Respiratory

Question 1

COPD prophylaxis of acute exacerbations (patients that have had >3 exacerabtions in a year)

Answer 1

Azithromycin

Question 2

Management of COPD

Answer 2

General = stop smoking, annual flu vaccine, pneumococcal vaccine
SABA or SAMA 
LABA or LAMA
ICS 
Triple therapy = LAMA + LABA + ICS

Question 3

Hypercalcaemia and respiratory disease

Answer 3

Sarcoidosis

Question 4

What type of drug is toitropium?

Answer 4

LAMA!

Question 5

Management of sleep apnoea

Answer 5

Weight loss

CPAP

Question 6

Why does CPAP work for sleep apnoea?

Answer 6

Continuous pressure keeps the airway open

Question 7

What type of drug is ipratropium?

Answer 7

SAMA

Question 8

What type of drug is salbutamol?

Answer 8

SABA

Question 9

Causes of ground glass appearance on x-ray

Answer 9

Allergic alveolitis (job related)
Interstitial lung disease
Infectious disease

Question 10

Contraindications to lung cancer surgery

Answer 10

SVC obstruction
FEV <1.5
Malignant pleural effusion (Lights criteria)
Vocal cord paralysis

Question 11

Causes of type 1 respiratory failure

Answer 11

Pneumonia 
Acute asthma 
Bronchiectasis 
PE
Pulmonary oedema 
Pneumothorax 
ILD

Question 12

Causes of type 2 respiratory failure

Answer 12

It’s failure of ventilation
COPD (hyper inflated chest, pink face, pursed lips)
Tiring (end of asthma attack)
Opioids

Question 13

What detects CO2 levels in the blood?

Answer 13

Chemoreceptors in the aorta

Question 14

Clinical findings of hypoxia

Answer 14

Low spO2
Tachycardia
Shortness of breath

Question 15

Ix for hypoxia

Answer 15

ABG

Chest X-ray

Question 16

Risk factors of acute respiratory distress syndrome

Answer 16

Sepsis
Aspiration
Pancreatitis 
Severe burns 
Trauma 

Anything that can cause inflammation, positive cycle that gets worse and worse

Question 17

Histological changes in ARDS

Answer 17

Diffuse alveolar damage
First several days = interstitial oedema, haemorrhage and oedema, alveolar collapse. Lots of fluid. Reduced breath sounds. Crackles.

Question 18

What is ARDS

Answer 18

Something triggers inflammation that means fluid leaks into the lungs.
Likely to develop multiple organ failure

Question 19

Why can you get right ventricular dysfunction in ARDS?

Answer 19

Increased fluid in lungs creates a pulmonary hypertensive effect, right heart can’t pump efficiently

Question 20

Ix for ARDS

Answer 20

ABG 
SpO2
Chest X-ray 
BNP 
Echocardiogram (help to rule out a cardiac cause)

Sepsis is the most likely cause so do a septic screen

Question 21

Symptoms of ARDS

Answer 21

Hypoxia
Feeling faint
Rapid, shallow breathing
Tiredness/confusion