BCS
Layers pierced in a pleural tap?
1. Skin
2. Subcutaneous tissue
3. Scarpa's fascia
4. External intercostal muscle
5. Internal intercostal muscle
(—Intercostal nerve block)
6. Innermost intercostal muscle
7. Parietal pleura/endothoracic membrane
8. Pleural cavity
—pleural tap
9. Visceral pleura
What are the 5 A's of smoking cessation?
Ask, Assess, Advise, Arrange, Assist
Give a reason when a death certificate cannot be issued?
When the patient's death is reportable to the coroner
Where the cause of the person's sudden death is unknown
Death was unnatural or violence
Death occurred under suspicious or unusual circumstances
Death was not a reasonably expected outcome of a health-care related procedure
Person had not been seen by medical practitioner in the 6 months preceding their death
Red flags of back pain
Symptoms of cauda equina lesion
Trauma, Unexplained weight loss, Neurologic symptoms, Age > 50, Fever, IVDU, Steroid User, History of Cancer (+ night pain)
Faecal/urinary incontinence (changes in sensation on wiping?), Weakness or sensory disturbance in limbs, Erectile dysfunction, Saddle anaesthesia
2 key findings on CXR of emphysema?
1. Hyperinflated lungs
2.. Small heart
What is the most common route of cancer spread to the vertebra?
Through the venous system, specifically via the Batson's plexus (a paravertebral venous plexus, is valveless allowing for the spread of malignant disease and sepsis)
Key diagnostic tool to differentiate between asthma and COPD?
COPD: irreversible bronchodilator response
List some health conditions that may affect a patient's ability to drive?
Epilepsy/seizure disorders
Stroke
MS
PD
Dementia
Syncope
Arrythmias
Visual impairments (cataracts, glaucoma, macula degeneration, diabetic retinopathy)
Psychiatric conditions (schizophrenia)
Diabetes (hypoglycaemic episodes)
What are some questions you might ask taking the history of a febrile child?
Have you measured the child's temperature? When did you measure it? Where did you measure it?
When did the fever start? How long has it been going on for? Has the child been persistently febrile, or does it fluctuate throughout the day? Has the child have a fever like this in the past?
Associated symptoms:
- SCREEN FOR TOXICITY (A: arousal/alertness/activity, B: tachypnoea/increased work of breathing think tracheal tug/intercostal & subcostal recession/grunting - 'do you see their skin sucking in at neck or ribs?',
C: circulation/cry,
D: dehydration e.g dry mucous membranes, poor skin turgor, sunken eyes/fontanelles AND <4 wet nappies in 24 hrs + <1/2 normal fluid intake)
- Tugging at ears (AOM?)
- Changes to bladders (frequency? colour? volume? smell?) (UTI?)
- Changes to bowels (consistency? frequency? colour? constipation or diarrhea?)
- Corzyal symptoms (runny nose, rhinorrhea etc) + have they been in contact with anyone sick
- Rash
- Are they limping/not using a particular limb? Any swollen limbs or joints?
- Sleep/energy/mood
+ Obstetric history
- Gestational term (full-term? pre-mature?)
- Number of maternal pregnancies
- Complications during & after pregnancy and labour
- Mode of delivery (C-section? vaginal?)
- Admission to NICU
- APGAR/AVPU scores?
+ Developmental Status
- Height & weight progression
- Milestones
- Feeds (breastfed/formula/solids)
+ Vaccinations & Immunisations
+ Smoke exposure in household/Care givers
How can you prevent deterioration in a COPD patient?
Ensure smoking cessation
Ensure up to date with vaccinations (influenza, pneumococcal)
Consider mucolytics/oxygen therapy if indicated
Chest physiotherapy
Encourage regular exercise and healthy diet
Follow a COPD management plan
Prescribe bronchodilators & ensure patients have correct bronchodilator technique
Spirometry review to monitor management
What is Cheyne-Stokes breathing?
