resp

Question 1

Which drugs should you avoid giving to asthma pts?

Answer 1

Aspirin

Beta blockers

Question 2

What Ix would you do first in a patient suspected asthma?

Answer 2

PEF and spirometry

Question 3

Outline the stages of management for asthma

Answer 3

1) SABA
2) SABA + inhaled steroid (beclomethasone dipropionate)
3) SABA + ICS + LTRA/LABA

Question 4

What are the markers of severe asthma?

Answer 4

PEF 33-50
RR > 25
HR >110
Inability to complete sentences

Question 5

What are the markers of life-threatening asthma?

Answer 5

PEF<33%
SpO2 < 92%
PaO2 < 8kPa
Silent chest
Confusion
Exhaustion

Question 6

What tx should be considered if an acute exarcerbation of asthma is not responding to inhaler and steroid tx?

Answer 6

Single dose magnesium sulphate or IV salbutamol

Question 7

What would a CXR show in COPD?

Answer 7

Flattened diaphragms due to over inflation

Question 8

What are the management stages for COPD?

Answer 8

1) SABA or SAMA
2) No asthmatic features = LABA + LAMA
OR asthmatic features (low FEV1/obstructive) = LABA + ICS
3) Triple therapy (LABA, LAMA + ICS)

Question 9

What is the tx for acute COPD exarcerbation?

Answer 9

SABA + SAMA + pred PO + O2

Only abx if clinically indicated

Question 10

When do you diagnose HAP instead of CAP?

Answer 10

If pneumonia develops greater than 2 days post admission

Question 11

Outline the CURB 65 score?

Answer 11

Confusion
Urea > 7
Resp rate > 30
BP < 90/60
>= 65

Question 12

What score in the CURB 65 score corresponds to what?

Answer 12

0-1 PO amox at home
2 hospital tx with PO amox and clarith
3-5 - hospital tx with IV co-amox

Question 13

What test can you do for legionella/pneumococcal?

Answer 13

Urinary antigen test

Question 14

Name two tests for latent TB

Answer 14

Tuberculin skin test (Mantoux)

Interferon gamma release assay

Question 15

How is active TB infection diagnosed?

Answer 15

CXR
3 X sputum acid fast bacilli smear
Sputum culture
NAAT of sputum if rapid dx needed

Question 16

What are the advantages of using NAAT to dx TB?

Answer 16

Rapid (useful if immunocompromised pt)

Provides information about drug resistance

Question 17

What is TB tx?

Answer 17

6M Rifampicin and isoniazid

2M pyrazinamide and ethambutol

Question 18

SEs of TB drugs

Answer 18

Rifampicin = orange secretions , liver enzyme inducer
Isoniazid = peripheral neuropathy
Pyrazinamide = hepatotoxic
Ethambutol = colour blindness/ optic neuritis

Question 19

What tests are important to do before starting TB tx?

Answer 19

LFTs and vision testing

Question 20

How are PEs/DVTs prevented in hospital?

Answer 20

Heparin to all immobile pts
Stop HRT and COCP pre-op
Compression stockings

Question 21

What spirometry pattern is seen in restrictive lung disease?

Answer 21

FEV1 and FVC less than 80% predicted

FEV1/FVC ratio normal (>0.7)

Question 22

What spirometry pattern is seen in obstructive lung disease?

Answer 22

FEV1 < 80% predicted
FVC normal/low
FEV1/FVC less than 0.7

Question 23

What are the features of pulmonary fibrosis? (4Ds)

Answer 23

Dry cough
Dyspnoea
Digital clubbing
Diffuse inspiratory crackles

Question 24

What does a CT show in idiopathic pulmonary fibrosis?

Answer 24

Honeycombing

Question 25

What drug can help tx IPF?

Answer 25

Pirfenidone

Question 26

Name some supportive mx options in IPF

Answer 26

o2, PT, exercise, weight loss, vaccinations, smoking cessation steroids for acute exarcerbations

Question 27

What criteria is used to determine whether a pleural effusion is an exudate or transudate?

Answer 27

Lights criteria

Question 28

What are the causes of bilateral hilar lymphadenopathy?

Answer 28

``` (TIMES) TB Inorganic dust (silicosis) Malignancy EAA Sarcoidosis ```

Question 29

How do you tx a tension pneumothorax?

Answer 29

Large bore cannula in second intercostal space mid clavicular Aim just above rib to miss neurovascular bundle

Question 30

Which bacteria most commonly affects CF sufferers?

Answer 30

Pseudomonas aeruginosa

Question 31

What ix for bronchiectasis/

Answer 31

Sputum culture CXR HRCT chest Spirometry - obstructive

Question 32

Tx of bronchiectasis

Answer 32

Exercise Airways clearance physio If culture +ve - always give abx

Question 33

Which 4 conditions can aspergillus cause?

Answer 33

Asthma exarcerbation Allergic bronchopulmonary aspergillosis Aspergilloma Invasive aspergillosis

Question 34

What blood test is used to dx CF in neonates?

Answer 34

Immunoreactive trysinogen

Question 35

What are the signs on ECG of pulmonary htn?

Answer 35

P pulmonale Right axis deviation RV hypertrophy

Question 36

What are the types of lung Ca?

Answer 36

Small cell | Non-small cell (squamous, large cell, adenocarcinoma)

Question 37

What are the features of goodpastures syndrome?

Answer 37

Glomerulonephritis and pulmonary haemorrhage

Question 38

What Ix diagnoses goodpastures syndrome/

Answer 38

Anti-GBM Abs

Question 39

What abx would you use for atypical pneumonia such as legionella?

Answer 39

Clarithromycin (macrolides)

Question 40

What are the causes of a transudate pleural effusion?

Answer 40

Heart failure Nephrotic syndrome Liver cirrhosis Hypoalbuminaemia

Question 41

What is Lofgren syndrome?

Answer 41

``` BHL Erythema nodosum Arthralgia Fever (favourable prognosis of sarcoidosis) ```

Question 42

Which chromosome carries the gene defect in cystic fibrosis?

Answer 42

7

Question 43

What are the components of virchows triad?

Answer 43

Circulatory stasis Hypercoaguble state Endothelial injury

Question 44

What is the anion gap equation?

Answer 44

(sodium + potassium) - (chloride + bicarbonate)

Question 45

What does a normal anion gap in acidosis indicate?

Answer 45

Increased bicarbonate losses (e.g. diarrhoea) | Acid ingestion

Question 46

What is the diagnostic test for bronchiectasis?

Answer 46

HRCT - signet ring sign