RESPIRATORY

Question 1

severity of airflow obstruction can be graded according to

Answer 1

predicted FEV1 following the use of bronchodilators

Question 2

severity of airflow obstruction, stages

Answer 2

FEV1 > 80% stage 1 or mild COPD

FEV1 50–79% stage 2 or moderate COPD

FEV1 30–49% stage 3 or severe COPD

FEV1 < 30% stage 4 or very severe COPD

Question 3

appropriate tool to use for the annual review of asthma in a child aged four years

Answer 3

Childhood Asthma Control Test (or Mini Asthma Quality of Life Questionnaire or Paediatric Asthma Quality of Life Questionnaire)

Question 4

clinical feature is MOST likely to suggest an alternative diagnosis to chronic obstructive pulmonary disease (COPD)

Answer 4

Haemoptysis

Question 5

assessment of patients for LTOT should include the measurement of arterial blood gases when

Answer 5

two occasions at least three weeks apart

Question 6

What is the threshold NUMBER of exacerbations per year, if any, after which long-term antibiotics are recommended for treating adult bronchiectasis?

Answer 6

3

Question 7

If inhaled corticosteroids are not controlling a person’s asthma symptoms, then NICE recommendswhat to add

Answer 7

leukotriene receptor antagonist (LTRA)

Question 8

If inhaled corticosteroids are not controlling a person’s asthma symptoms, then BTS/SIGN recommend

Answer 8

adding in a long-acting beta-2 agonist

Question 9

acute severe asthma episode is defined as any one of

Answer 9

Peak expiratory flow (PEF) 33–50% best or predicted

respiratory rate ≥ 25 breaths per minute

heart rate ≥ 110 beats per minute

inability to complete sentences in one breath

Question 10

CRB65 -RR and BP

Answer 10

RR >=30, SBP <=90, DBP <=60

Question 11

steroid and dose for ECOPD

Answer 11

pred 30mg for 5 days

Question 12

drugs which may cause pulmonary fibrosis

Answer 12

nitrofurantoin, methotrexate, cytotoxic drugs, amiodarone, heroine

Question 13

suspicion for lung cancer - next step

Answer 13

get urgent chest xray

Question 14

indications for urgent referral to respiratory for cancer?

Answer 14

needs to have chest xray first (CT scan indicated, or persistent haemoptysis for smokers/exsmokers age 40 or over)

Question 15

asthma would be defined as life-threatening when

Answer 15

Peak expiratory flow rate (PEFR) < 33% best or predicted

Pulse oximeter oxygen saturation < 92%

Altered conscious level

Exhaustion

Arrhythmia

Hypotension

Cyanosis

Silent chest

Question 16

age when LTRA is added after SABA

Answer 16

2-5 years old

Question 17

treatment for pseudomonas in bronciectasis

Answer 17

cipro for 7-14 days

Question 18

NICE) advises that an urgent chest X-ray should be considered to assess for lung cancer in people aged 40 years or over with any of the following

Answer 18

Persistent or recurrent chest infection

Finger clubbing

Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy

Chest signs consistent with lung cancer

Thrombocytosis

Question 19

indication of endometrial cancer and therefore pelvic ultrasound should be considered in women aged 55 years and over

Answer 19

Thrombocytosis with visible haematuria or vaginal discharge

Question 20

occupational asthma involves peak flow reading at work and at home twice each for how many weeks

Answer 20

3 weeks

Question 21

characterised by the development of large conglomerate masses of dense fibrosis usually in the upper lung zones usually caused by methotrexate and rheumatoid arthritis

Answer 21

Progressive massive fibrosis

Question 22

how many days of antibiotic course should be started for infective exacerbations of bronchiectasis

Answer 22

7-14 days

Question 23

TEST recommended to confirm a diagnosis of COPD

Answer 23

Post-bronchodilator spirometry

Question 24

alternative treatment’ for her mild intermittent asthma

Answer 24

Behavioural programmes centred on breathing exercises such as the Buteyko metho

Question 25

percentage of cases of occupational asthma is caused by sensitiser-induced disease

Answer 25

90

Question 26

why long-acting muscarinic antagonists (LAMAs) are NOT recommended for people with acute asthma

Answer 26

The onset of bronchodilation is too slow

Question 27

disease associated with non-cystic fibrosis bronchiectasis

Answer 27

Rheumatoid arthritis

Question 28

For CAP, patients can expect what to resolve in how many weeks (5x)

Answer 28

One week: the fever should have resolved Four weeks: the chest pain and sputum production should have substantially reduced Six weeks: the cough and breathlessness should have substantially reduced Three months: most symptoms should have resolved but fatigue may still be present Six months: most people will feel back to normal

Question 29

Spirometry may under-diagnose and over-diagnose what population

Answer 29

under-diagnose younger adults and over-diagnose elderly patients

Question 30

Need for LTOT in COPD is assessed by measuring ABG when

Answer 30

on two occasions, at least three weeks apart

Question 31

In COPD, Long-term oxygen should be offered to those with a partial pressure of oxygen (PaO2) of

