03/03

Question 1

What are features of life threatening asthma?

Answer 1

PEF <33% of predicted
Sats <92%
Normal pCO2
Silent chest/ cyanosis/poor resp effort
Bradycardia or hypotension
Exhaustion, confusion or coma

Question 2

When should LTOT be offered to patients with COPD?

Answer 2

PaO2 <7.3kPa after 2 ABG

OR

PaO2 7.3-8 kPa plus one of the following

• secondary polycythaemia
• peripheral oedema
• pulmonary hypertension

Cannot be offered to patients who refuse to stop smoking despite support and programmes being offered

Question 3

What are features of pulmonary fibrosis?

Answer 3

Exertional dyspnoea
Clubbing
Dry cough
Bi-basal fine end inspiratory crepitations

Question 4

How can thoracic kyphosis impact on lung function?

Answer 4

It is a restrictive chest wall disease- meaning the lungs cannot expand as well as they would like to

• causes an increase in FEV1:FVC
• a normal or decreased TLCO
• an increased transfer coefficient
• massively reduced FVC
• reduced FEV1

Question 5

What are causes of increase TLCO?

Answer 5

Asthma
Pulmonary haemorrhage e.g. Wegeners
Left to right cardiac shunts
Polycythaemia 
Exercise

Question 6

What are causes of decreased TLCO?

Answer 6

Pulmonary fibrosis
Pneumonia
PE
Emphysema
Pulmonary oedema 
Anaemia
Poor CO

Question 7

What testing is needed in adults with suspected asthma?

Answer 7

Spirometry with bronchodilator reversibility

FeNo testing

Question 8

What is the mode of action of varencline?

Answer 8

Partial nicotine receptor agonist

Most common SE- nausea

Question 9

What is the mode of action of bupropion?

Answer 9

A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Small risk of seizures
Contraindicated in epilepsy, pregnancy and breast feeding

Question 10

What scale is used to determine likelihood of obstructive sleep apnoea?

Answer 10

Epworth scale

Question 11

What vasculitis can cause nasal polyps?

Answer 11

Churg Strauss syndrome

Question 12

What criteria needs to be met in order for a diagnosis of asthma to be made?

Answer 12

Exhaled FeNo testing of >40
Post bronchodilator improvement
-Total long volume >200ml
-FEV1 >12%

PEF variability of 20%
FEV1:FVC <0.7

Question 13

What are causes of ARDs?

Answer 13

Infection
Acute pancreatitis
Smoke inhalation
Trauma
Massive blood transfusion

Question 14

What are features of ARDs?

Answer 14

Dyspnoea
Raised resp rate
Bilateral lung crackles
Low sats