Respiratory

Question 1

LRTI

Answer 1

pneumonia
acute bronchitis - bronchi or bronchioles

Question 2

Pneumonia defn

Answer 2

inflammation of lung tissue in the alveolar space

Question 3

Aspiration Pneumonia is?

Answer 3

due to the aspiration of food or fluids
impaired swallow

anerobic bacteria

Question 4

signs of pneumonia?
auscultation?
percussion note?

Answer 4

bronchial breath sounds: HARSH inspiratory and expiratory due to consolidation around the airways

focal coarse crackles
dull to percussion : lung tissue filled wih sputum or collapsed

Question 5

Percussion findings respiratory exam why dull?

Answer 5

increased tissue density

more solid tissues : consolidation
mass (cancer)
fluid
sputum

pleural effusion is sometimes said to be stony dull

Question 6

Percussion findings respiratory exam why hyper resonant?

Answer 6

too much air
pneumothorax

Question 7

what is the sepsis indication sin LRTI?

Answer 7

tachypnoea
tachycardia
hypoxic
hypotense
fever
confusion

Question 8

CURB-65 /CRb-65

Answer 8

confused?

urea >7mmol/l
RR >30
BP : <90 systolic or 60 diastolic
65 > age

Question 9

atypical pneumonia

Answer 9

cannot be cultured in the normal way / detected by gram stain

Question 10

Mx of atypical pneumonia?

Answer 10

macrolide
fluoroquinolones
tetracyclines

Question 11

Infected water systems > atypical pneumonia > which investigations?

Answer 11

legionella pneumophilia

SIADH = hyponatraemic
urine antigen test

Question 12

SOB, cough, unwell but with target lesions?

Answer 12

rash is erythema multiforme : pink ring with pale center

Mycoplasma pneumoniae

neuro symptoms in some patients

Question 13

atypical pneumonia with the mnemonic: “Legions of psittaci MCQs

Answer 13

Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydophila pneumoniae
Qs – Q fever (coxiella burnetii)

Question 14

PCP mx?

Answer 14

co trimoxazole

fungal pneumonia

Question 15

Ix pneumonia

Answer 15

CXR
FBC
renal profile : urea / aki
CRP

sputu
blood cultures
urinary antigen tests

Question 16

when does CRP start to rise?

Answer 16

6 hours from onset and peaks 24-48 hours

Question 17

mild pneumonia tx ?

Answer 17

5 days oral
amoxicillin
doxy
clarithromycin

Question 18

Complications of pneumonia?

Answer 18

sepsis
ARDS
pleural effusion
Empyema
Abscess
Death

Question 19

Acute Bronchitis - defn

Answer 19

Oedematous large airways
production of Sputum
3 weeks
self resolve
viral

Question 20

Mx of Acute bronchitis is dependent on what lab measure?

Answer 20

CRP >100mg/l
offer abx - DOXY

analgesia
good fluid intake

Question 21

what is the name of the respiratory stimulant used when NIV or intubation is not appropriate?

In COPD acute exarcebation

Answer 21

Doxapram

Question 22

NIV - inclusion criteria COPD

Answer 22

Persistent respiratory acidosis
(pH < 7.35 and PaCO2 > 6)
despite maximal medical treatment

Potential to recover
Acceptable to the patient

Question 23

IPAP

Answer 23

inspiratory pressure - air is forced into the lungs

positive airway pressure

Question 24

EPAP

Answer 24

pressure during expiration – stopping the airways from collapsing

Question 25

most common cause of COPD exarcebations?

Answer 25

bacterial: haemophilus influenzae streptococcus pneumoniae moraxella catarrhalis

Question 26

what Abx in COPD exacerbation?

Answer 26

Amoxicillin Clarithromycin Doxycycline

Question 27

admission criteria for COPD?

Answer 27

severe breathlessness acutely confused cyanosis oxygen sat <90% on pulse oximetry

Question 28

Oxygen therapy secondary care COPD before blood gases?

Answer 28

28% - WHITE venturi mask 4L/min

Question 29

Severe exacerbations requiring secondary care: COPD

Answer 29

O2 therapy nebulised bronchodilators > Salbutamol : Beta2 adrenergic agonist > muscarinic antagonist : Ipratropium bromide IV hydrocortisone IV theophylline

Question 30

BiPaP pressures COPD

Answer 30

EPAP: 4-5cm H2O IPAP: 12-15cm H2O

Question 31

CXR findings of COPD

Answer 31

hyperinflation bullae: flat hemidiaphragm exclude lung cancer

Question 32

Severity of COPD - FEV1

Answer 32

>80% : Stage 1 mild 50-79% : Stage 2 30-49% : Stage 3 <30% : Stage 4

Question 33

LTOT : COPD

Answer 33

pO2 <7.3 kPa, pO2 of 7.3-8 kPa 1) secondary polycythaemia 2) peripheral oedema 3) pulmonary HTN

Question 34

oral PDE-4 inhibitors such as roflumilast reduce risk of?

Answer 34

?

Question 35

Idiopathic pulmonary fibrosis

Answer 35

acute SOBOE dry cough > 3 months finger clubbing

Question 36

Interstitial fibrosis : drug which reduces fibrosis and inflammation by inhibiting tyrosine kinase?

Answer 36

nintedanib

Question 37

Pirfenidone

Answer 37

reduces fibrosis and inflammation through various mechanisms pulmonary fibrosis