Respiratory

Question 1

2 characteristics of asthma?

Answer 1

Airway inflammation and hyper-responsiveness

Question 2

Atopic Trias

Answer 2

Asthma, Allergic Rhinitis and Ecezma

Question 3

Risk factors for acute asthma

Answer 3

Atopy, young male/old female, respiratory infections in childhood, smoking, obesity and social deprivation

Question 4

Presentation of acute asthma

Answer 4

Wheeze, cough, breathlessness, chest tightness - diurnal variation

Question 5

Trigger of asthma

Answer 5

Cold, allergens, NSAIDs, B-blockers, infection, exercise

Question 6

Asthma Investigations

Answer 6

PEFR, FEV1/FVC - bronchodilatory reversibility

Question 7

2 underlying causes of COPD

Answer 7

Chronic Bronchiectasis and Emphysema

Question 8

Chronic Bronchitis Pathology

Answer 8

Hypertrophy of mucus glands and inflamed bronchioles + squamous metaplasia - Blue Bloater

Question 9

Emphysema Pathology

Answer 9

Destruction of tissues distal to the terminal bronchioles. - Pink Puffer

Question 10

COPD Risk factors

Answer 10

Smoking, Occupation, Alpha-1-antitrypsin, air pollution

Question 11

COPD Presentation

Answer 11

Cough, Wheeze, SoB, frequent exacerbations, poor chest expansion, hyperinflation, accessory muscle use

Question 12

COPD Investigations + findings

Answer 12

Spirometry - Irreversible obstructional airflow.
CXR - Hyperinflated lungs, diaphragm flat and long narrow heart
ABG - PP = normal, BB = Hypoxia +/- hypercapnia

Question 13

COPD Treatment

Answer 13

Stop smoking, anticholinergics, SABA, LABA and corticosteroids.

Question 14

Two types of Bronchial Carcinoma

Answer 14

Small cell - 15%

Non-small Cell - 85%

Question 15

Small Cell Lung Cancer characteristics

Answer 15

Highly malignant and usually inoperable at presentations

Question 16

Non-Small Cell Lung Cancer types

Answer 16

42 % Squamous cell carcinoma, 39% Adenocarcinoma

Question 17

Risk factors for bronchial carcinoma

Answer 17

Smoking, Age, COPD, Asbestos exposure

Question 18

Bronchial carcinoma presentation

Answer 18

Cough, dysopnoea, haemoptysis, clubbing, SVC obstruction, lymphadenopathy (Virchow’s node),

Question 19

Bronchial carcinoma investigations + findings

Answer 19

CXR - Circular opacity, hilar enlargement, consolidation, pleural effusion
Contrast CT, bronchoscopy + biopsy

Question 20

Small and Non small cell treatment

Answer 20

SCLC - Chemo/radiotherapy - 25 % 5yr survival

NSCLC - Neoadjuvant and adjuvant chemo/radiotherapy and surgical resection.

Question 21

Risk factors for Pneumothorax

Answer 21

Smoking (22x), tall, Marfans, COPD, TB

Question 22

Pneumothorax presentation

Answer 22

Sudden pain, SoB, tachycardia, pulsus paradoxus, tracheal deviation, hyperresonance + reduced breath sounds

Question 23

Pneumothorax Treatment - simple, tension and recurrent

Answer 23

O2 for hypoxia + to increase N2 excretion
Tension = Drainage - 2/3 ICS mid clav or 4/5 ICS mid axillary
If recurrent then Pleurodesis

Question 24

Proportion of benign and malignant pleural effusions

Answer 24

Malignant = 40,000/yr
Benign = 80,000/yr

Question 25

Two different types and different causes

Answer 25

Transudative - hydrostatic/osmotic disruption | Exudative - Increased permeability

Question 26

Transudative effusion contents and causes

Answer 26

Protein < 30g/l | Heart failure, cirrhosis, hypoalbuminemia, dialysis

Question 27

Exudative effusion contents and causes

Answer 27

50% protein, 50% LDH | Pneumonia or Malignancy

Question 28

What is a chylothorax and a pseudochylothorax

Answer 28

``` Chylothorax = Chlye present due to disruption to thoracic duct - neoplasms, TB, trauma, sarcoidosis Pseudochylothorax = Cholesterol crystals in long standing effusion ```

Question 29

Pleural Effusion Presentations

Answer 29

SoB, Cough, Pleuritic chest pain, reduced chest expansion, stony dullness, reduced breath sounds

Question 30

Pleural Effusion investigations

Answer 30

CXR +/- aspiration for cytology

Question 31

Pleural Effusion Treatment

Answer 31

Treat underlying cause, chest drain/ pleurodesis if recurrent

Question 32

Define pneumonia

Answer 32

Acute inflammation with intense infiltration of neutrophils in and around the alveoli

Question 33

Pneumonia risk factors

Answer 33

Smoking, alcohol, asthma, COPD, malignancy

Question 34

Pneumonia causative organisms

Answer 34

S.pneumoniae, S.aureus, H.influenza

Question 35

Pneumonia presentation

Answer 35

Cough, purulent sputum, SoB, fever, malaise | Tachypnea, bronchial breathing, crepitations, pleural rub, dull percussion

Question 36

Pneumonia scoring system

Answer 36

``` CURB56 Confusion Urea >7mmol/l Resp rate >30/min Blood pressure <90 systolic Age > 65 ```

Question 37

Pneumonia treatment - inc specific Abx

Answer 37

``` O2, Fluids, Analgesia and Abx: Mild = Amoxicillin/Tetracylcine Moderate = Amoxicillin + Macrolide Severe = Stable B-lactam + Macrolide HAP = Co-amoxiclav ```

Question 38

Risk factors of PE

Answer 38

Hypercoagulability, reduce motility, blood vessel abnormalities, surgery, late pregnancy, fracture, malignancy, IVDU

Question 39

PE presentation

Answer 39

Non-specific symptoms - SoB, pleuritic chest pain, cough/haemoptysis, DVT

Question 40

Scoring system for PE

Answer 40

Wells

Question 41

PE Investigations

Answer 41

CT angiogram and D-dimer

Question 42

PE Treatment

Answer 42

O2 high flow, venous access, analgesia LMWH/Fondaparinux + Vit K antagonist for 3 months Rivaroxaban prophylaxis Surgical embolectomy if thrombolysis ineffective