Respiratory Qs

Question 1

When can you prescribe an ICS in COPD?

Answer 1

• Eosinophil > 300
• Concomitant asthma
• Hospitalisation due to exacerbations
• 6 exacerbations in the last yr, 4 of which were mod

Question 2

When can’t you prescribe an ICS in COPD?

Answer 2

• 4 pneumonia infections in the last month
• CI in repeat pneumonia

Question 3

If LABA/ICS is ineffective in COPD

Answer 3

triple therapy LABA/ICS/LAMA

Question 4

Cystic fibrosis
Those who have evidence of lung disease and inadequare reponse to dornase alfa =

Answer 4

o Add hypotonic sodium chloride inhaler as mucolytic therapy

Question 5

What must you rule out before prescribing infliximab?

Answer 5

TB
- T spot test or Mantoux test

Question 6

Which LAMA can be used BD

Answer 6

Aclinidium

Question 7

Which LAMA is taken OD?

Answer 7

• Tiotropium
• Glycopyrronium
• Umelicinium

Question 8

Acute angle glaucoma medical emergency

Answer 8

• Cloudiness
• N+V + headache
• AM: ipratropium can trigger or worsen

Question 9

What is the dose of Montelukast in asthma?

Answer 9

15 years and older: 10 mg OD
6yrs - 14yrs: 5mg OD
6 months - 5yrs: 4mg OD

Question 10

Bronchiestasis

Answer 10

• lung’s bronchi become permanently damaged and widened
• more common in women than in men.
• Coughing up yellow or green mucus daily -
• SOB that gets worse during flare-ups.

Question 11

When should montelukast be taken?

Answer 11

Evening

Question 12

what is the treatment for acute exacerbation that shows a peak flow of <33%, sats <92% with altered consciousness, exhaustion, and cardiac arrhythmia? →

Answer 12

life-threatening:
- oxygen to maintain sats between 94-98%
- nebulized salbutamol 5mg (oxygen driven) + consideration for nebulized ipratropium 500mcg
- prednisolone 40-50mg for at least 5 days
- patients should be followed up within 48 hours of discharge or presentation if not admitted!

Question 13

Life-threatening exacerbation

Answer 13

PF <33%
Sats < 92%
Altered consciusness
Exhaustion
Cardiac arrythmias

Question 14

What is the treatment for acute exacerbation of asthma where peak flow is 33-50% and oxygen saturation is at least 92% where pulse is at least 110/min and respiratory rate is at least 25/min? →

Answer 14

SEVERE
- oxygen to maintain sats between 94-98%
- nebulized salbutamol 5mg (oxygen driven)
- prednisolone 40-50mg for at least 5 days
- patients should be followed up within 48 hours of discharge or presentation if not admitted!

Question 15

Severe asthma exacerbation

Answer 15

• PF 33-50%
• Sat at least 92%
• Pulse at least 110/min
• RR at least 25/min

Question 16

What is the treatment for acute exacerbation of asthma where peak flow (best of predicted) is 50-75% and pulse is <110 min →

Answer 16

MODERATE
- salbutamol pMDI + spacer up to 10 puffs
- prednisolone 40-50mg for at least 5 days
- patients should be followed up within 48 hours of discharge or presentation if not admitted!

Question 17

Moderate asthma exacerbation

Answer 17

• PF 50-75%
• pulse is <110/min

Question 18

Pt develops a stutter

Answer 18

Montelukast

Question 19

Current smoking and theophylline

Answer 19

Smoking reduces theophylline levels by increasing the clearance

Question 20

What if pt starts smoking during theophylline treatment

Answer 20

Dose increase to max DD of 2.5mg tds may be reuqired in pt who are smoking or start smoking during treatment

Question 21

Stopping smoking during theophylline treatment

Answer 21

• Increases theophylline levels
• May need dose decrease

Question 22

Which condition may increase the risk of a patient developing TB disease? Depression, diabetes, hyperthyroidism, obesity, smoking? →

Answer 22

diabetes - people living with diabetes who are also infected with TB are more likely to develop TB disease and become sick with TB (even if they have latent TB)

Question 23

CURB

Answer 23

Confusion (mental test score of 8 or less)
Urea > 7mmol/L
RR >30
BP < 90/60
Age > 65

Question 24

CURB score of 5 = high severity
Treatment

Answer 24

Amoxicillin 1g TDS IV + azithro 500mg OD IV for 5 days

Question 25

How often do you need to replace the spacer

Answer 25

1 yr

Question 26

How often do you need to wash spacer?

Answer 26

1m