Respiratory II

Question 1

What stain type do you use for PCP? [1]

Answer 1

Silver Stain

Question 2

Recent NV use and rapid desaturation of O2 sats suggests what pathology? [1]

Answer 2

Pneumothorax can occur following high pressure non-invasive ventilation

Question 3

A patient presents with the following, alongside respiratory symptoms.

Which infective organism is most likely to have caused this?

Answer 3

Mycoplasma pneumonia

Question 4

A patient presents with the following, alongside respiratory symptoms.

Which infective organism is most likely to have caused this?

Answer 4

Streptococcus pneumonia

Herpes labialis

Question 5

Mechanical ventilation and a rapid drop in O2 sats = ?

Answer 5

Tension pneumothorax

Question 6

What is the difference in presentation of near fatal vs life threatening asthma? [1]

Answer 6

Near fatal - normal Co2
Life threat - 33-92 CHEST

Question 7

A patient has a secondary pneumothorax & > 2cm rim on CXR. What is the next best management plan? [1]

Answer 7

Chest drain (skip aspiration)

Question 8

Anterior mediastinal mass + MG symptoms - think…?

Answer 8

Also will have a thyoma

Question 9

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A 35-year-old woman visits her general practitioner (GP) complaining of a productive cough of 6 weeks duration. On further questioning she has a history of fever and night sweats and lost about 10 kg in weight during this time. She lived in Nigeria until she was 16 years old.

Which investigation should the GP request first?

Bronchoscopy

Full blood count

Mantoux test

Serum interferon-gamma release assay

Sputum for acid fast bacillus

Answer 9

.
A 35-year-old woman visits her general practitioner (GP) complaining of a productive cough of 6 weeks duration. On further questioning she has a history of fever and night sweats and lost about 10 kg in weight during this time. She lived in Nigeria until she was 16 years old.

Which investigation should the GP request first?

Bronchoscopy

Full blood count

Mantoux test

Serum interferon-gamma release assay

Sputum for acid fast bacillus

Question 10

What are the four criteria that determines if something is ARDS? [4]

Answer 10

The four criteria:
- acute onset (within 1 week of a known risk factor)
- pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
- non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
- pO2/FiO2 < 40kPa (200 mmHg)

Question 11

What do you give patients prior to bronchoscopy? [2]

Answer 11

Benzodiazepam - for sedation
Fentanyl - for pain

Question 13

How do you treat ARDS? [4]

Answer 13

• Large randomised trials have shown that low tidal volume ventilation reduces mortality in ARDS
• Haemodynamic support: To maintain mean arterial pressure >60 mmHg.
• DVT prophylaxis.
• Nutritional support: Using enteral/parenteral means if necessary.
• Regular repositioning of patient for pressure ulcer prophylaxis.
• Antibiotics should be administered only if an infectious cause for the ARDS is identified (such as pneumonia or sepsis).

Question 14

Prior to discharge, following an acute asthma attack, a patient should have been stable on their discharge medication (i.e. no nebulisers or oxygen) for []-[] hours

Answer 14

Prior to discharge, following an acute asthma attack, a patient should have been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 hours