Respiratory

Question 1

What is community acquired pneumonia?

Answer 1

Acute inflammation with intense infiltration of neutrophils in and around the alveoli, and the terminal bronchioles – due to bacteria or viruses

Question 2

What is the most common pathogen in CAP?

Answer 2

pneumococcal/ streptococcal pneumoniae

Question 3

What are the common signs in CAP on percussion and auscultation?

Answer 3

localised coarse crackles, dullness on percussion

Question 4

What is the scoring system for CAP? What do they mean?

Answer 4

CRUB65
Confusion, 
resp. rate >30, 
urea >7, 
BP – systolic < 90 (diastolic < 60), 
age 65

Question 5

What are the investigation for CAP?

Answer 5

FBC, WBC, CRP, renal function, U&Es, LFTs, blood cultures, pneumococcal, legionella urinary antigen tests, CXR, sputum culture, blood gas, pleural fluid aspiration (biochemistry and culture)

Question 6

What is the treatment for CAP?

Answer 6

Antibiotics - Amoxicillin
Hospital - Co-amoxiclav
or trust guideline

Question 7

What is Horner’s syndrome? In what condition does it present in?

Answer 7

Drooping of the upper eyelid (ptosis), constricted pupil (mitosis), absence of sweating over the affected side of the face.

Presents in lung cancer

Question 8

Symptoms: weight loss, haemoptysis, cough, Horner’s syndrome, SOB, chest pain, fever, N&V, hoarseness, wheezing & stridor, SVC obstruction.
What could be the diagnosis?

Answer 8

Lung cancer

Question 9

What are the investigations for lung cancer?

Answer 9

FBC - CRP, neutrophil, WBC
CXR
Bronchoscopy
Contrast enhanced CT scan

Question 10

What are the differential diagnosis for collapse, chest pain and SOB?

Answer 10

PE
Acute coronary syndromes, Aortic dissection, 
Cardiac tamponade, Pneumonia, 
Pneumothorax, 
Sepsis

Question 11

What is pleural effusion?

Answer 11

Excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.

Question 12

How are pleural effusion classified?

Answer 12

Exudative (high protein) or transudative (low protein).

Question 13

What does high or low protein mean in pleural effusion?

Answer 13

high protein- exudative (from outside - think infection)

low protein - transudative (from within - think within the body)

Question 14

What are the common causes of exudative pleural effusion?

Answer 14

Malignancy
Infections such as pneumonia (parapneumonic pleural effusion)
Granulomatous disease such as tuberculosis or coccidioidomycosis, collagen vascular diseases, Other inflammatory states.

Question 15

What are the common causes of transudative pleural effusion?

Answer 15

Congestive heart failure (CHF),
Cirrhosis
Nephrotic syndrome
PE

Question 16

What are the symptoms of asthma?

Answer 16

Breathlessness, wheeze, chest tightness, cough

Question 17

What are the common atopic disorders associated with asthma?

Answer 17

Hay fever, eczema

Question 18

What can be heard on auscultation for asthma?

Answer 18

Widespread wheeze of the chest

Question 19

When do symptoms of asthma get worse?

Answer 19

Worse at night and in the early morning
Symptoms in response to exercise, allergen exposure and cold air
After taking aspirin or beta blockers

Question 20

What are the signs from ABG indicate that the patient’s acute asthma exacerbation has deteriorated?

Answer 20

PaO2 <8 kPa
Normal PaCO2 (4.6-6.0 kPa)

Question 21

What are the signs of life-threatening acute asthma?

Answer 21

silent chest
cyanosis
poor respiratory effort
arrhythmia
exhaustion 
altered conscious level hypotension

Question 22

What are the initial assessments in severe asthma? And what are their measurements?

Answer 22

Peak flow meter - 33- 50% (Severe), <33% life-threatening
Pulse oximetry - <92% , aim to maintain spO2 94-98%
ABG - severe asthma PaO2 < 8kPa, PaCO2 normal, life-threatening - PaCO2 - raised
BP - hypotension
Heart rate - > 110
reap rate >25

Question 23

What are the physical and examination signs of acute asthma?

Answer 23

Cyanosis, poor respiratory effort ( due to exhaustion), on auscultation - silent chest

Question 24

How are acute asthmatic patients managed/treated?

Answer 24

• O2 - aim for 94 -98%
• Beta2 agonist bronchodilators - salbutamol
• Steroid - prednisolone / hydrocortisone
• Ipratropium bromide
  _ Magnesium sulphate (IV)
• (Theophylline/ aminophylline)