A 65-year-old man with a history of Parkinson's disease is referred to the respiratory clinic with shortness of breath. He has never smoked. Spirometry is performed:
Which one of the following drugs is most likely to be responsible?
Correct Answer E: This patient has developed pulmonary fibrosis (explaining the restrictive picture on spirometry) secondary to pergolide therapy.
Parkinson's disease: management:
Currently accepted practice in the management of patients with Parkinson's disease (PD) is to delay treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist. If the patient is elderly, levodopa is sometimes used as an initial treatment.
Dopamine receptor agonists:
Levodopa:
MAO-B (Monoamine Oxidase-B) inhibitors:
Amantadine:
COMT (Catechol-O-Methyl Transferase) inhibitors:
Antimuscarinics:
*Pergolide was withdrawn from the US market in March 2007 due to concern regarding increased incidence of valvular dysfunction
Which one of the following is least associated with the development of COPD?
Correct Answer D: Isocyanates are more associated with occupational asthma.
COPD: causes:
Other causes:
A 33-year-old man is seen in the respiratory clinic. He was referred with poorly control asthma and has recently had salmeterol added in addition to beclomethasone dipropionate inhaler 200mcg bd and salbutamol prn. There has unfortunately been no response to adding the salmeterol.
What is the most appropriate action?
Correct Answer E:
Asthma: stepwise management in adults: The management of stable asthma is now well established with a step-wise approach:
*Beclometasone dipropionate or equivalent.
Additional notes:
Leukotriene receptor antagonists:
Fluticasone is more lipophilic and has a longer duration of action than beclomethasone Hydrofluoroalkane is now replacing chlorofluorocarbon as the propellant of choice. Only half the usually dose is needed with hydrofluoroalkane due to the smaller size of the particles.
Long acting B2-agonists acts as bronchodilators but also inhibit mediator release from mast cells. Recent metaanalysis showed adding salmeterol improved symptoms compared to doubling the inhaled steroid dose.
What is the first line treatment in allergic bronchopulmonary aspergillosis?
Allergic bronchopulmonary aspergillosis:
Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia.
Features:
Investigations:
Management:
A 45-year-old female with a 30 pack-year history of smoking is admitted to the Emergency Department with shortness of breath. Arterial blood gases taken on room air are as follows:
Which one of the following is the most likely diagnosis?
Correct Answer C: Pulmonary embolism needs to be excluded. Even with a significant smoking history a reduced pO2 should not be attributed to anxiety. A salicylate overdose would not account for a reduced pO2, unless it is severe enough to have caused pulmonary oedema. This option is much less likely than a pulmonary embolism.
Respiratory alkalosis: Common causes:
*Salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis.
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