GP - Resp

Question 1

What is the management for asthma in children?

Answer 1

1. SABA
2. SABA + low-dose ICS
3. SABA + low-dose ICS + LTRA
4. SABA + low-dose ICS + LABA
5. SABA + low-dose ICS MART
6. SABA + moderate-dose ICS MART or separate LTRA
7. Increase ICS dose + refer

Question 2

What is the management for asthma in children <5 years?

Answer 2

1. SABA
2. SABA + 8-week trial of moderate-dose ICS
3. SABA + low-dose ICS + LTRA
4. Refer

Question 3

What is the management for asthma in adults?

Answer 3

1. SABA
2. SABA + low-dose ICS
3. SABA + low-dose ICS + LTRA
4. SABA + low-dose ICS + LABA
5. SABA +/- LTRA + low-dose ICS MART
6. SABA +/- + moderate-dose ICS MART
7. Increase ICS dose and refer

Question 4

What are features of moderate acute asthma?

Answer 4

• PEFR 50-75%
• Speech normal
• RR <25/min
• Pulse <110bpm

Question 5

What are features of severe acute asthma?

Answer 5

• PEFR 33-50%
• Can’t complete sentences
• RR >25/min
• Pulse >110bpm

Question 6

What are features of life-threatening acute asthma?

Answer 6

• PEFR <33%
• O2 sats <92%
• Silent chest/cyanosis/feeble respiratory effort
• Bradycardia/dysrhythmia/hypotension
• Exhaustion/confusion/coma

Question 7

What is the management for acute asthma?

Answer 7

O SHIT ME (different order)
- Oxygen
- Nebulised salbutamol
- Nebulised ipratropium bromide
- Hydrocortisone IV or oral prednisolone
- IV Magnesium sulphate
- Theophylline/aminophylline
- IV salbutamol
- Escalate

Question 8

Give an example of each type of asthma medication

Answer 8

• SABA = salbutamol
• ICS = budesonide/beclomethasone
• LTRA = montelukast
• LABA = formoterol

Question 9

What are the investigations for COPD?

Answer 9

• Spirometry = FEV1/FVC <70%
• Chest x-ray = hyperinflation/bullae/flat hemidiaphragm
• FBC (exclude secondary polycythaemia)
• BMI

Question 10

When do you give each type of oxygen therapy?

Answer 10

Type 1 respiratory failure (normal CO2) = CPAP

Type 2 respiratory failure (high CO2) = BiPAP

Question 11

What findings are seen on CXR in a PE?

Answer 11

• Fleischner sign (dilated central pulmonary vessels)
• Westermark sign (collapse of vasculate distal to PE)
• Hampton’s hump (wedge-shaped infarct)

Question 12

What findings are seen on ECG in a PE?

Answer 12

• Sinus tachycardia
• ST depression

Question 13

How are management options in COPD decided?

Answer 13

Whether or not there are features of steroid responsiveness:
- Asthmatic features
- Atopic illness
- Variation in FEV1

Question 14

What is the management for COPD in steroid responsive patients?

Answer 14

1. SABA or SAMA
2. SABA + LABA + ICS
3. SABA + LABA + ICS + LAMA

Question 15

What is the management for COPD in non steroid responsive patients?

Answer 15

1. SABA or SAMA
2. SABA + LABA + LAMA

Question 16

What will an x-ray show in transient tachypnoea of the newborn?

Answer 16

Fluid in the horisontal fissure

Question 17

What will an x-ray show in COPD?

Answer 17

• Chest hyperinflation
• Bullae
• Flat hemidiaphragm

Question 18

What will an x-ray show in croup?

Answer 18

Posterior anterior view = subglottic narrowing (steeple sign)

Question 19

What will an x-ray show in acute epiglottitis?

Answer 19

Lateral view = swelling of epiglottis (thumb sign)

Question 20

What will a high resolution CT show in interstitial lung disease?

Answer 20

Ground glass appearance

Question 21

What are the causes of typical community-acquired pneumonia?

Answer 21

• Strep. pneumoniae
• Haemophilus influenzae
• Staph aureus

Question 22

What are the causes of atypical community-acquired pneumonia?

Answer 22

• Mycoplasma pneumoniae
• Coxiella burnetii

Question 23

What are the causes of bacterial hospital-acquired pneumonia?

Answer 23

• Klebsiella
• E. coli
• Pseudomonas

Question 24

What is the management for pneumonia?

Answer 24

• Abx
• Oxygen
• IV fluids
• Analgesia/antipyretics
• Pneumococcal vaccine