Respiratory

Question 1

CRB 65 score

Answer 1

Confusion
RR >30
BP <90/60
>65yo

0 = low risk - PO Abx
1-2 = intermediate risk = <10% mortality - Consider admission
3-4 = high = >10% mortality - admit urgently

Question 2

Acute asthma severity

Answer 2

Life threatening
Peak flow <33%, signs of shock
- 999 admit immediately

Severe
Peak flow 33-50%, tachy
- consider hospital. Give salbutamol nebs

Moderate
Peak flow >50%, normal speech
- salbutamol inhaler 10 puffs. if no response for nebs. if no response hospital.

Question 3

Acute asthma Mx

Answer 3

Aim sats 94-98%
Pred 40mg OD (unless high BMI 50mg) for 5/7
FU in 2 days

Question 4

COPD Mx

Answer 4

1st
- annual flu, covid, pneumococcal vaccine
- pulmonary rehab
- smoking cessation (ifrequired)
- oxygen assessment if sats <93%
- healthy BMI

2nd
- LABA+LAMA (eg Annoro ellipta)
- ICS+LABA (eg Relvar ellipta, fobumix easyhaler) - if asthma overlap

3rd (triple therapy)
- LABA + LAMA + ICS

Question 5

Asthma Mx

Answer 5

1st
- ICS + SABA (eg budesonide, clenil)

2nd lose dose
- ICS + LABA (+ SABA PRN if fixed dose)
- otherwise MART = ICS/LABA regular and PRN
- eg Fostair, Symbicort, fobumix

3rd
- trial montelukast 10mg ON
- discontinue if no benefit after 6 weeks

3rd
- ICS + LABA moderate dose

4th - refer

Question 6

Obstructive sleep apnoea definition

Answer 6

Irregular breathing at night
with collapsing of the upper airway resulting in interrupted sleep and excessive daytime
sleepiness, reduced concentration and alertness

Question 7

OSA Mx

Answer 7

Lifestyle - weight management, exercise, reduce alcohol, stop smoking

STOP driving - until assessment, if daytime sleepiness. STOP driving immediately if group 2 (van lorry)

Epworth sleepiness questionnaire
>10 = abnormal
>18 = severe

Refer sleep clinic

Refer to ENT if children

Question 8

Lung Ca 2WW

Answer 8

CXR findings suggestive
>40 + unexplained haemoptysis

Question 9

2WW CXR assessment in the following

Answer 9

> 40 and Smoker PLUS:
Cough
* Fatigue
* Shortness of breath
* Chest pain
* Weight loss
* Appetite loss.

> 40 non smoker PLUS:
* Persistent or recurrent chest infection.
* Finger clubbing.
* Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy.
* Chest signs consistent with lung cancer.
* Thrombocytosis.

Question 9

Spirometry interpretation

Answer 9

Normal
FEV1/ FVC >0.7
FEV 1 >80%
FVC >80%

Obstructive
FEV1/FVC <0.7
FEV1 <80%
FVC norm/ low

Restrictive
FEV1/ FVC >0.7
FEV1 <80%
FVC <80%

Reversibility = before and after 20mins of salbutamol

Question 10

COPD exacerbation Mx

Answer 10

SABA
PO Pred 30mg-40mg OD 5/7
Abx (eg Doxy) if infective Sx