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Year 3 GP > Resp > Flashcards

Resp Flashcards

1
Q

Asthma

A

Chronic respiratory condition associated with airway inflammation and hyper-responsiveness

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2
Q

Asthma presentation

A 
Dry cough
Wheeze
Chest tightness
Shortness of breath
Worse in morning and night
Atopy
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3
Q

Precipitating factors of asthma

A 
Exercise
Allergen
Irritant exposure
Changes in weather
Viral respiratory infections
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4
Q

Risk factors for asthma

A 
Atopy 
FHx
Exposure to smoking or smoker 
Premature birth and associated low birth weight
Respiratory infections in infancy
Obesity
Social deprivation 
Workplace exposures including flour, dust and isocyanates from paint
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5
Q

Diagnosis

A

Hx
Peak flow
Fractional exhaled nitric oxide (FeNO) testing - 17+ yo
- 40 ppb or more
- children - 35 ppb or higher
Spirometry - Bronchodilator reversibility
- less than 0.7 gets better with salbutamol
Blood - eosinophils

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6
Q

Acute severe asthma signs

A 
PEF < 50% 
Difficulty completing sentences 
PO2 reduced but above 92% 
RR 25+/min
Pulse rate of at least 110/min
Accessory muscle use
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7
Q

Complete control of asthma

A

No daytime symptoms.
No night-time waking due to asthma.
No need for rescue medication.
No asthma attacks.
No limitations on activity including exercise.
Normal lung function (FEV1 and/or PEF > 80% predicted or best). However, be aware that lung function measurements cannot be used reliably to guide asthma management in children under five years of age.
Minimal side-effects from medication.

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8
Q

Mx of asthma

A 
Assess the person's baseline asthma status
Vaccinated 
Education 
Action plan 
Medication
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9
Q

Stepwise medication for asthma

A
  1. SABA + ICS
  2. SABA + combined ICS+LABA
    2b. SABA + ICS + LTRA
  3. medium dose ICS
  4. High dose ICS
  5. Prednisolone
  6. Prophylactic oral macrolides (50 - 70 yo)
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10
Q

Types of inhaler

A

Pressurized metered-dose inhalers
Dry-powder inhalers

  • Spacer
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11
Q

Asthma review

A 
Annual: 
No. of attacks
oral corticosteroid use
time off school/nursery/work due to asthma.
Nocturnal symptoms.
Adherence 
Possession of/use of a self-management plan/written personalised asthma action plan.
Exposure to tobacco smoke
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12
Q

Life threatening asthma

A 
PEFR less than 33%
Oxygen saturation of less than 92%
Altered consciousness or exhaustion 
Silent chest 
Cyanosis 
Poor respiratory effort 
Confusion
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13
Q

Follow up after hospital admission

A

Within 2 days

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14
Q

COPD

A

Chronic bronchitis - referring to cough and sputum production for at least 3 months in each of 2 consecutive years

Emphysema - alveolar destruction

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15
Q

Presentation of COPD

A

Persistent symptoms:

  • breathlessness
  • Productive cough
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16
Q

Exacerbations of COPD

A

Exacerbations are acute episodes of worsening COPD symptoms beyond normal day to day variation

17
Q

Risk factors for COPD

A 
Smoking 
Occupation dust exposure 
Pollution 
FHx
Asthma
18
Q

Complications of COPD

A 
Cor pulmonale - RHF
Frequent chest infections - pneumonia 
Pneumothorax
Lung cancer 
Respiratory failure
19
Q

Diagnosis of COPD

A

35+ yo with a risk factor and 1 + more symptoms

Spirometry - FEV1/FVC < 0.7
- does not get better with bronchodilator

Chest X-ray 
Full blood count — to identify anaemia or polycythaemia
- Serum alpha-1-antitrypsin
(MRC) dyspnoea scale
ECG
20
Q

(MRC) dyspnoea scale

A

1 - Not troubled by breathlessness except during strenuous exercise

2- Short of breath when hurrying or walking up a slight hill

3 - Walks slower because of breathlessness, or has to stop for breath when walking at own pace

4 Stops for breath after walking about 100 m or after a few minutes on the level

5 Too breathless to leave the house, or breathless when dressing or undressing

21
Q

Mx of stable COPD

A 
Smoking cessation 
Vaccinations 
Pulmonary rehabilitation 
Personalised mx plan 
SABA 
LABA + LAMA 
LABA + LAMA + ICS
Oral theophylline (slow release)
Oral mucolytic therapy
Prophylactic oral macrolides
22
Q

Pulmonary rehabilitation

A

individually tailored, multidisciplinary care program for people with COPD which aims to optimize physical and psychological condition through exercise training, education, and nutritional, psychological, and behavioural interventions.

23
Q

Follow up

A

FEV1/FVC < 0.7 - annually

FEV1/FVC < 0.3 - twice a year

24
Q

End-stage COPD Mx

A

Advance care plan

Breathless

  • opiates and analgesia
  • oxygen

Cough

  • nebulised sodium chloride
  • mucolytic - Carbocisteine

Year 3 GP (20 decks)

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