Y3 CARDIORESPIRATORY

Question 1

Causes of a left parasternal heave?

Answer 1

Right ventricular hypertrophy
(Very rarely caused by severe left atrial enlargement which can push the right ventricle towards)

Question 2

What is pulmonary artery hypertension?

Answer 2

An elevated pulmonary arterial pressure >=25mmHg at rest, measured by right heart catheterisation

Question 3

How does pulmonary arterial hypertension present?

Answer 3

SOB on exertion
Chest pain
Fatigue
Syncope

Question 4

What is pickwickian syndrome?

Answer 4

This is obesity hypoventilation syndrome

Question 5

Blood gas findings in a PE

Answer 5

Hypoxaemia
Hypocapnia
Respiratory alkalosis

Question 6

Whats the MOA of ipratropium and tiotropium? Whats the main difference between them?

Answer 6

It blocks muscarinic acetylcholine receptors
Tiotropium is longer acting

Question 7

Examples of SABAs?

Answer 7

Salbutamol
Terbutaline

Question 8

Examples of LABAs?

Answer 8

Salmeterol
Formoterol

Question 9

Examples of SAMAs?

Answer 9

Ipraotropium

Question 10

Examples of LAMAs?

Answer 10

Tiotropium

Question 11

What is bronchoscopy?

Answer 11

This involves passing a long, thin, flexible telescope with a bright light on the end into the lungs through the nose
Photos and samples can be taken

Question 12

What is monitored during bronchoscopy?

Answer 12

Pulse oximetry and ECG

Question 13

Is a bronchoscopy performed under any anaesthesia?

Answer 13

Yes under GA

Question 14

Investigations for lung cancer?

Answer 14

Bloods
CXR first
CT chest
Bronchoscopy to allow biopsy
PET scanning in non-small cell lung ca

Question 15

How does mesothelioma present?

Answer 15

Dyspnoea first symptom from pleural effusions
Weight loss, chest wall pain, clubbing

Question 16

Which lung is more commonly affected by mesothelioma?

Answer 16

The right

Question 17

Where does mesothelioma metastasise to?

Answer 17

Contralateral lung
Peritoneum

Question 18

Whats the latent period for mesothelioma after asbestos exposure?

Answer 18

30-40 years

Question 19

Which lung cancers are typically central?

Answer 19

SCC and small cell lung cancer

Question 20

Lung cancer risk factors?

Answer 20

Smoking
Radon
Occupation exposure and pollution - arsenic, asbestos, beryllium, nickel, silica, coal fumes, cadmium

Question 21

What is the moa of bupropion?

Answer 21

A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
Reduces the reinforcing efefcts of nicotine and helps alleviate nicotine withdrawal symptoms

Question 22

Whats the moa of varenicline?

Answer 22

Nicotinic receptor partial agonist

Question 23

Which valvular heart disease causes the most severe pulmonary hypertension?

Answer 23

Mitral stenosis

Question 24

Of all the rate controlling AF drugs, which acts the fastest?

Answer 24

Metoprolol

Question 25

What cases S3?

Answer 25

Diastolic filling of the ventricle
Normal if <30
Causes: LV failure, constrictive pericarditis and mitral regurgitation

Question 26

What causes S4?

Answer 26

Caused by atrial contraction against a stiff ventricle
Causes: AS, HOCM, hypertension

Question 27

What are some causes of hypertension and hypokalaemia?

Answer 27

Primary hyperaldosteronism e.g. conns
Liddles syndrome
Cushing syndrome
Renal aretry stenosis
Congenital adrenal hyperplasia
Renin-producing tumours

Question 28

How can excess licorice affect bp?

Answer 28

Too much glycyrrhizinic acid can inhibit 11 beta-hydroxylase

Question 29

What is interstitial pneumonitis? What can cause it?

Answer 29

Aka idiopathic interstitial pneumonia/fibrosis
Non-infective inflammation of the interstitium in the lungs that can be caused by RA/SLE/scleroderma, amiodarone therapy, chemotherapy drugs, environmental exposures, radiation, hypersensitivity reaction to mold etc

Question 30

Risk factors for asthma?

Answer 30

PHx or FHx of atopic disease
Male sex pre-pubertal and female sex in adulthood
Respiratory infections in infancy
Exposure to tobacco smoke
Premature birth and LBW
Obesity
Social deprivation
Exposure to inhaled particulates

Question 31

What are some workplace exposure risks for asthma?

Answer 31

Isocyanates from spray paints or foam moulding - most common
Flour dust at bakeries
Platinum salts
Soldering flux resin
Glutaraledehyde
Epoxy resins
Proteolytic enzymes

Question 32

Whats the max dose of amlodipine?

Answer 32

10mg OD

Question 33

What is the pathophysiology of asthma?

Answer 33

Inflamed airways react to environmental triggers -> airways narrow -> excessive mucus production = bronchial mucus plugging

Question 34

Protein level in transudate and exudate causes?

Answer 34

Transudate <30g/L
Exudate >30g/L

Question 35

What are causes of transudate pleural effusions?

Answer 35

This usually indicates a problem with pressure/balance of fluid within the body’s capillaries. Usually B/L

HF - most common
Hypoalbuminaemia e.g. liver disease, nephrotic syndrome, malabsorption
Hypothyroidism
Meig’s syndrome

Question 36

What are causes of exudate pleural effusions?

Answer 36

This usually indicates inflammation, infection or damage to the pleural membranes. Usually U/L

Infections - pneumonia (MC), TB
Connective tissue diseases e.g. RA, SLE
Neoplasia
Pancreatitis
PE
Dressler’s syndrome
Yellow nail syndrome

Question 37

What is the pleural friction rub?

Answer 37

A raspy breathe sound that is like a squeak or grating sound
From the movement of inflamaed pleural surfaces against each other during the movement of the chest wall

Question 38

What can cause a pleural friction rub?

Answer 38

PE
Pneumonia
Rarely - pleural malignancy or spontaneous pneumothorax

Question 39

Which genetic paediatric syndrome can cause aortic stenosis?

Answer 39

Williams syndrome - can cause supravalvular aortic stenosis