Symptoms, Signs, Treatment

Question 1

asthma

Answer 1

1) cough, dyspnoea, chest tightness, wheeze and fatigue in expiration
2) fatigue in expiration and hyper inflated chest
3) SABA, inhaled steroids, LABA, oral steroids (acute exacerbations)

Question 2

COPD

Answer 2

1) on going productive cough, sputum, recurrent chest infection, shortness of breath, weight and muscle loss, decreased exercise tolerance, ankle swelling and chest tightness
2) increased JVP, cyanosis, cachexia, wheeze, smoker
3) smoking cessation, diet, pulmonary rehab, short acting/long acting bronchodilators and ICS and NIV

Question 3

COPD exacerbation

Answer 3

1) increasing SOB, change in colour and increase in volume of sputum, more cough
2) SA bronchodilators, nebuliser, oxygen, steroids, antibiotics o palliative management

Question 4

TB

Answer 4

1) cough, weight loss, fever, night sweats
2) apical fluffy opacities, mediastinal lymphadenopathy, pleural effusion
3) 4:2=2:4
(H+R+Z+E).2=(R+H):4

Question 5

pneumonia

Answer 5

1) fever, myalgia, rigor, pleuritic chest pain, productive cough, dyspnoea and haemoptysis and sputum
2) tachycardia, tachypnoea, dull on oercussion, bronchial resonance, reduced expansion, increased vocal resonance, crepitations
3) CURBS 0-1: amoxycillin, 2: amoxicillin + clarythromycin, 3-5: co-amoxiclav

Question 6

acute bronchitis

Answer 6

1) cough and sputum for max 3 weeks

2) supportive management unless it doesn’t go away or fever longer than three days

Question 7

bronchiectasis

Answer 7

1) productive cough, purulent and smelly sputum, haemoptysis, recurrent LRTI, dyspnoea
2) nail clubbing, cyanosis, coarse crepitations, wheeze, obstructive spirometry
3) prolonged antibiotics (10-14 days)

Question 8

croup

Answer 8

1) barking cough, worse at night, hoarseness of the voice, fever, cough and rhinitis, respiratory distress
2) inspiratory stridor, child well
3) supportive management + oral dexamethasone

Question 9

epiglottitis

Answer 9

1) very toxic child, drooling, coughing, sore throat
2) stridor in inspiration
3) immediate intubation and antibiotics (no examination)

Question 10

bacterial tracheitis

Answer 10

1) sick child, feverish, usually croup that hasn’t gone away
2) antibiotics: co-amoxiclav

Question 11

bronchiolitis

Answer 11

1) cold like symptoms: fever, congestion, cough, dyspnoea
2) crackles and wheeze
3) supportive management, oxygen and NPA

Question 12

whooping cough

Answer 12

1) fits of cough followed by vomit, redness in face

2) antibiotics: macrolides (erythromycin, clarythromycin, azythromycin)

Question 13

children bronchitis

Answer 13

1) loose rattly cough which may lead to vomit
2) no wheeze, no crepitation
3) either supportive or antibiotics (viral or bacterial?)

Question 14

empyema

Answer 14

1) consequence of pneumonia, chest pain, unwellness

2) aspiration + US and chest drain

Question 15

pleural effusion

Answer 15

1) pleuritic chest pain, dyspnoea, heamoptysis, dry cough and fever
2) dull on percussion, decreased resonance, decreased expansion, deviated trachea
3) aspiration + US, chest drain, thoracoscopy and pleuradesis

Question 16

parapneumonic effusion

Answer 16

1) cough, chest pain, fever
2) history of pneumonia
3) drainage and IV antibiotics on area

Question 17

pneumothorax

Answer 17

1) pleuritic chest pain, cough, dyspnoea, pressure on chest and difficulty inhaling
2) rapid breathing, deviated trachea to collapsed lung, cyanosis
3) do nothing, aspiration, chest drain and oxygen

Question 18

tension pneumothorax

Answer 18

1) pleuritic chest pain, respiration distress
2) deviated trachea away from collapsed lung, tachycardia, tachypnoea, hypotension, hyper inflated chest and increased JVP
3) chest drain from 2nd intercostal space

Question 19

pleural plaque

Answer 19

1) asbestos exposure, incidental finding

2) benign mass, discuss and counsel

Question 20

asbestos pleural effusion

Answer 20

1) diagnose of exclusion and past medical history

2) can solve spontaneously or need to be drained (can progress)

Question 21

malignant mesothelioma

Answer 21

1) chest pain, cough, weight loss, weakness, fever and dyspnoea
2) pleural effusion, blood stain
3) not much space for surgery, chemotherapy and palliative care

Question 22

cystic fibrosis

Answer 22

1) recurrent not clearing cough, shortness of breath, chest tightness
2) pancreatic insufficiency, recurrent chest infections, crepitations/wheeze
3) for pancreas: enteric coated enzyme pellet, high energy diet, fat-soluble vitamins and mineral supplements
for chest infections: physiotherapy (clearance of airways), antibiotics (IV or oral), preventing antibiotics (azytrhomycin) supportive management
treatment with drugs (ivacaftor, lumacaftor, tezacaftor)
lung transplant

Question 23

DAD

Answer 23

1) sever dyspnoea, rapid breathing, low blood pressure
2) restricted spirometry, decreased lung volumes
3) not much, corticosteroids

Question 24

sarcoidosis

Answer 24

1) cough, sever dyspnoea, fever
2) arthralgia, erythema nodosum, bilateral hilar lymphadenopathy
3) no treatment, NSAID, topical steroids, systemic steroids
corticosteroids

Question 25

hypersensitivity pneumonitis

Answer 25

1) cough and dyspnoea, fever, unwellness
2) past medical history, tachypnoea, crackles and wheeze
3) antibiotics + stop exposure to antigen

Question 26

IPF

Answer 26

1) cough an dyspnoea
2) finger clubbing, cyanosis, crackles
3) not much, some respond to steroids

Question 27

pulmonary embolism

Answer 27

1) -small peripheral: pleuritic chest pain, hemoptisis and cough
- isolated: isolated episodes of dyspnoea
- massive: cardiac arrest or syncope
2) -pyrexia, stony dull at percussion, pleural rub
- tachycardia, tachypnoea, hypoxia
- tachycardia, tachypnoea, hypoxia, hypotension
3) oxygen, low molecular heparin, DOAC, thrombolysis, Pulmonary embolectomy

Question 28

pulmonary hypertension

Answer 28

1) exertion dyspnoea, chest pain, exertion presyncope or syncope
2) high JVP, loud pulmonary second heart beat sound, hepatomegaly, ankle-oedema, right ventricular heave
3) treating overlying problem, oxygenation, anticoagulants diuretics, phosphodiesterase inhibitors, endothen receptors antagonists

Question 29

rhinitis

Answer 29

1) runny nose, sore throats itchy eyes

2) supportive management , if gets worse review

Question 30

otitis media

Answer 30

1) redness inside (inflamed), erythema, drum pushed out

2) analgesia or augmentin (has more side effects)

Question 31

tonsillitis

Answer 31

1) red swollen tonsils, sore throat, fever, white patches on tonsils, enlarged neck lymph nodes
2) either nothing or 10 days penicillin

Question 32

pharyngitis

Answer 32

1) headache, runny nose, body ache, general unwellness

2) either nothing or 10 days penicillin