SAQs Flashcards
State the three types of asbestos (3)
Chrysotile (White) Crocidolite (Blue) Amosite (Brown)
A patient with known exposure to asbestos has a chest radiograph for a work-related medical. A lung opacity can be visualised in the right upper lobe. What is the most likely diagnosis of this chest x-ray finding? (1)
Asbestos Plaques
Discuss the relationship between smoking, asbestos exposure and the risk of developing lung cancer (5)
Both smoking and asbestosis can cause lung cancer. When exposure occurs together, smoking and Asbestos exposure have a synergistic effect. The risk when having worked with asbestos and having smoked is greater than the sum of the two individual risks.
tate three occupations that increase the risk of developing lung cancer. (3)
Mining Demolition Workers Sandblasters Fire Fighters Plumbers Electricians Carpenters Painter and Decorators Construction workers Engineers Gas and heating fitters Roofing contractors
a) Discuss three ways of reducing employees exposure to occupational hazards that increase the risk of lung cancer (3)
Personal protective equipment Breathing apparatus Using less harmful chemicals etc
A 30-year old woman with a 10-year history of asthma is admitted to an acute medical ward with a 24-hour history of increasing shortness of breath and wheeze. She has had an upper respiratory tract infection for 4 days, which has been treated by her GP with antibiotics. Her arterial blood gases breathing room air are as follows (Reference ranges are in brackets): PaO2 kPa (10.5-14kPa), PaCO2 3.8kPa (4.7-6kPa), pH 7.51 (7.37-7.42), H+ 32nm (35-45nm), HCO3 24mmol/L (24-28 mmol/L) a) Suggest 6 factors in the history and examination that will help you in assessing the severity of this asthma attack at the bedside. (6)
RR HR Ability to complete sentences Saturations Cyanosis Level of consciousness PEFR
A 30-year old woman with a 10-year history of asthma is admitted to an acute medical ward with a 24-hour history of increasing shortness of breath and wheeze. She has had an upper respiratory tract infection for 4 days, which has been treated by her GP with antibiotics. Her arterial blood gases breathing room air are as follows (Reference ranges are in brackets): PaO2 kPa (10.5-14kPa), PaCO2 3.8kPa (4.7-6kPa), pH 7.51 (7.37-7.42), H+ 32nm (35-45nm), HCO3 24mmol/L (24-28 mmol/L) a) Give 3 initial treatments you would use for this patient. (3)
Oxygen Steroids High Dose Beta-2 Bronchodilator Ipratropium Bromide IV magnesium sulphate IV aminophylline
A 30-year old woman with a 10-year history of asthma is admitted to an acute medical ward with a 24-hour history of increasing shortness of breath and wheeze. She has had an upper respiratory tract infection for 4 days, which has been treated by her GP with antibiotics. Her arterial blood gases breathing room air are as follows (Reference ranges are in brackets): PaO2 kPa (10.5-14kPa), PaCO2 3.8kPa (4.7-6kPa), pH 7.51 (7.37-7.42), H+ 32nm (35-45nm), HCO3 24mmol/L (24-28 mmol/L) a) How would you explain the blood gas results? (2)
Respiratory Alkalosis due to CO2 loss due to increased RR
A 30-year old woman with a 10-year history of asthma is admitted to an acute medical ward with a 24-hour history of increasing shortness of breath and wheeze. She has had an upper respiratory tract infection for 4 days, which has been treated by her GP with antibiotics. Her arterial blood gases breathing room air are as follows (Reference ranges are in brackets): PaO2 kPa (10.5-14kPa), PaCO2 3.8kPa (4.7-6kPa), pH 7.51 (7.37-7.42), H+ 32nm (35-45nm), HCO3 24mmol/L (24-28 mmol/L) a) What would happen to the blood gases if the patient’s condition continues to deteriorate? (2)
Increased/normal PaCO2, decreased PaO2
A 30-year old woman with a 10-year history of asthma is admitted to an acute medical ward with a 24-hour history of increasing shortness of breath and wheeze. She has had an upper respiratory tract infection for 4 days, which has been treated by her GP with antibiotics. Her arterial blood gases breathing room air are as follows (Reference ranges are in brackets): PaO2 kPa (10.5-14kPa), PaCO2 3.8kPa (4.7-6kPa), pH 7.51 (7.37-7.42), H+ 32nm (35-45nm), HCO3 24mmol/L (24-28 mmol/L) a) What course of action should be taken if the clinical situation continues to deteriorate and does not correct itself on your first line management? (2)
Assisted Ventilation
What two ‘diseases’ are found in patients with COPD? (1)
Emphysema and Chronic Bronchitis
a) Give two features of the pathology of each of these diseases. Emphysema and Chronic Bronchitis (in COPD) (2)
Emphysema = increased airspaces within lungs and loss of alveolar walls Bronchitis = Increased secretions of mucous, increased numbers of goblet cells
a) Give three investigations that you would perform, and the findings that you would expect to see in a patient with COPD. (3)
CXR – Hyperexpanded lungs Spirometry – Check for decreased FEV1/FVC ABG - Hypoxia
The patient asks if his condition (COPD) might be due to his smoking. You explain, and suggest that he should try and give up. a) Give 4 methods that might help this patient stop smoking. (4)
Quit with family/friend, nicotine patches, referral to smoking cessation service, indoor cigarettes
After 6 months, your COPD patient represents to the surgery. He has stopped smoking, but has become gradually more breathless. Following a thorough history and examination, you decided to prescribe and inhaler. a) List two inhalers that you might prescribe which have different mechanisms of action, and explain how these work.
Salbutamol - b2 agonist, causes dilation of airways by relaxing smooth muscle Ipatropium bromide – anti-muscuranic blocks ACh effect on bronchi
