Respiratory

Question 1

Acute exacerbation COPD

Answer 1

O2 therapy
bronchodilation (salbutamol and ipratropium)
steroids - iv hydrocortison --`. pred po (5d)
abx if infective - Need 2 of:
o Increased breathlessness
o Increased sputum volume
o Increase sputum purulence
o Increased breathlessness

Question 2

COPD

Answer 2

o General

i. Smoking cessation
ii. Annual influenza vaccine + one off pneumococcal vaccine
iii. Home supply of antibiotics and prednisolone if recurrent exacerbations

o Medical therapy escalation:

1. SABA or SAMA
2. Add LAMA, or LABA (with ICS if FEV1 <50%)
3. Take all 3
4. Theophylline
5. Mucolytics

Question 3

Indications for LTOT

Answer 3

• Ankle oedema
• Two ABGs with pO2 < 7.3
• FEV1 <30%
• Cyanosis
• Polycythaemia
• Raised JVP
• Sats of less than or equal to 92% room air

Question 4

COPD diagnosis

Answer 4

FEV1/FVC < 70% + symptoms suggestive of COPD

Question 5

pneumonia

Answer 5

o CURB65 score (confusion, urea >7, RR>30, BP<90/60, >65)
o 0-1 = home care (<3% mortality) à amoxicillin 5 days
o 2-3 = hospital care (3-15% mortality) à amoxicillin + clarithromycin 7 days
o 3+ = ITU (15%+ mortality) à consider co-amox or Tazocin

Question 6

lung cancer - surgery CI

Answer 6

o SVC obstruction
o FEV < 1.5L
o Malignant pleural effusion
o Vocal cord paralysis
o Stage IIIb or IV OR tumour near hilum

Question 7

acute asthma

Answer 7

1. Oxygen to 94-98%
2. Salbutamol nebuliser back to back driven by oxygen
3. Ipratropium nebulise once
4. Prednisolone for at least 5 days
5. Magnesium sulphate 1.2-2g over 20 mins
6. IV salbutamol

Question 8

bipap

Answer 8

• COPD with acidosis of 7.25-7.35
• Type II respiratory failure
• Cardiogenic pulmonary oedema unresponsive to CPAP
• Weaning from tracheal intubation

Question 9

pe/dvt

Answer 9

Treating:
o If hypotensive (sbp<90) à massive PE à Heparin whilst you wait for thrombolysis = alteplase
o If stable:

i. LMWH for 5 days or until INR >2 (whichever is longer) – if active cancer LMWH is kept for full 6 months

ii. Warfarin started within 24 hours and for:
a. 3 months if PE was provoked (surgery, trauma, immobility)
b. 6 months if unprovoked