Respiratory

Question 1

Step 1 of adult asthma management

Answer 1

AIR therapy
Low dose inhaled ICS/ formoterol PRN

Question 2

Step 2 of adult asthma management
e.g. for those who are highly symptomatic

Answer 2

MART therapy
Low dose inhaled ICS/ formoterol BD plus PRN

Question 3

Step 3 of adult asthma management

Answer 3

MART therapy with Moderate dose inhaled ICS/ formoterol BD plus PRN

Question 4

Step 4 of adult asthma management - normal FeNO and eosinophils

Answer 4

MART therapy with moderate dose fobumix e.g. then add LAMA (e.g. tiotropium) or LTRA (e.g. montelukast)

If no benefit then stop and try the other

Question 5

Step 4 of adult asthma management - raised FeNO or eosinophils

Answer 5

Refer to specialist

Question 6

Step 5 of adult asthma management

Answer 6

If not controlled refer to specialist

Question 7

Moderate asthma exacerbation criteria

RR
HR

PF

Answer 7

Peak flow 50-75% best predicted
RR <25
HR <110

Question 8

Severe asthma exacerbation criteria

PEFR
RR
HR

Answer 8

ONE only needed of:

PEFR 33-50% best predicted
Can’t complete sentences
RR >25
HR >= 110

Question 9

Life threatening asthma criteria

Answer 9

PEFR <33% best predicted
O2 sats <92%
Silent chest
Weak or feeble resp effort
Exhaustion/ confusion/ coma

Question 10

COPD management (after SABA) NO features of asthma

Answer 10

LABA + LAMA

Question 11

COPD management (after SABA) with features of asthma (such as raised eosinophils

Answer 11

Add LABA + ICS

Question 12

Vaccinations for COPD

Answer 12

Annual influenza and once off pneumococcal

Question 13

Obstructive lung disease PFTs

Answer 13

FEV1 sig reduced
FVC reduced or normal
FEV1% reduced

Question 14

Restrictive lung disease PFTs

Answer 14

FEV1 reduced
FVC sig reduced
FEV1% normal or increased

Question 15

Risk factors for poor outcomes associated with asthma

Answer 15

Obesity, social isolation, sleep apnoea, poor socio-economic status, nasal polyps, GORD

Question 16

Definition of high probability of asthma

(which would warrant immediate trial of treatment without further investigation)

Answer 16

Adults and children with typical clinical assessment:
Recurrent episodes of symptoms (attacks), wheeze heard, Hx of atopy, recorded Hx of variable airflow recording and no alternative diagnosis

Question 17

Diagnostic threshold for FeNO level in adults

Answer 17

> 40pb

Question 18

First line treatment of pulmonary sarcoid

Answer 18

Prednisolone oral
(High rate of spontaneous remission)

Question 19

How often do drivers with OSAS need to reapply for a licence

Answer 19

3 yearly for group 1
Annually for group 2

Question 20

Below what level is the FEV1/ FVC ratio in keeping with COPD

Answer 20

< 70%

Question 21

Management of a positive sputum culture in a patient with CF without symptoms

Answer 21

Should receive prompty abx regardless of symptoms or signs

Question 22

How many cigarettes equate one pack year

Answer 22

20 a day

Question 23

Most common causative organism in CAP

Answer 23

Strep. pneumoniae

Question 24

Organism that causes croup

Answer 24

Parainfluenza

Question 25

Causative organism of pneumonia following flu

Answer 25

Staph. aureus

Question 26

Organism typically causing a dry cough preceded by flu like symptoms, may have a 'target' rash

Answer 26

Mycoplasma pneumoniae

Question 27

Organism causing pneumonia in patients with HIV

Answer 27

Pneumocystis jiroveci (patients may have few chest signs and present with exertional dyspnoea)