MSRA RESp

Question 1

What do we give in infective exacerbation of COPD?

Answer 1

 amoxicillin doxycycline clarithromycin
Only to be used acutely not for prophylaxis

Question 2

What prophylactic can we give in copd patients

Answer 2

Azithromycin

This is not for eveyone
Only if meds have been optimised
Patient is a non smoker
Patient Keeps getting hospitalised with exacerbations
Prolonged sputum production

Before starting need to have some work up liver function tests(not good if you don’t have good liver ) and ct thorax (to exclude other lung pathologies) and sputum culture and ecg to look for qt prolongation as can prolong the qt

250 three x a week

Question 3

What is the dose of steroids we gave in COPD exacerbations?

Answer 3

Prednisolone 30 for five days

Question 4

Do all COPD exacerbations receive antibiotics?

Answer 4

We only give if we suspect it’s infective so the sputum is pent or we suspect pneumonia because they have fever crackles or look very generally unwell we don’t just give antibiotics

Question 6

The most common bacteria as virus responsible for infective exacerbation of COPD isn

Answer 6

H. Influenza
Rhino virus

Question 7

Admission criteria copd

Answer 7

Low sats <90
Cyanotic
Confused (co2 retention)
Severe breathlessness

Question 8

What class of drug is ipatrorpium?

Answer 8

SAMA

Question 9

What class is of drug is tiotropium?

Answer 9

LAMA

Question 10

Examples
Of LABA

Answer 10

Salmeterol/formetweol

Question 11

Copd protocol for asthmatic features

Answer 11

Take SABA or SAMA prn

Ics + LABA regularly

If still not working can add a LAMA
(If taking a SAMA switch to Saba )

Question 12

Copd protocol for no asthmatic features

Answer 12

Sama/saba
LAMA and LAbA regularly

If taking sama switch to SAba

Question 13

What are the asthmatic features of COPD

Answer 13

Diurnal variation in peak expiratory flow >20%
Atopy
Previous diagnosis of asthma or atopy
Raised eosinophil count
Substantial variation in fev1 over time (at least 400 ml)

Question 14

What is dirunal variation in asthma

Answer 14

Tends to be worse at night and early
Morning
Gets better in the afternoon

So it’s normal for asthma to have this variation and it helps to distinguish from similar causes like COPD the larger the gap could
Mean the greater the severity of the asthma

Question 15

What the ration we use to measure obstructive diseases and what does it mean

Answer 15

FEV1/FVC ratio

Low ratio - obstructive
High - restrictive

In restrictive both values decrease but because they both decrease it cancels out so the ratio can be normal

In obstructive fev1 will be less because it’s decrease the amount of sir

FVC = size of the bottle
• FEV₁ = how fast the bottle empties in the first second

Question 16

What should the normal spirometer values be

Answer 16

FEV1: >80% predicted
FVC: >80% predicted
FEV1/FVC ratio: >0.7

Question 17

How to assess reversibility for spirometry test

Answer 17

To assess reversibility, administer 400 micrograms of salbutamol and repeat spirometry after 15 minutes:

Before that patient should not have had any treatment beforehand

Question 18

Examples of restrictive diseases

Answer 18

Pulmonary edemas
Cancers
Fibrosis

Question 19

What to do if u take IcS

Answer 19

Regular rinse mouth after taking
Reduce risk of candiadia

Question 20

If taking theophyline classification what to be careful of

Answer 20

Have to reduce the dose with taking fluoroquinolone or macrolides

Question 21

What is salmeterol

Answer 21

LABA!!!!!!!

Question 22

CAP treatment

Answer 22

Low CuRb 0-2 - amoxicillin 5 days

If pen allergic clarithromycin

Moderated curb dual therapy if curb score >2

Question 23

Point of care CrP test ?

Answer 23

Can be done in Gp for patients suspected of pneumonia not widely available

0-20 no abx
20-100 consider delayed abx
>100 deffo abx

Question 24

Asthma management

Answer 24

Nebs set
Back to back
Iv magnesium 20 mins 2 mg (has a bronchodilator effect)(automatic admission as needs monitorin)

Aminophylline needs senior !!