Answer 31

< 7.3 kPa when stable or < 7.3 kPa and < 8 kPa when there is associated peripheral oedema, pulmonary hypertension, secondary polycythaemia or nocturnal hypoxaemia, or oxygen saturation levels are 92% or less breathing air

Question 32

first-line treatment for patients with progressive chronic pulmonary sarcoidosis

Answer 32

Prednisolone

Question 33

Finger clubbing is suggestive of which dieases (3x)

Answer 33

lung cancer, interstitial lung disease, or bronchiectasis. NOT COPD

Question 34

risk factors for continuing symptoms of post-acute COVID-19 (4x)

Answer 34

Older age, high BMI, female sex and asthma

Question 35

When is pulmonary rehabilitation indicated for management of COPD

Answer 35

indicated in patients who have functional impairment or an MRC dyspnoea score of 3 or above

Question 36

Basic support for patients with COPD (3x)

Answer 36

supported to stop smoking and offered a pneumococcal vaccination and an annual influenza vaccination

Question 37

Long term oxygen therapy (LTOT) should be prescribed for at least

Answer 37

15 hours a day

Question 38

high-risk CAP treatment

Answer 38

Co-amoxiclav + clarithromycin

Question 39

patient on regular low dose ICS + SABA - not working, next step?

Answer 39

Switch to MART

Question 40

Pulmonary fibrosis spirometry

Answer 40

proportionally reduced FEV1 and FVC, FEV1/FVC>70

Question 41

GOLD guidelines recommend additional investigations at the diagnosis of COPD with

Answer 41

chest x-ray, pulse oximetry and alpha-1 antitrypsin deficiency screening

Question 42

The typical COPD patient tends to present at a younger age (<45 years) with

Answer 42

lower lobe emphysema

Question 43

self-management plan option for exacerbations should be advised for asthma according to NICE

Answer 43

quadrupling inhaled corticosteroid (ICS) therapy

Question 44

staging of COPD is based on

Answer 44

FEV1 % of predicted

Question 45

Exertional saturations should only be checked in patients with

Answer 45

resting saturations of 96% and higher who have exertional symptoms such as breathlessness or light-headedness.

Question 46

NICE guidelines recommend additional investigations at the diagnosis of COPD with

Answer 46

BMI, FBC

Question 47

recommended management of non-cystic fibrosis bronchiectasis

Answer 47

Airway clearance techniques

Question 48

percentage of cases of occupational asthma is caused by sensitiser-induced disease?

Answer 48

90

Question 49

recommended duration of abx for bronchiectasis if indicated

Answer 49

14 days

Question 50

findings support a diagnosis of asthma (feno, fev1, pef)

Answer 50

eosinophil count is above the laboratory reference range -FeNO level is 50 ppb or more. - if the FEV1 increase is 12% or more and 200 ml or more from the pre-bronchodilator measurement on spirometry. - if PEF variability (expressed as amplitude percentage mean) is 20% or more.

Question 51

antibiotic is the preferred antibiotic to reduce the number of infective exacerbations for bronchiectasis

Answer 51

azithromycin

Question 52

Patient on CPAP for OSA, DVLA reqs for renewal of licence (Group 1 and 2)

Answer 52

Group 1 - every 3 years, Group 2 - every year review

Question 53

Which has more excacerbations and by how much, COPD or ACOS

Answer 53

ACOS, three times

Question 54

should be referred for specialist assessment due to the need for further investigations

Answer 54

People with suspected occupational asthma

Question 55

latest asthma guidance states that in a patient with symptoms, what are required to diagnose asthma

Answer 55

abnormal FENO (>50ppb) or raised serum eosinophils

Question 56

first line diagnostic test for asthma for adults

Answer 56

blood eosinophils or FeNO

Question 57

first line diagnostic test for asthma for children

Answer 57

FeNO

Question 58

suspected asthma, first line diagnostic is normal, next? Results?

Answer 58

do spirometry, FEV1 >=12% and in adults must be >=220mL increase OR FEV1 >=10% predicted

Question 59

if second line diagnostics for asthma normal or not available, what to do next and result?

Answer 59

Peak flow variability for 2 weeks. Asthma is confirmed if PEF variability >= 20%

Question 60

If Peak flow variability is normal in trying to diagnose asthma, what to do in children and asults?

Answer 60

Children: do skin prick for house or dust mite OR total IgE AND eosinophils (positive if IgE raised AND eosinophils >0.5) Adults: bronchial challenge test

Question 61

Asthma OUT OF CONTROL if any of

Answer 61

Restricting normal activities. Exacerbation requiring oral steroids. Using reliever inhaler ≥3 days/week Waking due to asthma ≥1 nights/w.