05/01

Question 1

What smoking cessation therapy is first choice in pregnancy?

Answer 1

Nicotine replacement therapy

Others are contraindicated

Question 2

What options are there for smoking cessation therapy?

Answer 2

NRT, Bupropion and Varenicline

Question 3

What are the side effects of NRT?

Answer 3

Headache, flu like illness, N&V

Question 4

How long should a course of varenicline go on for?

Answer 4

Began 1wk before target stop date and continued for 12wks as long as patient is not smoking

Question 5

What are the side effects of varenicline?

Answer 5

Headache
Insomnia 
Nausea
Abnormal dreams
Thought to increase risk of suicide in depressed patients so caution

Question 6

What are side effects of bupropion?

Answer 6

Seizures- contraindicated in epilepsy

Should be started 1-2wks before target stop date

Question 7

What antibiotic is used as prophylaxis for infections in patients with COPD?

Answer 7

Azithromycin

Only done if patient has recurrent exacerbations, do not smoke, are good with medications and have relevant vaccinations

Question 8

What is transfer factor?

Answer 8

The rate in which a gas is transported from the alveoli into the blood

Question 9

What causes an increase in transfer factor?

Answer 9

Asthma
Male
Exercise
Left to right cardiac shunts
Polycythaemia

Question 10

What causes a decrease in transfer factor?

Answer 10

Pulmonary fibrosis
PE
Pulmonary oedema
Pneumonia

Question 11

What is the optimal way to administer a dose from a pressurised meter dose inhaler?

Answer 11

Shake inhaler
Breathe out gentley
Place inhaler in mouth and breathe in deeply and slowly as you press the button
Hold breath for 10 seconds

Wait 30 seconds before repeating dose

Question 12

If a patient with COPD has pneumonia, what additional medication should be given?

Answer 12

Prednisolone- even if no sign of COPD exacerbation

Question 13

How is COPD staged?

Answer 13

Based on FEV1:FVC and FEV1 predicted

Question 14

What is stage 1 (mild) COPD?

Answer 14

FEV1: FVC <0.7

FEV1 >80%

Question 15

What is stage 2 (moderate) COPD?

Answer 15

FEV1:FVC <0.7

FVEV1 50-79%

Question 16

What is stage 3 (severe) COPD?

Answer 16

FEV1:FVC <0.7

FEV1 30-49%

Question 17

What is stage 4 (very severe) COPD?

Answer 17

FEV1:FVC <0.7

FVC <30%

Question 18

How should asthma treatment be stepped down?

Answer 18

Work backwards down the asthma treatment pathway

Aim for a reduction in dose by 25-50% (depending on what you are reducing)

Question 19

What is sarcoidosis?

Answer 19

Multisystem disorder of unknown cause

Non caseating granulomas (areas of inflammation)

Question 20

What are symptoms of sarcoidosis?

Answer 20

Hypercalcaemia
Parotid swelling
Facial palsy 
Erythema nodosum
Eye problems
Swinging fever
Persistent cough
Hilar lymphadenopathy

Question 21

What are the causes of a white out on CXR?

Answer 21

Pleural Effusion
Consolidation
Collapse
Specific lesions e.g. tumour
Pneumonectomy

Question 22

What causes tracheal deviation towards white out on CXR?

Answer 22

Pneumonectomy
Lung collapse
Pulmonary hypoplasia

Question 23

What causes tracheal deviation away from whiteout on CXR?

Answer 23

Pleural Effusion
Diaphragmatic hernia
Thoracic mass

Question 24

What is raised in sarcoidosis?

Answer 24

Serum ACE is raised in 60% of patients

Question 25

What are the symptoms if idiopathic pulmonary fibrosis?

Answer 25

``` Exertional Dyspnoea Dry Cough Weight Loss Clubbing More common in men Peak age 50-70 ```

Question 26

When should a chest drain be inserted in a pneumothorax?

Answer 26

Primary - >2cm Secondary - >50yo and >2cm - 1-2cm then attempt aspiration - <1cm admit and observe - all pts should be admitted for 24 hrs

Question 27

How do panic attacks present on ABG?

Answer 27

``` Hyperventilation Resp alkalosis (low CO2) Normal oxygen as no impairment of gas exchange ```

Question 28

What is the most common cause of infective exacerbations of COPD?

Answer 28

H.influenzae | Treat with amoxicillin

Question 29

How is occupational asthma diagnosed?

Answer 29

Serial peak flow readings both inside and outside of work Then referred to resp medicine where they can have IgE testing

Question 30

What spirometry picture does pulmonary fibrosis give?

Answer 30

FEV1:FVC >0.7 FVC reduced Transfer capacity reduced Is a restrictive picture

Question 31

How can exudative pleural effusion be diagnosed?

Answer 31

Protein level >30g/L Or Lights Criteria (at least one should be met) - pleural fluid protein divided by serum protein >0.5 - pleural fluid LDH divided by serum LDH >0.6 - Pleural fluid LDH more than 2 times upper normal limit of serum

Question 32

What are exudative causes of pleural effusion?

Answer 32

Lung Cancer Pneumonia RA TB

Question 33

What are transudative causes of pleural effusion?

Answer 33

Congestive cardiac failure Hypoalbuminaemia e.g. Nephrotic Syndrome Meig Syndrome Hypothyroidism