Respiratory

Question 1

Define COPD

Answer 1

1. Progressive and irreversible
2. Obstructive airway disease
3. Combination of emphysema and chronic bronchitis

Question 2

Clinical presentation of COPD

Answer 2

1. Dyspnoea = breathlessness
2. Tachypnoea = rapid breathing
3. Cough + wheeze
4. Recurrent sputum
5. Barrel chest

Question 3

Diagnosis of COPD

Answer 3

1. FEV1/FVC < 0.70 + lack of reversibility of post-bronchodilator
2. Chest X-ray
3. FBC

Question 4

Treatment of COPD

Answer 4

1. Smoking cessation
2. Pulmonary rehab
3. Vaccines
   
   • one-off pneumococcal
   • annual influenza
4. MedicatioN
   
   • SABA = Short Acting Beta Agonist SALBUTAMOL
   • SAMA = Short Acting Muscarinic Antagonoist IPRATROPIUM
   • LABA = Long Acting Beta Agonist SALMETROL
   • LAMA = Long Acting Muscarinic Antagonist TIOTROPIUM
   • ICS = Inhaled CorticoSteroid BECLOMETASONE

Question 5

Define asthma

Answer 5

Chronic airway inflammation and bronchospasm

Question 6

Clinical presentation of asthma

Answer 6

1. Diurnal variation - worse at night and early morning
2. Known symptom trigger (help differentiate)
3. Episodic shortness of breath
4. Dry cough
5. Aspirin sensitivity

Question 7

Diagnosis of asthma

Answer 7

1. Fractional exhaled nitric oxide (FeNO) >40ppb
2. Spirometry - FEV1/FVC < 70%
   
   • Bronchodilator reversibility (BDR) if spirometry +ve

Question 8

Treatment of asthma

Answer 8

1. SABA
2. ICS
3. LABA

Question 9

Define Pneumonia

Answer 9

1. Acute inflammation of terminal bronchioles
2. Usually secondary to infection

Question 10

State the microorganisms involved in Pneumonia

Answer 10

1. Community Acquired Pneumonia
   
   • Strep. pneumoniae
   • Haemophilus influenzae
   • Staph. aureus
2. Hospital Acquired Pneumonia
   
   • Pseudomonas (5 days after admission)
   • E. coli
   • Staph. aureus
3. FUNGI
   
   • Pneumocystis jiroveci

Question 11

Clinical presentation of Pneumonia

Answer 11

1. Productive cough
2. Reduced breath sounds
3. Pleuritic chest pain
4. Fever
5. Dyspnoea

Question 12

Diagnosis of Pneumonia

Answer 12

1.CXR - consolidation
2. FBC - leukocytosis
3. U&E - deranged
4. CRP - infection marker
5. Sputum culture

Question 13

Treatment of Pneumonia

Answer 13

1. CAP
   
   • Oral amoxicillin
   • IF PENICILLIN ALLERGIC = DOXYCYCLINE/CLARITHROMYCIN
   • IV if severe
2. HAP
   
   • LOW severity = oral co-amoxiclav
   • HIGH severity = IV tazocin
   • MRSA = ADD vancomycin

Question 14

Describe the 4 types of TB

Answer 14

TB = RESTRICTIVE DISEASE
1. Primary infection
- Respiratory droplets from patients with active disease
2. Latent TB
- Immunocompetent patients harbour infection but asymptomatic
- Immunocompromised -> reactivation can occur
3. Secondary TB
- Reactivation and failure to contain bacteria
4. Miliary TB
- Systemic spread

Question 15

Clinical presentation of TB

Answer 15

1. Haemoptysis - coughing up blood
2. Dyspnoea - trouble breathing
3. Fever
4. Weight loss
5. Night sweats
6. Finger clubbing if longstanding

Question 16

Diagnosis of LATENT TB

Answer 16

Mantoux screening
- Intradermal injection of 0.1 mL
- 1:1000 purified protein derivative (PPD) tuberculin
- Inspect site 48-7h later
- Measure diameter of induration across forearm
- < 5mm = -ve
- > 5-15mm = +ve
- = previous BCG vaccine or TB infection if risk factors present
- > 15mm = STRONG +ve
- TB infection

Question 17

Diagnosis of ACTIVE TB

Answer 17

1. CXR
2. Microbiology - sputum stain and mycobacterium culture
3. Nucleic-Acid Amplification Test (NAAT0
4. HIV and hepatitis status

Question 18

Treatment of ACTIVE TB

Answer 18

1. Initial phase (RIPE for 2months)
   
   • Rifampicin - red secretions (S.E)
   • Isoniazid - Feve, jaundice, nausea)
   • Pyrazinamide - Hyperuricaemia
   • Ethambutol - Optic neuritis
2. Continuation phase (further 4 months)
   
   • Rifampicin
   • Isoniazid
3. Multi-drug resistant TB
   
   • Extended for 1-24 months with at least 6 drugs
4. TB meningitis
   
   • Longer continuation phase for 10 months
   • Dexamethasone if required

Question 19

Define CF

Answer 19

1. Autosomal recessive
2. Multi system
3. CF transmembrane conductance regulator (CFTR) mutation

Question 20

State the systems affected by CF

Answer 20

1. Respiratory system
2. GI
3. Pancreas
4. Liver
5. Right heart failure (due to pulmonary hypertension)

Question 21

State the clinical presentations and their diagnosis (->) of CF at different stages

Answer 21

1. ANTENATAL
   
   • Hyperechogenic bowel on ultrasound
     -> chorionic villus sampling
2. NEONATAL
   
   • Prolonged jaundice
   • Meconium ileus
     -> Guthrie heel-prick test
3. CHILDHOOD
   
   • Recurrent chest infections
   • Failure to thrive
   • Malabsorption
   • Delayed puberty
     -> Sweat test
4. ADULTHOOD
   
