Respiratory

Question 1

COPD Complications

Answer 1

Polycythaemia (raised haematocrit)

Question 2

Pulmonary function tests Restrictive lung disease

Answer 2

FEV1 - reduced
FEV1/ FVC - Normal or increased

Question 3

Pulmonary function tests Obstructive lung disease

Answer 3

FEV1 - significantly reduced
FEV1 / FVC - Reduced

Question 4

Clubbing - respiratory causes

Answer 4

Lung Ca
CF, bronchiectasis, empyema
Tb
Asbestosis, mesothelioma

Question 5

COPD Mx

Answer 5

1st - SABA or SAMA

a) No asthmatic features
1 - LABA + LAMA + SABA
2 - LABA + LAMA + ICE (+SABA)

b) Asthmatic features
1 - LABA + ICS
2 - LAMA + LABA + ICS (+SABA)

3rd line - PO Theophylline

4th - Refer Resp - PO PDE-4 inhibitors (eg roflumilast) - if severe (eg >2 exacerbations on Triple therapy, or FEV 1 <50% after bronchodilator)

Question 6

COPD Prophylaxis

Answer 6

Azithromycin
LFT and ECG prior to starting - to exclude QT prolongation
Can not be started if patient is still smoking (must be stopped if re-starts smoking)

Question 7

COPD exacerbation Mx

Answer 7

Steroids - PO Prednisolone 30mg 5 days
+/- Abx if purulent sputum

Question 8

Adult Asthma Mx

Answer 8

1st - SABA
2nd (Sx >3/ week or disturbed sleep) - SABA + ICS
3rd - SABA + ICS + LTRA (Montelukast)
4th - SABA + ICS + LABA (Continue LTRA if helpful)
5th - SABA +/- LTRA + ICS/LABA MART regime
6th - Refer resp - SABA +/- LTRA + increase dose MART

Question 9

Bronchitis Mx

Answer 9

1st - Doxycycline (unless pregos)
2nd - Amox

Question 10

Asthma Ix

Answer 10

Fractional exhaled Nitric Oxide (FeNO) + Spirometry/ bronchodilator reversibility test

Question 11

Asthma Ix in Children (age 5-16)

Answer 11

1st - Spirometry with bronchodilator reversibility
2nd - FeNO if above normal

If <5yo - clinical judgement

Question 12

COPD exacerbations cause (bacteria)

Answer 12

Haemophillus influenza

Question 13

Occupational asthma Mx

Answer 13

Refer to resp

Question 14

When to consider LTOT in COPD

Answer 14

FEV 1 <50%
cyanosis
polycythaemia (Hb raised)
Peripheral oedema
Raised JVP
O2 <93%

Question 15

CAP Mx

Answer 15

1st- Amox
2nd - Doxy/ eryth/ clarith

Question 16

2WW Lung Ca referral reasons

Answer 16

CXR shows suspicion of lung ca
>40yo + unexplained haemoptysis

Question 17

Bronchiectasis Mx

Answer 17

Physio - inspiratory muscle training
Postural drainage

Question 18

Acute asthma criteria - Life threatening

Answer 18

PEFR < 33%
O2 < 92%
Silent chest, cyanosis
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

Question 19

Acute asthma criteria - severe

Answer 19

PEFR 33 - 50%
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

Question 20

Acute asthma criteria - Mod

Answer 20

PEFR 50-75%
Speech normal
RR < 25 / min
Pulse < 110 bpm

Question 21

Churgg Strauss Fx (Eosinophilic granulomatosis with polyangiitis)

Answer 21

sinusitis, asthma, haematuria, eosinophilia

Question 22

squamous cell ca paraneoplastic syndrome association

Answer 22

HyperCA secondary to PTH
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

Question 23

Small cell Lung ca paraneoplastic syndrome association

Answer 23

ADH - HypoNa
ACTH - HTN, hyperglycaemia, hypoKal, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

Question 24

Smoking cessation options

Answer 24

1st - Nicotine replacement therapy (CBT prior to NRT in pregnancy)

Bupropion
- a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
- contraindicated in pregnancy and breast feeding

Varenicline
- a nicotinic receptor partial agonist
- used with caution in depression/ self harm
- contraindicated in pregnancy, breast feeding, epilepsy, eating disorder

If unsuccessful at quitting, do not repeat prescription within 6 months

Question 25

MRC breathlessness scale for COPD

Answer 25

0 Not troubled by breathlessness except during strenuous exercise
1 Short of breath when hurrying or walking up a slight hill
2 Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
3 Stops for breath after walking about 100 m or after a few minutes on the level
4 Too breathless to leave the house, or breathless when dressing or undressing