Corrections pt. 2 - Respiratory

Question 1

What is the investigation of choice to investigate suspected lung cancer?

Answer 1

CT

Question 2

How can lung cancer affect platelets?

Answer 2

Can cause RAISED platelets

Question 3

What medications are available for smoking cessation?

Answer 3

1) Nicotine replacement therapy (NRT)

2) Bupropion

3) Varenicline

NICE state that clinicians should not favour one medication over another.

Question 4

Can you offer NRT, varenicline and bupropion in combination?

Answer 4

NO

Question 5

Adverse effects of NRT?

Answer 5

nausea & vomiting, headaches and flu-like symptoms

Question 6

What NRT can be offered to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past?

Answer 6

NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray).

Question 7

What class of drug is varenicline?

Answer 7

a nicotinic receptor partial agonist

Question 8

When should varenicline be started in smoking cessation?

Answer 8

Should be started 1 week before the patients target date to stop.

Question 9

Common adverse effects of varenicline?

Answer 9

Nausea is the most common adverse effect.

Other common problems include headache, insomnia, abnormal dreams

Question 10

Who should varenicline be used with CAUTION in for smoking cessation?

Answer 10

Patients with a history of depression or self-harm.

Question 11

Contraindications for varenicline?

Answer 11

Pregnancy & breastfeeding.

Question 12

What class of drug is bupropion?

Answer 12

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Question 13

When should bupropion be started in smoking cessation?

Answer 13

should be started 1 to 2 weeks before the patients target date to stop

Question 14

Contraindications for Bupropion?

Answer 14

1) epilepsy (small risk of seizures)

2) pregnancy

3) breastfeeding

4) (having an eating disorder is a relative contraindication)

Question 15

1st line interventions for smoking cessation in pregnant women?

Answer 15

1) CBT
2) Motivational interviewing
3) Structured self-help and support from NHS Stop Smoking Services

If fails –> NRT

Question 16

Describe the weakness in Lambert-Eaton syndrome

Answer 16

1) Weakness in proximal muscles
- commonly seen in lower limbs
- gradually pogresses from proximal to distal muscle groups and in the cranial direction.

2) Weakness improves with prolonged exertion (CONTRAST to myasthenia gravis)

3) Hyporeflexia

4) Autonomic dysfunction: blurry vision, dry mouth, orthostatic hypotension, impaired sweating and constipation.

Question 17

Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems?

Answer 17

Consider bronchiectasis

Question 18

What type of lung cancer are cavitating lesions more commonly seen in?

Answer 18

Squamous cell carcinoma

Question 19

Give the stepwise management of an asthma attack

Answer 19

1) O2
2) Salbumatol nebuliser
3) Ipratropium bromide nebuliser
4) Hydrocortisone IV or oral Prednisolone
5) Magnesium sulphate IV
6) Aminophylline / IV salbutamol

Question 20

How many lobes does the right lung consist of?

Answer 20

3: superior, middle, and inferior lobes

Question 21

How many lobes does the left lung consist of?

Answer 21

2: superior and inferior lobes.

Question 22

Features of a lung abscess?

Answer 22

1) subacute presentation: symptoms may develop over weeks

2) systemic features such as night sweats and weight loss may be seen

3) fever

4) productive cough: often foul smelling sputum

5) chest pain

6) SOB

7) dull percussion & bronchial breathing

8) clubbing may be seen

Question 23

What do lung abscesses most commonly form 2ary to?

Answer 23

Aspiration pneumonia –> poor dental hygiene, previous stroke and reduced consciousness are some of the risk factors for this

Question 24

Give 3 organisms causing lung abscess

Answer 24

1) staph. aureus

2) klebsiella pneumonia

3) pseudomonas aeruginosa

Question 25

1st step in management of a pleural effusion?

Answer 25

If no are increasing oxygen requirements –> pleural aspirate (to determine the origin)

If increasing oxygen requirements –> chest drain

Question 26

When should non-invasive ventilation (NIV) be considered in acute COPD exacerbations?

Answer 26

When a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment.

Maximum treatment consists of:
- O2 via venturi mask
- nebulised salbutamol
- nebulised ipratropium bromide
- broad spec Abx e.g. amoxicillin

Question 27

Most common cause of pneumonia in bronchiectasis?

Answer 27

H. influenzae

Question 28

Is it safe to breastfeed whilst taking prednisolone?

Answer 28

Yes

Question 29

What are the top 3 causes of exudative pleural effusions?

Answer 29

1) malignancy: lung cancer or mesothelioma

2) infection: pneumonia or TB

3) RA

Question 30

What 2 urine tests may be helpful in patients with pneumonia?

Answer 30

1) Legionella urinary antigen

2) Pneumococcal urinary antigen

Question 31

What are 2 key examination findings in idiopathic pulmonary fibrosis?

Answer 31

1) Bibasal fine end-inspiratory crackles

2) Finger clubbing

Question 32

What are the 3 criteria for using non-invasive ventilation to treat an exacerbation of COPD?

Answer 32

1) Persistent respiratory acidosis (pH <7.35 and PaCO2 >6) despite max medical treatment

2) Potential to recover

3) Acceptable to patient

Question 33

What are the 2 most common infective organisms in bronchiectasis?

Answer 33

1) H. influenzae

2) Pseudomonas aeruginosa

Question 34

What is Lofgren’s syndrome?

Answer 34

Lofgren syndrome is a specific acute clinical presentation of systemic sarcoidosis, consisting of a classic triad of fever, erythema nodosum, and bilateral hilar adenopathy.

Question 35

What is the triad of features in Lofgren’s syndrome?

Answer 35

1) Erythema nodosum

2) Bilateral hilar lymphadenopathy

3) Polyarthralgia (joint pain in multiple joints)

Question 36

What is the mechanism of tiotropium?

Answer 36

Long acting muscarinic antagonist (LAMA)

Question 37

What is the mechanism of ipratropium?

Answer 37

Short acting muscarinic antagonist (SAMA)

Question 38

What is the mechanism of montelukast?

Answer 38

Leukotriene receptor antagonist

Question 39

What value defines pulmonary hypertension?

Answer 39

A mean pulmonary arterial pressure of >20 mmHg

Question 40

What dose of steroids should be given in a mild asthma exacerbation?

Answer 40

Quadrupled dose of their ICS for up to 2 weeks

Question 41

What type of atypical pneumonia is most associated with erythema multiforme?

Answer 41

Mycoplasma pnuemoniae

Question 42

What common antibiotic can cause pulmonary fibrosis?

Answer 42

Nitrofurantoin

Question 43

What are the four most prevalent types of cancer in the UK (in order)?

Answer 43

1) Breast
2) Prostate
3) Lung
4) Bowel

Question 44

Other than spirometry, what other tests can be used to support a diagnosis of asthma?

Answer 44

1) FeNO

2) Spirometry with reversibility

3) Peak flow variability (diary)

Question 45

What is found on chest auscultation in a patient with bronchiectasis? (3)

Answer 45

1) Scattered crackles throughout chest

2) Crackles clear or change after coughing

3) Scattered wheezes and squeaks