Resp conditions (FCM)

Question 1

What are the 4 features of acute severe asthma ?

Answer 1

1. Pulse >110bpm
2. PEFR 33-50% of normal value
3. RR >25/min
4. Cant complete sentences

Question 2

How is a moderate asthma exacerbation characterised? (3 things)

Answer 2

1. Increasing symptoms
2. PEFR >50-75% of the patient’s best or predicted score
3. No features of acute severe asthma

Question 3

List the 8 things that are indicative of Life- threatening asthma

Answer 3

1. PEFR of <33%
2. New-onset arrhythmia
3. Exhaustion
4. Hypotension
5. Reduced Glasgow coma score (GCS)
6. Reduced respiratory effort
7. Cyanosis (usually of the lips)
8. Absence of audible breath sounds over the chest (silent chest)

Question 4

How would you manage someone with a new diagnosis of asthma? (6 steps)

Answer 4

1. Explain the diagnosis and the aims for treatment which is to get complete control of the disease (no daytime symptoms, no asthma attacks, no nocturnal symptoms, improved lung function)
2. Assess their baseline peak flow (and ensure they have their own peak flow)
3. Ensure the person has a personalised asthma plan
4. Ensure that the person is up to date with all vaccinations
5. Provide sources of information (Asthma UK) + advise them to avoid triggers - weight loss and smoking cessation If appropriate
6. Initiate drug treatment (at the level of their symptoms) - review in 4-8 weeks
   - salbutamol
   - or salbutamol and Montelukast (LRTA)
   - next step is SABA, LTRA and LABA (Salmeterol)

Question 5

What criteria best describes Chronic Bronchitis?

Answer 5

Cough, Sputum production for at least 3 months in each of two consecutive years

Question 6

What best describes Emphysema?

Answer 6

Condition that causes a loss of parenchymal lung texture and reduces surface area available for gas exchange

Question 7

What is cor pulmonale ?

Answer 7

Impaired right ventricular function as a result of respiratory disease

Question 8

What is COPD ?

Answer 8

A common chronic inflammatory lung condition that causes obstructed airflow from the lungs

Question 9

How do you diagnose COPD?

Answer 9

spirometry with a post bronchodilator test

Question 10

What type of TB would affect the lungs, liver and spleen causing organomegaly?

Answer 10

Miliary TB

This causes small calcifications on the lungs

Question 11

How would you manage a pneumothorax?

Answer 11

• Decompression

- Large bore needle inserted into the Second intercostal space, midclavicular line

Question 12

What is glandular fever?

Answer 12

Aka - infective mononucleosis.
Commonly caused by EBV
Spread through saliva or semen/ blood

Question 13

Symptoms of glandular fever? (3 things)

Answer 13

• Sore throat
• Cervical lymphadenopathy
• Fever

Question 14

How do you confirm a diagnosis of glandular fever?

Answer 14

1. FBC
2. Monospot test - immunocompetent
3. EBV serology test in children younger than 12 years of age and in people who are immunocompromized.

Question 15

Management of glandular fever (5 things)

Answer 15

1. Symptomatic relief with paracetamol or ibuprofen.
2. Reassurance that the condition is usually self limiting and that fatigue is common.
3. Encouraging the person to return to normal activities as soon as possible. Exclusion from work or school is not necessary.
4. Advising the person to avoid heavy lifting and contact or collision sports for the first month of the illness (to reduce the risk of splenic rupture).
5. Advising on ways to limit the spread of the disease (for example by avoiding kissing and by not sharing eating utensils).

Question 16

New!

Asthma management ?

Answer 16

1. SABA (salbutamol)
2. Low dose ICS (inhaled corticosteroid)
3. CHECK ADHERENCE BEFORE ADDING ANYTHING ON
4. LTRA (montelukast ) - then review in 4-8weeks
   (SABA+ICS +LTRA)

IF STILL UNCONTROLLED

5. Add LABA (salmeterol)

Question 17

What condition is a hallmark for ‘red-currant jelly’ sputum?

Answer 17

Klebsiella pneumoniae

Note: Klebsiella is more common in alcoholics

Question 18

COPD management if they have asthmatic features?

Answer 18

1. SABA (salbutamol) or SAMA (Ipratropium) - if breathless and has exercise limitations
2. LABA (salmeterol or formoterol) + ICS (ENDS IN ‘sone’)
3. IF STILL HAS SX
   LABA+LAMA+ICS

Question 19

COPD management if they don’t have asthmatic features?

Answer 19

1. SABA (salbutamol) or SAMA (Ipratropium) - if breathless and has exercise limitations
2. LABA+LAMA
3. IF STILL SX –
   LABA+LAMA + ICS (3 month trial)
   if controlled continue and review annually

Question 20

What should you be awar eof in people taking ICS with a bg of COPD?

Answer 20

Increased risk of pneumonia

Question 21

What is included in the rescue pack for COPD?

Answer 21

1. oral corticosteroids (if not contraindicated)
   - 30 mg oral prednisolone once daily for 5 days
2. Amoxicillin (first line)

Question 22

What do you do if a patient with COPD sees no improvements in 2-3 days

Answer 22

1. Send sputum for culture
2. try another first line abx

• Amoxicillin 500 mg three times a day for 5 days (FIRST CHOICE)
• Doxycycline 200 mg on first day, then 100mg once a day for 5-day course in total
• Clarithromycin 500 mg twice a day for 5 days.

Question 23

What is the difference between a transudative and exudative pleural effusion ?

Answer 23

Transudative:

• Caused by increased hydrostatic pressure
• Low protein and LDH
• Usually bilateral

Exudative:

• Caused by inflammation and increased capillary permeability
• High in protein and LDH

Question 24

What supplement is offered to those on abx for TB treatment? +why

Answer 24

Pyridoxine – to help prevent the side effect of peripheral neuropathy from isoniazid

Question 25

Number of points - Low - high clinical risk for developing PE on wells score

Answer 25

Low - <2 points
Moderate- 2-5 points
High- >6 poins