respiratory

Question 1

how is asthma investigated?

Answer 1

spirometry
will show an obstructive pattern with reduced FEV1:FVC ratio (decreased FEV1 and a normal FEV)

Question 2

what is the long term management of asthma?

Answer 2

1. SABA and ICS (beclomethasone)
2. SABA + ICS + LABA
3. add LTRA/theophylline/LAMA
4. increase ICS

Question 3

how is an acute presentation of asthma managed?

Answer 3

OSHITME
oxygen
salbutamol (neb)
hydrocortisone IV or oral prednisolone
ipratropium (neb)
theophylline (oral)
magnesium sulphate (IV)
escalate

Question 4

what is a genetic risk factor for COPD?

Answer 4

alpha 1 antitrypsin deficiency

Question 5

what is the consequence of COPD?

Answer 5

chronic bronchitis and emphysema

Question 6

how is COPD investigated at the point of diagnosis?

Answer 6

spirometry
obstructive pattern (decreased FEV1, FVC normal)

Question 7

how is COPD investigated during an exacerbation?

Answer 7

CXRAY
sputum sample
FBC

Question 8

what is the long term management of COPD?

Answer 8

SABA/SAMA
if poor response then- LABA+LAMA
if good response then- LABA+ICS

Question 9

how is an exacerbation of COPD managed at home?

Answer 9

oral prednisolone
increase SABA/SAMA dose
abx

Question 10

how is an exacerbation of COPD managed in hospital?

Answer 10

ISOAP
ipratropium
salbutamol
oxygen
amoxicillin (or doxy if pen allergic)
prednisolone

Question 11

what is pulmonary fibrosis?

Answer 11

progressive interstitial fibrosis of unknown cause

Question 12

what are the signs and symptoms of pulmonary fibrosis?

Answer 12

progressive dyspnoea
dry cough
weight loss
fatigue
malaise
clubbing
cyanosis
bilateral fine inspiratory crackles

Question 13

what are the investigations for pulmonary fibrosis?

Answer 13

CXRAY
- bilateral infiltrates
- reduced lung volume
CT
- ground glass appearance
PFTs
-restrictive pattern

Question 14

how is pulmonary fibrosis managed?

Answer 14

supportive measures
antifibrotic drugs (eg. perfenidone)

Question 15

what is bronchiectasis?

Answer 15

irreversible and abnormal dilation of the bronchial tree

Question 16

what can cause bronchiectasis?

Answer 16

CF (most common in developed countries)
COPD
lung infection
idiopathic (50% of cases)

Question 17

what are the most common strains of bacteria that can cause bronchiectasis?

Answer 17

H influenzae
pseudomonas aeruginosa

Question 18

how does bronchiectasis present?

Answer 18

chronic productive cough
fever and malaise
“flecks” of haemoptysis
clubbing
course crackles

Question 19

what are the investigations for bronchiectasis?

Answer 19

HRCT
- thickened and dilated airways

Question 20

how is bronchiectasis managed?

Answer 20

treat underlying cause
chest physio
abx when infections

Question 21

what is the most common cause of TB?

Answer 21

mycobacterium tuberculosis (gram +ve bacilli)

Question 22

what are the risk factors for TB?

Answer 22

immigrants
recent contact
social deprivation
immunosuppression

Question 23

what does TB present with?

Answer 23

cough +/- haemoptysis
dyspnoea
fevers and chills
night sweats
WL
erythema nodosum

Question 24

what are the investigations for TB?

Answer 24

CXRAY
- shadows, lesions and consolidation
- ghon focus in the middle of lung
- bilateral hilar lymphadenopathy
SAMPLES
- 3 separate sputum samples are needed
- Zhiel Neelson staining

Question 25

how is TB treated?

Answer 25

RIPE for 4 months
RI for a further 2 months

Question 26

what is pneumonia?

Answer 26

LRT infection characterised by inflammation of the lung tissue

Question 27

what is the most common bacteria that causes penumonia?

Answer 27

strep pneumoniae (70% of cases)- community aquired

Question 28

what does strep pneumoniae present with?

Answer 28

rust coloured sputum

Question 29

can haemophilus influenzae cause pneumonia?

Answer 29

yes (5% of cases)- usually in COPD and elderly patients

Question 30

what colour is the sputum in H influenzae?

Answer 30

green

Question 31

who does staph aureus causing pneumonia usually affect?

Answer 31

PWID

Question 32

where do people catch legionella from?

Answer 32

contaminated water drops (patient usually been on holiday)

Question 33

where do people catch coxiella burneti causing pneumonia from?

Answer 33

farming

Question 34

where do people usually catch chlamydia psittaci causing pneumonia from?

Answer 34

birds (patient usually has a pet parrot_

Question 35

who usually gets klebsiella pneumonia?

Answer 35

alcoholics (aspiration pneumonia)

Question 36

what is the sputum in klebsiella like?

Answer 36

red current jelly like

Question 37

who is usually affected by pneumocytis jirovaci?

Answer 37

immunosuppressed eg HIV patient

Question 38

how is pneumonia investigated?

Answer 38

generally extra investigation isnt needed in the community
HOSPITAL
- FBC, CRP, U and E
-CXRAY
- if moderate/severe: sputum
: blood culture
: legionella and pneumococcal urinary antigens

Question 39

how is community acquired pneumonia with a low CURB score (0-2) treated?

Answer 39

amoxacillin

Question 40

how is community acquired pneumonia with a curb score of 3-5 treated?

Answer 40

co amox IV and doxy IV

Question 41

how is community acquired pneumonia treated in the ICU?

Answer 41

co amox IV and clarithromycin IV

Question 42

how is non-severe hospital acquired pneumonia treated?

Answer 42

amox

Question 43

how is severe hospital acquired pneumonia treated?

Answer 43

IV amox and gentamicin

Question 44

how is non severe aspiration pneumonia treated?

Answer 44

amox and metronidazole

Question 45

how is severe aspiration pneumonia treated?

Answer 45

IV amox, gentamicin and metronidazole

Question 46

how is legionella pneumonia treated?

Answer 46

clarithro/erythromycin

Question 47

how is coxiella burneti, chlamydia psittaci and pneumocytis jiroveci treated?

Answer 47

doxycyline