Management

Question 1

Invasive aspergillosis

Answer 1

IV voriconazole
OR
Liposomal amphotericin

Question 2

ABPA

Answer 2

Steroids

2nd line: itraconazole

Question 3

Histoplasmosis

Answer 3

Itraconoazole
OR
Amphotericin

Question 4

Recurrent pleural effusion

Answer 4

• Recurrent aspiration
• Pleurodesis
• Indwelling pleural catheter
• Opioids for SOB

Question 5

Indications for Non-invasive Ventilation (NIV)

Answer 5

• COPD with Respiratory acidosis pH 7.25 - 7.35^
• T2RF secondary to chest wall deformity, NMD or OSA
• Cardiogenic pulmonary oedema unresponsive to CPAP
• Weaning from tracheal intubation

(^ if pH <7.25 monitor on HDU with low threshold for intubation and ventilation)

Question 6

NIV initial settings

Answer 6

1. EPAP 4-5cm H2O
2. IPAP 10 (RCP) or 12-15 (BTS) cm H2O
3. Back up rate 15 breaths/min
4. Back up insp:exp ratio 1:3

Question 7

Churg-Strauss Syndrome

Answer 7

Leukotriene receptor antagonists e.g. montelukast may PRECIPITATE the disease

Question 8

Acute Asthma

Answer 8

1. Oxygen driven salbutamol and ipratropium nebulisers
2. Prednisolone
3. +/- antibiotics

Timely review by ITU if life-threatening fx

If not responding:
* 1.2 - 2g IV magnesium sulphate over 20 mins

If not responding consider:
* IV salbutamol

Question 9

Bosentan

Answer 9

Endothelin Receptor Antagonist

Question 10

Eosinophilic pneumonia

Answer 10

Oral corticosteroids (prednisolone)

Question 11

IPF

Answer 11

• pulmonary rehab
• +/- pirfenidone
• +/- supplementary O2
• +/- lung transplant