Respiratory

Question 1

Alpha-1 antitrypsin deficiency late stage treatment:

Answer 1

Lung volume reduction surgery

Question 2

Pt with COPD, worsening breathlessness and dry cough, treatment:

Answer 2

30 mg prednisolone for 5 days.
Antibiotics (amoxicillin, clarithromycin or doxycycline) only if purulent sputum or clinical signs of pneumonia

Question 3

When to request CXR for patients with suspected pneumonia?

Answer 3

Suspected community-acquired pneumonia and at risk of underlying lung pathology (such as lung cancer) or if the cause of their symptoms is uncertain

Question 4

Non-invasive ventilation indications in COPD

Answer 4

COPD with respiratory acidosis pH 7.25-7.35

Question 5

Target oxygen saturation for COPD patient with normal pCO2

Answer 5

94-98%.
Prior to availability of blood gases, 28% Venturi mask at 4 l/min and aim for 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

Question 6

Asthma patient currently managed with salbutamol + beclometasone, having frequent exacerbations, next step:

Answer 6

LTRA

Question 7

Symptom control in non-CF bronchiectasis:

Answer 7

Inspiratory muscle training + postural drainage

Question 8

Intervention most likely to increase survival in patients with COPD?

Answer 8

Smoking cessation, then long-term oxygen therapy if hypoxic

Question 9

Smoker, chronic cough, FEV1/FVC <0.7, FEV1 81%, COPD severity:

Answer 9

Stage 1 mild, symptomatic with >80% FEV1
50-79% Stage 2 - Moderate
30-49% Stage 3 - Severe
< 30% Stage 4 - Very severe

Question 10

Treatment for severe asthma:

Answer 10

Oxygen if hypoxaemic, SABA, oral steroids.
If not responding: nebulised ipratropium bromide (SAMA), IV magnesium sulfate

Question 11

Most common organism causing infective exacerbations of COPD is:

Answer 11

Haemophilus influenzae

Question 12

Male 50-70 years presenting with progressive exertional dyspnoea associated with clubbing, bibasal fine end-inspiratory crepitations and a restrictive picture on spirometry:

Answer 12

Idiopathic pulmonary fibrosis

Question 13

First-line pharmacological treatment of COPD

Answer 13

SABA or SAMA

Question 14

Spirometry for alpha-1.antitrypsin deficiency

Answer 14

Obstructive

Question 15

Subacute presentation productive cough, dyspnoea, and pleuritic chest pain, fluid-filled cavity on CXR, not responding to antibiotics: dx and management

Answer 15

Lung abscess, percutaneous drainage

Question 16

Coarse crackles in the left upper lobe in a diabetic/alcoholic:

Answer 16

Klebsiella pneumoniae

Question 17

Treatment for small-cell lung cancer:

Answer 17

Chemo +/- radiotherapy, surgery for very early stages