A 54-year-old woman with chronic obstructive pulmonary disease (COPD) is prescribed an inhaled corticosteroid.
What is the main therapeutic benefit of inhaled corticosteroids in patients with COPD?
Correct Answer E: COPD - reason for using inhaled corticosteroids - reduced exacerbations.
COPD: stable management:
NICE updated it's guidelines on the management of chronic obstructive pulmonary disease (COPD) in 2010.
General management:
Bronchodilator therapy:
FEV1 > 50%:
FEV1 < 50%:
For patients with persistent exacerbations or breathlessness:
Oral theophylline:
Mucolytics:
Cor pulmonale:
Factors which may improve survival in patients with stable COPD:
A 55-year-old man is diagnosed with non-small cell lung cancer.
Which one of the following is a contraindication to surgery?
Correct Answer B: Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis.
Lung cancer: non-small cell management:
Management:
Surgery contraindications:
* However if FEV1 < 1.5 for lobectomy or < 2.0 for pneumonectomy then some authorities advocate further lung function tests as operations may still go ahead based on the results.
A 31-year-old woman is investigated for lethargy, arthralgia and cough. Over the past few weeks she has also developed painful erythematous nodules on both shins. Respiratory examination is normal. A chest x-ray is performed which is reported as follows:
Given the likely diagnosis, what is the most appropriate course of action?
Correct Answer E: This patient has sarcoidosis as evidenced by the erythema nodosum and bilateral hilar lymphadenopathy. The chest x-ray is consistent with stage 1 changes. There are no indications here for steroid therapy so observation is the most appropriate action.
Sarcoidosis: management:
Sarcoidosis is a multisystem disorder of unknown aetiology characterized by non-caseating granulomas. It is more common in young adults and in people of African descent.
Indications for steroids:
A newborn female baby is diagnosed with cystic fibrosis following an episode of meconium ileus shortly after birth.
Which one of the following is least likely to occur as a consequence of her underlying diagnosis?
Correct Answer E: Arthropathy is not a common feature of cystic fibrosis.
Cystic fibrosis: features:
Presenting features:
Other features of cystic fibrosis:
A 23-year-old female who is 28 weeks pregnant presents with shortness-of-breath and right-sided pleuritic chest pain. A diagnosis of pulmonary embolism is suspected.
Which one of the following statements regarding the appropriate management is incorrect?
Correct Answer C:
Pregnancy: DVT/PE investigation:
Guidelines were updated in 2010 by the Royal College of Obstetricians. Key points include:
Comparing CTPA to V/Q scanning in pregnancy:
D-dimer is of limited use in the investigation of thromboembolism as it often raised in pregnancy.
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