Resp

Question 1

Discharge criteria for asthma

Answer 1

Asthma action plan
Nurse review
PEFR >75
Off nebs for 24hrs
Pred 5 days
GP f/u in 2 days
Specialist referral if necessary

Question 2

Stepwise management of asthma in adults

Answer 2

Baseline SABA

1. ICS
2. • LTRA
3. • LABA
4. Incr ICS or try theophylline
5. Oral steroids

Question 3

Causes of COPD

Answer 3

Smoking
Alpha1 antitrypsin def
Industrial toxins

Question 4

What is COPD

Answer 4

Chronic obstructive disorder caused by either:

• chronic bronchitis
• emphysema

Question 5

Management of COPD

Answer 5

Conservative:
Stop smoking
Pulmonary rehab
Singing
Huffing/lung clearance techniques
Diet
Flu vaccine

Medical:
PRN Salbutamol and IB
Steroids
Mucolytics
LTOT?

Surgical:
Lung volume reduction

Question 6

Organism most commonly causing COPD exacerbations

Answer 6

H. Influenzae

Question 7

Organisms causing CAP

Answer 7

H. Influenzae
S. Pneumoniae
Mycoplasma pneumoniae

Question 8

Organisms causing HAP

Answer 8

S. Aureus (inc MRSA)

Enterobacter (gram -ve rods)

Question 9

Requirements for LTOT

Answer 9

PO2 <7.3 most of the time (or <8 if cor pulmonale)
pH 7.25-35 (normal 7.35-7.45)
Non smoker
Non retainer
Benefit outweigh loss of independence
Can commit to it 18hrs a day

Question 10

Management of pneumonia

Answer 10

Hospital:
Sputum sample and blood cultures
Amoxicillin + macrolide

Home:
5 days amoxicillin
Safety net

Question 11

Baseline tests before starting TB tx

Answer 11

Visual acuity (ethambutol = optic neuritis)
LFTs (rifampicin, isoniazid, pyrazinamide = hepatitis)

Question 12

Treatment of lung fibrosis

Answer 12

Allergic:
Steroids
Remover trigger

Non-allergic (usual interstitial pneumonitis):
Doesn’t respond to steroids. Supportive

Rheum (RA, sarcoidosis, diffuse SS):
DMARDS etc

Question 13

Investigations for COPD

Answer 13

FBC - Hb, haematocrit
ABG - resp alk
CXR - hyperinflation, flattened hemi diaphragms
CT - bullae
Pul function tests: obstructive pattern - fev1 <0.8, fev1:fvc <0.7
ECG - RH strain/hypertrophy
Response to bronchodilators - <15% improvement