Asthma

Question 1

What are the 3 main questions to ask a patient attending an asthma review clinic?

Answer 1

1. Have you had any problems sleep because of you asthma since the last check up?
2. Have you had your usual asthma symptoms during the day?
3. Has your asthma interfered with your normal daily activities?

Question 2

Give the 2 main types of abnormal breathing on respiratory examination.

Answer 2

1. Diminished breath sounds

2. Bronchial breathing

Question 3

Recall the 4 types of added breath sounds

Answer 3

1. Wheeze
2. Crepitations
3. Pleural rub
4. Stridor

Question 4

What are the 3 states in which bronchial breath sounds are heard?

Answer 4

1. Consolidation
2. Lobar collapse with a patent bronchus
3. Lung cavity

Question 5

What does a wheeze on clinical examination indicate?

Answer 5

Narrowing of the airways due to either bronchospasm or secretions in the small airways.

Question 6

Recall the 2 categories of wheeze

Answer 6

1. Sibilant (high pitch)

2. Sonorous (low pitch)

Question 7

What is the pathophysiology of a sibilant and sonorous wheeze respectively?

Answer 7

1. A sibilant wheeze is brought about by bronchospasm of the small airways.
2. A sonorous wheeze is caused by narrowing of the small airways due to secretions.

Question 8

Name a condition that is associated with a sibilant wheeze

Answer 8

Asthma

Question 9

Name a condition associated with a sonorous wheeze

Answer 9

Chronic bronchitis

Question 10

What causes crepitations?

Answer 10

Collapse of peripheral airways on expiration either due to interstitial fibrosis or the due to secretions/fluid

Question 11

Give a cause of early inspiratory crepitations

Answer 11

Bronchiolitis

Question 12

Give a cause of mid inspiratory crepitations

Answer 12

Pulmonary Oedema

Question 13

Give 6 causes of late inspiratory crepitations

Answer 13

1. Pulmonary fibrosis
2. Pulmonary oedema
3. COPD
4. Resolving pneumonia
5. Lung abscess
6. Tuberculous lung cavity

Question 14

Name a condition in which biphasic crepitations can be heard

Answer 14

Bronchiectasis

Question 15

Define Bronchiectasis

Answer 15

Permanent dilation of the of the bronchi due to destruction of the elastic and muscular components of the bronchial wall.

Question 16

What are the 4 main differentials for patients presenting with bronchiectasis?

Answer 16

1. COPD
2. Asthma
3. Pneumonia
4. Chronic sinusitis

Question 17

Fine crepitations are heard in which 3 conditions?

Answer 17

1. Bronchiolitis
2. Pulmonary oedema
3. Pulmonary fibrosis

Question 18

Coarse crepitations are heard in which 5 conditions?

Answer 18

1. COPD
2. Resolving pneumonia
3. Lung abscess
4. Tuberculous lung cavities
5. Bronchiectasis

Question 19

Coarse crackles and wheeze are characteristic of which condition?

Answer 19

Cystic fibrosis

Question 20

Give 3 potential causes of a pleural rub

Answer 20

1. Consolidation
2. Infarction
3. Uremia

Question 21

Why is it particularly important for patients with asthma to receive their flu vaccinations?

Answer 21

Influenza can cause further inflammation of the airways and lungs and thus can worsen the patient’s symptoms or even trigger acute asthma attacks.

Question 22

Define Peak Expiratory Flow Rate

Answer 22

The maximal rate at which a person can exhale during a short maximal expiratory effort after a full inspiration.

Question 23

What parameters are required in order to predict a patient’s peak flow rate?

Answer 23

Patient’s sex and height

Question 24

Give 2 examples of long acting beta agonist (LABA)

Answer 24

1. Salmeterol

2. Formoterol

Question 25

Give an example of a long acting muscarinic antagonist (LAMA)

Answer 25

Tiotropium

Question 26

How would you distinguish between obstructive and restrictive lung disease on spirometry testing?

Answer 26

Through consideration of the FEV1/ FVC ratio. If the ratio is decreased (<70%) then this is indicative of obstructive disease and conversely an increased ratio above normal levels may suggest restrictive lung disease

Question 27

What additional drug can be given alongside a short acting beta-2 agonist?

Answer 27

Ipatropium Bromide

Question 28

Define the A-a gradient

Answer 28

The difference between the partial pressure of oxygen inspired and the arterial oxygen partial pressure.

Question 29

What is the normal value for an A-a gradient

Answer 29

10

Question 30

An elevated A-a gradient can indicate what? (3)

Answer 30

1. Right to left intrapulmonary shunt 2. V/Q mismatch 3. Alveolar hypoventilation

Question 31

List the structures that make up the left border of the heart on CXR (4)

Answer 31

1. Aortic knuckle 2. Pulmonary outflow tract 3. Left atrial appendage 4. Left ventricle

Question 32

List the structures that make the up the right border of the heart on CXR (3)

Answer 32

1. SVC 2. Right ventricle 3. IVC

Question 33

What is the most likely cause of a unilateral silent chest and wheeze?

Answer 33

Foreign body aspiration

Question 34

What 4 features are suggestive of acute severe asthma?

Answer 34

1. A peak flow reading 33-50% of best or predicted value 2. RR > 25 3. HR > 110 4. Inability to complete sentences in one breath