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Year 3 - MedEd Lectures > Resp 2 > Flashcards

Resp 2 Flashcards

1
Q

How does Asthma typically present?

A

Younger person

Cough, SOB, wheeze

Time dependent

FHx, Hx of atopy

Recurrent Episodes

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2
Q

How would you diagnose Asthma?

A

FEV1:FVC Ratio <70% with 12% reversibility post-bronchodilator spirometry

PEFR variation

Bloods

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3
Q

How would you treat chronic Asthma?

A

1) SABA (Salbutamol)
2) SABA + ICS (Beclometasone)
3) SABA + ICS + Leukotriene Receptor Antagonist (Montelukast)
4) LABA + ICS (Symbicort = Budeosine + Formoterol) + LTRA
5) LABA + More ICS + LTRA
6) Trial Medicines
7) Oral CS (Prednisolone)

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4
Q

How do you determine the severity of an acute asthma attack?

A

Measure PEF

50-75% = Moderate

33-50% = Acute-Severe

Life Threatening = <33%

Hypercapnia = Near fatal

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5
Q

What % should you aim to maintain sats at during an Acute Asthma Attack?

A

94-98%

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6
Q

How should you manage a patient experiencing an Acute Asthma Attack?

A

O2

Nebulised SABA (+Ipratropium in severe case)

Oral Prednisolone/IV Hydrocortisone

IV Magnesium Sulphate + Senior help

IV Aminophylline

ITU + Intubation

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7
Q

How do typical COPD patients present?

A

SOB

Productive Cough

Some Wheeze

Long-term smoker

Older

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8
Q

What would you look for on examination of a potential COPD patient?

A

Tar Staining, Cyanosis, Barrel Chest

Reduced expansion + Hyper-resonance

Wheezing, Coarse crackles

Signs of RHF

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9
Q

How would you diagnose someone with COPD?

A

Post-bronchodilator FEV1/FVC < 0.7

Severity depends on FEV1%

>80% = Mild

50-79% = Moderate

30-49% = Severe

<30% = Very Severe

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10
Q

How would you investigate a suspected case of COPD?

A

Spirometry

Bloods, ABG

CXR

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11
Q

How would you manage a patient with COPD?

A

Mild - SABA

Moderate - SABA + LABA

or SAMA (muscarinic) + LAMA

Severe - LABA + LAMA

or LABA + ICS

Very Severe - LAMA + LABA + ICS

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12
Q

Describe the long-term therapy guidelines in patients with COPD.

A

Smoking Cessation, Influenza Vaccinations and Pneumococcal Vaccination

Long term O2 therapy

Lung Volume reduction surgery

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13
Q

When would you prescribe a COPD patient long term O2 therapy?

A

PO2 < 7.3 kPa

or

PO2 of 7.3kPa - 8kPa +

Secondary Polycythaemia

Nocturnal Hypoxaemia

Peripheral Oedema

Pulmonary Hypertension

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14
Q

How would you manage an infective exacerbation of COPD?

A

24% O2 - Blue venturi mask

Neb. Salbutamol + Ipratropium Bromide w/ IV/Oral steroids

IV Amoxicillin

IV Aminophylline

BiPAP (for T2 Resp. Failure)

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15
Q

What is Interstitial Lung Disease?

A

Umbrella term for conditions causing Pulmonary Fibrosis.

This scarring causes stiffness, which restrict breathing.

Diseases include:

Idiopathic Pulmonary Fibrosis

Hypersensitivity Pneumonitis

Sarcoidosis

Pneumoconiosis

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16
Q

How would a typical Idiopathic Pulmonary Fibrosis patient present?

A

SOB on exertion, dry cough, no wheeze

Smoker, exposed to animal/vegetable dusts.

Occupational exposure to metals/wood

Drugs

17
Q

Which drugs may cause Idiopathic Pulmonary Fibrosis in patients?

A

Bleomycin

Methotrexate

Amiodarone

18
Q

What are the signs of Idiopathic Pulmonary Fibrosis on examination?

A

Clubbing

Bi-basal, fine, insipratory crepitations

Signs of RHF

19
Q

How would you investigate a suspected case of Idiopathic Pulmonary Fibrosis?

A

Bloods, ABG, Biopsy

CXR - ground-glass, reticulonodular, cor pulmonale, honeycombing

High resolution CT - ground Glass appearance

Lung function tests (restrictive pattern)

20
Q

How would a typical Hypersensitivity Pneumonititis patient present?

A

SOB on exertion, Fever, Dry Cough

Have pets

Occupations:

Pick Mushrooms

Bird-Keeper

Farmer

Plumber

Malt-Worker

21
Q

What would you see on examination of a patient with Hypersensitivity Pneumonitis?

A

Clubbing (rare)

Mild Pyrexia

Bi-basal, fine, inspiratory crepitations

22
Q

How would you investigate a suspected case of Hypersensitivity Pneumonitis?

A

Bloods, ABG

CXR (May be normal)
CT - Ground Glass

LFTs

Broncho-alveolar lavage

23
Q

How would a patient with Pneumoconiosis typically present?

A

SOB, dry cough

Coal-worker/Builder

Long Latency

Asymptomatic

Asbestos exposure may lead to both Asbestosis (a form of pneumoconiosis) and mesothelioma

24
Q

How would investigate someone with possible Pneumoconiosis?

A

CXR - Simple = Micro-nodular mottling

Complex = Bilateral lower zone reticulonodular shadowing and pleural plaques.

CT - Fibrotic changes

LFTs

25
Q

Define Sleep Apnoea.

A

Recurrent collapse of pharyngeal airway and apnoea during sleep, followed by arousal from sleep.

26
Q

How would a patient with Sleep Apnoea typically present?

A

Chronic fatigue, unrefreshed after sleep, snoring

Obese smoker who drinks.

Fatigued truck driver

May have Marfan’s, enlarged tonsils or macroglossia.

27
Q

How would you investigate a possible case of Sleep Apnoea?

A

Sleep Study

TFTs

Year 3 - MedEd Lectures (29 decks)

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