Respiratory

Question 1

What is bronchitis and how does it present?

Answer 1

• Infection and subsequent inflammation of the bronchi

- Presents as cough, sore throat, wheezing etc.

Question 2

How is bronchitis managed?

Answer 2

• Fluids
• Simple analgesia
• Antibiotics for those at risk of complications (adults: 100mg doxycycline, children: amoxicillin 500mg)

Question 3

Name some of the treatment options for an acute exacerbation of asthma

Answer 3

• Oral prednisolone
• SABA relievers
• Nebulised bronchodilators salbutamol and ipratropium
• Oxygen
• IV magnesium sulphate
• IV theophyllines
• Antibiotics
• Correct fluid and electrolyte disturbances

Question 4

Which class of asthma medication is not used in children?

Answer 4

LAMA

Question 5

What is the main treatment for otitis media?

Answer 5

Analgesia

Question 6

How does croup present?

Answer 6

• Coryza
• Stridor
• Hoarse voice
• Barking cough

Question 7

How is croup managed?

Answer 7

Oral dexamethasone

Question 8

How does epiglottitis present?

Answer 8

• Stridor
• Drooling
• Unwell child

Question 9

How is epiglottitis managed?

Answer 9

• Intubation

- Antibiotics

Question 10

How does bronchiolitis present?

Answer 10

• <1 year old
• Increased work of breathing
• Difficulty feeding
• Wheeze/crackles
• Cough

Question 11

When should a child with bronchiolitis be admitted to hospital?

Answer 11

• RR > 60
• Less than 50% usual oral intake
• Dehydration
• Cyanosis
• Grunting/marked chest recession
• Known risk factors

Question 12

How is bronchiolitis managed?

Answer 12

• Oxygen if sats <92% (CPAP can be used)
• Upper airway suctioning
• Fluids by NG tube or IV
• If children are being looked after at home then safety net the red flags

Question 13

Describe how the severity of COPD can be determined?

Answer 13

FEV1

• Mild >80% predicted
• Moderate 50-79%
• Severe 30-49%
• Very severe <30%

Question 14

How can COPD be investigated?

Answer 14

• Spirometry
• CXR
• ECG
• FBC
• BMI
• AIAT

Question 15

Name some of the complications of COPD

Answer 15

• Acute exacerbation
• Pneumonia
• Macro-nutrient deficiency
• Muscle wasting
• Secondary polycythaemia
• Pulmonary hypertension
• Cor pulmonale
• Pneumothorax
• Depression

Question 16

Describe the management options for COPD in order of use

Answer 16

• SABA
• LAMA or LABA
• Further LAMA or LABA
• Triple therapy (ICS, LABA and LAMA)

Question 17

When should a COPD patient be started on long term oxygen?

Answer 17

-PaO2 < 7.3 kPa
Or
-PaO2 7.3-8 kPa if polycythaemia, nocturnal hypoxia, peripheral oedema or pulmonary hypertension

Question 18

How can an acute exacerbation of COPD be managed?

Answer 18

• Short acting bronchodilators
• Steroids
• Antibiotics
• Hospital admission (tachypneoa, sats <90%, hypotension etc.)

Question 19

Name the four types of lung cancer

Answer 19

• Squamous
• Adenocarcinoma
• Small cell
• Large cell

Question 20

Name the treatment options for lung cancer

Answer 20

• Surgery
• Radiotherapy
• Chemotherapy

Question 21

How can obstructive sleep apnoea be managed?

Answer 21

• Information and support
• Lifestyle measures
• CPAP or intra-oral devices
• Advice on driving and informing the DVLA

Question 22

Which antibiotics can be used in pneumonia

Answer 22

• Amoxicillin
• Clarithromycin if severe
• Doxycycline if penicillin allergic

Question 23

What is the pleural fluid protein level found in transudate pleural effusions

Answer 23

<30g/l

Question 24

What are the causes of transudate pleural effusions?

Answer 24

• Liver cirrhosis
• Nephrotic syndrome
• PE

Question 25

What is the pleural fluid protein level found in exudate pleural effusions?

Answer 25

>30g/l

Question 26

What are the causes of exudate pleural effusions?

Answer 26

- Malignancy - PE - Rheumatoid arthritis - Autoimmune

Question 27

Describe the management of TB

Answer 27

- Rifampicin, Isoniazid, ethambutol and pyrazinamide for 2 months - Rifampicin and Isoniazid for fourth months

Question 28

How does bronchiectasis present?

Answer 28

- Persistent productive cough - Breathlessness - Haemoptysis - Chest pain - Wheeze and course crackles

Question 29

Which gene is responsible for cystic fibrosis?

Answer 29

-CFTR

Question 30

How does cystic fibrosis present?

Answer 30

- Antenatal cvs and echogenic bowel - Neonatal screening - Meconium ileus - Recurrent chest infections - Failure to thrive - Nasal polyps and sinusitis - Male infertility - Pancreatic insufficiency

Question 31

Name the common respiratory pathogens found in CF

Answer 31

- Staph aureus - Haemophilus influenzae - Pseudomonas aeruginosa

Question 32

Which drug addresses the primary defect in CF?

Answer 32

Ivacaftor