Respiratory

Question 1

which patients with copd need inhaled steroids?

Answer 1

ones where FEV1 < 50% of predicted AND

have had at least 2 exacerbations in 1 year (that needed treatment with abx or steroids)

Question 2

Long term oxygen therapy is needed in which copd patients?

Answer 2

with;

PaO2 < 7.3kpa and stable
pao2 ; 7.3 - 8 with complications i.e;

polycythaemia (v. high Hb), pulmonary hypertension, peripheral oedema, nocturnal hypoxaemia

Question 3

What is part of a patients CO2 self management plan?

Answer 3

1. Lifestyle changes;
   First step = stop smoking, nicotine replacement.
   Healthy diet. breathing and coughing excercises. excercise plan.
2. Drug list + instructions
   what to take when

Question 4

Pupose of inhaled steroids in copd?

Answer 4

reduce the median annual EXACERBATION rate!

Question 5

What does pulmonary rehabilitation involve?

Answer 5

its a course where patients are taught exercises and knowledge to help manage breathlessness

Question 6

What is asthma

Answer 6

generalised airway narrowing that goes with treatment or spontaneously

Question 7

How does one diagnose asthma?

Answer 7

History
Tests;
1. Peak flow - variability by time
2. Spirometry w/inhaled bronchodilators
3. Peak flow - oral steroids
4. Exercise test

Question 8

Some features of asthma uncommon in COPD?

Answer 8

FH of asthma or allergic diseases

Being woken at night due to breathlessness

improvement of FEV1 by 400mls on use of bronchodilators or prednisolone

peak flow shows diurnal or daily variation

Question 9

Treatment for asthma?

Answer 9

Outdated as of 2022

1

Question 10

What a important features that signify that asthma is under control

Answer 10

doesnt disturb sleep
peak flow above 85% of personal best
doesnt restrict daily activities

if peak flow falls between 70-85% asthma getting worse!

Question 11

Severe asthma is characterised by what peak flow % ?

name an steroid that can be taken in this instance?

Answer 11

50-70%

prednisolone

Question 12

What constitutes an emergency situation in relation to asthma?

what should a patient do?

Answer 12

worsening symptoms. peak flow 50% or less.

take 8 (5mg) prednisolone tablets and contact ambulance

Question 13

What tests to do to differentiate asthma and COPD?

Answer 13

spirometry
home peak flow
excercise test
low/high dose steroid + peak flow

Question 14

Superior Vena Cava syndrome occurs due to SVC-Obstruction name some common causes of this?

Answer 14

malignancy - i.e. breast cancer with mets.

pacemaker leads

central venous lines

Question 15

Symptoms of svc obstruction?

exacerbation factors?

Answer 15

Common symptoms are facial swelling and arm swelling as seen, as well as dyspnoea, cough and facial plethora.

lying down or bending forward

Question 16

Ivx for SVCO?

Answer 16

The most useful imaging test is a chest CT with IV contrast which establishes the diagnosis and also shows the exact location of the pathology

Question 17

Signs of lung cancer with Horner’s syndrome indicate a what? located where?

Answer 17

Pancoast tumour of the apex of the lung ipsilaterally

Question 18

Pink frothy sputum is characteristic of what?

Answer 18

pulmonary oedema

Question 19

What is Goodpasture’s syndrome?

antibody implicated?

Answer 19

It is one of the few causes of pulmonary renal syndrome, which is characterised by pulmonary haemorrhage with rapidly progressive GN.

so you will see pulmonary symptoms like haemoptysis and also deranged renal function tests, also those indicative of GN ; ++ protein, blood - urine.

anti-GBM

Question 20

Positive ANCA usually suggests?

Answer 20

a diagnosis of Wegener’s granulomatosis, Churg-Strauss or microscopic polyarteritis

Question 21

IN legionella pneumonia, why dont we confirm with sputum?

Answer 21

legionella does grow on culture mediums - do a urine antigen test

Question 22

What is the diagnosis?
Textbook signs are persistent cough, with copious purulent sputum together with intermittent haemoptysis. This can also be congenital, or post-infection

Answer 22

bronchiectsis