Outline 5 clinical features of COPD
Dyspnoea
Cough, often with sputum
Hyper-resonance
Decreased heart sounds
Increased work of breathing
Wheezing (with prolonged expiratory phase)
Hyper-inflation with flattening of diaphragm on CXR
Cachexia (esp. emphysema)
List 4 things doctors are required to certify?
Sickness certificate
Workers compensation forms
Death certificates
Fitness to exercise certificates
Accident compensation forms
Carers leave certificates
Life/travel insurance forms
1. Outline signs of anaphylaxis
2. What are the 3 key MoA of adrenaline?
3. Outline immediate steps in managing anaphylaxis
Anaphylaxis: angioedema of lips, tongue, face, eyes, throat, urticaria (hives), swelling or tightness in throat welts, generalised erythematous appearance, difficulty/noisy breathing (wheeze), hoarse voice, hypotensive, syncope, nausea, vomiting, diarrhoea, abdominal distension and discomfort, pale and floppy (young children)
Vasoconstriction, bronchodilation, increases vascular permeability
1. Remove the allergen
2. Lay the person flat (unless they are have difficulty breathing, then can allow them to sit)
3. Grip EpiPen with sift, remove blue safety cap, hold leg still, place orange end on outer mid-thigh
4. Push down firmly until a click is heard/felt for 3 sec (1:1000, 0.01mg/kg, max dose is 0.05mg) Then remove Epipen
5. Repeat in 5 mins PRN
List 3 clinical features of (a) chronic bronchitis versus (b) emphysema
Chronic bronchitis
1. Blue bloaters
2. Productive cough with copious sputum often occurring in morning
3. Often obese
4. CXR shows cardiomegaly with large vessels
5. Central cyanosis; signs of cor pulmonale may be present
6. Type II respiratory failure (low pO2, high pCO2)
Emphysema
1. Pink puffers
2. Often thin
3. Dyspnoea
4. CxR shows hyperinflated lungs and small heart
5. Cor pulmonale is a late event
6. Breathing assisted with pursed lips and accessory muscles
List 3 factors which cause a right-sided shift in the oxygen-haemoglobin dissociation curve
1. Increase in H+
2. Increase in CO2 concentration
3. Increase in temperature
[4. Increase in 2,3-BPG]
Outline the pharmacological treatment for mild versus severe pneumonia?
(non-tropical)
mild: amoxicillin + doxycycline
severe: ceftriaxone/cefotaxime + azithromycin
Outline some important features of a medical certificate
1. Demographics (patient + doctor personal information)
2. Details (specifics of illness relevant to certificate requirements)
3. Dates (date of examination, certificate issuing, dates needed off)
(3 D's)
Outline how you would systematically interpret this CXR in line with the protocol (ABCDEFGH)
Summarise the key pathological findings
What features would you expect on clinical examination of this patient?
Patient details: Name & DOB, Date of Scan, View (PA), Presence of radiographer's markings
Technical factors: RIPE
Rotation: medial ends of clavicle are equidistant from the spinous processes
Inspiration: 8-10 ribs posteriorly
Picture: Clavicles are horizontal, Scapula are symmetrical
Exposure: Can see spinous processes through to L4 & cardiac shadow through hemidiaphragm
Airway: Trachea is midline, can see R and L main bronchi and carina
Bones: No rib fractures
Cardiac: Cardiothoracic ratio > 0.5, thus cardiomegaly (boot leg appearance) There is no buldging of any of the heart chambers, or buldging/loss of any heart borders.
