Question Bank

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.

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%.

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.

For a primary spontaneous pneumothorax, if the patient is symptomatic or the rim of air is >2cm, needle aspiration is the first-line treatment. If it fails (pneumothorax remains >2cm), a chest drain is indicated.

The patient's CURB-65 score is 4 (Confusion, RR ≥30, BP <90/60, Age ≥65). A score of 3 or more indicates high risk and mandates urgent hospital admission for intravenous antibiotics and stabilization.

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).

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.

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.

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

Squamous cell carcinoma is often centrally located and is classically associated with paraneoplastic hypercalcaemia due to the secretion of parathyroid hormone-related protein (PTHrP).

The triad of erythema nodosum (tender nodules on shins), bilateral hilar lymphadenopathy (BHL), and dry cough/arthralgia is highly suggestive of acute sarcoidosis (Löfgren's syndrome).

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.

NICE recommends adding a low-dose ICS if a patient has symptoms ≥3 times a week or is waking at night. If symptoms are uncontrolled on SABA + ICS, the next step would be adding an LTRA.

Low pH (<7.35) and high pCO2 (>6.0 kPa) indicate respiratory acidosis (Type 2 failure). The elevated bicarbonate (29 mmol/L) suggests the body has begun to compensate (chronic/partially compensated), but the pH remains acidotic.

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.