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402 - general practice > Asthma & Coughs > Flashcards

Asthma & Coughs Flashcards

1
Q

Other than B symptoms, what are the 6 red flag features of a cough?

A 
Haemoptysis.
Hoarseness.
Peripheral oedema with weight gain.
Prominent dyspnoea, especially at rest or at night.
Trouble swallowing.
Vomiting
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2
Q

7 co-morbidities that could cause a cough?

A 
Asthma
COPD
Heart Failure
Allergies
Sleep Apnoea
GORD
Bronchiectasis
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3
Q

What medication can cause a cough?

A

ACE inhibitors

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4
Q

What pack history is significant in smokers?

A

30

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5
Q

What is the time limit on acute cough?

A

3 weeks

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6
Q

If someone had an acute cough with sudden onset pleuritic pain what 2 conditions would you suspect?

A

Pneumothorax

PE

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7
Q

Common causes of a chronic cough?

A

Asthma
Smokers
GORD
ACE inhibitor associated

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8
Q

If a cough is worse on weekdays but better at weekends what would you suspect?

A

Environmental or occupational causes

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9
Q

In someone had a cough what 4 other symptoms would suggest heart failure?

A

significant breathlessness,
orthopnoea
paroxysmal nocturnal dyspnoea.
peripheral oedema

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10
Q

A cough with sputum, breathlessness, haemoptysis, weight loss, fever, night sweats, anorexia, general malaise, and finger clubbing. What do you suspect?

A

TB

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11
Q

When would you refer someone for admission with an acute cough?

A

Pneumothorax
PE
Foreign body
Systemically Unwell

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12
Q

In a URTI how long does a cough usually last for?

A

3 or 4 weeks

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13
Q

Safety net for acute cough

A

seek medical advice if symptoms worsen rapidly or significantly,
do not improve in 3–4 weeks,
or they become systemically very unwell.

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14
Q

For people with acute cough who are systemically unwell what would you offer?

A

doxycycline

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15
Q

If you suspect pneumonia what tool would you use to help guide management?

A

CRB-65

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16
Q

What are the criteria of the CRB-65

A

Confusion (new disorientation in person, place, or time; or abbreviated mental test score 8 or less).
Raised respiratory rate (30 breaths per minute or more).
Low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg).
Age 65 years or more.

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17
Q

When would you order a CXR for someone with a CAP?

A

If there was the possibility of underlying pathology

18
Q

What do you do if the person with sub-acute cough does not need emergency admission and has clinical features of post-infectious cough?

A

explain that the cough is often self-limiting and usually lasts for no longer than 8 weeks (advise the person to re-attend for assessment if the cough does not improve after 2 months

19
Q

How do the CRB scores relate to management?

A

Score of 3 or more, arrange urgent admission to hospital.
Score of 1 or 2, hospital assessment should be considered (particularly for people with a score of 2).
Score of 0, treatment at home should be considered, depending on clinical judgement and the person’s social circumstances

20
Q

Safety net for pneumonia when antibiotics prescribed?

A

Symptoms worsen rapidly or significantly.
Symptoms do not start to improve with 3 days, or they are not improving as expected.
They become systemically very unwell

21
Q

What investigation would you organise for a pt following a CAP?

A

CXR 6 weeks later

22
Q

How would you differentiate between bronchitis and CAP?

A

Sputum production and pain - possible
Systemically unwell
Exam - pneumonia= focal signs

23
Q

What is the difference in terms of management between bronchitis and pneumonia?

A

Bronchitis - self limiting so self care

Pneumonia - antibiotic

24
Q

Why wouldn’t you usually prescribe antibiotics for bronchitis?

A

Acute bronchitis is usually a self-limiting illness and the cough usually lasts about three to four weeks.
Antibiotics do not make a large difference to the duration of symptoms, only shortening cough duration by about half a day on average.
Adverse effects, including diarrhoea and nausea are possible with antibiotic treatment.

25
Q

When would you write up an antibiotic prescription for pt with bronchitis?

A

Systemically unwell

26
Q

When would you write a back up prescription for someone with bronchitis?

A 
A pre-existing comorbid condition
Hospital admission in the previous year.
Type 1 or type 2 diabetes mellitus.
History of congestive heart failure.
Current use of oral corticosteroids.
27
Q

What is the time limit and cause of a sub acute cough?

A

4-8 weeks

post infective

28
Q

What is the management of a subacute cough?

A

Usually self resolving, come back if not improved in 2 months

29
Q

Pattern of asthma symptoms

A

episodic,
diurnal (worse at night or in the early morning), and/or triggered or exacerbated by exercise,
viral infection,
and exposure to cold air or allergens

30
Q

What classes of drug can trigger asthma?

A

non-steroidal anti-inflammatory drugs

beta-blockers.

31
Q

What aspects of asthma do you typically monitor on follow up?

A

Number of asthma attacks, oral corticosteroid use, time off school/nursery/work due to asthma.
Nocturnal symptoms.
Adherence (which can be assessed by reviewing prescription refill frequency).
Possession of/use of a self-management plan/written personalised asthma action plan.
Exposure to tobacco smoke.

32
Q

What 3 questions do you ask to determine assthma ccontol?

A

Have you had difficulty sleeping because of your asthma symptoms (including cough)?
Have you had your usual asthma symptoms during the day (e.g. cough, wheeze, chest tightness, or breathlessness)?
Has your asthma interfered with your usual activities (e.g. housework, work, school)?

33
Q

What do these finding suggest?
PEFR less than 33% best or predicted, or oxygen saturation of less than 92%, or altered consciousness, or exhaustion, or cardiac arrhythmia, or hypotension, or cyanosis, or poor respiratory effort, or silent chest, or confusion.

A

Life threatening acute exacerbation of asthma

34
Q

Management of Acute exacerbations of asthma treatment whilst waiting for ambulance

A

Oxygen
SABA - salbutamol via nebuliser
ipratropium bromide as well
Corticosteroids

35
Q

Draw step wise management for asthma?

A 
1 - SABA/SAMA PRN
2 - SABA + ICS (low dose)
3 - LABA + ICS (low dose)
4 - LABA + ramp up ICS OR trial LAMA
5 -  More ICS and refer
36
Q

Define complete control of asthma (6)

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
37
Q

Example of a SABA

A

Salbutamol

38
Q

Example of a SAMA

A

Ipratropium Bromide

39
Q

Example of a LABA

A

Salmeterol

40
Q

Example of a LAMA

A

tiotropium

41
Q

Example of a LRTA and who usually gets this

A

Montelukast

Children

42
Q

Example of ICS

A

beclomethasone/prednisolone

402 - general practice (8 decks)

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