Yr5 Revision

Question 1

What reflex is absent in acoustic neuroma

Answer 1

corneal reflex

Question 2

What is normal FEV1/FVC ratio in spirometry? What result for obstructive and what for restrictive? What diseases go into these categories?
What further test can you do to differentiate the diagnosis?

Answer 2

> 75%
obstructive <75% - asthma, COPD, bronchiectasis, emphysema, CF
Restrictive - normal ratio. Fibrosis, Oedema

Reversibility testing with bronchodilators

Question 3

Causes of dyspnoea

Answer 3

PE
Pneumonia
Pneumothorax
COPD
Pulmonary oedema
Lung cancers
Heart failure
Foreign body
MI
Asthma
Effusion

Question 4

Scoring system for dyspnoea

Answer 4

MRC dyspnoea scale
0 - no breathlessness
1 - when hurrying or slight hill
2 - slower than people of same age
3- when walking <100m
4 - doing ADLs, can’t leave house

Question 5

describe a wheeze

Answer 5

high pitched continuous sound on expiration that can be polyphonic (COPD, asthma) or monophonic (larger airway narrowing eg large mucus plug or tumour)

Question 6

Causes of airway obstruction - within lumen, within wall, extrinsic

Answer 6

lumen - foreign body, tumour
wall - anaphylaxis, laryngospasm, tumour, epiglottis and croup
Extrinsic - goitre, after neck surgery, lymphadenopathy

Question 7

causes of haemoptysis

Answer 7

lung cancer
TB

Question 8

cause of pink frothy sputum

Answer 8

pulmonary oedema

Question 9

Pleural effusion examination findings

Answer 9

stony dull percussion
elevated rr
reduced breath sounds
decreased vocal resonance
bronchial breathing
reduced/asymmetric expansion

Question 10

Consolidation examination findings

Answer 10

coarse crackles
reduced expansion
vocal resonance increased
bronchial breathing
dull percussion

Question 11

difference between coarse and fine crackles

Answer 11

coarse are heard throughout both stages of respiration. lower pitch. Sound like blowing air through straw in drink
fine are heard in mid-late stage of inspiration. higher pitch, sound like fire crackling softly

Question 12

rx of COPD

Answer 12

SABA or SAMA PRN
Then - consider if asthmatic features or steroid responsiveness
If no - SABA PRN + LABA + LAMA
If yes - SABA or SAMA PRN + LABA + ICS
Then everything

Question 13

What features are suggestive of asthmatic or steroid responsiveness in copd pts

Answer 13

significant diurnal variation in PEFR
known asthma or atopy
raised blood eosinophils

Question 14

what is the severity of cold based on

Answer 14

FEV1 readings not symptoms

Question 15

what could be the diagnosis if a young person has symptoms of copd

Answer 15

alpha 1 antitrypsin deficiency

Question 16

all its with pneumonia should have an outpatient cxr organised. At what week post discharge should this take place

Answer 16

6 weeks

Question 17

rx of acute exacerbation of copd, clear sputum

Answer 17

prednisolone 5 day course
Not recommended to use abx unless purulent sputume

Question 18

A 67-year-old female attends the emergency department with a 3-week history of cough productive of clear sputum and intermittent low-grade fever. She denies shortness of breath, chest pain, weight loss or haemoptysis. She has no history of respiratory illness, but takes metformin for type 2 diabetes and has a 25-pack-year smoking history. She has no known drug allergies.

A chest x-ray is performed in the emergency department which is normal. Blood tests are taken which show:
CRP >100
WBC normal

What is the diagnosis and what is the rx

Answer 18

acute bronchitis
Rx with oral doxycycline first line

Question 19

features of acute sarcoidosis

Answer 19

erythema nodosum, swinging fever, BHL on CXR, polyartralgia, cough, hypercalcaemia

Question 20

what ix are done for pulmonary fibrosis once spirometry confirms a restrictive pattern and what is seen on this

Answer 20

High resolution CT chest
honeycombing

Question 22

SLE antibodies

Answer 22

ANA and anti dsDNA

Question 23

SLE blood results

Answer 23

pancytopenia (haemolytic anaemia)
lowcomplements
anti dsDNA and ANA

Question 24

SLE presentation

Answer 24

SOAP BRAIN

Question 25

SLE Rx

Answer 25

Sun cream
NSAIDs

Steroids if organ involvements for flare ups
Hydroxychloroquine

Question 26

monitoring sle

Answer 26

complements low during active disease
pancytopenias
anti ds dna titres

Question 27

Sjogrens presentation acronym

Answer 27

MAD FRED
Myalgia
Arthralgia
Dry mouth/skin/vagina
Fatigue
Raynauds/renal tubular acidosis
Enlarged parotids
Dry eyes

Question 28

antibodies in sjogrens

Answer 28

anti-ro and anti-la

May have RF and anti dsdna
May have ANA

Question 29

rx of sjogrens

Answer 29

Artificial tears
pilocarpine - stimulates saliva production
Vag lube
skin emollients
Pain meds for msk sx

K+ for RTA

Question 30

complications of sjogrens

Answer 30

b Cell lymphoma
RTA
Corneal ulcerations
pulmonary fibrosis
peripheral neuropathies

Question 31

Scleroderma/systemic slerosis sx

Answer 31

CREST
calcinosis
raynauds
Eosophogeal dysmotility
Sclerodactyly
Talengiectasia

Question 32

Electrolyte abnormalities (inc glucose) in acute pancreatitis

Answer 32

hypocalcaemia, hypokalaemia
hyperglycaemia (not producing insulin)

Question 33

What TB drug causes peripheral neuropathy and what do you give to prevent it

Answer 33

isoniazid
give pyridoxine (Vit B6)

Question 34

Presentation of neonatal hypoglycaemia

Answer 34

jittery, irritable, not feeding, tachypnoea

preemies

Question 35

beyond what bp reading would you admit a pregnancy lady for observation and antihypertensives

Answer 35

160/110