Respiratory

Question 1

4 stages of clubbing

Answer 1

-increased fluctuancy of nail bed -loss of angle -curvature of nail -expansion of terminal phalanx

Question 2

Features of a pancoast Tumour

Answer 2

T1 nerve root lesion Horner’s syndrome Upper lobe Carcinoma Wasting of small muscles of hand Pain in axilla

Question 3

Pleural Effusion examination

Answer 3

Expansion reduced on the side of the Effusion Reduced percussion (stony dull) Trachea usually normal Air entry reduced and TVF reduced

Question 4

Causes of a pleural exudate

Answer 4

Local causes Carcinoma of bronchus Infection- lobar pneumonia and TB Pulmonary Embolism RA- low glucose

Question 5

How to tell if it’s an Effusion or collapse?

Answer 5

Collapse —> tracheal deviation Effusion—> trachea central or to opposite side if massive Stony dull in Effusion Bronchial breathing in Effusion

Question 6

Causes of loss of lung volume and tracheal deviation

Answer 6

Trachea—> towards affected side Pneumonectomy TB and old TB treatment Unilateral fibrosis —> radiotherapy Collapse of lobe —> foreign body

Question 7

Causes of trachea to be pushed away from affected side

Answer 7

Massive pleural Effusion Pneumothorax with tension

Question 8

Causes of obstructive pattern

Answer 8

FEV1/FVC<75% Asthma COPD Bronchiectasis

Question 9

Signs of severe asthma

Answer 9

1 sign - admit Unable to complete sentences in one breath RR>25 HR>110 PFR<50% predicted/best

Question 10

Signs of life threatening asthma

Answer 10

1 sign- ITU 33-92-CHEST PFR<33% O2 sats<92% Cyanosis Hypotension Exhaustion with feeble respiratory effort Silent chest Tachycardia/bradycardia - VT/SVT/heart block

Question 11

Acute asthma management

Answer 11

OSHITME Oxygen Salbutamol Hydrocortisone Ipatropium Bromide Theophylline Magnesium sulphate Escalate No sedation Reassess PFR every 15 mins

Question 12

Conditions affecting the upper lung zone

Answer 12

TB SPACE TB Sarcoidosis Pneumoconiosis Ankylosing Spondylitis Cystic fibrosis Extrinsic allergic alveolitis

Question 13

Conditions affecting the lower lung zones

Answer 13

ACID Asbestosis Connective tissue disease- alpha1 antitrypsin Idiopathic pulmonary fibrosis Drugs

Question 14

Which drugs affect the Lungs?

Answer 14

AMEN Amiodarone Methotrexate Ergot-derivatives (e.g. carbergoline) Nitrofurantoin

Question 15

Causes of clubbing with basal crackles

Answer 15

IPF Bronchiectasis Asbestosis NOT COPD, if clubbing and COPD then CXR for cancer

Question 16

Examination signs of consolidation

Answer 16

Reduced expansion Increased tactile vocal fremitus Dull to percussion Reduced air entry Bronchial breathing Coarse crackles

Question 17

CURB-65

Answer 17

Confusion (abbreviated Mental Test Score <=8) (1 point) Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) Respiratory Rate > 30 per minute (1 point) Blood Pressure: diastolic < 60 or systeolic < 90 mmHg (1 point) Age >= 65 years (1 point)

Question 18

CURB-65 mortality

Answer 18

1-5% 2-13% 3-17% 4-42% 5-57%

Question 19

Pneumonia differentials

Answer 19

Pneumothorax PE LVF Endobronchial lesion Endocarditis in IVDU

Question 20

Pneumonia investigations

Answer 20

FBC, ESR, CRP, U&E, LFTs Serology for legionella Blood and sputum for culture, CXR and ECG ABG if SpO2<95%

Question 21

Pneumonia complications

Answer 21

Systemic sepsis Lung abscess Pleural Effusion Empyema

Question 22

Explain the pathophysiology of pneumoconiosis

Answer 22

Question 23

Acute vs chronic extrinsic allergic alveolitis

Answer 23

Question 24

Effects of asbestos exposure on the Lungs?

Answer 24

• pleural plaques and thickening (radiological evidence of exposure)
• asbestosis- fibrotic lung disease
• Carcinoma of bronchus- 5x increase in non-smokers, 50% increase in smokers
• mesothelioma- malignant Tumour typically affecting pleura and causing chest wall pain

Question 25

What is sarcoidosis?

Answer 25

systemic disease of unknown aetiology typified by non-caseating granulomas

increased incidence in Afro-Caribbean’s

typically affects young adults

Question 26

Sarcoidosis acute presentation

Answer 26

erythema nodosum

joint pains- ankle and knee

fever may occur

hilar lymphadenopathy

benign and self limiting in 80-90%, settles in 4-6 weeks

Question 27

Sarcoidosis chronic presentation

Answer 27

hilar lymphadenopathy and fibrotic lung disease due to lymphatic alveolitis, with systemic features:

tender swelling of fingers, sometimes with bone cysts

facial rash

attacks of anterior uveitis

retinal problems due to posterior uveitis

parotiditis

facial nerve palsy

hypercalcaemia- ^ hydroxylation of vitD by sarcoidosis macrophages

Question 28

fever pain score

Answer 28

Fever in last 24 hours

Purulence

Attends with symptoms < 3 days

Inflamed tonsils

No cough or coryza.

Score 0-1 = 13-18% streptococci, use NO antibiotic strategy

Score 2-3 = 34-40% streptococci, use 3 day back-up antibiotic prescription strategy

Score ≥4 = 62-65% streptococci, use immediate antibiotic if severe, or 48 hour short back-up prescription- Phenoxymethylpenicillin

Question 29

Causes of erythema nodosum

Answer 29

sarcoid

strep

TB

UC/Crohns

OCP, Sulphonamides