Respiratory

Question 1

Spirometry:

FEV1/FVC of asthma?

Answer 1

Obstructive pattern…<70%

Low FEV1 and PEFR

Question 2

Spirometry:

Evidence of reversibility of asthma?

Answer 2

Post-bronchodilator FEV1 increased by at least 12%

Question 3

Asthma hypersensitivity type and description…Ig?

Answer 3

Type I
IgE mediated
Clinical atopy

Question 4

Asthma step 1 treatment

Answer 4

SABA as required

CONSIDER low dose ICS

Question 5

Asthma step 2 treatment

Answer 5

Reliever: SABA

Low dose ICS

Question 6

Asthma step 3 treatment

Answer 6

Reliever: SABA (or low dose ICS)

Low dose ICS/LABA

Question 7

Asthma step 4 treatment

Answer 7

Reliever: SABA (or low dose ICS)

Med/high dose ICS/LABA

Question 8

Asthma step 5 treatment

Answer 8

Reliever: SABA (or low dose ICS)
(refer for add on treatment:)
Tiotropium
Mepolizumab
Omalizumab

Question 9

What drug is common anti-emetic?

Answer 9

Metoclopramide

Question 10

Daytime symptoms of OSA?

Answer 10

Sleepiness!!
Headaches (morning)
Dry throat
Poor concentration
Anxiety/depression

Question 11

Nightime symptoms of OSA?

Answer 11

Snoring
Apnoeas
Choking
Sweating
Restlessness

Question 12

Investigations for confirming OSA?

Answer 12

Sleep studies (polysomnography)
Nocturnal oximetry tracing

Question 13

Treatment for OSA?

Answer 13

LIFESTYLE! 
- Lose weight
- Cut alcohol
- Smoking cessation
CPAP!!
- Continuous positive airways pressure

Question 14

Dorsal and ventral respiratory groups in medulla responsible for?

Answer 14

Dorsal respiratory group = inspiratory
(and inhibits ventral RG)
Ventral respiratory group = expiratory
(Pre-botzinger complex in VRG)`

Question 15

At normal PO2 + PCO2, what is main stimulus for respiration?

Answer 15

CO2

Question 16

Reasons for night-sweats in OSAHS?

Answer 16

Holding breathing causes catecholamine excess…leading to night sweats

Question 17

Cause of nocturia in OSAHS?

Answer 17

Increase in atrial natriuretic peptide (due to atrial distention)
This dilates arteries+veins…increased GFR…increased diuresis and natriuresis (Na excretion)

Question 18

Acute asthma attack treatment?

Answer 18

1. Give oxygen, steroids, and SABA.
2. a) Give MgSO4 if acute severe
   b) Give Ipratropium bromide if life threatening

Question 19

ECG signs of PE?

Answer 19

S1Q3T3
Large S wave in lead I
Q wave in lead III
T wave inversion in lead III

Question 20

COPD first line inhalers?

Answer 20

SABA or SAMA

Question 21

COPD 2nd line inhalers

Answer 21

Depends on FEV1:
>50% - LABA or LAMA

<50% - LABA + ICS or LAMA