Respiratory - Breathlessness and wheeze

Question 1

patient with breathlessness , wheeze and cough and a new onset rash after exposure to hairdye

what is the most likely diagnosis

a.asthma
b.copd
c.bronchiectasis
d.left ventricular failure
e.anyphylaxis

Answer 1

e.anyphylaxis

Question 2

patient with wheeze, cough, breathlessness with angina, prev MI patient also has oedema
what is the most likely diagnosis

a.asthma
b.copd
c.bronchiectasis
d.left ventricular failure
e.anyphylaxis

Answer 2

d.left ventricular failure

Question 3

what is the most common cause of wheeze, cough and breathlessness

Answer 3

copd

Question 4

hyperinflation and flattened diaphragm on cxr is indicative of what

a.asthma
b.copd
c.bronchiectasis
d.left ventricular failure

Answer 4

b.copd

Question 5

if FEV1:FVC ratio is <0.7 what is indicated

Answer 5

obstructive disorder

Question 6

a ………….. in a1 antitrypsin causes neutrophil elastase to go unnopposed and the alveoli are destroyed

a.deficiency
b.overproduction

Answer 6

a.deficiency

Question 7

FEV 1 >= 80% predicted

Answer 7

GOLD 1

Question 8

FEV 1 50-79 % predicted

Answer 8

GOLD 2

Question 9

FEV 1 30-49 % predicted

Answer 9

GOLD3

Question 10

FEV 1 <30 % predicted

Answer 10

GOLD4

Question 11

COUGH AND SPUTUM for more than ……….. months is required to diagnose bronchitus

Answer 11

3 minths

Question 12

emphysema pathophysiology

Answer 12

destruction of alveolar walls

Question 13

what is the first step in management of copd

a.SABA as needed
b.LABA/LAMA
c.LABA/LAMA/ICS
d.stop smoking

Answer 13

d.stop smoking

Question 14

what is the second stage of copd management

a.SABA as needed
b.LABA/LAMA
c.LABA/LAMA/ICS
d.stop smoking

Answer 14

a.SABA as needed

Question 15

what is the third stage of copd management

a.SABA as needed
b.LABA/LAMA
c.LABA/LAMA/ICS
d.stop smoking

Answer 15

b.LABA/LAMA

Question 16

what is the next step in copd management after LABA/LAMA if it still affects day to day quality of life or they have 1+ exacerbation per year

a.SABA as needed
b.LABA/LAMA
c.LABA/LAMA/ICS
d.stop smoking

Answer 16

c.LABA/LAMA/ICS

as a trial for 3 months
if no improvement
back to LABA/LAMA maintainence

Question 17

asthma

Answer 17

patients present younger
variable symptoms

Question 18

asthma pathophysiology

Answer 18

inhaled allergen
immune response
airway inflammation
TH2 response
eosinophils
bronchospasm
remodelling and airway oedema

Question 19

reversibility of ….% or more or 200ml is supportive of asthma diagnosis

a.5%
b.25%
c.12%
d.10%

Answer 19

c.12%

Question 20

what is the first treatment for asthma

a.SABA
b. SABA + ICS
c. SABA+ ICS+ LABA
d.SABA + ICS (increased dose) +LABA
e.SABA +ICS (increased dose)

Answer 20

a.SABA

Question 21

what is the 2nd step for asthma treatment

a.SABA
b. SABA + ICS
c. SABA+ ICS+ LABA
d.SABA + ICS (increased dose) +LABA
e.SABA +ICS (increased dose)

Answer 21

b. SABA + ICS

Question 22

what is the 3rd step in asthma management

a.SABA
b. SABA + ICS
c. SABA+ ICS+ LABA
d.SABA + ICS (increased dose) +LABA
e.SABA +ICS (increased dose)

Answer 22

c. SABA+ ICS+ LABA

Question 23

patient on SABA,ICS and LABA for asthma . beneffiting from the addition of the LABA but still uncontrolled what should be offered next

a.SABA
b. SABA + ICS
c. SABA+ ICS+ LABA
d.SABA + ICS (increased dose) +LABA
e.SABA +ICS (increased dose)

Answer 23

d.SABA + ICS (increased dose) +LABA

Question 24

patient on SABA,ICS and LABA for asthma . no response from the addition of the LABA , still uncontrolled what should be offered next

a.SABA
b. SABA + ICS
c. SABA+ ICS+ LABA
d.SABA + ICS (increased dose) +LABA
e.SABA +ICS (increased dose)

Answer 24

e.SABA +ICS (increased dose)

Question 25

if patient on SABA, LABA and highest doses of ICS and still persistent poor control of asthma what should be offered

Answer 25

SABA, LABA , high dose ICS, and leukotriene receptor antagonist

then oral steroid tablets and specialist referral