Question Bank

This patient's CURB-65 score is 5, as all five criteria are met: Confusion ✓ (present), Urea ≳7 mmol/L ✓ (8.2 mmol/L), Respiratory rate ≥30/min ✓ (32/min), Blood pressure ≤90 systolic or ≤60 diastolic ✓ (85/55 mmHg), Age ≥65 ✓ (82 years). A score of 3 or more indicates severe pneumonia with high mortality risk, mandating urgent hospital admission. A score of 4 or 5 should prompt consideration of ITU-level care. Intravenous antibiotics per local CAP protocol (typically co-amoxiclav + clarithromycin) should be commenced promptly after blood cultures are taken.

HRCT is the gold standard for diagnosing bronchiectasis, showing hallmark signs such as the 'signet ring' sign (dilated bronchi wider than adjacent vessels) and lack of bronchial tapering.

A pleural protein level >30 g/L is classified as an exudate. Bronchial carcinoma is a common cause of exudative effusions. Heart failure, cirrhosis, and nephrotic syndrome typically cause transudates (protein <30 g/L).

A Wells score >4 indicates that a pulmonary embolism is likely. In this clinical scenario, the patient should proceed directly to definitive imaging (CTPA) rather than a D-dimer, which is only used to rule out PE in 'unlikely' cases.

NICE recommends 5 days of oral prednisolone (30mg) for COPD exacerbations and a course of antibiotics if sputum is purulent. Current guidelines have moved away from longer 10-14 day courses of steroids to reduce side effects.

While the Epworth scale and oximetry are screening tools, multi-channel polysomnography (in a sleep lab) is the gold standard for diagnosing Obstructive Sleep Apnoea (OSA). It monitors EEG, airflow, and respiratory effort.

For the first isolated growth of Pseudomonas aeruginosa in CF patients, the goal is eradication. NICE/UK protocols typically use a combination of oral ciprofloxacin and nebulised antibiotics (like colistimethate or tobramycin) for 3 months.

Idiopathic Pulmonary Fibrosis typically presents with clubbing and bi-basal fine crackles. HRCT characteristically shows a 'usual interstitial pneumonia' (UIP) pattern, featuring subpleural honeycombing and traction bronchiectasis.

Severe asthma is defined by any one of: PEF 33-50% predicted, respiratory rate ≥25/min, heart rate ≥110/bpm, or inability to complete sentences in one breath. Life-threatening features would include a silent chest, cyanosis, or PEF <33%.

Rifampicin causes orange/red discoloration of urine, tears, and sweat. Optic neuritis is associated with ethambutol; peripheral neuropathy with isoniazid; and hyperuricaemia with pyrazinamide.