Paper III — Respiratory medicine

Appendix — Rapid Revision Grid

Numbers and thresholds most likely to be asked. Read this last on the night before the examination.

Numerical thresholds

Parameter Value

COPD diagnosis Post-bronchodilator FEV1/FVC <0.70 (LLN preferred in the elderly) GOLD spirometric grades 1–4 FEV1 ≥80 / 50–79 / 30–49 / <30 % predicted GOLD Group E (2026) ≥1 moderate or severe exacerbation in the past year Symptom cut-offs mMRC ≥2 or CAT ≥10 Eosinophil thresholds for ICS Favour ≥300/µL; avoid <100/µL Normal vs susceptible-smoker FEV1 decline 25–30 mL/year vs >50 mL/year Reversibility indicating asthma >200 mL rise in FEV1; PEF variability >20% NIV threshold in COPD exacerbation pH <7.35 despite maximal therapy Oxygen target in CO2 retainers SpO2 88–92% (94–98% in others)

Respiratory failure PaO2 <60 mmHg (8 kPa) ± PaCO2 >50 mmHg (6.7 kPa)

LTOT indications PaO2 <7.3 kPa, or 7.3–8.0 kPa with polycythaemia, pulmonary hypertension, oedema or nocturnal hypoxaemia LTOT minimum daily use / survival ≥15 hours/day; about 50% survive 3 years Age-adjusted D-dimer (age >50) Age × 10 µg/L (ADJUST-PE, JAMA 2014)

Revised Geneva probability bands Low 0–3, intermediate 4–10, high >10 Minimum anticoagulation after PE 3 months; extended/indefinite if unprovoked or persistent risk factor Pneumonia — absent fever/cough in elderly 30–40% of cases Pneumonia — radiographic clearance Up to 12 weeks in older adults ADA cut-offs in TB Pleural >40, ascitic >39, pericardial >40, CSF >10 IU/L EPTB treatment duration 6 months; 12 months for CNS and osteoarticular disease MMSE and inhaler use <24 predicts a very high risk of inhaler failure Optimal aerosol particle size 1–5 µm Named trials, guidelines and eponyms Name What it established NOTT (1980) and MRC LTOT ≥15 h/day improves survival in hypoxaemic COPD LOTT (2016) No benefit of oxygen in moderate resting or isolated exercise desaturation ADJUST-PE (2014) Age-adjusted D-dimer safely excludes PE in older patients PESI / sPESI Validated short-term mortality prediction in acute PE, including the elderly HI-PEITHO (NEJM 2026) Catheter-directed thrombolysis superior to anticoagulation alone in intermediate-high-risk PE 2026 AHA/ACC PE Guideline Five-tier Clinical Categories A–E; PERTs, LMWH over UFH, DOACs over VKA (all Class 1) BOREAS / NOTUS Dupilumab reduces COPD exacerbations by about 30% in eosinophilic disease METREX / METREO / MATINEE Mepolizumab reduces COPD exacerbations by about 18–21% GOLD 2026 One moderate exacerbation defines Group E; disease activity as a target; biologics; AI chapter FIBRONEER-IPF / FIBRONEER-ILD Nerandomilast (PDE4B inhibitor) slows FVC decline in IPF and progressive pulmonary fibrosis (2025)

INBUILD / SENSCIS Nintedanib in progressive fibrosing ILD and in systemic sclerosis-ILD PANTHER-IPF Triple immunosuppression is harmful in IPF CAPE COD (NEJM 2023) Hydrocortisone reduces mortality in severe community-acquired pneumonia FLORALI (2015) / SOHO (NEJM Early promise of HFNO not confirmed — SOHO found identical 28-day mortality (14.6%) vs 2026) standard oxygen ERS 2022 HFNC guideline HFNO over conventional oxygen and over NIV in hypoxaemic ARF; try NIV first in hypercapnic COPD Index-TB guidelines (IJMR) India's EPTB guidance — Xpert in diagnosis, adjunct steroids, treatment duration BPaLM (NTEP 2024) 6-month all-oral MDR/RR-TB regimen; excludes CNS, bone and disseminated disease ACIP October 2024 (MMWR Jan Pneumococcal conjugate vaccine for all PCV-naive adults from age 50 2025)

BODE index BMI, Obstruction, Dyspnoea, Exercise capacity — validated prognostic index in COPD Langhans giant cell / caseating Histological hallmark of tuberculosis granuloma Pott's disease, gibbus, cold abscess Spinal tuberculosis eponyms S1Q3T3 Classic but uncommon ECG pattern in pulmonary embolism Six lines to carry into every respiratory answer