Respiratory Conditions Management

Question 1

Chronic Brochitis - Management (3/6/0)

Answer 1

conservative 1) smoking cessation 2) pulmonary rehabilitation (inc. exercise, education, breathing techniques) 3) vaccinations (annual influenza, pneumococcal) medical 1) LAMA 2) SAβA (as required) 3) INH corticosteroid (severe) 4) long term domiciliary oxygen therapy (severe, non-smokers) 5) antimucolytic 6) diuretic (oedema)

Question 2

Emphysema - Management (3/5/0)

Answer 2

conservative 1) smoking cessation 2) pulmonary rehabilitation (exercise, education, breathing techniques) 3) vaccinations (annual influenza, pneumococcal) medical 1) LAMA (+ LAβA in persistent dyspnoea) 2) SAβA (as required) 3) INH corticosteroid (severe) 4) long term domiciliary oxygen therapy (severe, non-smoker) 5) alpha-1-antitrypsin replacement (deficiency)

Question 3

Asthma - Management (3/6/0)

Answer 3

conservative 1) avoid allergen 2) inhaler technique 3) vaccinations (influenza) medical 1) SAβA (as required) 2) + LAβA 3) + INH corticosteroid (beclometasone) (increase dose as required) 4) PO corticosteroid (prednisolone) (severe) 5) montelukast (consider if severe) 6) theophylline (consider if severe)

Question 4

Asthma - Management (Attack) (5)

Answer 4

1) NEB SAβA 2) PO corticosteroid (prednisolone) 3) oxygen therapy (severe) 4) anti-ACh (ipatropium) (severe) 5) magnesium (severe)

Question 5

Small Cell Lung Carcinoma - Management (0/3/1)

Answer 5

medical 1) chemotherapy 2) radiotherapy 3) prophylactic cranial irradiation surgery 1) surgical excision (e.g. lobectomy) (rare due to late presentation)

Question 6

Non-Small Cell Lung Carcinoma - Management (0/2/1)

Answer 6

medical 1) chemotherapy 2) radiotherapy surgery 1) surgical excision (e.g. lobectomy)

Question 7

Pulmonary Embolism - Management (0/5/2)

Answer 7

medical 1) IV fluids 2) adrenaline 3) oxygen (high flow, 60-100%) 4) anticoagulant (LMW heparin + warfarin) 5) thrombolysis (IV alteplase) surgery 1) pulmonary thrombectomy (thrombolysis contraindicated) 2) vena caval filter (thrombolysis contraindicated) (can be long term)

Question 8

Community Acquired Pneumonia - Management (4/4/2)

Answer 8

conservative 1) smoking cessation 2) rest 3) fluids (IV if dehydrated or shock) 4) vaccination (influenzae, pneumococcal) medical 1) hospital guideline empirical antibiotics (e.g. amoxicillin, clarithromycin) 2) specific antibiotics (severe) 3) oxygen (aim for SaO2>94% or SaO2>88% in COPD) 4) analgesia (pleuritic pain) surgery 1) thoracentesis (pleural effusion) 2) surgical drainage (lung abscess)

Question 9

Hospital Acquired Pneumonia - Management (4/4/2)

Answer 9

conservative 1) smoking cessation 2) rest 3) fluids (IV if dehydrated or shock) 4) vaccinations (influenzae, pneumococcal) medical 1) hospital guideline empirical antibiotics (e.g. amoxicillin, clarithromycin) (before culture results) 2) specific antibiotics (after culture results) 3) oxygen (aim for SaO2>94%, SaO2>88% in COPD) 4) analgesia (pleuritic pain) surgery 1) thoracentesis (pleural effusion) 2) surgical drainage (lung abscess)

Question 10

Immunocompromised Pneumonia - Management (4/4/2)

Answer 10

conservative 1) smoking cessation 2) rest 3) fluids (IV if dehydrated or shock) 4) vaccinations (influenzae, pneumococcal) medical 1) hospital guideline empirical antibiotics (amoxicillin, clarithromycin) (before culture results) 2) specific antibiotics (after culture results) 3) oxygen (aim for SaO2>94%, SaO2>88% in COPD) 4) analgesia (pleuritic pain) surgery 1) thoracocentesis (pleural effusion) 2) surgical drainage (lung abscess)

Question 11

Aspiration Pneumonia - Management (4/4/2)

Answer 11

conservative 1) smoking cessation 2) rest 3) fluids (IV if dehydrated or shock) 4) vaccinations (influenzae, pneumococcal) medical 1) hospital guideline empirical antibiotics (e.g. amoxicillin, clarithromycin) (before culture results) 2) specific antibiotics (after culture results) 3) oxygen (aim for SaO2>94%, SaO2>88% in COPD) 4) analgesia (pleuritic pain) surgery 1) thoracentesis (pleural effusion) 2) surgical drainage (lung abscess)

Question 12

Tuberculosis - Management (5/4/0)

Answer 12

conservative 1) neonatal BCG vaccine 2) notify Public Health England 3) ensure medical compliance 4) contact tracking 5) screening patient contacts medical 1) rifampicin (2 months intensive, 4 months continuation) 2) isoniazid (2 months intensive, 4 months continuation) 3) pyrazinamide (2 months intensive) 4) ethambutol (2 months intensive)

Question 13

Type I Respiratory Failure - Management (0/4/0)

Answer 13

medical 1) treat underlying cause 2) face mask oxygen (24-60%) 3) assisted ventilation oxygen (>60%) (e.g. CPAP) 4) endotracheal intubation + mechanical ventilation oxygen (unconscious)

Question 14

Type II Respiratory Failure - Management (0/4/0)

Answer 14

medical 1) treat underlying cause 2) face mask oxygen (24-60%) 3) assisted ventilation oxygen (>60%) (e.g. CPAP) 4) endotracheal intubation + mechanical ventilation oxygen (unconscious)