   • Same as childhood
   • DM
   • Male infertility
   • Female sub-infertility

Question 22

Treatment of CF

Answer 22

RESP. SYSTEM
1. Airway clearance
2. Broonchodilator
3. Mucoactive agents
- rhDNase
GI & hepatobiliary
1. High calorie + high fat diet
2. Fat soluble vit supplementation for pancreatic insufficiency
3. PPI
4. Pancreatic enzyme replacement

Question 23

Define Bronchiectasis

Answer 23

1. Debilitating lung disease
2. Permanent dilation of bronchi
3. Due to chronic bronchial inflammation

Question 24

Clinical presentation of Bronchiectasis

Answer 24

1. Shortness of breath
2. Excess sputum
3. Auscultation
   
   • Coarse crackling on inspiration
   • High pitch inspiratory squeak
4. Clubbing
5. Haemoptysis

Question 25

Diagnosis of Bronchiectasis

Answer 25

1. Chest X ray 2. High res CT chest - signet ring sign 3. Sputum culture 4. FBC

Question 26

Treatment of Bronchiectasis

Answer 26

1. Chest physio 2. Annual flu vaccine 3. Mucoactive agent 4. Bronchodilator 5. Nebulised saline

Question 27

Define and state the 2 types of pleural effusion

Answer 27

Abnormal excess of fluid in pleural space 1. Transudative effusion protein < 30g/L 2. Exudative effusion protein > 30g/L

Question 28

Clinical presentation of pleural effusion

Answer 28

1. Dyspnea 2. Reduced chest expansion 3. Cough 4. Dullness to percussion

Question 29

diagnosis of pleural effusion

Answer 29

1. Chest x ray 2. Pleural aspiration and analysis - Colours suggestive of different conditions

Question 30

Treatment of pleural effusion

Answer 30

1. Treat underlying cause 2. Thoracentesis = chest drainage 3. Pleurodesis

Question 31

Define and state types of pneumothorax

Answer 31

Abnormal accumulation of air within pleural space. Young, Male, Low BMI most likely 1. Primary spontaneous (no presence of underlying lung disease) 2. Secondary spontaneous (presence of lung disease) 3. Traumatic (any type of trauma) 4. Tension (previous 3 can turn into this; EMERGENCY)

Question 32

Clinical presentation of pneumothorax

Answer 32

1. sudden onset pleuritic chest pain 2. Sudden onset dyspnoea 3. Reduced breath sounds ipsilaterally

Question 33

Diagnosis of pneumothorax

Answer 33

1. CXR 2. CT chest

Question 34

Treatment of pneumothorax

Answer 34

1. Aspiration and chest drain 2. TENSION = significant cardiorespiratory compromise - Needle decompression 2nd intercostal, midclavicular, line, same side

Question 35

State the 3 main types of lung cancers

Answer 35

1. Small-cell lung cancer (SCLC) 2. Non-small cell lung cancer (NSCLC) 3. Mesothelioma

Question 36

Summarise SCLC

Answer 36

1. LOCATION - Central lesion 2. SMOKING - Strong link 3. TREATMENT - Chemoradiotherapy

Question 37

State the 3 types of NSCLC and summarise

Answer 37

1. Adenocarcinoma - Peripheral lesion - Low smoking link - Surgery treatment 2. Squamous-cell (MOST COMMON) - Central lesion - Strong smoking link - Surgery treatment 3. Large-cell - Peripheral lesion - Strong smoking link - Surgery treatment

Question 38

Diagnosis of lung cancer

Answer 38

1. CXR 2. CT chest with contrast 3. Biopsy

Question 39

Define mesothelioma

Answer 39

1. Epithelial malignancy of mesothelial cells of pleura 2. Primary cause = asbestos

Question 40

Clinical presentation of mesothelioma

Answer 40

1. Cough + shortness of breath 2. Finger clubbing 3. Reduced breath sounds 4. Pleuritic chest pain

Question 41

Diagnosis of mesothelioma

Answer 41

1. CXR 2. CT chest with contrast

Question 42

Treatment of mesothelioma

Answer 42

1. Surgery 2. Chemotherapy 3. Radiotherapy

Question 43

Summarise pulmonary fibrosis

Answer 43

1. Interstitial fibrosis of lung parenchyma 2. Caused by many underlying conditions

Question 44

Define sarcoidosis

Answer 44

1. Inflammation 2. Non-caseating granulomas

Question 45

Clinical presentation of sarcoidosis

Answer 45

1. Non productive cough 2. Dyspnoea 3. Lupus type rash 4. Photophobia

Question 46

Diagnosis of sarcoidosis

Answer 46

1. Routine bloods for inflammatory markers 2. Serum calcium: hypercalcaemia 3. Raised ACE 4. CXR

Question 47

Treatment of sarcoidosis

Answer 47

1. Steroids - methylprednisalone 2. Immunosuppressant - Methotrexate

Question 48

Describe the CURB-65 score for pneumonia

Answer 48

1. Confusion 2. Urea > 7 2. Resp rate ≥ 30 mins 3. SBP ≤ 90mmHg or DBP ≤ 60mmHg 4. Age ≥ 65 1 POINT FOR EACH. 3-4 = URGENT HOSPITAL

Question 49

State and describe the types of resp. failure

Answer 49

1. TYPE 1 - Low O2 - Normal CO2 2. Type 2 - Low O2 - High CO2

Question 50

State the type of resp failure for all resp. conditions

Answer 50

1. Asthma - Type 1 2. PE - Type 1 3. COVID - Type 1 4. COPD - Type 2 5. Pneumonia - Type 2

Question 51

Pulomary hypertension is defined as pressure above what mmHg?

Answer 51

20 mmHg