Respiratory

Question 1

State at least 4 respiratory causes of clubbing

Answer 1

Cancer (bronchial or mesothelioma), empyema, cystic fibrosis, bronchiectasis, idiopathic pulmonary fibrosis, TB

Question 2

State 3 cardiac causes of clubbing

Answer 2

Infective endocarditis, congenital cyanotic heart disease, atrial myxoma

Question 3

State 4 GI causes of clubbing

Answer 3

Cirrhosis, IBD, coeliac disease, GI lymphoma

Question 4

Describe the empirical treatment regime for mild pneumonia

Answer 4

Amoxicillin 500mg tds PO for 5 days or clarithromycin 500mg bd PO for 7 days

Question 5

Describe the empirical treatment regime for moderate pneumonia

Answer 5

Amoxicillin 500mg tds and clarithromycin 500mg bd PO or IV for 7 days

Question 6

Describe the empirical treatment regime for severe pneumonia

Answer 6

Co-amoxiclav 1.2g tds IV or cefuroxime 1.5g tds IV, plus clarithromycin 500mg bd IV for 7-10 days

Question 7

Describe the empirical treatment regime for a mild HAP

Answer 7

Co-amoxiclav 625mg PO tds for 7 days

Question 8

Describe the specific risk factors, features, and management of pneumococcal pneumonia

Answer 8

RFs elderly, CHF, pulmonary disease, EtOH, immunosuppression, lobar pneumonia, treated with amoxicillin/benzylpenicillin/cephalosporins

Question 9

Describe the specific risk factors, features, and management of Staphylococcal pneumonia

Answer 9

RFs influenza infection, IVDU, comorbidities, causes bilateral cavitating bronchopneumonia, managed with flucloxacillin/vancomycin

Question 10

Describe the specific risk factors, features, and treatment of Klebsiella pneumonia

Answer 10

Rare - elderly, EtOH, diabetes, causes upper lobe cavitating pneumonia, treated with cefotaxime

Question 11

Describe the specific risk factors and management of Pseudomonas pneumonia

Answer 11

RFs Bronchiectasis, CF, treated with tazocin

Question 12

Describe the specific risk factors, features, and management of Mycoplasma pneumonia

Answer 12

RFs epidemic, causes flu-like prodrome, dry cough, reticulonodular shadowing, erythema multiforme, rarely SJS, GBS, hepatitis, treated with clarithromycin/ciprofloxacin

Question 13

Describe the specific risk factors, features, and management of Legionella pneumonia

Answer 13

RFs travel, Air con, features flu-like prodrome, dry cough, dyspnoea, anorexia, D&V, hyponatraemia from SIADH, hepatitis, renal failure, confusion, managed with clarithromycin plus rifampicin

Question 14

Describe the specific risk factors, features, and management of Chlamydia psittaci pneumonia

Answer 14

RFs parrots, features dry cough, patchy consolidation, rose spots, splenomegaly, epistaxis, hepatitis, nephritis, meningoencephalitis, treated with clarithromycin

Question 15

Describe the specific risk factors, features, and management of PCP pneumonia

Answer 15

RFs immunocompromise, features dry cough, exertions dyspnoea, bilateral creps, xray may be normal, management high dose co-trimoxazole or pentamidine, prophylaxis after first attack

Question 16

State at least 5 causes of bronchiectasis

Answer 16

Idiopathic (50%),CF, Kartageners, Youngs syndrome (bronchiectasis and azoospermia), post-infectious (measles, pertussis, TB, bronchiolitis, pneumonia), hypogammaglobulinaemia, rheumatoid arthritis, UC, yellow nail syndrome

Question 17

Describe the management of bronchiectasis

Answer 17

Chest physio, antibiotics for exacerbations (e.g. 7-10 days ciprofloxacin), bronchodilators (salbutamol), treat underlying cause if present, surgery for severe localised disease

Question 18

Define allergic bronchopulmonary aspergillosis

Answer 18

Type 1 and 3 hypersensitivity reaction to Aspergillus fumigated causing bronchoconstriction and later bronchiectasis

Question 19

Describe the treatment of allergic bronchopulmonary aspergillosis

Answer 19

Prednisolone 40mg a day and itraconazole for acute attacks, maintenance prednisolone 5-10mg a day, bronchodilators for asthma

Question 20

State at least 2 pulmonary and 4 non-pulmonary causes of ARDS

Answer 20

Pulmonary: pneumonia, aspiration, inhalation injury, contusion
Systemic: shock, sepsis, trauma, multiple transfusions, pancreatitis, acute liver failure, DIC, eclampsia, amniotic emboli, aspirin, heroin

Question 21

State the classification of pleural effusions

Answer 21

Protein <25g/l transudate, >35g/l exudate, between apply Lights criteria
Lights criteria: exudate has one of serum protein ratio >0.5, serum LDH ratio >0.6, or LDH 0.6xupper limits of normal

Question 22

State at least 5 causes of an exudative pleural effusion

Answer 22

Pneumonia, TB, lung cancer, mesothelioma, lymphoma, RA, SLE, infarction