Respiratory General

Question 1

What is the MRC dyspnoea scale?

Answer 1

Used to grade level of breathlessness

1. Not troubled except for strenuous exercise
2. SOB Hurrying or walking up slight incline
3. When walking at pace of contemporaries on level ground, or when has to stop to catch breath when walking at own pace
4. No more than 100m
5. Can’t leave house; SOB when dressing/undressing

Question 2

Difference between type one and 2 respiratory failure?

Answer 2

Type I: hypoxia with normal or low pCO2

Type II: hypoxia with hypercapnia due to alveolar hypo ventilation with or without v/q mismatch

Question 3

Causes of type I resp failure?

Answer 3

Pneumonia
Asthma
PE
POe
ARDS
IPF

Question 4

Causes of type II failure?

Answer 4

COPD
Asthma
Pneumonia
Neuromuscular disease - GB
Kyphoscoliosis

Question 5

What is the pathophysiology of bronchiectasis?

Answer 5

Vicious cycle
Mucociliary impairment leads to build up of mucus
Subsequent infection.
Infection leads to more mucus secretion and increased inflammation.
Cause airway dilatation, resulting in impaired mucociliary clearance
cycles continues

Question 6

Causes of bronchiectasis?

Answer 6

Cystic fibrosis
Childhood infections: pertussis, pneumonia
Immunodeficiency
Ciliary dysfunction: PCD, Kartagener’s
Toxic or mechanical (e.g. FB) insult
Linked with systemic disease, e.g. IBD, CTD

Question 7

What is progression of bacterial colonisation in bronchiectasis ?

Answer 7

Staph aureus
H.influenzae
Moraxella catarrhalis
Pseudomonas

Question 8

Principles of management?

Answer 8

Self care because chronic condition e.g. Px ABx
Chest physio
inhaled medication - BA, ICS
? Mucolytics
Psychological support
MDT
rapid treatment of exacerbations and awareness that ABX course may take longer e.g. Two weeks