Chronic pulmonary infection

Question 1

Commonest cause of immunodeficiency

Answer 1

CVID

Question 2

Organism which might cause empyema/abscess after flu?

Answer 2

Staph (CAVITATES!)

Question 3

When does an effusion need drained?

Answer 3

pH 1000

glucose

Question 4

Strep milleri

Answer 4

Gram positive

Question 5

Staph aureus

Answer 5

Usually psot op, or nosocmial

Immunocompromised

Question 6

D sign

Answer 6

Empyema!

Question 7

Treatment for empyema (Abx)

Answer 7

IV

Amoxicillin and metronidazole!!

Question 8

Treatment for bronchiectasis

Answer 8

Stop smoking
Pneumococcal vaccine
When colonised with persistent bacteria
– Prophylactic antibiotics
– Nebulised colomycin
– Pulsed IV abx
– Alternating oral antibiotics

Question 9

Anti-inflammatory treatment for bronchiectasis

Answer 9

Low dose macrolide antibiotics have been shown to reduce exacerbation rates in bronchiectasis
– Clarithromycin 250 mg OD
– Azithromycin 250mg Three Times a Week
• Particularly effective in pseudomonas colonised individuals

Question 10

CF carrier rate

Answer 10

1/25

Question 11

CF incidence rate

Answer 11

1/2500

Question 12

Bronchial challenge testing

Answer 12

Methacholine/histamine

-look to see what concentration produces a 20% decrease in FEV1

Question 13

↓FEV1 or ↓PEF post exercise

Answer 13

Asthma

Question 14

How to check lung volume

Answer 14

Helium dilution / N2 washout : functional residual capacity

↑TLC in hyperinflation(Emphysema) ↓TLC in restrictive lung disease

Question 15

Exhaled breath nitric oxide

Answer 15

Non invasive marker of eosinophilic airway inflammation in asthma

Question 16

Asthma triad

Answer 16

Reversible airflow obstruction
Airway hyperresponsiveness
Airway inflammation

Question 17

Hallmarks of remodelling is asthma?

Answer 17

Thickening of BM
Collagen deposition in submucosa
Hypertrophy of smooth muscle

Question 18

Asthma histology

Answer 18

Desquamation
Eosinophils
Mucus plugging
Epithelial shedding

Question 19

Cells in COPD

Answer 19

CD8+
Alveolar macrophage
Neutrophil

Question 20

Cells in bronchitis?

Answer 20

Chronic neutrophil inflammation

Question 21

How to assess risk of exacerbations in COPD?

Answer 21

Two exacerbations or more within the last year or an FEV1

Question 22

Diagnosing asthma

Answer 22

•  History and examination
•  Diurinal variation of peak flow rate
•  Reduced forced expiratory ratio
(FEV1/FVC 15%)
•  Provocationtesting→bronchospasm
- exercise
- histamine/allergen inhalation

Question 23

Ipratropium

Answer 23

Short acting SAMA

Question 24

Tiotropium

Answer 24

LAMA

Question 25

Salbutamol

Answer 25

SABA

Question 26

Actions of a spacer divider

Answer 26

Avoids coordination problems with pMDI • Reduces oropharyngeal and laryngeal side effects • Reduces systemic absorption from swallowed fraction • Acts a holding chamber for aerosol • Reduces particle size and velocity • Improves lung deposition

Question 27

LTD4

Answer 27

``` Increased mucus secretion Edema Decreased mucus transport Epithelial cell damage Contraction and proliferation of airway smooth muscle ```

Question 28

Montelukast

Answer 28

LTRA, oral

Question 29

How do you give Omalizumab?

Answer 29

Anti-IgE monoclonal antibody | Injection every 2-4 weeks

Question 30

M1

Answer 30

enhance cholinergic reflex

Question 31

M2

Answer 31

Inhibit Ach release

Question 32

M3

Answer 32

Mediate bronchoconstriction and mucus secretion

Question 33

When are high doses of nebulised ipratropium given?

Answer 33

Acute COPD, acute asthma

Question 34

When is IV aminophylline given?

Answer 34

Acute attacks

Question 35

Name a drug theophylline could react with?

Answer 35

erythromycin (P450 drug interactions)

Question 36

Rofumilast

Answer 36

PDE4 inhibitor | might add it in COPD as addition to LABA/LAMA instead of ICS

Question 37

Side effect of PDE4 inhibitors

Answer 37

Nausea, diarrhoea, headache, weight loss

Question 38

Abx for COPD exacerbation

Answer 38

Amoxicillin

Question 39

Treatment of acute asthma

Answer 39

TREATMENT OF ACUTE ASTHMA • Oral prednisolone (or iv hydrocortisone ) • Nebulised high dose salbutamol, ± Neb ipratropium, ± iv aminophylline/magnesium • 60% O2 • ITU Assisted mecahnical intubated ventilation if falling PaO2 and rising PaCO2 - never use respiratory stimulant

Question 40

Treatment for pulmonary hypertension?

Answer 40

Pharmacologic Treatment - prophylactic anticoagulation [warfarin] - O2 if hypoxic - Po Vasodilators :Endothelin antagonist (Oral Bosentan) , PDE5-inhibitor (Oral Sildenafil), iv Epoprostenol

Question 41

Peumothorax risk factors in babies

Answer 41

IPPV, CPAP and ventilation | RDS (stiff lungs)

Question 42

Treatment for surfactant deficiency

Answer 42

Steroids

Question 43

Raised immunoreactive trypsin

Answer 43

CF (also F508 deletion etc)

Question 44

Which virus causes bronchiolitis?

Answer 44

RSV

Question 45

How to remember bronchiolitis? FACT

Answer 45

Fast breathing:shallow not taking in a lot of air Appetite: poor/can't feed normally Cough: distinctive rasping cough Temperature

Question 46

Organism which usually causes epiglottitis?

Answer 46

Haemophilus influenza

Question 47

Steeple sign on x-ray

Answer 47

Epiglottitis

Question 48

Viral laryngotracheobronchitis

Answer 48

Croup

Question 49

Treatment for croup

Answer 49

Steroid

Question 50

Drug treatment for TB in children?

Answer 50

2 mths- Isoniazid, Rifampicin, Pyrazinamide 4 mths- Isoniazid, Rifampicin

Question 51

Recurrent laryngeal nerve palsy

Answer 51

Hoarse voice

Question 52

Pancoast tumour

Answer 52

Brachial plexus invasion

Question 53

Eaton lambert syndrome

Answer 53

Weakness that can develop from tumour (lung cancer) | Mimics myasthenia gravis, resolves when tumour is resected

Question 54

Treatment for laryngeal obstruction

Answer 54

Treat underlying cause eg foreign body removal, anaphylaxis Mask bag ventilation with high flow O2 Cricothyroidotomy Tracheostomy

Question 55

Treatment of anaphlyaxis

Answer 55

``` IM Epinephrine (adrenaline) IV antihistamine IV corticosteroid High flow O2 Nebulised bronchodilators Endotracheal intubation if necessary ```

Question 56

Treatment for obstructive sleep apnoea

Answer 56

Remove underlying cause | CPAP