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Respiratory and sleep medicine
29 notes, 91 questions and 249 flashcards.
Tier 1 is core knowledge expected of every trainee. Tier 2 is deeper or less common.
Presentations
- Approach to dyspnoeaFree sampleAcute versus chronic breathlessness, the life-threatening causes to exclude first, positional clues, a staged work-up (CXR, ECG, spirometry, NT-proBNP, echo, DLCO, CTPA or V/Q, CPET) and management of chronic breathlessness.Tier 1, approach to a presentation, 3 questions, 8 flashcards
- Chronic cough with or without sputumCough over 8 weeks in adults, the CXR and spirometry baseline, red flags, the treatable traits (asthma, eosinophilic bronchitis, reflux, rhinosinusitis, ACE inhibitors), wet cough and refractory cough hypersensitivity.Tier 1, approach to a presentation, 3 questions, 8 flashcards
Key conditions
- Acute and chronic respiratory failureFree sampleType 1 and type 2 failure, the A-a gradient, oxygen targets, choosing between HFNO, NIV and intubation, ARDS, and chronic hypercapnic failure needing home ventilation.Tier 1, condition, 3 questions, 9 flashcards
- AsthmaDiagnosis by variable airflow limitation or FeNO, anti-inflammatory reliever first, MART stepping, acute severe asthma and when to refer for biologics.Tier 1, condition, 3 questions, 9 flashcards
- BronchiectasisCT diagnosis, the aetiology screen, Pseudomonas and its prognosis, exacerbation treatment, airway clearance, long-term macrolides (EMBRACE, BAT, BLESS), inhaled antibiotics, brensocatib, and the burden in First Nations communities.Tier 1, condition, 3 questions, 9 flashcards
- Chronic obstructive pulmonary diseaseSpirometric diagnosis, GOLD 2026 ABE assessment, stepwise inhalers, exacerbation care, oxygen and NIV criteria, and the interventions that improve survival.Tier 1, condition, 4 questions, 9 flashcards
- Lung cancer and pleural malignancyRecognition and fast-track referral, staging with TNM 9th edition, molecular testing before treatment, stage-based management of NSCLC and small cell lung cancer, paraneoplastic syndromes and mesothelioma.Tier 1, condition, 3 questions, 9 flashcards
- Pleural effusionTransudate or exudate by Light's criteria, the fluid tests that change management, pleural infection, malignant effusion options and the traps of heart failure on diuretics.Tier 1, condition, 3 questions, 9 flashcards
Sleep disorders
- InsomniaDiagnosing chronic insomnia, screening for comorbid sleep apnoea and other causes, CBT-I as first-line treatment, where sleep hygiene fits, and the limited, careful role of hypnotics.Tier 1, condition, 3 questions, 9 flashcards
- Obstructive sleep apnoea and sleep-disordered breathingWho to test and how, AHI severity, the cardiorespiratory effects of sleep-disordered breathing, CPAP and its alternatives (splints, surgery, tirzepatide), central sleep apnoea and ASV, and Austroads driving rules.Tier 1, condition, 3 questions, 9 flashcards
Less common or complex conditions
- Cystic fibrosisFree sampleGenetics and diagnosis in adults, CFTR modulators (elexacaftor-tezacaftor-ivacaftor and vanzacaftor) and their PBS access, Pseudomonas and other organisms, exacerbations, the extrapulmonary screen, and transplant referral.Tier 1, condition, 4 questions, 10 flashcards
- Interstitial lung diseaseClassifying ILD, the HRCT patterns and multidisciplinary diagnosis of IPF, progressive pulmonary fibrosis, antifibrotics and their PBS access, nerandomilast, acute exacerbations and the classic traps (triple therapy, upper versus lower zone, drug causes).Tier 2, condition, 3 questions, 9 flashcards
- Lung abscess and empyemaAspiration and secondary causes of lung abscess, telling an abscess from empyema on CT, the cavity differential (TB, cancer, GPA, melioidosis), prolonged anaerobic cover, when to bronchoscope or drain, and the follow-up imaging that catches an underlying tumour.Tier 2, condition, 3 questions, 7 flashcards
- Lung transplantationWho to refer (ISHLT 2021), the main contraindications, immunosuppression and its drug interactions, and the post-transplant problems a general physician meets (infection, rejection, CLAD, skin cancer and renal impairment).Tier 2, condition, 3 questions, 8 flashcards
- PneumothoraxPrimary versus secondary spontaneous pneumothorax, the symptom-led BTS 2023 and ERS/EACTS/ESTS 2024 approach, the Australian PSP trial, when to drain or refer for surgery, and the advice on flying, diving and smoking.Tier 2, condition, 3 questions, 8 flashcards
- Pulmonary and pleural metastasesWhich cancers spread to the lung and pleura, the radiological patterns (cannonball, lymphangitic, cavitating, calcified), when a new nodule in a cancer patient needs a biopsy, oligometastatic disease with SABR or metastasectomy, and where pleural drainage fits.Tier 2, condition, 3 questions, 8 flashcards