Iv salbutamol (usually itu setting )

Intubation and ventilation

Question 25

Why are we hesitant to consider aminophyllline

Answer 25

Narrow TI Side effects such as seizures and arrhythmia

Question 26

Step 4 of asthma

Answer 26

Markers Feno and eosinoohils If elevated - refer to specialist If normal - add leukotriene like monteleukast or LaMA for 8-12 weeks

Question 27

Basal atelactasis

Answer 27

Common after surgery that’s why we encourage deep breathing, early mobilisation and enough pain killers so they can breath deep it’s preventable After surgery you tend not to breath too deep so you are not cleaning the secretions leading to alveolar collapse usually happens 72 hours post surgery Triad Hypoxia Dyspnea Decreased air entry at bases No fever (more infection vibes) Position the patient upright

Question 28

Treatment for OSA diagnosis

Answer 28

Loose weight -first line CPAP intraoral devices Some people do surgical interventions to increase size of airway like removing tonsils or some jaw surgery to move the jaw forwards and that questionnaire - Epworth Sleepiness Scale: questionnaire completed by the patient ± partner * Multiple Sleep Latency Test (MSLT): measures time to fall asleep in a dark room (using EEG criteria) definitve - sleep study or polsomnorgaphy - electrodes atatched to head looks at eye movement, brain activity, chest movement, oxygen levels

Question 29

Leptospiros

Answer 29

Zoonotic - animals dropping in water - water sports inhaling the water Usually flu like but can develop a serious version Weils disease Liver failure Jaundice Internal bleeding Can cause bleeding in the lungs

Question 30

Legionnaires

Answer 30

Water systems hot tubs air conditioning It’s a lung diseaae Usually flu like illness

Question 31

Silicosis

Answer 31

Inhaling silica dust, sand dust Cough, sob, chest pain Cxr- egg shell calcification Patients are at risk of TB due to decreased alveolar macrophages so always screen in silicosis Ultimately leads to fibrosis

Question 32

Sarcoidosis FACTS everything

Answer 32

Can affect any organ but mostly lymph nodes and lungs sob, dry cough, constitutional symptoms such as malaise and weight loss, polyarthralgia CXR, rf women , african, young -Acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia * Insidious: dyspnoea, non-productive cough, malaise, weight loss * Ocular: uveitis * Skin: lupus pernio * Hypercalcaemia: due to increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol) by macrophages within granulomas SYNDROMES LOFGRENS SYNDROME HEERFORD SYDNROME

Question 33

Sarcoidosis vs silicosis

Answer 33

Silicosis - occupational whereas sarcoidosis is unknown cause Sarcoidosis - bilateral upper zones More systemic - erythema nodusum

Question 34

Hypersensitivity pneumonitis

Answer 34

Hypersensitivity Pneumonitis (HP) is a lung disease from an immune system overreaction to inhaled substances like mold, bacteria, or animal proteins, causing inflammation (pneumonitis) in the lung tissue (interstitium). Also called extrinsic allergic alveolitis, it leads to symptoms like cough, shortness of breath, fever, and fatigue, with chronic exposure potentially causing permanent lung scarring (fibrosis). Management involves identifying and avoiding the trigger, plus treatments like corticosteroids, to prevent severe lung damage.

Question 35

Stages of COPd

Answer 35

Stage 1>80 Stage 2 50/79 Stage 3 30-49 Stage 4 <30

Question 36

Klesbsiella

Answer 36

Common in alcoholics and diabetes nB! Red current jelly sputum Often affects upper lobes Can lead to abscess and emyema Can occur post aspiration.

Question 37

coarse crackles vs fine

Answer 37

fine smaller airways pe, heart failure, pulmonary fibrosis coarse larger airways pneumonia, bronchiactais

Question 38

non cardiogenic PE

Answer 38

not due to heart failure but due to leaky lung vessels rather thanincreased hydrostaic pressure 1.infammation 2. injury 3. ards 4. DROWINING common causes is sepsis, trauma, ARDS , aspiration, transfusion relation lung injurry, drug reactions high alitdue pE, pancreatitis

Question 39

how to tell the difference between cardiogenica and non cardiogenic edeam

Answer 39

cardiogenic Big CT ratio kerley b lines pleural effusions batwing non cardiogenic normal heart no kerley b lines effusions less likley

Question 40

cardiogenic pulmonary edema

Answer 40

due to increased hydrostaic pressure anything that increases left atrial pressures causeing back flow such as such mitral stensosis anything to do with the heart, cardiomytopthies, arrytmia, ACS BUT MOST COMMON IS HEART FAILURE

Question 41

TREATMENT OFPULMONAEY EDEMA

Answer 41

depends on the cause in cardiogenic its usually the same prinicple 1. oxygen 2. Furesmide 3. nitrates 4. morphine but non cardiogenic mainly have to treat the underlying issue, if its sepsis, then abx, etc

Question 42

recomended initial settings for bipap

Answer 42

IPAP ( helps you breathe in ) EPAP (to stop your airways from collapsing as you breathe out) Epap 4-5 cm h20 IPAP 10 CM h20 bts says 12-15 h20

Question 43

drugs that can exacerbate MG

Answer 43

beta blockers aminoglycosided (gent) magnesium quinolones lithium phetnytoin

Question 44

lambety eaton

Answer 44

fatigueablity that IMPORVES WITH EXCERCISE associted with SMALL cell lungc ancer affects your calcium channels in presynaptic membrane which stores the ca 2+ in the vesicles so it isnt even released from synaptic cleft proximal weakness

