Respiratory

Question 1

Which antibiotic is typically used to treat community acquired pneumonia (CAP) and atypical pneumonia?

Answer 1

CAP-Amoxicillin

Atypical - Erythromycin

Question 2

What are the lift threatning features of an acute asthma attack?

Answer 2

• Silent chest
• Oxygen sats <92%
• Poor respiratory effort
• Bradycardia
• Exhaustion
• Confusion
• Cyanosis
• PEFR <33% predicted

Question 3

What happens in an asthma attack?

Answer 3

Bronchial hypersensitivity causes bronachial inflammation and subsequent constriction

Question 4

What are the 3 main causative microorganisms in CAP?

Answer 4

• Streptococcus Pneumoniae
• Mycoplasma Pneumoniae
• Hamophilus Influenzae

Question 5

What is the CURB-65 scores and what are the associated values?

Answer 5

It is a score important in determining the severity of pneumonia

Question 6

What are some conditions often associated with asthma?

Answer 6

• Eczema
• Hayfever
• Allergic rhinitis
• Peanut/food allergues

Question 7

What are some common triggers of asthma?

Answer 7

• Pollen
• Smoking
• Dust mite
• Smoking
• Infection
• Chemicals
• Aerosols
• Animals

Question 8

What are the four steps of asthma management?

Answer 8

1. Inhaled SABA
2. Inhaled Steroid
3. Inhaled LABA
4. Increase the inhaled steroid (2), or add LTRA, or add theophylline

According to BTS^

Question 9

You diagnose a patient with asthma. What are some recommendations you should make to minimise them having attacks?

Answer 9

• Avoid triggers
• Good inhaler technique
• Medication compliance
• Encourage exercise (to increase lung capacity)

Question 10

What is atopy?

Answer 10

Group of disorder that often run in families cased by an IgE related hypersensitivity reaction.

Key words - IgE hypersensitivity in families

Question 11

Management in COPD exacerbation

Answer 11

• Oxygen carefully titrated to ABGs
• Nebulised salbutamol
• Corticosteroids
• Antibiotics according to local protocol
• Consider NIV

Question 12

What is the FEV1/FVC ratio in a COPD patient?

Answer 12

<70% (0.7) predicted

Question 13

What two drugs should a patient with DVT be started on?

Answer 13

Enoxaparin (LMWH) is used together with warfarin to treat acute deep vein thrombosis with or without pulmonary embolism

Question 14

What is bronchiectasis?

Answer 14

Bronchiectasis is a permanent dilation of bronchi caused by recurrent cycles of infection/inflammation leading to fibrosis and remodeling. This causes impaired mucus clearance. Any infection will therefore be more devastating.

Caused by:

• Cystic fibrosis (accounts for about 50% of all cases)
• COPD
• Recurrent pulmonary infections/aspiration
• Kartagener’s syndrome
• Foreign body

It is typically due to childhood infection which scars the lungs, causing bronchiectasis into adulthood. The irreversible damage and impaired mucociliary clearance leaves the patient susceptible to even more infection, which then causes more damage and scarring and it becomes a vicious cycle

Question 15

What are some features of bronchiectasis?

Answer 15

• Halitosis
• Clubbing
• Coarse crepitations
• Sputum production

Question 16

What investigations would you request for bronchiectasis?

Answer 16

• HRCT (High resolution CT)
• Sputum culture
• Inflammatory markers