Sessions 5-8 Rev

Question 1

What ECG signs of PE

Answer 1

S1Q3T3
Sinus tachycardia
Or Nothing

Question 2

Respiratory failure seen in PE

Answer 2

Type 1, low paO2, normal or low CO2

Question 3

Can you rule out possibility of PE if d dimer is normal

Answer 3

No

Question 4

What would ad ABG for a PE patient show

Answer 4

Respiratory alkalosis (secondary to hyperventilation, CO2 levels decrease, less converted to acid)

Question 5

45 year old woman on COCP, risk factor for PE

Answer 5

Temporary- COCP

Question 6

What examination findings would be important in relation to possibility of PE

Answer 6

Leg DVT, chest auscultation, tachycardia, tachypnoea

Question 7

Chemoreceptors do not respond to

Answer 7

PaO2

Question 8

Cause of altered ABG whilst on oxygen

Answer 8

Loss of pulmonary arteriole hypoxic vasoconstriction

Decreased ability of oxygenated haemoglobin to carry CO2

Question 9

Most common cause of DVT, PE in young Europeans

Answer 9

Protein C resistance secondary to factor V Leiden mutation

Question 10

Equation for partial pressure of oxygen in air

Answer 10

0.209 x atmospheric pressure

Question 11

Equation for partial pressure of oxygen in URT

Answer 11

0.209 x (atmospheric pressure- SVP)

Question 12

Why would partial pressure of oxygen be lower in alveoli than in URT

Answer 12

O2 diffusion into capillaries

Question 13

What mechanism explains hypoxaemia at high altitude

Answer 13

Low partial pressure of oxygen in inspired air

Question 14

Where should a normal chest drain be inserted for a spontaneous pneumothorax

Where should a needle aspiration be placed for tension pneumothorax

Answer 14

5th intercostal space, mid axillary line

2nd intercostal space, mid clavicular line

Question 15

Vocal resonance in patient with pleural effusion

Answer 15

Decreased as sound does not travel as well through fluid as air

Question 16

3 anatomical landmarks of triangle of safety

Answer 16

Pec major
Lat Dorsi
5th intercostal space (nipple)

Question 17

Key underlying mechanism which causes lung collapse in pneumothorax

Answer 17

Alveolar and atmospheric pressure > intrapleural pressure

Air goes from high to low pressure

Increased intrapleural pressure causes pressure collapse of lung

Lung collapse

Question 18

A 30 year old lady with known asthma presents to A&E with symptoms consistent with an exacerbation of her asthma. At home, the patient has taken her salbutamol inhaler as instructed, but this hasn’t improved her symptoms.

On examination, her peak flow is 190, Respiratory Rate 25, Hear Rate 120, and O2 Saturation 92% on air. Normally, her peak flow is around 420.

CLASSIFY HER ASTHMA ATTACK

Answer 18

Oxygen sats are life threatening

Question 19

Next step if a patient is not controlling their asthma with a short acting B2 antagonist like salbutamol

Answer 19

Add an inhaled corticosteroid once inhaler technique checked

Question 20

Types of respiratory failure in asthma attacks

Answer 20

Mild to moderate asthma attack = type 1 as low CO2 and low O2

Severe = type 2 as high CO2 and low O2

Question 21

What replace ciliated cells in a disease process

Answer 21

Goblet cells

Question 22

What is most commonly used to diagnose COPD

Answer 22

CXR

Question 23

What is often the first sign of COPD

Answer 23

Cough that is worse in the mornings

(Followed by productive cough, SOB at rest, cough worse after exercise)

Question 24

Which 3 conditions make up Young’s syndrome and Kartagener’s syndrome

Answer 24

Youngs syndrome = Bronchiectasis, sinusitis, reduced fertility in men

Kartageners syndrome = Bronchiectasis, sinusitis, situs inversus

Question 25

Which condition is seen in 20% of newborns with CF

Answer 25

Meconium ileus

Bowel blocked with sticky secretions

Question 26

Why are people with CF at higher risk of being underweight

Answer 26

Malabsorption from the GI tract

Question 27

Pulmonary rehab is offered to those with an MRC dyspnoea score of

Answer 27

3 or 4

Question 28

What does a reduced DLCO mean

Answer 28

reduced alveolar-capillary interface for gas exchange: cause in parenchyma

Question 29

causes of Interstitial lung disease

Answer 29

amiodarone or bleomycin, or pulmonary toxic drugs

Question 30

what causes pneumoconiosis

Answer 30

occupational history

Question 31

what causes hypersensitivity pneumonitis

Answer 31

pet history

Question 32

Most likely cause of restrictive lung disease with no obvious history

Answer 32

idiopathic pulmonary fibrosis

Question 33

causes of restrictive lung disease

Answer 33

ILD, autoimmune disorder, pneumoconiosis, hypersensitivity pneumonitis, Idiopathic pulmonary fibrosis, muscle weakness

Question 34

Body helium dilution tests

Answer 34

functional residual capacity

Question 35

incentive spirometry for

Answer 35

avoided atelactesis after surgery

Question 36

supine spirometry assesses

Answer 36

strength of diaphragm

Question 37

if there is no change after bronchodilator on spirometry what does this indicate

Answer 37

no significant reversibility