Respiratory

Question 1

Tension pneumothorax

Answer 1

Key points
May occur following thoracic trauma when a lung parenchymal flap is created.
This acts as a one way valve and allows pressure to rise.
The trachea shifts and hyper-resonance is apparent on the affected side.
Treatment is with needle decompression and chest tube insertion

• insert 14G cannula into the top of the third rip in the intercostal space midclavicular line to miss nuerovascular bundle
• If classic signs - no time for a xray

Question 2

Restrictive lung disease - FEV1 pattterns

example of restrictive lung disease

Answer 2

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis
Neuromuscular disorders

Question 3

How to calculate anion gap?

Answer 3

the gap is the extra ions that dont make up equation, and if these acids increase then anion increase (e.g diabetic ketoacisosi)

Na + K - (CL+ HCO3)
normal anion gap is 8-16

MUDPILES - anion gap metabolic acidosis

Methanol - Uremia - DKA/Alcoholic KA - Paraldehyde - Isoniazid - Lactic Acidosis - Etoh/Ethylene Glycol - Rhabdo/Renal Failure - Salicylates

Non-Anion Gap Acidosis: HARDUPS

Hyperalimentation
Acetazolamide
Renal Tubular Acidosis
Diarrhea
Uretero-Pelvic Shunt
Post-Hypocapnia
Spironolactone

Question 4

Kartagener syndrome

Answer 4

Features
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

Question 5

COPD oxygen therapy

Answer 5

• if at risk of hypercapnia then 88-92 (28% Venturi mask at 4 l/min)
• if no hypercapnia then aim for 94-98

Question 6

Presentation for sarcoidosis

Answer 6

Features

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

noncaseating granulomas.
Levels of ACE, Calcium, and Vit D - can track therapy

• first line treatment - prednisolone
• methotrexate, cyclophosphamide

Question 7

SHort term COPD exaserbation management

When to give non-invasive ventilation

Answer 7

salbutamol and ipratropium nebulisers, oral prednisolone and intravenous theophylline

-NIV - if resp acidosis still persists despite maximal medical therapy

Question 8

When to give NIV

Answer 8

Non-invasive ventilation - key indications
COPD with respiratory acidosis pH 7.25-7.35*
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation