Med: Resp

Question 1

Tx of Chronic Asthma

Answer 1

1. SABA
2. SABA + Low ICS
3. SABA + Low ICS + LTRA
4. SABA + Low ICS + LABA +/- LTRA
5. SABA + Low MART +/- LTRA
6. SABA + Med MART +/- LTRA
7. Inc MART Dose or Add Aminophylline

Question 2

Tx of Long-Term COPD

Answer 2

1. SABA + SAMA
2. If signs of asthma or good steroid response: no add LABA+LAMA OR yes add LABA+ICS
3. SABA + LABA + LAMA + ICS

Question 3

What are signs of a good steroid response?

Answer 3

Hx of atopy, high eosinophils, >20% change in FEV1 over time

Question 4

What are the top ddx for a chronic cough in a non-smoker?

Answer 4

Asthma, Post-Nasal Drip, GORD + ask about COVID testing

Question 5

What are heart failure cells?

Answer 5

Iron Laden Macrophages

Question 6

What are the major criteria of ABPA? (5)

Answer 6

Hx of asthma, central bronchiectasis on CXR, immediate skin reactivity to aspergillus antigen, blood eosinophilia, inc serum IgE >1000IU/mL

Question 7

Mx of ABPA

Answer 7

1. Glucocorticoids
2. Itraconazole

Question 8

What are the causes of bronchiectasis?

Answer 8

Idiopathic
Post-Infective
Immunodeficiency

Plus: CF, ABPA, foreign body, tumour, rheumatoid, IBD

Question 9

Ix for Bronchiectasis

Answer 9

Obstrc Spirometry
Sputum Cultures
HRCT

And identify cause: Ig, Sweat Test, Aspergillus Markers

Question 10

What would you see on HRCT in a pt w bronchiectasis?

Answer 10

Dilated thickened airways w evidence of mucus plugging

Question 11

What are the different types of lung cancer?

Answer 11

NSCLC: central squamous + peripheral adenocarcinoma

SCLC: ectopic ACTH + LEMS

Question 12

Which lung cancers are heavily linked to smoking?

Answer 12

Squamous + SCLC

Question 13

Which lung cancers metastasise early?

Answer 13

Adenocarcinoma + SCLC

Question 14

Ix for Lung Cancer

Answer 14

CXR
Volumetric CT
Biopsy

And identify mets: PET-CT w 18-FDG

Question 15

Tx of Lung Cancer

Answer 15

MDT, Chemo, Radio

And if NSCLC: consider lobectomy if localised

Question 16

Tx of Bronchiectasis

Answer 16

MDT, Smoking Cessation, Pulm Rehabilitation

Plus: physio, abx, correct underlying cause

Question 17

Ix for COPD

Answer 17

FBC
BNP
A1AT
PFTs
ABG - evaluate severity of resp failure
CXR
HRCT - looking for distribution of disease if considering pts for lung volume reduction surgery
Echo -
mMRC
GOLD

Question 18

What is the modified MRC dyspnoea scale to assess the functional impairment of COPD?

Answer 18

0. Strenuous
1. Hurrying
2. Walking
3. 100m
4. Dressing

Question 19

Tx of COPD

Answer 19

MDT, Smoking Cessation, Pulm Rehabilitation

Plus: oxygen, bronchodilators, steroids, NIV for abnormal ABG, abx for exacerbation, monitor for lung cancer

Question 20

Ix for Pleural Effusion

Answer 20

CXR
Aspiration (MCS, TB, protein, glucose, pH exclude empyema, LDH, cytology)

Question 21

Tx for Pleural Effusion

Answer 21

MDT
US guided Drain
Tx underlying cause

Question 22

What are the causes of ILD?

Answer 22

Idiopathic
Autoimmune
Hypersensitivity

Plus: sarcoidosis + drugs

Question 23

Which drugs classically cause ILD?

Answer 23

Methotrexate
Amiodarone
Nitrofurantoin

Question 24

Ix for ILD

Answer 24

Drug Hx
Complement
Autoantibodies
Precipitins
CXR
HRCT
PFTs
BAL
Echo

Question 25

What would you see on HRCT in a pt w established ILD?

Answer 25

Honeycombing - IPF Ground Glass - NSIP

Question 26

Tx of ILD

Answer 26

MDT, Smoking Cessation, Pulm Rehabilitation Plus: ambulatory O2, LTOT, antifibrotics for IPF, immunosuppressives for CTD/sarcoid related, transplant workup

Question 27

Asthma vs COPD

Answer 27

Spirometry w reversibility

Question 28

What are the four stages of pneumonia?

Answer 28

Congestion Red Hepatization Grey Hepatization Resolution

Question 29

What are the criteria for discharge following acute asthma?

Answer 29

Stable on discharge meds for >12hrs, PEF >75%, inhaler technique checked and recorded

Question 30

Tx of HAP

Answer 30

Piperacillin-Tazobactam

Question 31

How does NIV work?

Answer 31

It improves the ventilation perfusion mismatch by improving recruitment of collapse alveoli and thus reduces work of breathing

Question 33

What are the top three indications for NIV?

Answer 33

Nasals - Sleep Apnoea - prevents soft palate from closing CPAP - Pulmonary Oedema - reduces LVEDP and afterload BiPAP - COPD - improve both ventilation and tidal volume

Question 35

What must you do before starting a pt on NIV?

Answer 35

CXR: any focal consolidation + a pneumothorax are CIs

Question 36

What is the best predictor for impending need of resp support?

Answer 36

RR >25/min