- Pulmonary vasculitides and pulmonary haemorrhageHow GPA, MPA, EGPA and anti-GBM disease affect the lung, recognising diffuse alveolar haemorrhage (rising DLCO, bloodier BAL aliquots), interpreting ANCA, induction with glucocorticoids plus rituximab or cyclophosphamide, and mepolizumab or benralizumab for EGPA.Tier 2, condition, 3 questions, 9 flashcards
Sleep disorders
- REM sleep behaviour disorderDream enactment in the second half of the night, why video-polysomnography is required, mimics (OSA, NREM parasomnia, nocturnal seizures), antidepressant-induced RBD, bedroom safety, melatonin versus clonazepam, and counselling about the high risk of Parkinson disease and Lewy body dementia.Tier 2, condition, 3 questions, 8 flashcards
- Restless legs syndrome and periodic limb movements of sleepThe five IRLSSG criteria and the mimics, secondary causes (iron deficiency, kidney failure, pregnancy, drugs), iron thresholds for RLS, why the AASM 2024 guideline moved gabapentinoids ahead of dopamine agonists, recognising augmentation, and periodic limb movement disorder.Tier 2, condition, 3 questions, 8 flashcards
Investigations and procedures
- Arterial blood gas interpretationA six-step read of the arterial blood gas with reference ranges, the A-a gradient and P/F ratio, co-oximetry, venous versus arterial gases, sampling errors, and worked examples from COPD, salicylate and pulmonary embolism.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- Chest imaging interpretationA systematic read of the chest X-ray, lobar collapse signs, HRCT patterns, incidental nodules (Fleischner 2017 and the Australian screening protocol), CTPA versus V/Q, PET-CT pitfalls and lung ultrasound.Tier 1, medical sciences concept, 3 questions, 9 flashcards
- Pulmonary function test interpretationReading spirometry, flow-volume loops, lung volumes and DLCO with z-scores and the GLI equations, the ERS/ATS 2022 interpretive approach, bronchodilator and provocation testing, and the patterns of obstruction, restriction, neuromuscular weakness and pulmonary vascular disease.Tier 1, medical sciences concept, 3 questions, 9 flashcards
- Thoracentesis and intercostal catheter insertionUltrasound-guided pleural aspiration and chest drain insertion (BTS 2023), the safe site, drain size, anticoagulants, how to read a drain (swinging, bubbling, draining), when to remove it, complications, and indwelling pleural catheters.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- Bronchoscopy, EBUS and thoracic tissue biopsyWhat flexible bronchoscopy, BAL, EBUS-TBNA, CT-guided biopsy, cryobiopsy and pleural biopsy each reach, how to choose the test that diagnoses and stages at once, reading BAL and EBUS results, and safety (anticoagulants, lidocaine, pneumothorax).Tier 2, medical sciences concept, 3 questions, 9 flashcards
- Cardiopulmonary exercise testing and six minute walk testWhat CPET and the six minute walk test measure, how to tell cardiac from ventilatory limitation and deconditioning, peak VO2 thresholds for surgery and heart transplant, 6MWD cut-offs in pulmonary hypertension, and exertional desaturation for ambulatory oxygen.Tier 2, medical sciences concept, 3 questions, 8 flashcards
- Diagnostic sleep studiesLevels of sleep study and what each records, AASM scoring rules for apnoeas, hypopnoeas and hypoventilation, how to read a polysomnography report, MBS access for attended and home studies, and MSLT and MWT for hypersomnolence.Tier 2, medical sciences concept, 3 questions, 8 flashcards
- Pulse oximetry and oxygen therapyHow oximeters work, where SpO2 misleads (carbon monoxide, methaemoglobin, skin pigmentation, poor perfusion), the saturation gap, TSANZ acute oxygen targets and devices, and who qualifies for home oxygen under the TSANZ 2024 guideline.Tier 2, medical sciences concept, 3 questions, 8 flashcards
Specific issues
- Non-invasive ventilationHow bilevel NIV and CPAP work, who benefits (COPD, obesity hypoventilation, motor neurone disease, cardiogenic oedema), setting up and titrating a mask, reading the 1-hour gas, troubleshooting leak and asynchrony, recognising failure, and starting home NIV.Tier 1, medical sciences concept, 4 questions, 9 flashcards
- Respiratory medicine: specific issuesHow ageing, obesity, tobacco, asbestos, silica and bushfire smoke change the lungs, how the heart and lungs interact, respiratory disease and drugs in pregnancy, and end-of-life care in chronic lung disease, with the Australian rules, registries and numbers.Tier 2, topic overview, 4 questions, 10 flashcards