Respiratory Medicine

Question 1

How is COPD diagnosed?

Answer 1

Post bronchodilator FEV1/FVC < 0.7

Question 2

What is the first line treatment for COPD?

Answer 2

SABA/SAMA

Question 3

What is the second line treatment for COPD if no features of asthma/steroid responsiveness are present?

Answer 3

Add LABA + LAMA

(If already taking SAMA, switch to SABA)

Question 4

What is the second line treatment for COPD if features of asthma/steroid responsiveness are present?

Answer 4

LABA + ICS + LAMA

Question 5

What is the third line treatment for COPD?

Answer 5

Triple therapy - ICS + LABA + LAMA

Question 6

What are the treatment options for COPD?

Answer 6

Physical training
Postural drainage
Antibiotics for exacerbations
Bronchodilators
Immunisations
Surgery

Question 7

Which parameters make up a CURB 65 score?

Answer 7

Confusion
Urea >7
RR > 30
BP SBP <= 90mmHg and/or diastolic <= 60mmHg
65 - Age >= 65

Question 8

Which acute features are seen in sarcoidosis?

Answer 8

Erythema nodosum
Bilateral hilar lymphadenopathy
Swinging fever
Polyarthralgia

Question 9

Which insidious features are seen in sarcoidosis?

Answer 9

Dyspnoea
Non productive cough
Malaise
Weight loss

Question 10

Which skin rashes/lesions are associated with sarcoidosis?

Answer 10

Lupus pernio
Erythema nodosum

Question 11

Which triad are features are characteristic in Granulomatosis with polyangiitis (GPA)?

Answer 11

Haemoptysis
Renal impairment
Saddle nose

Question 12

Which features are seen in moderate acute asthma?

Answer 12

PEFR 50-75%
Speech normal
RR < 25
HR <110 bpm

Question 13

Which features are seen in severe acute asthma?

Answer 13

PEFR 33-50%
Can’t complete sentences
RR > 25
HR >110 bpm

Question 14

Which features are seen in life threatening acute asthma?

Answer 14

PEFR < 33%
SpO2 <92%

Question 15

Which features suggest asthmatic features/steroid responsiveness in COPD?

Answer 15

Asthma/atopy
Eosinophilia
Substantial variation in FEV1
Diurnal variaration in PEF

Question 16

Which antibiotic is given for COPD exacerbation prophylaxis?

Answer 16

Azithromycin

Question 17

Which ABG features are suggestive of chronic CO2 retention in COPD?

Answer 17

Normal pH
Increased PaCO2
Increased bicarb (chronic renal compensation)
Low PO2

Question 18

Which features of Light’s criteria suggest that a pleural effusion is exudative?

Answer 18

LDH >2/3rds upper limit of serum
Pleural fluid LDH/ serum LDH >0.6
Pleural protein / serum protein >0.5

Question 19

How should asthma treatment be stepped down?

Answer 19

Reduced ICS dose by 25-50%

Question 20

How is a primary pneumothorax <2cm with no SOB managed?

Answer 20

Discharge

Question 21

How is a primary pneumothorax <2cm with SOB managed?

Answer 21

Aspiration

Question 22

How is a primary pneumothorax <2cm with SOB managed if initial management fails?

Answer 22

Chest drain

Question 23

How is a secondary pneumothorax >2cm, with SOB, in a patient >50 years managed?

Answer 23

Chest drain

Question 24

How is a secondary pneumothorax with a rim of 1-2cm managed?

Answer 24

Aspiration

Question 25

What can cause anterior mediastinum masses?

Answer 25

Thymoma, thymic mass, thyroid mass, lymphadenopathy.

Question 26

What is the commonest cause of bronchiectasis in children/young people?

Answer 26

Cystic fibrosis

Question 27

What is the second line treatment for asthma?

Answer 27

SABA + ICS + LABA

Question 28

Which features are seen on examination in a haemothorax?

Answer 28

Dull percussion of affected side with absent breath sounds?

Question 29

What is lupus vulgaris?

Answer 29

Painful cutaneous TB lesions. Nodular in appearance

Question 30

Which ABG features are seen in T1RF?

Answer 30

Hypoxia Normal/low PaO2

Question 31

Which ABG features can be seen in PE?

Answer 31

Low Co2, increased pH (respiratory alkalosis) V/Q mismatch - increased respiratory drive

Question 32

What is the commonest lung injury following blunt trauma?

Answer 32

Pulmonary contusion

Question 33

Which condition can cause hyper-resonance on percussion?

Answer 33

Pneumothorax Emphysema

Question 34

How does Strep. pneumoniae pneumonia typically present?

Answer 34

CAP Rust coloured "blood tinged" sputum Lobar pattern of infection

Question 35

What is the first line management for HAP?

Answer 35

Co-amoxiclav

Question 36

What is the second line management for HAP?

Answer 36

Doxycycline

Question 37

What are the top 3 causes of pleural effusion?

Answer 37

Malignancy Heart failure Pneumonia

Question 38

Define mild COPD

Answer 38

FEV1 >80%

Question 39

What is the rationale for prescribing ICS in COPD patients?

Answer 39

Reduces frequency of exacerbations