Question 45

myasthenia gravis signs diagnosis treatments

Answer 45

1. diplopia 2. fatigeability by the end of day 3. bulbar features- dysphonai and dysphagia diagnosis ach receptor antibodies , anti musk , lmr4 antibodies CT - chest tensilon test - if it imporves get better sign of MG EMG spirometry - in a crisis If the forced vital capacity is 15 mL/kg or less, the patient should be considered for mechanical ventilation. applying ice pack - imporves symptoms can cause the ptosis to imporve neurology reviews physiotherapy inhibitorts- pyridostigmine or neostigmine immunoglobulin (IVIG) or plasmapheresis in severe, steroid-refractory, cases. thymectomy - if they have thymoma a

Question 46

lambert vs MG

Answer 46

L pre-synaptic ca 2+ associated with small cell better with excercise MG neuromusclar junction associated wit thymoma worse with exertion

Question 47

anterior mediastinum masses

Answer 47

4 T'S terrible lymphadenoathy teratoma thmyic mass

Question 48

PET SCAN

Answer 48

poistitron emission tomography nuclear medicine radiactive substances - use a tracer like a sugar 18 fluorodeoxyglucose MAINLY FOR NON SMALLL CELL use it to detect cancers and spread -

Question 49

high platelets can be a sign of lungs cancer

Question 50

RF of OSA SIGNS

Answer 50

Obesity * Macroglossia: acromegaly, hypothyroidism, amyloidosis * Large tonsils * Marfan's syndroME Daytime somnolence * Compensated respiratory acidosis- would be at night time, most peopleit will be normal in the daytime as they are awake and breathing fine * Hypertension

Question 51

lupus pernio what is the rules for pleural fluid

Answer 51

skin manifestation of sarcoidosis common in africans All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling: * if the fluid is purulent or turbid/cloudy, a chest tube should be placed to allow drainage * if the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection, a chest tube should be placed

Question 52

SYNDROMES ASSOCIATED WITH SARCOIDOIS S

Answer 52

LOFGRENS SYNDROME HEERFORD SYDNROM

Question 53

MOST COMMON CAUSE OF LUNG ABSCEESS SIGNS OF LUNGS ABSCESS

Answer 53

SECONDARY TO ASPIRATION similar to pneumonia but a more subacute cause - (less aggresive cause) - develops over weeks smetimes chest pain, cough, (foul smelling sputum) , hemoptyis in some people , clubbing Initially, the cough is nonproductive, but it becomes productive when bronchial communication develops, a hallmark sign of lung abscess

Question 54

pneumonectomy on a cxr treatment of tb

Answer 54

white out of 1 lung pulled towards the side of the white out like atelactasis ACTIVE -RIPE 2MONTHS RI- 4 MONTHS LATENT RI - 3 MONTHS OR ISONIZIAD FOR 6 MONTHS

Question 55

lights criteria what things can we look for in plueral fluid anayis

Answer 55

0.5 for protein 0.6 for lDH low glucose: rheumatoid arthritis, tuberculosis * raised amylase: pancreatitis, oesophageal perforation * low complement (C3, C4): systemic lupus erythematosus (SLE) o pleural effusions occur in approximately 30–50% of SLE patients during the course of their disease and may be the presenting feature * heavy blood staining: mesothelioma, pulmonary embolism, tuberculosi

Question 56

what should be initall venturi setting for COPD befroe any information recurrent pleural effusions

Answer 56

28% 4 L recurrent aspiration * pleurodesis * indwelling pleural catheter * drug management to alleviate symptoms, e.g. opioids to relieve dyspnoea, diueretcis

Question 57

what is pulse pressure and wat do we apply it do

Answer 57

the difference between systolic and diastolic standard is 40mmhg 120-90 in AS “Fixed outflow obstruction → reduced stroke volume → low systolic pressure → narrow pulse pressure” as the diastolic stays around the same but systolic gets lower so you can get a smaller pulse pressure like 20mmgh

Question 58

what picture would you see in a salisylate overdose

Answer 58

respiratory alkalosis as it stimulate the centre in the brain then followed by metabolic acidosis

Question 59

common cold

Answer 59

is the rhinovirus

Question 60

papovavirus

Answer 60

causes warts- includes HPV

Question 61

flu virus

Answer 61

orthomyxoviridae

Question 62

IS TB A ROUTINE VACCINE NOW? where to vaccinate and rules of the vaccine

Answer 62

NO because rates are low in the uk only in high risk people dont give a vaccine in the same limb, for 3 months after - due to lymphadenitis its the left arm intradermal no live vaccines to peope who are immunocompirmised -