Respiratory

Question 1

What are the signs of pulmonary HTN?

Answer 1

• Palpable RV heave and 2nd heart sound
• Loud H2
• S4
• Pulmonary flow murmur

Question 2

What is type 1 respiratory failure?

Answer 2

Impaired gas exchange –> hypoxaemia (PaO2

Question 3

What is type 2 respiratory failure?

Answer 3

Hypoventilation produces hypercapnia (PaCO2 >50)

Question 4

What is ARDS?

Answer 4

Acute respiratory distress syndrome: increased pulmonary capillary permeability causes gas exchange defects and mechanical defects

Question 5

How do you manage ARDS?

Answer 5

• High flow, humidified O2
• Careful monitoring: clinical, SpO2, ABG
• CPAP/BiPAP
• Invasive ventilation if type II failure develops

Question 6

What is the pathogenesis of COPD?

Answer 6

• Noxious agent (cigarette smoke) leads to DNA damage (ROS) and inflammation (neutrophils, macrophages, CD8 cells)
• Small airways disease: airway inflammation and remodelling
• Parenchymal destruction: loss of alveolar attachments and elastic recoil (proteinase-antiproteinase imbalance)
• The above leads to airflow limitations
• Mainly affects peripheral airways
• Prominent mucous hypersecretion

Question 7

What investigation would you use to diagnosis COPD and what would you expect to see?

Answer 7

Spirometry: FER

Question 8

What is the COPD-X plan?

Answer 8

• Confirm diagnosis and assess severity
• Optimise lung function
• Prevent deterioration
• Develop support network and self-management plan
• eXacerbation: manage appropriately

Question 9

What are some management strategies in COPD?

Answer 9

• Smoking cessation
• Beta2-agonists (short acting for PRN, long acting for regular)
• Anti-cholinergics (eg/ Spiriva = tiotropium)
• Inhaled CS
• Combination therapy
• Pulmonary rehabilitation
• Vaccination
• Home O2 therapy if PO2

Question 10

What are some causes of COPD exacerbations?

Answer 10

• Respiratory infections
• HF, arrhythmia
• Systemic infection, fever
• Anaemia
• Anxiety
• Anything that increases metabolic rate

Question 11

What are the clinical criteria for a COPD exacerbation?

Answer 11

• Increased dyspnoea
• Increased sputum production
• Sputum becoming discoloured

Question 12

What is the CURB65 criteria?

Answer 12

Used in pneumonia

• Confusion
• Urea >7
• RR >30
• SBP 65yo

If >2 = admit

Question 13

How do you treat severe asthma?

Answer 13

• Oxygen
• Oral prednisolone or IV hydrocortisone
• Regular bronchodilators
• ICU assessment
• IV Mg2+

Question 14

How can you diagnose an allergy?

Answer 14

• Skin prick tests (SPT)
• Serologic assays: RAST
• Challenge testing

Question 15

What is the mechanism of anaphylaxis?

Answer 15

Massive mediator release primarily from mast cells and circulating basophils –> vasodilation, fluid extravasation, bronchial SMC contraction and mucosal oedema –> death due to shock or hypoxaemia

Question 16

What are some symptoms of anaphylaxis?

Answer 16

• Angioedema: lips, tongue, larynx
• Wheeze, hypotension
• LOC