1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| Asthma, nasal polyps, aspirin or NSAID reactions | Aspirin-exacerbated respiratory disease | Avoid NSAIDs; montelukast may be added (Australian Asthma Handbook 2025). |
| Asthma, fleeting infiltrates, central bronchiectasis | Allergic bronchopulmonary aspergillosis | High total and Aspergillus-specific IgE; prednisolone, with itraconazole to spare steroid. |
| Late asthma, eosinophilia, sinusitis, mononeuritis | Eosinophilic granulomatosis with polyangiitis | ANCA (usually MPO) is positive in under half; a negative test does not exclude it. |
| Basal panacinar emphysema, young or liver disease | Alpha-1 antitrypsin deficiency | AAT level and phenotype; test first-degree relatives. |
| Clubbing, basal velcro crackles, older man | Idiopathic pulmonary fibrosis | A UIP pattern on HRCT may avoid biopsy. PBS lists nintedanib and pirfenidone for IPF. |
| Hilar nodes, erythema nodosum, ankle periarthritis | Löfgren syndrome (sarcoidosis) | Biopsy often unnecessary; usually remits; NSAIDs for symptoms. |
| Engineered stone worker, upper-zone nodules | Accelerated silicosis | Engineered stone banned in Australia from 1 July 2024. Raises TB risk. |
| Tall young smoker, first large pneumothorax, stable | Primary spontaneous pneumothorax | Conservative care noninferior, with fewer adverse events (Australian and NZ PSP trial, NEJM 2020). |
| Snoring, witnessed apnoeas, resistant hypertension | Obstructive sleep apnoea | CPAP treats symptoms but did not cut cardiovascular events (SAVE, Australian-led, NEJM 2016). |
| Obesity, awake PaCO2 45 mmHg or more, high bicarbonate | Obesity hypoventilation syndrome | CPAP or NIV; titrate any oxygen to 88 to 92% (TSANZ 2015). |
| Cheyne-Stokes breathing in HFrEF | Central sleep apnoea | Avoid adaptive servo-ventilation if LVEF is 45% or less: mortality rose (SERVE-HF, NEJM 2015). |
2Australia-only high-yield (won't be in UK or US banks)
COPD (COPD-X V2.78, 2025; Lung Foundation Australia stepwise guide, 2026). Step from a LAMA or LABA to LAMA plus LABA. Add an ICS (triple therapy) for one severe or two moderate exacerbations in 12 months despite dual therapy, with eosinophils of 0.3 x 109/L or more where measured, or asthma features. Never give a SAMA with a LAMA. Exacerbation: prednisolone 30 to 50 mg for 5 days; amoxicillin or doxycycline for 5 days if infected (COPD-X 2025).
Asthma (Australian Asthma Handbook, version 3.0, 2025). Every level includes an ICS: SABA alone is not recommended for any adult or adolescent. Preferred: as-needed low-dose budesonide-formoterol (AIR-only), then low-dose MART, then medium-dose MART, then specialist targeted treatment. PBS lists budesonide-formoterol for asthma (streamlined authority).
Biologics (PBS, October 2026). Mepolizumab, benralizumab, dupilumab, omalizumab and tezepelumab are Authority Required for uncontrolled severe asthma. Mepolizumab is also listed for uncontrolled COPD; the TGA has approved mepolizumab and dupilumab for type 2 COPD on triple therapy (COPD-X V2.78).
Fibrosis and cystic fibrosis (PBS, October 2026). Nintedanib: IPF and progressive fibrosing ILD; pirfenidone: IPF. Elexacaftor-tezacaftor-ivacaftor, ivacaftor, lumacaftor-ivacaftor and tezacaftor-ivacaftor are listed for cystic fibrosis.
