Respiratory conditions

Question 1

Define COPD

Answer 1

Progressive disease characterised by airway obstruction with little or no reversibility and an FEV1/FVC ratio of <0.7. It includes chronic bronchitis and emphysema

Question 2

What is chronic bronchitis?

Answer 2

Defined clinically as cough with sputum production on most days for 3 moths of 2 successive years

Question 3

What is emphysema?

Answer 3

Defined histiologically as enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

Question 4

What is the target oxygen sats for a COPD patient?

Answer 4

88-92%. Normally need 15 hours/day long term oxygen therapy

Question 5

What is asthma?

Answer 5

Chronic inflammatory condition of the lung airways characterised by reversible airflow obstruction and bronchospasm

Question 6

3 characteristics of asthma?

Answer 6

Reversible airflow limitation
Airway hyper-responsiveness
Inflammation of the bronchi with T cell, mast cell, eosinophils and smooth muscle hypertrophy, mucus plugging and epithelial damage

Question 7

What can trigger an asthma attack?

Answer 7

Cold air, exercise, emotion, allergens

Question 8

Describe the stepwise management of asthma?

Answer 8

Short acting beta2 agonist 
Add inhaled steroid
Add long acting beta2 agonist
Increase dose of inhaled steroid
Add regular oral steroid

Question 9

What type of carcinoma accounts for 95% of all primary lung tumours?

Answer 9

Bronchial carcinoma - split into small cell lung cancers (15%, highly malignant, usually inoperable) and non-small cell lung cancers (85%, better prognosis)

Question 10

What is the classical description of the typical patient who gets a primary spontaneous pneumothorax?

Answer 10

Tall, thin, young male

Question 11

How is a pneumothorax treated?

Answer 11

Chest drain insertion into ‘safe’ triangle (lateral border of pec major, anterior border latissimus, line superior to horizontal level of nipple)
Tension pneumothorax: Insert large bore cannula into 2nd intercostal space midclavicular line, then formal chest drain

Question 12

Pleural effusions can be divided into transudates or exudates depending on their protein concentration, what are the limits for each?

Answer 12

Transudates: <25g/L
Exudates: >35g/L

Question 13

Symptoms of pulmonary embolism?

Answer 13

Size-dependent.

Acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope, cough

Question 14

What is gold standard investigation to confirm PE diagnosis?

Answer 14

CTPA (CT pulmonay angiogram)

Question 15

What is seen on an X-ray of a patient with PE?

Answer 15

Wedge shaped infarction of area supplied by downstream vessels

Question 16

Management of PE?

Answer 16

Oxygen, morphine, consider thrombolysis, iv LMWH (tinzaparin)

Question 17

What organisms most commonly cause community acquired pneumonia?

Answer 17

Strep pneumoniae, H. influenzae, mycoplasma pneumoniae, S. aureus, legionella spp., moraxella catarrhalis, Chlamydia spp., 15% caused by virus

Question 18

What organisms most commonly cause hospital acquired pneumonia?

Answer 18

Gram negative eneterobacteria, S. aureus, pseudomonas, klebsiella, clostridia

Question 19

What scoring system is used to help indicate severity of pneumonia?

Answer 19

CURB65
C - Confusion
U - Urea (>7mmol/L)
R - Resp rate (>30/min)
B - BP (<90 systolic)
65+ age
If 0-1, treat at home. If 2 = treat in hospital. If 3+, consider ITU

Question 20

Honeycombing is a late sign of which disease present on X-ray?

Answer 20

Pulmonary fibrosis