Respiratory

Question 1

What improves prognosis in COPD?

Answer 1

Smoking cessation

LTOT if meets criteria

Question 2

COPD: what

Answer 2

• Chronic obstructive pulmonary disease
• Airflow obstruction
• Chronic bronchitis: chronic cough + sputum
• Emphysema: enlargement of airspaces distal to terminal bronchioles + destruction of alveolar walls

Question 3

COPD: causes

Answer 3

Smoking
Pollution
Alpha 1 antitrypsin

Question 4

COPD: signs + symptoms

Answer 4

Hyperinflation
Central cyanosis
Weight loss
Cor pulmonale (raised JVP, right ventricular heave, hepatomegaly)
Asterixis
Pursed lip breathing
Accessory muscles
Wheeze
Reduced breath sounds

Question 5

COPD: differentials

Answer 5

Asthma
HF
Lung ca
ILD
Bronchiectasis

Question 6

COPD: diagnosis

Answer 6

> 35
Risk factor eg smoking
Symptoms: SOBOE, chronic cough, wheeze, sputum, chest infx
LFTs: FEV1/FVC ratio <0.7
CXR - hyperinflation, bullae, pulmonary hypertension (prominent vasculature)
FBC - ?polycythaemia
ECG - RAD, RBBB

Question 7

COPD: management

Answer 7

1. SABA (salbutamol) or SAMA (ipratropium)
2. Combined therapy: LABA (salmetorol) + LAMA (tiotropium)
   or LABA + ICS (budesonide) (if asthma-like/steroid responsive)
3. Tripe therapy:
   LABA + LAMA + ICS

Question 8

DECAF score

Answer 8

Dyspnoea
Eosinophils (low)
Consolidation on CXR
Acidaemia
AF

= Risk stratification for in patient mortality

Question 9

PE

Answer 9

Raised JVP

RBBB (right heart strain as it pumps against clot in pulmonary circulation)