Oxygen (TSANZ acute 2015; TSANZ adult home oxygen 2024). In COPD or chronic respiratory failure, start below 88% and target 88 to 92%; otherwise start below 92% and target 92 to 96%. FiO2 0.40 or more needs senior review; 0.50 or more, ICU review. LTOT (mortality benefit): stable PaO2 55 mmHg or less, or 56 to 59 with hypoxaemic sequelae; not for moderate or isolated nocturnal hypoxaemia. See Physify's Oxygen Therapy course.
Lung cancer screening (NLCSP, from 1 July 2025; MBS 57410). Aged 50 to 70, smoking now or quit within 10 years, and at least 30 pack-years: bulk-billed low-dose CT about every 2 years.
Vaccines (NIP; NSW schedule, October 2026). Pneumococcal (Capvaxive) from 65, from 25 for First Nations people or from 18 with a risk condition; RSV (Arexvy) from 75, or from 60 for First Nations people.
3Sample questions (Physify format)
1. A 68 year old man with COPD takes tiotropium-olodaterol daily with good technique and adherence. In the past 12 months he has had two exacerbations treated with prednisolone and antibiotics, neither needing hospital. His blood eosinophil count is 0.4 x 109/L and he has no history of asthma. Under COPD-X and the Lung Foundation Australia stepwise guide, what is the most appropriate next step?
- A. Add regular ipratropium four times daily
- B. Switch to a single triple therapy inhaler
- C. Start daily azithromycin as the next step
- D. Refer for mepolizumab before any inhaler change
- E. Switch to an ICS-LABA inhaler, stopping the LAMA
Answer: B
B. Correct. Two moderate exacerbations in 12 months despite LAMA plus LABA, with eosinophils of 0.3 x 109/L or more: add an ICS as ICS-LAMA-LABA, ideally in one device.
A. A SAMA must never be used with a LAMA, and it does not prevent exacerbations.
C. COPD-X reserves long-term macrolides for recurrent exacerbations despite optimised preventive therapy, given cardiac, hearing and resistance risks.
D. Biologics are add-on treatment for type 2 COPD that is uncontrolled despite optimised triple therapy.
E. Stopping the LAMA loses bronchodilation; the ICS is added to dual therapy, not swapped in.
2. A 27 year old woman has asthma confirmed on spirometry. She has symptoms about twice a month, no night waking and no exacerbations, and uses salbutamol as needed. Under the 2025 Australian Asthma Handbook, what is the preferred treatment?
- A. Continue salbutamol as needed, as symptoms are infrequent
- B. As-needed low-dose budesonide-formoterol
- C. Regular montelukast plus salbutamol as needed
- D. Medium-dose ICS-LABA twice daily plus salbutamol
- E. Regular low-dose ICS plus salbutamol as needed
Answer: B
B. Correct. Level 1, the recommended regimen: low-dose budesonide-formoterol as an anti-inflammatory reliever (AIR-only), which cuts severe exacerbations compared with SABA alone.
A. SABA alone is not recommended for any adult or adolescent, however infrequent the symptoms.
C. Montelukast has a limited role and a TGA warning about neuropsychiatric effects.
D. A level 3 alternative: far more treatment than her symptoms need.
E. An alternative at level 1, not the preferred regimen; adherence to a daily ICS is often poor.
3. Five people without symptoms of lung cancer ask about the National Lung Cancer Screening Program. Which of them is eligible for a screening low-dose CT?
- A. 47 year old man who smokes, 40 pack-years
- B. 58 year old woman, 32 pack-years, quit 6 years ago
- C. 64 year old man who smokes, 22 pack-years
- D. 66 year old woman, 50 pack-years, quit 14 years ago
- E. 73 year old man who still smokes, 55 pack-years
Answer: B
B. Correct. Aged 50 to 70, quit within the past 10 years and at least 30 pack-years: eligible for bulk-billed low-dose CT about every 2 years (MBS 57410).
A. Under 50, despite a heavy smoking history.
C. Fewer than 30 pack-years.
D. Quit more than 10 years ago.
E. Over the age limit, which ends at 70 years and 364 days.