Respiratory

Question 1

Fev1/Fvc <75%

Answer 1

Obstructive

Asthma, COPD, bronchiectasis, bronchiolitis obliterans

Question 2

Fev 1 /Fvc normal/raised

Answer 2

restrictive
PF, asbestosis, sarcoidosis
ARDS, kyphoscoliosis, neuromuscular disorders

Question 3

HAP -most common bacteria type

Answer 3

Gram negative anaerobes

Question 4

Most common organism CAP

Answer 4

Strep pneumonia
HI
Mycoplasma

Question 5

Aspiration microbes

Answer 5

Anaerobes

Question 6

Pneumococcal

Answer 6

Most common
Fever, pleurisy, herpes labialis
Lobar consolidation
rust coloured sputum

Question 7

Staphylococcal

Answer 7

Complicates flu
Young, old, IVDU
Bilateral cavitating pneumonia

Question 8

Klebsiella

Answer 8

Rare
Old, DM
Upper lobe cavitating
Drug resistance often
red current jelly sputum

Question 9

Pseudonomas - who gets it?

Answer 9

Bronchiectasis

CF

Question 10

Mycoplasma

Answer 10

Epidemics 4 yrs
Flu symptoms > dry cough
cold agglutinins
CXR reticular nodular shadowing patches
>autoimmune hemolytic anaemia
>erythema multiform, Stephen Johnsons, GBS

Question 11

Legionella

Answer 11

Flu like > dry cough
D&V, renal failure
CXR Bilateral consolidation
Lymphopenia
Hyponatraemia
Deranged LFTs

Question 12

RSV

Answer 12

Bronchiolitis

Question 13

Parainfluenza virus

Answer 13

Croup

Question 14

Rhinovirus

Answer 14

Common cold

Question 15

Haemophilus Influenzae

Answer 15

CAP
Most common for bronchiectasis exacerbations
Acute epiglottitis

Question 16

Pneumocystis Jiroveci

Answer 16

HIV
Few chest signs
Exertional dyspnoea

Question 17

Tonsitilits

Answer 17

group B haemolytic strep

Question 18

Pseudomembranous croup

Answer 18

staph A

Question 19

q fever

Answer 19

corxiella burnetti
cattle sheep goats
flu like + GI symp
>ARDS, endocarditis

Question 20

chlamydia psittaci

Answer 20

bird fanciers lung
systemic prodrome
rising titre complement fixing antibody

Question 21

Exudate

Answer 21

protein > 30

Inflammatory, cancer

Question 22

Transudate

Answer 22

<30

HF, cirrhosis etc

Question 23

Positive BDR testing

Answer 23

Improvement of FEV1 of 12% or more and increase in volume of 200 ml or more
In children just 12%

Question 24

Diagnosis Asthma

Answer 24

Spirometry and BDR test

Should have FeNO test

Question 25

FeNO results

Answer 25

Children > 35 parts/ billion | Adults > 40

Question 26

g

Answer 26

jyg

Question 27

LAMA examples

Answer 27

glycopyronium | tiotropium

Question 28

Theophylline

Answer 28

Phosphodiesterase inhibitor | Increases cAMP ..... > decrease leukotrienes

Question 29

How to step down asthma therapy.

Answer 29

If stable reduce ICS by 25-30% every 3 months

Question 30

Spirometry grade severity COPD

Answer 30

``` FEV1: FVC ration < 70 AND FEV1: >80 - - mild (stage 1) 50 - mod 30 - severe <30 v severe (stage 4) ```

Question 31

Most common viral cause of COPD

Answer 31

Human rhinovirus

Question 32

First line abx for exacerbation of COPD

Answer 32

Amox, clari, doxy

Question 33

Asthma Adult management

Answer 33

``` SABA + low ICS +LTRA +LABA +MART - low, medium > high seperate ICS + LABA + LAMA/ theophylline/ expert ```

Question 34

Asthma management 5-16

Answer 34

As per adults - changes: Stop LTRA if not working High dose MART available ``` SABA + low ICS + LTRA - stop if not working + LABA > MART - low, med, high. ``` Trial theophylline

Question 35

Asthma management in children <5

Answer 35

SABA Trial 8 moderate ICS > back in 4/52 - low ICS > >4/52 - retrial 8 weeks + LTRA Stop, refer paeds

Question 36

COPD management

Answer 36

SABA/ SAMA Then.. is there asthma features? Yes - LABA + ICS (then + LAMA) No - LABA + LAMA ``` Theophylline Oral abx - macrolide - azith (should not smoke), needs CT thorax, sputum cultures LFTs/ QT hearing loss tinnitus ```

Question 37

Prophylactic antibiotics in COPD

Answer 37

Macrolide - azith (should not smoke), needs CT thorax, sputum cultures LFTs/ QT hearing loss tinnitus

Question 38

Example LABA

Answer 38

Salmeterol

Question 39

Example LAMA

Answer 39

Tiotropium

Question 40

What is theophylline

Answer 40

Phosphodiesterase inhibitor.. | relaxes smooth muscle