Respiratory

Question 1

Moderate asthma criteria

Answer 1

PEFR 50-75%
normal speech
RR < 25
HR < 110

Question 2

Severe asthma criteria

Answer 2

PEFR 33-50%
Incomplete sentences
Bilateral wheeze
RR > 25
HR > 110
Use of accessory muscles

Question 3

Life threatening asthma criteria

Answer 3

PEFR < 33%
Silent chest, cyanosis, exhaustion
O2 < 92%
normal PaCO2
Bradycardia, hypotension, dysrrhythmia
Coma and confusion

Question 4

Asthma investigations

Answer 4

• Peak flow
• ABG
• CXR (rule out pneumothorax, or underlying cause)

Question 5

Acute asthma management

Answer 5

1. O2
2. Hydrocortisone 100mg IV/ or oral prednisolone 40mg
3. Nebulised salbutamol 5mg back to back
4. Neb ipratropium bromide 500 mcg
5. Theophylline or IV aminophylline
6. Magnesium sulphate IV
7. Escalate to senior/ ITU

Question 6

Asthma discharge criteria

Answer 6

1. PEFR > 75%
2. Stable for 12-24 hrs on discharge med
3. Inhaler technique checked
4. Oral prednisolone 5 days
5. Written action plan
6. Follow up appointment (2 working days GP, 4 weeks resp clinic)

Question 7

Inhaler technique for pMDI

Answer 7

1. Remove the cap and shake
2. breathe out
3. Seal lips around inhaler, breathe in slowly and deeply then press the cannister and continue
4. hold breath for > 10 sec
5. wait at least 30 sec before repeating
   *if ICS, wash mouth afterwards

Question 8

Bronchitis vs pneumonia

Answer 8

1. Sputum, breathlessness and wheeze may be absent in bronchitis but present in pneumonia
2. Examination: only wheeze in bronchitis. no crepitations, bronchial breathing, dull percussion

Question 9

Acute bronchitis mx

Answer 9

Mostly viral

• analgesia and fluid intake
• abx only if systemically very unwell, preexisting co-morbidities (doxycycline if not, amoxicillin or macrolides)

Question 10

Laryngeal mask contraindications

Answer 10

• Not being fasted (no protection from gastric reflux)
• High-pressure ventilation

Question 11

What type of air for tracheostomy?

Answer 11

Humidified air. Due to dried secretions

Question 12

Endotracheal tube

Question 13

Sx of COPD exacerbation

Answer 13

• Fever
• Cough and change in sputum
• raised WCC and CRP
• increased dyspnoea, and wheeze

Question 14

General management for COPD

Answer 14

• Smoking cessation
• annual flu and 1 pneumococcal vaccine
• Pulmonary rehabilitaion

Question 15

O2 in acute COPD

Answer 15

2l O2
- > 94%

if CO2 retainer (on ABG pCO2 raised ) aim for 88-92%

Question 16

COPD mx

Answer 16

Question 17

Abx prophylaxis in COPD

Answer 17

Azithromycin (risk of long QT and deranged LFT)

Question 18

1st line abx for hospital-acquired pneumonia and aspiration pneumonia

Answer 18

Co-amoxiclav (oral if moderate, IV if severe)

Question 19

1st line abx for CAP and COPD exacerbation

Answer 19

Amoxicillin
*if CURB65 = 3 or more - co-amoxiclav

Question 20

PE suspected + renal impairment

Answer 20

ventilation-perfusion scan (VQ scan)