Pulmonology

Question 1

Criteria for Asthma Severity

Answer 1

Daytime Symptoms
Limitation of Activities
Nocturnal Symptoms
Need for Reliever
Lung Function
Exacerbation

Question 2

Controlled Asthma

Answer 2

All of the ff

Daytime Symptoms       2x or less / week
Limitation of Activities   
Nocturnal Symptoms     
Need for Reliever           2x or less / week
Lung Function                Normal
Exacerbation

Question 3

Partly Controlled Asthma

Answer 3

Any measure present

Daytime Symptoms       > 2x / week
Limitation of Activities         Any
Nocturnal Symptoms          Any
Need for Reliever            >2x / week
Lung Function

Question 4

Uncontrolled Asthma

Answer 4

3 or more

Daytime Symptoms
Limitation of Activities
Nocturnal Symptoms
Need for Reliever
Lung Function

Question 5

Asthma Lung Function

Answer 5

• FEV1 increase by >12% and 200ml after inhaling bronchodilator
• average diurnal PEF variability is > 10%
• FEV1 increase by >12% and 200ml after 4 weeks of anti inflammatory treatment

Question 6

Talks in phrases, prefers sitting to lying, not agitated

Answer 6

Mild or moderate

Question 7

RR below 30

Answer 7

Mild or moderate exacerbation

Question 8

No use of accessory muscles

Answer 8

Mild or moderate exacerbation

Question 9

Pulse rate 100-120

Answer 9

Mild or moderate exacerbation

Question 10

O2 Sat 90 - 95

Answer 10

Mild or moderate exacerbation

Question 11

Peak Expiratory Flow > 50% predicted

Answer 11

Mild or moderate exacerbation

Question 12

Treatment:
SABA
Ipratropium bromide
Prednisolone 1mg/kg PO
Controlled O2

Answer 12

Mild or moderate exacerbation

Question 13

Spirometry findings of COPD

Answer 13

TLC, FRC, RV - may be INCREASED

^ air trapping

Question 14

Indications for thoracentesis in parapneumonic effusion:

Answer 14

1) loculated pleural fluid

2) pleural fluid pH

Question 15

Virchow’s Triad

Answer 15

1) inflammation
2) hypercoaguability
3) endothelial injury

Question 16

Management of ARDS

Answer 16

Lower Tidal Volume by setting it to 6ml/kg

Give positive end expiratory volume

Question 17

Asthma Controller Management

Answer 17

Steps
Step 1: SABA
Step 2: SABA + low dose ICS
Step 3: SABA + low dose ICS/LABA
orrrrrrr ICS/Formoterol maintenance + reliever therapy
Step 4: Low dose ICS/Formoterol maintenance + reliever therapy
orrrrrrr medium dose ICS/LABA + SABA
Step 5: refer to expert investigation
Add on treatment: Omalizumab (anti IgE) low dose oral
steroids

Question 18

MV setting for neuromuscular disease

Answer 18

10-12ml/kg

Question 19

O2 flow to FiO2 in nasal cannula

Answer 19

O2 flow x 4 plus 20. Up to 6 only

Question 20

Low Risk CAP VS

Answer 20

Stable

RR = 90/60

Question 21

Low Risk CAP features

Answer 21

No altered mental state of acute onset
No suspected aspiration
No or stable comorbids

Question 22

Stable

RR = 90/60

Answer 22

Low Risk CAP

Question 23

No altered mental state of acute onset
No suspected aspiration
No or stable comorbids

Answer 23

Low Risk CAP

Question 24

Moderate Risk CAP

Answer 24

RR >= 30
PR >= 125
Temp >40 or

Question 25

Moderate Risk CAP features

Answer 25

Altered mental state of acute onset Suspected aspiration Decompensated comorbidities

Question 26

Moderate Risk CAP disposition

Answer 26

Ward admission

Question 27

Empiric Therapy for Low Risk CAP. Previously healthy

Answer 27

Amoxicillin or extended macrolides (azithromycin)

Question 28

Empiric Therapy for Low Risk CAP. With stable comorbid illness

Answer 28

Beta-lactate/beta-lactamase inhibitor combination (e.g. amoxicillin-clavulanic acid, amoxicillin-sulbactam, sultamicillin) Or 2nd generation oral cephalosporins (e.g. Cefaclor, cefuroxime) +/- extended macrolides (e.g. Azithromycin, clarithromycin) ALTERNATIVE: 3rd generation oral cephalosporin (e.g. Cefdinir, cefixime, cefpodoxime) +/- extended macrolide