07/01

Question 1

What are the indications for steroid treatment in sarcoidosis?

Answer 1

Parenchymal lung disease
Uveitis
Hypercalcaemia
Neurological or cardiac involvement

Question 2

What is the treatment for an acute exacerbation of COPD?

Answer 2

Amoxicillin or Clarithromycin or Doxycycline

Question 3

What is the most common cause of bacterial exacerbation of bronchiectasis?

Answer 3

H. influenzae

Other causes include pseudomonas aeruginosa, Klebsiella and step pneumoniae

Question 4

What is the management of a primary pneumothorax with no symptoms and <2cm in size?

Answer 4

Discharge and review

Aspiration should only be attempted if pneumothorax is >2cm or patient is symptomatic

Question 5

What clinical sign can help differentiate between a simple and tension pneumothorax?

Answer 5

Patient will be hypotensive

Question 6

What is the management of an acute asthma attack?

Answer 6

1) admit
2) oxygen if hypoxic
3) SABA either via inhaler or nebuliser- repeat as often as needed
4) commence PO prednisolone and continue for 5 days
6) Ipratropium bromide if do not respond to SABA or in severe cases via nebuliser
7) IV magnesium sulphate
8) IV aminophylline following consultation from senior staff
9) Consider ITU admission

Question 7

What are features of Klebsiella pneumonia?

Answer 7

More common in alcoholics and diabetics
Red-currant jelly sputum
Often affects upper lobes

Question 8

What are clinical features of ARDs?

Answer 8

Acute dyspnoea and hypoxia hours/days post even
Multi organ failure
Rising ventilatory pressures

Question 9

What are causes of ARDs?

Answer 9

Sepsis
Direct lung injury
Trauma
Acute pancreatitis
Long bone fractures or multiple fractures
Head injury

Question 10

What are causes of acute mediastinal widening?

Answer 10

Vascular problems e.g. thoracic aortic aneurysm
Lymphoma
Retrosternal goitre
Teratoma
Tumours of the thymus

Question 11

How can you differentiate between a right lower and middle lobe pneumonia?

Answer 11

Lower lobe would obscure the hemidiaphragm whereas the middle would not

Question 12

When diagnosing alpha -1 antitrypsin deficiency what is an important counselling point?

Answer 12

It can be detected pre natally

Question 13

When should non invasive ventilation be considered in patients with COPD?

Answer 13

Acute exacerbation with resp acidosis PaCO2 >6kPA and pH between 7.26 and 7.35 persists despite maximal treatment