Respiratory

Question 1

How should primary PTX be managed?

Answer 1

if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise, aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men

Question 2

How should secondary PTX be managed?

Answer 2

Recommendations include:
if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
regarding scuba diving, the BTS guidelines state: ‘Diving should be permanently avoided unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively.’

Question 3

Normal PaCO2 in an asthma attack is…

Answer 3

Life-threatening. A normal PaCO2 in an acute asthma attack indicates exhaustion and should, therefore, be classified as life-threatening

Question 4

What is the Centor Criteria? What is it used for?

Answer 4

The Centor criteria* are as follows:

• presence of tonsillar exudate
• tender anterior cervical lymphadenopathy or lymphadenitis
• history of fever
• absence of cough

If 3 or more of the 4 Centor criteria are present there is a 40-60% chance the sore throat is caused by Group A beta-haemolytic Streptococcus

Question 5

What is a major feature of aspergillosis?

Answer 5

Eosinophilia is a feature of allergic bronchopulmonary aspergillosis

Question 6

Define mild, moderate and severe asthma in terms of PEF

Answer 6

Mild - 50-75%
Moderate - 33-50%
Severe - <33%

Question 7

Up to how many salbutamol puffs can you take in an asthma exacerbation (and how often)

Answer 7

10 puffs (every 30-60 seconds)

Question 8

Which questionnaire can be used to assess the severity of a patient’s asthma?

Answer 8

Asthma Control Test (ACT)

Question 9

Definition of COPD

Answer 9

FEV1/FVC <0.7 post-bronchodilator - non reversible

Question 10

Oxygen saturations in a CO2 retainer

Answer 10

88-92%

Question 11

Class. Tiotropium

Answer 11

LAMA

Question 12

Class. Ipratropium

Answer 12

SAMA

Question 13

Class. Salmeterol

Answer 13

LABA

Question 14

Which questionnaire can be used to assess the severity of a patient’s COPD?

Answer 14

COPD Assessment Test (CAT)

Question 15

Diagnosis of obstructive sleep apnoea

Answer 15

Initial: Epworth Sleepiness Scale
11-12 mild
13-15 moderate
16-24 severe

> 10 refer for polysomnography

Question 16

Definition of pneumonia

Answer 16

signs and symptoms of respiratory infection with CXR confirmation

Question 17

Definition of Hospital Acquired Pneumonia

Answer 17

hospital in the last 10 days or in-patient for >5 days plus signs and symptoms of respiratory infection with CXR confirmation

Question 18

Severe CAP treatment

Answer 18

IV Co-amoxiclav and PO Doxycycline (or IV Levofloxacin as monotherapy for penicillin allergic)

Question 19

Severe HAP treatment

Answer 19

IV Amoxicillin and Gentamicin (or Co-trimoxazole and Gentamicin if penicillin allergic) –> step down to PO Co-trimoxazole

Question 20

Non Severe Aspiration Pneumonia

Answer 20

PO Amoxicillin and Metronidazole (or PO Doxycycline and Metronidazole for penicillin allergic)

Question 21

Severe Aspiration Pneumonia

Answer 21

IV Amoxicillin + Metronidazole + Gentamicin (If penicillin allergic swap amox with PO Doxycycline or IV Clarithromycin) –> Step down to PO Amoxicillin and metronidazole (swap amoxicillin with doxycycline if penicillin allergic)

Question 22

Causes of bronchiolitis

Answer 22

RSV, metapneumovirus (2001)

Question 23

Causes of croup

Answer 23

parainfluenza type 1 or 3

Question 24

pH of infective pleural tap

Answer 24

<7.2

Question 25

Cause of epiglottitis

Answer 25

HiB

Question 26

“thumbprint” sign of lateral neck XR

Answer 26

Epiglottitis

Question 27

Management of epiglottitis

Answer 27

Ceftriaxone

Question 28

Which influenza causes pandemics ?

Answer 28

A

Question 29

Which influenza is associated with annual outbreaks?

Answer 29

B

Question 30

What is the cut-off for a normal FEV1/FVC?

Answer 30

70%

Question 31

Which ectopic hormone production is associated with Squamous NSCLC?

Answer 31

PTH

Question 32

Which ectopic hormone production is associated with SCLC?

Answer 32

ACTH -> Cushings

ADH -> SIADH

Question 33

Diagnosis of PE?

Answer 33

Clinical suspicion -> Wells Score ≥4 -> positive D-dimer -> CTPA

Question 34

Acute management of Tension PTX

Answer 34

Large bore needle in 2nd ICS MCL

Question 35

Causes of upper zone lung fibrosis

Answer 35

CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

Question 36

High anion gap metabolic acidosis

Answer 36

Organic acid formed

Lactic acidosis (Salicyclates, Shock)
Ketoacidosis (DKA)
Formic acidosis (Methanol poisoning)
Oxalic acid (Ethylene glycol poisoning)

Question 37

Normal anion gap metabolic acidosis

Answer 37

Loss of bicarbonates; hyperchloraemic acidosis (Chloride reabsorbed in kidneys to compensate the loss of bicarbonate)

• Diarrhoea
• Renal Tubular Acidosis

Question 38

COPD severity categorised by FEV1

Answer 38

Stage 1: >80% with mild symptoms
Stage 2: 50-79% (mod)
Stage 3: 30-49% (sev)
Stage 4: <30% (v.sev)

Question 39

Features of Kaposi’s Sarcoma

Answer 39

Associated with HIV + HHV-8
Purple-black papules on skin or GI mucosa or respiratory tracy (causing haemoptysis)
Radiotherapy and resection

Question 40

Acute exacerbation of COPD

Answer 40

Oral Prednisolone 5 days

+ Oral Amoxicillin 7 days if has purulent sputum or clinical signs of pneumonia

Question 41

Features of mycoplasma pneumonia

Answer 41

Worsening flu-like illness
Dry cough
Erythema Multiforme

Question 42

Which do you treat first?

Hypomagnesiumia or Hypokalaemia

Answer 42

Hypomagnesemia may exacerbate hypokalemia, by increasing distal tubule potassium secretion. Treating low magnesium first can then make low potassium easier to handle