Respiratory

Question 0

Signs of life-threatening asthma attack

Answer 0

Silent chest, feeble inspiration effort and turning blue
PEFR <33% predicted
Bradycardic and hypotensive
Confused
ABG: type II respiratory failure, acidotic

Question 1

Signs of severe asthma attack

Answer 1

PEFR <25bpm
Unable to complete full sentences

NB. Sats are fine…

Question 2

What are 4 stages of CXR changes in Sarcoidosis?

Answer 2

1. Bilateral LNpathy (hilar)
2. Bilateral LNpathy + peripheral pulmonary infiltrates
3. Peripheral pulmonary infiltrates alone
4. Progressive pulmonary fibrosis, with bulla formation (honeycomb) and pleural involvement

Question 3

Sarcoidosis Management:

Acute (mild)

Severe sarcoid management

Answer 3

Acute flare: bed rest + NSAIDs.
Otherwise, patients with BHL do not need treatment
Steroids (indications on another card)

Severe: methylprednisolone 
Immusuppressants:
- methotrexate
- hydroxychloroquin
- cyclophosphamide
- cyclosporin

Question 4

Steroid use indications for SARCOID

Answer 4

PARENCHYMAL lung disease (ie. fibrosis or peripheral lung involvement)
Uveitis
Hypercalcaemia
Neuro or cardiac involvement

Question 5

Causes of increased serum ACE (angiotensin converting enzyme)

Answer 5

Sarcoidosis (helpful in monitoring sarcoid activity)
Hyperthyroidism
Gaucher's disease
Silicosis
TB
Pneumoconiosis

Question 6

Legionella

1. Clinical features
2. Diagnosis.

Answer 6

1. 3/4 of following means strong suspicion:
   - prodromal phase
   - dry cough/ diarrhoea/ confused
   - lymphopaenia (no leukocytosis)
   - hyponatraemia
2. Mainly 4x increase in serum Ab titres.
   Urinary antigen, sputum immunofluorescence

Question 7

Klebsiella

1. Patients at risk
2. Clinical features
3. Radiological features
4. Treatment

Answer 7

1. Elderly with lung and heart problems
   Alcoholics
   Very ill patients
2. Sudden onset severe systemic problems.
   Purulent sputum which become blood-stained
3. Upper lobes usually affected
   Bulging of fissures on lateral CXR
4. (‘K’ lebsiella = ‘C’eftriaxone)

Question 8

Pneumococcal pneumonia

• special clinical features

Treatments

Answer 8

Purulent pneumonia

Herpes labialis

2. Penicillins, then macrolides, then fluoroquinolones