Respiratory

Question 1

First line treatment for pregnant women trying to stop smoking?

Answer 1

Nicotine replacement patches

Varenicline and bupropion are C/I

Question 2

“fluid filled area surrounded by focal consolidation” on CXR is what?

Answer 2

Lung abscess

Question 3

What blood test is important in the work up with someone with worsening SOB with COPD?

Answer 3

Full blood count for RBCs - COPD causes polycythaemia

Question 4

CO₂ retainer, T2RF on admission, worsening ABGs on 2L. What is the best course of action regarding ventilation?

Answer 4

Non-invasive ventilation (BiPAP)

Question 5

What pH is an indication for intubation?

Answer 5

7.25 or less

Question 6

Management of primary pneumothorax <2cm without SOB?

Answer 6

Discharge and follow-up

Question 7

ENT sx + respiratory sx + kidney sx + weight loss = ?

Answer 7

Wegener’s granulomatosis / granulomatosis with polyangiitis

Test: cANCA

Question 8

Trauma pt. Acute deterioration following ventilation?

Answer 8

Tension pneumothorax

Question 9

Is trachea deviated away or towards a pleural effusion?

Answer 9

Away

Question 10

Treatment for allergic bronchopulmonary aspergillosis?

Answer 10

Oral glucocorticoids (e.g. prednisolone)

Question 11

A normal pCO2 in acute asthma suggests what level of severity?

Answer 11

Life-threatening. It’s a sign of tiring respiratory efforts.

High respiratory rate driven by hypoxia should cause low CO₂

Impaired expiration by constricted bronchioles ⇒ air trapped in lungs and can’t escape (hyper-resonant) ⇒ hypercapnia

Question 12

What would the aspirate be in empyema?

• pH
• glucose
• LDH

Answer 12

• Low pH (bacteria produce CO₂ during respiration)
• Low glucose (bacteria use it up for respiration)
• High LDH (lactate dehydrogenase needed for bacteria to respire)

Question 13

Second line for asthma not controlled by SABA?

Answer 13

Add budesonide (ICS)

Question 14

Which smoking cessation drug reduces seizure threshold (and is therefore contraindicated in pts with epilepsy)?

Answer 14

Bupropion

Question 15

Gold standard test for diagnosing mesothelioma?

Answer 15

Thoracoscopic biopsy

Question 16

Is TLCO raised or reduced in COPD?

Answer 16

Reduced

Alveoli are destroyed in emphysema ⇒ ↓ surface area available for gas transfer ⇒ ↓ TLCO (measure of gas transfer)

Question 17

When prescribing a LAMA (e.g. tiotropium), what should you do with an already-prescribed SAMA (e.g. ipratropium)?

Answer 17

Discontinue it, and replace with a SABA.

If prescribing a LAMA bc a patient is symptomatic on a SAMA, discontinue the SAMA to prevent anti-muscarinic side effects (e.g. dry mouth, blurred, vision, etc.). However the pt will still need a ‘rescue’ inhaler, so prescribe a SABA instead (e.g. salbutamol).

Ipratropium (SAMA)
Salbutamol (SABA)
Tiotropium (LAMA)
Salmeterol (LABA)

Question 18

COPD pt, no asthmatic features, still symptomatic on rescue inhaler. What is the next step?

Answer 18

Add a LAMA + LABA.

Discontinue a SAMA if on it, and switch to SABA.