Diaphragm: diaphragm appears flattened, perhaps indicative of over-expansion
Effusion: Mild blunting of costophrenic angles
Fields: Able to see pulmonary vessels, however there is bilateral opacities in the lung fields, perhaps indicative of pulmonary congestion; Also Kerley B lines indicative of septal thickening and pulmonary oedema Also able to visual some medical artefacts
Fissures: Difficult to visualise due to pulmonary congestion
Gas: Gastric bubble visible
Hila: pulmonary vasculature in upper zones of lung appears increasingly opacified --> this prominence is perhaps indicative of increased pulmonary venous pressure
Diagnosis: Heart Failure
Clinical features may include:
dyspnoea (esp on exertion), Orthopnea (may sleep with lots of pillows, PND, Peripheral oedema, Persistent cough (productive producing a pink/white-tinged mucus), Fatigue, Weight gain (due to excess fluid)
Summary: This is a PA CXR of Mr Smith, a 71 Y/O M taken on 6/05/2025, for the assessment of shortness of breath. The main findings include cardiomegaly, flattening of the diaphragm (due to over-expansion), mild blunting of costophrenic angles, upper zone vascular prominence with bilateral opacities in the lung fields, indicative of interstitial oedema and pulmonary congestion. These findings are suspicious for heart failure
There are 4 main types of emphysema, 3 of which are related to the anatomy of the lobules of the lung - describe these
1. Centriacinar: affects air sacs closes to bronchioles; key cause is smoking
2. Panacinar: affects entire acinus (i.e gas-exchanging portion of the lung at end of respiratory bronchioles, including alveoli, bronchioles, and blood vessels); key cause is alpha-1 antitrypsin deficiency
3. Paraseptal: rare; affects alveoli near the pleura
1. What is serotonin syndrome? List key features
2. List 2 classes of medications which when used together may cause serotonin syndrome
1. Is caused by an overstimulation of both central and peripheral 5-HT receptors, and involves a triad of mental, autonomic and neurological effects, such as elevated temperature, profuse sweating, hypertension, tremor, myoclonus, coma and possible death.
2. Antidepressants (e.g SSRIS, MAOIs, SNRIs) & Opioid analgesics (tramadol, pethidine, fentanyl)
What does SMART-COP stand for? (< 50 patient)
Systolic BP < 90mmHg
Multilobar involvement
Albumin less than 35g/L
Respiratory rate 25 breaths/min or more
Tachycardia 125bpm or more
Confusion (acute)
Oxygen low (< 93% sats)
PH less than 7.35Outline 3 key types of pneumoconioses?
1. Coal workers pneumoconioses (CWP)
2. Silicosis
3. Asbestosis
John Smith has come in for spirometry
(a) Outline how you would prepare him for this procedure? (i.e think the spirometry protocol)
(b) Describe 3 indications for spirometry
(c) Describe 3 contraindications for spirometry
(d) See his spirometry results - what do his findings indicate and list 3 possible conditions he might have?
(a)
Intro: Hand hygiene, Explain procedure, Consent, Confirm patient details (HECP)
Prepare patient: Sit upright, nose clip and mouth piece
Ask patient to take a deep breath in, seal lips around mouth piece and breathe out as hard and as fast as possible - keep exhaling til your lungs are empty
Obtain 3 acceptable results, discard mouthpiece & repeat hand hygiene
Obtain data and report highest value, then evaluate FEV1/FVC
(b) Indications:
- To assess the management/assist in the diagnosis of obstructive/restrictive lung conditions
- To assess high-risk groups (e.g smokers, people with occupational exposure)
- Investigate signs & symptoms of respiratory disease (e.g SoB, cough, wheeze
(c) Contraindications
- Recent pneumothorax
- Recent AMI or unstable angina
- Recent eye, ENT, thoracic or abdominal surgery
(d) This is a restrictive lung condition - thus, scoliosis, obesity, interstitial lung diseases (e.g idiopathic pulmonary fibrosis), sarcoidosis, neuromuscular disease (e.g muscular dystrophy, ALS)
Outline key signs on examination of COPD
-General inspection
-Percussion
-Auscultation
-General inspection: hyperinflation of chest (increased A-P diameter), reduced chest expansion, tachypnoea, wheeze, pursed lip breathing
-Percussion: hyperresonance
-Auscultation: soft breath sounds and a prolonged expiratory phase