Clinical Scenario

Question 1

Clinical station

points to remember

Answer 1

Re-assess - markers of improvement
Give doses
Communication - staff, patient, family
Long term - pulmonary rehab, community COPD, palliative etc SMOKING CESSATION
CEILING OF CARE

Question 2

PE Risk Scoring Tool

Answer 2

PESI
cancer, ccf, obs
Predicts 30 day outcomes

Question 3

When would you call a consultant

Answer 3

V complex/out of knowledge area
Difference of opinion between specialities
High risks decison
Patient being escalated to ICU

Question 4

PE ruling out score

Answer 4

PERC
<2% if no criteria

Question 5

COPD Severity Scoring

Answer 5

Question 6

LTOT Criteria

Answer 6

PaO2 <7.3
Or PaO2 <8.0 with PHTN, peripheral edema, polycythaemia (haematocrit <55%)

Question 7

Pneumothorax Update

Answer 7

New guidelines state if minimal sx or asymptomatic can be managed conservatively
Consider elective surgery for tension or high risk profession
Ambulatory management if possible

Question 8

Pneumothorax management

Answer 8

If >2cm and symptomatic - aspirate
If large but asymptomatic can also consider conservative Rx
If aspiration fails - drain
All need OP FU 2-4 weeks

Question 9

Non pharmacological COPD management

six points

Answer 9

Pulmonary rehab
address other comorbs
pneumoccal and flu vaccines
SMOKING CESSATION
self management plan
Inhaler techniques

Question 10

Management COPD (Non Acute)

Answer 10

SABA/SAMA inhaler
If steroid responsive - LABA +ICS
If not - LABA + LAMA

Question 11

What features would suggest someone in steroid responsive

Answer 11

Esinophilia
Asthma/atopy
FEV variation over time
PF Variation

Question 12

Questions to ask in asthma history

Answer 12

Diurnal/seasonal variation
Hx of atopy
Triggers

Question 13

Investigations for ?Asthma

Answer 13

Spirometry with reversibility FeNo
Peak flow variability

Can consider allergen testing, eosinophils IgE for info but not diagnostic

+ve for asthma - high Feno, obstructive spiro w reversbility/PF variation

Question 14

Asthma chronic management

Answer 14

SABA
If infrequent and well controlled SABA alone is ok
If not controlled w SABA, nighttime sx or sx 3x a week
Still not controlled - add LRTA
then LABA or theophylline

Question 15

Initial steps to ix ?PE

Answer 15

If postpartum or haemodynamically unstable, admit immediately
If Wells Score >4 CTPA +- interim tx
If <4 D-dimer

Question 16

Examination findings cor pulmonale

Answer 16

Raised JVP
Loud S2
Peripheral/sacral edema
Hepatomegaly

Question 17

Answer 17

Normal

Question 18

Answer 18

Obstructive

Question 19

Answer 19

Restrictive

Question 20

Reduced FEV1 <80% predicted
Reduced FVC
Reduced FEV1/FVC ratio <0.7

Answer 20

Obstructive spirometry

Question 21

Reduced FEV1 <80% predicted
Reduced FVC <80% predicted
Normal FEV1/FVC ratio

Answer 21

Restrictive spirometry

Question 22

Increased D/TLCO (transfer factor)

Answer 22

Asthma
Polycythaemia
Exercise
Pulmonary haemorrhage

Question 23

Reduced D/TLCO (transfer factor)

Answer 23

Empysema
ILD
Anaemia

Question 24

Features Life Threatening Asthma

Answer 24

Sats <92%
Silent chest
Cyansosis
Poor resp effort
Arrhythmia/hypotension
Altered conciousness
PF<33%

Question 25

Features Acute Severe Asthma

Answer 25

PF <50%
HR 110
Can’t complete sentences

Question 26

Acute Asthma Management
(As per BTS)

Answer 26

40-50mg prednisone
Nebs
Magnesium

Question 27

When to transfer acute asthmatic to ICU

Answer 27

Worsening PF
Persistent hypoxia
Hypercapnia
Altered Conciousness
Poor Resp Effort

Question 28

Types of ILD

Answer 28