Respiratory

Question 1

What is the cut off for deoxygenated haemoglobin for cyanosis to be present?

Answer 1

50g/L

Question 2

Describe pleural pain

Answer 2

Sharp, localised

Worse on inspiration and coughing

Radiates from front to back or up to shoulder (if pathology is at the diaphragm)

Question 3

What are some DDx of SOB

Answer 3

Anaemia

COPD

Heart Failure

Renal Failure

Diabetic ketoacidosis

Anxiety

Asthma

PE

TB

Malignancy

Pneumonia with significant effusion

Pneumothorax

Question 4

What are the three physiological mechanisms for the sensation of dyspnoea?

Answer 4

Increased drive to breath

Increased load (work of breathing)

Decrease muscle strength

Question 5

A force expiratory time over what time is significant?

Answer 5

>6s

Question 6

What is ARDS? What does it commonly follow?

Answer 6

Acute respiratory distress syndrome

Serious trauma

Question 7

What are some clinical signs of COPD?

Answer 7

Cachexia

Cyanosis

Hyperinflation

Rhonchi (wheezes)

Plethoric facies

Hoover’s sign

Resp distress

Signs of pulmonary HTN

Prolonged force expiratory time

Question 8

A decreased percussion note can reflect what?

Answer 8

Consolidation

Pleural effusion

Dense fibrosis

Elevated hemidiaphragm

Question 9

Rhonchi or wheeze implies the pathology is in which section of the lung?

Answer 9

The airways

Question 10

What is bronchiectasis?

Answer 10

Permenant widening of bronchi which are flabby and scarred

Question 11

How do you tell the difference between obstructive and restrictive lung disease from spirometry?

Answer 11

The forced expiratory ratio (FEV1/FEC) while be reduced in obstructive lung disease

The FER will be maintained in restrictive lung disease but the FVC will be reduced

Question 12

How do you calculate the A-a gradient?

Answer 12

A-a gradient = (150 - (1.25 x PaCO2)) - PaO2

Question 13

What are two possible prequels to empyema?

Answer 13

Pneumonia

Direct spread from the diaphragm

Question 14

An increased percussion note generally reflects what?

Answer 14

Pneumothorax

Hyperinflation

Question 15

When is stridor usually heard?

Answer 15

On inspiration

Question 16

What is a normal A-a gradient?

Answer 16

7-14

Question 17

What is Hoover’s sign?

Answer 17

Lower intercostal muscle retract due to flattening of diaphragm caused by lung hyperinflation

Question 18

How can you tell the difference between the two types of crepitations?

Answer 18

Bubbling through fluid will be heard througout inspiration and expiration

The popping open of alveoli will only be heard at late inspiration

Question 19

How can you differentiate pleural effusion and consolidation on clinical exam?

Answer 19

Both will be dull to percussion but pleural effusion will have reduced breath sounds while consolidation will have increased

Question 20

What is ABPA?

Answer 20

Allergic Bronchopulmonary Aspillergosis

Question 21

What are some signs of pulmonary hypertension?

Answer 21

RV heave and palpable S2

Loud H2

4th Heart slow

Pulmonary flow murmur

Question 22

What are the three main respiratory causes of clubbing?

Answer 22

Suppurative lung disease (eg bronchiectasis, TB)

Bronchogenic Cancer

Chronic lung fibrosis - idiopathic and asbestosis but not sarcoidosis

Question 23

What is the difference between cyanosis and pallor?

Answer 23

Cyanosis occurs when there is significant amounts of deoxygenated haemoglobin

Pallor occurs when there is reduced Hb concentration in blood (anaemia)

Question 24

Does COPD classically cause crepitations?

Answer 24

No

Question 25

When measuring chest expansion with a tape measure, what is the normal measurement for expansion and what is reduced?

Answer 25

~4cm is normal

Question 26

Outline a systematic approach to the causes of dyspnoea?

Answer 26

Respiratory

Cardiovascular

Metabolic/anaemic

MSK/Chest wall

Psychogenic

Question 27

Why might you get a loud P2 in PCP infection?

Answer 27

Widespread pulmonary infection > V-Q mismatch > A-V shunting > Pulmonary HTN (reduced capillary bed) > Loud P2