Resp - Useful facts from Passmed

Question 1

What situations would O2 therapy not be indicated if there is no evidence of hypoxia?

Answer 1

Situations where oxygen therapy should not be used routinely if there is no evidence of hypoxia:

• myocardial infarction and acute coronary syndromes
• stroke
• obstetric emergencies
• anxiety-related hyperventilation

Question 2

When is Non-invasive ventilation indicated?

Answer 2

Non-invasive ventilation - key indications

• COPD with respiratory acidosis pH 7.25-7.35
• type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
• cardiogenic pulmonary oedema unresponsive to CPAP
• weaning from tracheal intubation

Question 3

When is NIV contraindicated?

Answer 3

Pneumothorax

Vomiting

Question 4

When should you offer long term oxygen therapy?

Answer 4

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

• secondary polycythaemia
• peripheral oedema
• pulmonary hypertension

Question 5

Conditions with finger clubbing

Answer 5

IPF

Bronchiectasis

Lung cancer

Mesothelioma

CF

Ulcerative Colitis

Question 6

Cancers with raised platelets

Answer 6

Cancers with raised platelets - LEGO-C

• Lung
• Endometrial
• Gastric
• Oesophageal
• Colorectal

Question 7

Which lung cancer is most associated with Gynaecomastia?

Answer 7

Gynaecomastia in particular is associated with lung adenocarcinoma

Question 8

What diseases occur in upper lobe and lower lobe?

Answer 8

upper lobe:

C: Coal workers pneumoconiosis
H: Histiocytosis/Hypersensitivity pneumonitis
A: Ankylosing spondylitis/Allergic bronchopulmonary Aspergillosis
R: Radiation
T: TB
S: silicosis/sarcoidosis

lower lobe:

A: Asbestosis
C: Connectve Tissue disorders
I: idiopathic pulmonary fibrosis
D: drugs (amiodarone, methotrexate, bleomycin)

Question 9

Which smoking cessation treatments are contraindicated in pregnant women?

Answer 9

Varenicline and bupropion are contraindicated

Question 10

Side effects of Infliximab, Hydroxychloroquine, sulphasalazine, azathioprine, methotrexate

Answer 10

Infliximab - reactivation of TB, HBV, and demyelinating disease

Hydroxychloroquine - Corneal deposits and retinopathy

Sulphasalazine - oligospermia, rash, folate deficiency and megaloblastic/ Heinz body anaemia

Azothiaprine - Skin cancer (SCC), lymphoma, gout

Methotrexate - Myelosuppression, ILD/ pneumonitis and liver toxicity

Question 11

What is an important complication of COPD?

Answer 11

Polycythaemia is a complication of COPD

Long term COPD can cause secondary polycythaemia due to hypoxaemia

This causes the body to produce more red blood cells and thus polycythaemia

Question 12

Acronym for causes of upper zone fibrosis

Answer 12

CHARTS

• C - Coal worker’s pneumoconiosis
• H - Histiocytosis/ hypersensitivity pneumonitis
• A - Ankylosing spondylitis
• R - Radiation
• T - Tuberculosis
• S - Silicosis/sarcoidosis

Question 13

Triad for Meig’s Syndrome, way to remember it

Answer 13

‘Meigs BAPs’

• Benign ovarian tumour
• Ascites
• Pleural effusion

Question 14

Mnemonic for finger clubbing

Answer 14

Respiratory causes of clubbing (A-F):

• Abscess
• Bronchiectasis
• Cancer
• DON’T SAY COPD
• Empyema
• Fibrosis

Question 15

In acute asthma, what observation and what measurement would indicate an ABG?

Answer 15

In acute asthma, the BTS guidelines only recommend ABGs for patients with oxygen sats < 92%

Question 16

Examples of ICS drugs

Answer 16

beclometasone, budesonide, ciclesonide, fluticasone, and mometasone

Question 17

What do you give to patients with pneumonia in addition to antibiotics if they have COPD?

Answer 17

Patients diagnosed with pneumonia who have COPD should be given corticosteroids even if no evidence of the COPD being exacerbated

Question 18

What part of the lung is emphysema more present in, in A1AT and COPD

Answer 18

Emphysema is most prominent in the lower lobes in A1AT deficiency and the upper lobes in COPD