Resp

Question 1

Oxygen therapy in COPD patient who is not acutely unwell (you do not know the blood gas level yet)

Answer 1

Prior to availability of blood gases, use a 28% Venturi mask at 4 l/min

Aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

Adjust target range to 94-98% IF the pCO2 is normal

Question 2

Pulmonary embolism and renal impairment - what is the investigation of choice

Answer 2

V/Q scan

Question 3

A 60-year-old woman presents to the Emergency Department with a three week history of breathlessness and a dry cough. She does not smoke and drinks 15 units of alcohol a week. There is a target rash present on both her lower limbs. Her chest x-ray shows reticulo-nodular shadowing of the right lung. A diagnosis of bacterial pneumonia is made. What is the most likely organism causing her symptoms?

Answer 3

Mycoplasma pneumoniae

Mx: erythromycin/clarithromycin (tetracyclines are also an alternative)

Question 4

Most common causative agent of COPD exacerbation?

Answer 4

H. influenzae

Question 5

COPD exacerbation - dose and duration of prednisolone?

Answer 5

30mg prednisolone; 7-10 days

Question 6

Advise to give asthma patient to prevent oral candidiasis in their mouth

Answer 6

Patients taking inhaled steroids to treat asthma are advised to rinse their mouth straight after intake to prevent development of oral candidiasis

Question 7

Eosinophilic granulomatosis with polyangiitis (EGPA) is now the preferred term for Churg-Strauss syndrome.

What are its features?

Answer 7

Features:
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%

The initial phase is characterised by allergy with many patients having a history of asthma or allergic rhinitis. This inflammation of the nasal passages can lead to the development of nasal polyps.

The second phase is eosinophilia

The third stage is the vasculitis itself which affects small and medium-sized blood vessels and therefore resulting in damage to many organs. Given this patient’s kidney failure, it appears to be affecting his renal blood supply.

Question 8

You are doing the annual review of a 72-year-old man with chronic obstructive pulmonary disease (COPD). Last year he had three exacerbations of his COPD, one of which resulted in him being hospitalised. Today his chest is clear and his oxygen saturations are 94% on room air. According to NICE guidelines, what treatment should you offer him?

Answer 8

Home supply of prednisolone and antibiotic

Question 9

Which organism is more common in patients who have recently had influenza?

Answer 9

Staph aureus (hence co-prescribe flucloxacillin alongside amoxicillin)

Question 10

Management of thyrotoxic storm

Answer 10

Beta-blocks (for tachycardia)
Hydrocortisone (for hypotension)
Propylthiouracil (to inhibit thyroid)