Respiratory Chapter 1

Question 1

What causes a “smoke ring” to appear in the lung?

Answer 1

Cavitating lung carcinoma

Question 2

What are the most common pathogens for CAP? HAP?

Answer 2

CAP: Strep pneumo, then H. influenzae and Mycoplasma pneumoniae

HAP: most commonly g-ve enterobacteria or S aureus

Question 3

Name the U of CURB-65

Answer 3

Urea>7mmol

Question 4

How many points are needed of CURB-65 for hospital admission

Answer 4

2

Question 5

Who gets Pneumococcal vaccine?

Answer 5

> 65, chronic liver, lung, heart, kidney condition, DM, Immunosuppression.

Question 6

Klebsiella pneumonia affects who?

Answer 6

Elderly, diabetics, alcoholics

Question 7

SARS - whats the cause and px?

Answer 7

SARS-CoV Virus - coronavirus

persistent fever, chills, rigours, myalgia, cough, dyspnoea, diarrhoea, abnormal CXR and dec. WBC

Question 8

What’s an empyema

Answer 8

pus in the pleural space, –> pt with resolving pneumonia gets a recurrent fever

Question 9

List pneumonia complications

Answer 9

Resp failure, Hypotension, AF, Pleural effusion, empyema, lung abscess, septicaemia, peri/myocarditis, jaundice

Question 10

Name 4 causes of bronchiectasis

Answer 10

CF, 1ary ciliary dyskinesia, measles, pertussis, bronchial obstruction

Question 11

XR findings bronchiectasis:

Answer 11

cystic shadows, thickened bronchial walls

Question 12

CF- which mutation

Answer 12

CFTR gene on Chromosome 7 -> Cl-Channel causing defective Cl channelling and increased Na channelling

Question 13

What’s the gold standard for CF diagnosis?

Answer 13

Heel prick in newborn - but Sweat test: NaCl >60mmol/L

Question 14

Treatment of CF:

Answer 14

mdt: physiothx, antibx, mucolytics, bronchodilators

pancreatic enzyme replacement, ADEK supps, Tx dm etc. et.

Question 15

In what ways does Aspergillus affct the lung?

Answer 15

Asthma, allergic bronchopulmonary aspergillosis, aspergilloma, invasive aspergillosis, extrinisic allergic alveolitis

Question 16

What is the most common lung cancer and what percentage of all cancers does it account for?

Answer 16

Bronchial carcinoma - 19% of all cancers and 27% of cancer deaths.

Question 17

What’s the histology of bronchial carcinoma?

Answer 17

Squamous (35%), adenocarcinoma (27%), small cell (20%), large cell (10%), alveolar.

Question 18

Symptoms of bronchial cnx

Answer 18

cough, haemoptysis, dyspnoea, chest pain, B symptoms…

Question 19

Treatment for NSCLC

Answer 19

Excision for peripheral, curative Radiothx, Chemoradiothx

Question 20

Differential for lung nodule on XR

Answer 20

Malignancy, AV-malformation, abscess, granuloma, carcinoid tumour, pulm. hamartoma, encysted effusion, cyst, foreign body, skin tumour

Question 21

Define asthma

Answer 21

recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction

Question 22

What’s diurnal variation?

Answer 22

Variation in symptoms or peak flow - marked morning dipping of peak flow is common and can tip balance towards serious attack

Question 23

Which asthma symptoms to ask about specifically?

Answer 23

Precipitants, Diurnal, exercise, disturbed sleep, acid reflux, other atopic disease, the home, job, days per week off work

Question 24

Treatment of chronic asthma - when would you give a LABA?

Answer 24

step up after low-dose ICS (Tx step 2)

Question 25

What is the Omalizumab for?

Answer 25

Anti-IgE monoclonal antibody for patients with persistent allergic asthma

Question 26

What would be the FEV1 and FEV/FVC for a COPD patient

Answer 26

FEV1 <80% predicted

FEV1/FVC <0.7

Question 27

Prevalence of COPD?

Answer 27

10-20% of over-40s

Question 28

2 ends of the spectrum - what does the pink puffer show?

Answer 28

inc. alveolar ventilation, near-normal PaO2 and a normal or low PaCO2. Breathless but not cyanosed –> may progress to T1 Resp Failure

Question 29

What’s the management for severe COPD

Answer 29

combo of LABA and CS or tiotropium.