Respiratory Medicine

Question 1

Clinical features of ______ lung cancer:
More common in smokers
Secrete PTHrP, causing hypercalcaemia
Metastasise late (via lymph nodes)

Answer 1

Squamous cell carcinoma which is a type of non-small cell carcinoma

Question 2

Asthma Mx

Answer 2

Mild intermittent:

1. inhaled short acting β2 as needed
2. Regular preventer therapy: +inhaled steroid 200-800mcg
3. Add- on therapy:
   o + LABA ± é inhaled steroid to 800mcg
   o LABA not working: stop, use only inhaled steroid 800mcg
   o Consider leukotriene R antagonist or SR theophylline
4. Persistent poor control: inhaled steroid 800mcg
   o ± LRA, SR theophylline, β2 agonist tablet
5. Continuous or frequent use of oral steroid

Stepping down
• Consider at intervals ≥3months
• Maintain at lowest dose of inhaled steroids- cut down by 25-
50% each time you reduce

Question 3

COPD Mx

Answer 3

Question 4

What score is used for pneumonia

Answer 4

CURB-65
• Confusion
• RR ≥30 breaths/ min
• BP: systolic <90 or diastolic ≤60mmHg
• ≥65 years
0: likely for home treatment
1-2: consider hospital referral
3-4: urgent admission

Question 5

Pneumonia Mx

Answer 5

Management
• Home vs admission
• No smoking, rest, increase fluids
• Amoxicillin 500mg-1g tds, doxycycline 100-200mg od or
clarithromycin 500mg bd
• Treat pleuretic pain with Paracetamol 1g qds
• Review 48hrs- no improvement/ deterioration= CXR/ admit