Respiratory Medicine — Flashcards

Flashcard 51: All patients with life-threatening asthma should be?

Answer: • Admitted to hospital

Flashcard 52: Type of effusion if fluid protein/serum protein ratio >0.5?

Answer: • Exudative

Flashcard 53: What is the gold-standard investigation for Mesothelioma?

Answer: Thoracoscopic biopsy (histological)

Extra: Thoracoscopy (VATS) allows for direct visualization and obtaining large tissue samples, which are necessary for the histological subtype and immunohistochemistry required for a definitive diagnosis of mesothelioma.

Flashcard 54: What type of picture would spirometry show for alpha-1 antitrypsin deficiency?

Answer: • Obstructive picture FEV1/FVC <70% FEV1 reduced

Flashcard 55: Diagnosis?

Answer: • Lung metastases

Flashcard 56: What pattern would Emphysema cause on spirometry?

Answer: • Obstructive pattern

Flashcard 57: What syndrome can present with dextrocardia and bronchiectasis?

Answer: • Kartagener's syndrome

Flashcard 58: What finding on spirometry would be significantly reduced in obesity patients?

Answer: • Expiratory reserve volume

Flashcard 59: An empyema requires?

Answer: Prompt drainage alongside antibiotic drainage

Flashcard 60: What is the recommended pharmacological management for acute exacerbation of COPD (AECOPD) if there is no purulent sputum or clinical signs of pneumonia?

Answer: Systemic corticosteroids (e.g., Oral Prednisolone for 5 days) and Bronchodilators (SABA/SAMA). Antibiotics are NOT recommended if sputum is non-purulent.

Extra: In AECOPD, the decision to start antibiotics is based on the presence of increased sputum purulence (Anthonisen criteria). If purulence is absent and there are no signs of pneumonia/infiltration, antibiotics can be withheld. Systemic steroids (prednisolone 40mg for 5 days) are recommended to improve FEV1 and reduce recovery time. Ventilation (NIV) is indicated if there is respiratory acidosis (pH <7.35).