resp + vascular

Question 1

Pulmonary fibrosis:

• risk factors? 6
• commonest type?

Answer 1

• cigarette smoke
• exposure to pollutants (silica, asbestos)
• certain viral infections
• adverse drug reaction
• FH/genetics
• GORD

majority are idiopathic!!

Question 2

Pulmonary fibrosis:

• pulmonary symptoms? 2
• systemic symptoms? 3
• signs? 3

Answer 2

• dry cough
• progressive exertion dyspnoea
• malaise
• weight loss
• arthralgia
• cyanosis
• finger clubbing (seen in 2/3rds)
• fine end-inspiratory crackles

Question 3

pulmonary fibrosis:

• blood tests? 4
• other investigations (incl findings)? 3

Answer 3

• ABG (low O2)
• raised CRP
• ANA (+ve in 30%)
• rheumatoid facotr (+ve in 10%)

CXR

• initially ‘ground glass’ appearance (late = honeycomb lung)
• mainly in lower lobes
• decreased lung volume

CT
- similar to CXR, essential for diagnosis

spirometry
- restrictive disease pattern

Question 4

pulmonary fibrosis:

• management?
• complications?
• prognosis?

Answer 4

supportive care

• oxygen
• pulmonary rehabilitation
• opiates
• palliative inputs
• biologics and DMARDs may be of help
• lung transplant (if appropriate)
• respiratory failure
• cor pulmonale
• pulmonary hypertension
• 50% 5yr survival

Question 5

femoral arterial embolism:

• risk factors?
• symptoms/signs? 6
• treatment?

Answer 5

cardiovascular risk factors

• HTN
• diabetes
• high cholesterol
• reduced activity
• obesity
• FH

6Ps of acute limb ischaemia

• perishingly cold
• pale
• pulseless
• painful
• parasthesia
• paralysis
• thrombolytic drugs (e.g. rTPA)
• surgery if large
• aspirin etc

do secondary prevention