Rep

Question 1

Active TB investigation

Answer 1

Sputum MCS (3 if pulmonary/1 if extra)
- Acid fast bacilli (Ziehl-neelsen/Auramine 24-48hrs)
- NAAT (quickest test and should be performed at least on one specimen)
- Culture (6 weeks)

CXR - cavitation, pleural effusion, BHL, upper lobe parenchymas infiltrates

Question 2

Investigations for latent TB

Answer 2

Mantoux test (tuberculin skin test) - >5mm induration after 2-3 days

IFN-gamma release assay

Question 3

PE confirmed Haemodynamically unstable management

Answer 3

Unfractionated heparin infusion
Alteplase for thrombolysis
DOAC afterwards

Question 4

GOLD COPD

Answer 4

FEV1 percentage
1: > 80%
2: < 80%
3: < 50%
4: < 30%

Question 5

Hospital management for asthmatic exacerbations

Answer 5

O2 targeted to 94%-98%
SABA by pMDI or nebulised if life threatening/near fatal
Oral Prednisolone for 5 days/ IV hydrocortisone
Ipratropium bromide is severe/life threatening

Magnesium sulphate can also be given if nothing else works
IV aminophylline after if nothing else

Question 6

Non small cell lung cancer management

Answer 6

Stage I/II:
- lobectomy/pneumectomy (SABR if not suitable for surgery)
- post operative chemo (Ib/II) or radio (II + high risk)

Stage III:
- Pre-op chemo/chemoradiotherapy
- Lobectomy/pneumectomy
- Consider post op chemoradiotherapy

Stage IIIb/c (tumours too extensive for chemoradiotherapy) or stage IV:
- Supportive care, mutation specific treatments +/- chemotherapy

Question 7

Management for small cell lung cancer

Answer 7

Chemotherapy
Radiotherapy (only if limited at presentation)
Prophylactic cranial irradiation

If relapsed, chemo/radiotherapy again

Question 8

For pulmonale management

Answer 8

Loop diuretic
LTOT considered

Question 9

Drug class of ipratropium bromide

Answer 9

SAMA

In asthmatic severe/life threatening exacerbations
In COPD regular pathway

Question 10

COPD exacerbation management in GP

Answer 10

Increase bronchodilator use
Oral Prednisolone 5 days
Amoxicillin/clarithromycin/doxycycline if purulent sputum or pneumonia (CXR)

Question 11

COPD exacerbation management in hospital

Answer 11

Nebulised bronchodilator
Oral prednisolone/IV hydrocortisone (5 days)
Theophylline if nebulised bronchodilator not working

LTOT if pO2 < 7.3 or 7.3-8 if:
- polycythaemia, peripheral oedema, pulmonary hypertension

Bi-PaP (non invasive ventilation) if ARDS2

Question 12

Asthma diagnosis in adults

Answer 12

Spirometry with BDR > 12% improvement/increase in volume of 200ml

FeNO > 40 parts per billion

Question 13

Tuberculosis management

Answer 13

4 for 2 months then 2 for 4:
- isoniazid + rifampicin

Latent:
- 3 months isoniazid + rifampicin or 6 months of isoniazid

B6 always given with isoniazid