Respiratory

Question 1

Immunosuppression?

Answer 1

HIV/AIDS, haem cancer, lung conditions (especially silicosis), diabetes, chronic renal failure, immunosuppressive medications, alcoholism + smoking, malnutrition

Question 2

Obstructive lung disease: asthma
- Symptoms
- Risk factors
- Bad signs

Answer 2

Symptoms
- Chest pain/tightness
- SOB
- Cough +- wheeze
- Increased ventolin use

Risk factors
- Flares: exposure to triggers, recent URTI
- Personal or family history of atopy (eczema, allergic rhinitis)
- Medication: aspirin, beta blockers
- Smoking

Bad signs
- Home oxygen
- Corticosteroid use
- ICU admissions

Question 3

Obstructive lung disease: COPD
- Symptoms
- Risk factors
- Bad signs

Answer 3

Symptoms
- SOB: worse on exertion + lying down, may have pursed lip breathing and use accessory muscles
- Cough +- sputum
- Cyanosis
- Fatigue

Risk factors
- Past + family history
- Smoking

Bad signs
- Home oxygen
- Corticosteroid use
- ICU admissions

Question 4

Restrictive lung disease: interstitial pulmonary fibrosis
- Symptoms
- Risk factors

Answer 4

Symptoms:
- SOB: progressively worsening
- Cough: dry + persistent
- Fatigue

Risk factors
- Idiopathic: smoking
- Occupational: job
- Underlying disease: sarcoidosis, SLE, TB/legionella
- Drug induced: amiodarone, methotrexate, bleomycin

Question 5

Pneumonia
- Symptoms
- Risk factors

Answer 5

Symptoms
- Chest pain (often pleuritic)
- SOB
- Cough +- haemoptysis
- Fever, sweats, rigours
- If bad, vomiting, confusion

RISK FACTORS
Community acquired pneumonia
- Sick contacts
- Vaccination status
- Occupation
- Recent travel
- Country of origin
- Exposure to birds, farms, animals moulds, soils

Healthcare/hospital/ventilator acquired pneumonia
- Do you live in a nursing home?
- Have you recently been hospitalised?
- Have you recently been put on a ventilator?

Immunocompromised
- Underlying lung conditions: eg. COPD, asthma, cystic fibrosis
- Immunosuppressive disease: diabetes, cancer, HIV, transplant
- Immunosuppressive medications
- Alcoholics

Question 6

Tuberculosis
- Symptoms
- Risk factors ADDITIONAL to pneumonia

Answer 6

Symptoms
- As per pneumonia

Risk factors additional to pneumonia
- Endemic country
- Living in crowded settings - eg. jail, homeless shelter, long term care
- IV drug use

Question 7

DVT and PE
- Symptoms
- Risk factors

Answer 7

Symptoms
- Calf pain + leg swelling
- Chest pain (pleuritic)
- SOB
- Cough +- haemotopysis
- Palpitations (compensatory tachycardia)
- Syncope/fainting

Risk factors

Question 8

Lung cancer
- Symptoms
- Risk factors

Answer 8

Symptoms
- Chest pain (pleuritic)
- SOB
- Cough +- haemoptysis
- Constitutional symptoms

Risk factors
- Personal + family history of cancer
- Smoking
- Underlying lung conditions (involving inflammation and fibrosis)
- Occupation: exposure to irritants

Question 9

Pneumothorax
- Symptoms
- Risk factors

Answer 9

Symptoms
- Chest pain (pleuritic)
- SOB

RISK FACTORS
Primary spontaneous pneumothorax
- Past + family history
- Tall, thin, adolescent male

Secondary spontaneous pneumothorax
- Underlying lung conditions
- Marfan syndrome
- Smoking
- Inhaled illicit drug use - eg. marijuana via a bong, speed, ice.

Traumatic pneumothorax
- Trauma
- Thoracic surgery

Question 10

Rib fractures
- Symptoms
- Risk factors

Answer 10

Symptoms
- Chest pain
- SOB

Risk factors
- Trauma
- Osteoporosis
- Cancer metastasis to ribs
- Stress fractures: chronic cough, sports