Respiratory

Question 1

Dilated veins are a sign of?

Answer 1

Hypercapnia

Question 2

1st webspace wasting is a sign of?

Answer 2

T1 lesion as a result of Pancoast tumour- a tumour of the pulmonary apex

Question 3

Causes of fingernail clubbing?

a) Cardiovascular
b) Respiratory
c) GI
d) Others

Answer 3

Cardiovascular: congenital heart disease, infective endocarditis, atrial myxoma

Respiratory: interstital lung disease, cancer, suppurative lung disease, cystic fibrosis

GI: inflammatory bowel disease, cirrhosis, GI lymphoma, coeliac disease

Others: Grave’s disease, familial

Question 4

Koilonychia is a sign of?

Answer 4

Iron deficiency anaemia

Question 5

Flapping tremor is a sign of?

Answer 5

Respiratory failure Type 2 (carbon dioxide retention)

Question 6

Character of the radial pulse in hypercapnia?

Answer 6

Bounding

Question 7

Crepitations indicate what?

Answer 7

Fluid in the airspaces

Question 8

Vocal resonance:

a) increased
b) decreased (2)

Answer 8

a) consolidation

b) effusion, pneumothorax

Question 9

Examination findings: dull percussion note with reduced/bronchial breath sounds, increased vocal resonance

Answer 9

Consolidation

Question 10

Examination findings: dull percussion note, reduced or absent breath sounds, reduced or absent vocal resonance

Answer 10

Pleural effusion

Question 11

Examination findings: mediastinal shift away from side with hyper-resonant percussion, absent breath sounds

Answer 11

Tension pneumothorax

Question 12

Transudative causes of pleural effusion? (3)

Answer 12

LVF, volume overload (e.g. renal failure, over-aggressive fluid administration), hypoalbuminaemia

Question 13

Exudative causes of pleural effusion? (4)

Answer 13

Infection, infarction, inflammation, malignancy

Question 14

What is the aim of controlled oxygen therapy in the acute setting in COPD?

Answer 14

Raise the PO2 without worsening the acidosis; some patients rely on a hypoxic drive to ventilate, therefore giving 15L of oxygen reduces the respiratory drive and causes CO2 to be retained, causing acidosis

Question 15

How should oxygen therapy in acutely unwell patients be given initially?

Answer 15

2L via nasal cannula, or 24% (blue) Venturi

Question 16

What is the oxygen set at with a blue Venturi to achieve 24% FiO2?

Answer 16

4L

Question 17

What are the causes of Type 2 Respiratory failure?

Answer 17

Ventilatory failure:
Increased airways resistance e.g. COPD, asthma
Reduced breathing effort e.g. opiates
Neuromuscular e.g. GBS, MND
Deformity e.g. flail chest

Question 18

Respiratory alkalosis with hyperventilation, and peripheral/peri-oral tingling?

Answer 18

Panic attack

Question 19

Management of an acute exacerbation of COPD?

Answer 19

High-dose nebulised Salbutamol (2.5mg-5mg)
Oral steroids (prednisolone 30mg daily)
Antibiotics if sputum purulent/signs of infection
Oxygen therapy