, cough, purulent sputum, pleuritic chest pain and haemoptysis.

Question 11

What are the investigations for pneumonia?

Answer 11

ABG, bloods, blood culture, sputum for microscopy and culture, PCR, urine antigen and chest X ray (patchy airspace opacification)

Question 12

What are the symptoms of a pulmonary embolism?

Answer 12

Symptoms - Sudden SOB, pleuritic chest pain, haemoptysis, syncope/shock.
Signs - tachypnoea, tachycardia and hypoxia.
The most common ECG finding is sinus tachycardia. Investigate via CT pulmonary angiogram.

Question 13

What are the respiratory and cardiac causes of clubbing?

Answer 13

Respiratory - Lung cancer, mesothelioma, pulmonary fibrosis and chronic suppurative lung disease.
Cardiac - Cyanotic congenital heart defects, infective endocarditis, atrial myxoma

Question 14

What are the causes and signs of pulmonary hypertension?

Answer 14

Causes - Parenchymal lung disease (COPD, brochiectasis), pulmonary vascular disease (idiopathoc, portal hypertension), Hypoventilation, left sided heart disease.
Signs - Raised JVP, parasternal heave.

Question 15

What are the different types of respiratory failure?

Answer 15

Type 1 - Low O2 but normal CO2. caused by asthma, heart failure, PE, pneumothorax etc.
Type 2 - Low O2, high CO2. Caused by pulmonary fibrosis, obstructive lung disease, opiate toxicity, rub fracture.