Respiratory

Question 1

What causes mucosal inflammation in asthma?

Answer 1

IgE

Question 2

Which two drugs can exacerbate asthma?

Answer 2

Beta-Blockers

NSAIDS - Aspirin

Question 3

What are the main symptoms of asthma? Give 5

Answer 3

• Cough
• Wheeze
• Chest tightness
• SoB
• Hyper-inflated chest

Question 4

When is asthma worse?

Answer 4

Night/early morning

Question 5

What is classified as moderate asthma?

Answer 5

Symptoms + 50-75% best/predicted PEF

Question 6

What is classified as acute-Severe asthma?

Answer 6

Any one of:

• 33-50% PEF
• RR <25
• HR >100bpm
• Inability to complete sentence in one breath

Question 7

What classes as life-threatening asthma?

Answer 7

Any of:

• PEF <33%
• SpO2 <92%
• PaO2 <8
• Silent chest
• Cyanosis
• Poor resp effort
• Exhaustion/confusion

Question 8

What FEV1/FVC value is highly diagnostic of asthma?

Answer 8

<0.7 and/or most clinical features

Question 9

How do you know when a spacer is being used correctly?

Answer 9

• Spacer will whistle if inhaled too fast

Question 10

What is Step 1, mild-intermittent in asthma management?

Answer 10

Add Inhaled short-acting B2 agonist as required

Question 11

What is Step 2, regular asthma management?

Answer 11

Add Inhaled steroid 200-800mcg as a preventor

Question 12

What is the 3rd Step in asthma management?

Answer 12

1. Add inhaled long-acting B2 agonist (LABA)
2. Assess control of asthma:
   - If LABA has some benefit, continue and increase inhaled steroid dose to 800mcg/day
   - No response to LABA stop and increase steroid to 800mcg/day
3. If still unsuccessful try other therapies such as leukotriene receptor antagonist or SR theophylline

Question 13

What is the 4th Step in asthma management? (persistent poor control)

Answer 13

Increase inhaled steroid up to 2000mcg/day

Addition of a fourth drug - Leukotriene receptor antagonist, SR theophylline, B2 agonist tablet

Question 14

What are the main signs/symptoms of COPD?

Answer 14

• Tachypnoea
• Accessory muscle usage
• Hyperinflated chest
• Hyper resonant chest
• Quiet breath sounds

Question 15

What is a pink puffer?

Answer 15

• Increased ventilation
• Slightly low PaCO2
• Breathless but not cyanosed - develop Type I respiratory failure

Question 16

What is a blue bloater?

Answer 16

• Reduced ventilation
• Low PaO2 and high PaCO2
• Cyanosed but not breathless - respiratory centres are no longer sensitised to high CO2

Question 17

What is diagnostic of COPD?

Answer 17

Symptoms + FEV1/FVC <0/7

Question 18

When is long-term oxygen therapy indicated in COPD?

Answer 18

FEV1 <30% - only prescribed by specialist

Question 19

What is the first step in COPD management?

Answer 19

• SABA or SAMA

Question 20

If a patient with COPD has exacerbations or persistent breathlessness with an FEV1 >50%, what is the management?

Answer 20

• SABA + LABA

Question 21

If a patient with COPD has exacerbations or persistent breathlessness with an FEV1 <50%, what is the management?

Answer 21

• SABA + LABA + ICS or

- SABA + LABA + LAMA

Question 22

If a patient with COPD has persistent exacerbations or persistent breathlessness with an FEV1 >50%, what is the management?

Answer 22

• SABA + LABA + ICS or

- SABA + LABA + LAMA

Question 23

If a patient with COPD has persistent exacerbations or persistent breathlessness with an FEV1 <50%, what is the management?

Answer 23

• SABA + LABA + LAMA + ICS