SOB

Question 1

How to do investigate for Asthma?

Answer 1

Spirometry (FEV1/FVC <0.7 shows an obstructive pattern). Shows reversibility if >12% with SABA

FeNO test (>35-40 parts/billion)

PEFR (varies by >20% for >3 weeks)

Question 2

Whats the general management of asthma?

Answer 2

1) SABA
2) SABA + ICS (inhaler used >2 a week)
3) SABA + ICS + LTRA
4) LABA + ICS +/- LTRA
5) LABA + increased ICS +/- LTRA
6) Trials e.g. Theophylline or LAMA
7) Oral Corticosteroids

Question 3

Examples of each asthma treatment?

Answer 3

SABA = salbutamol
ICS = beclometasone, budenoside
LTRA = montelukast
LABA + ICS = symbicort
Oral CS = prednisolone

Question 4

Asthma life-threatening symptoms?

Answer 4

PEF <33% best effort or predicted.
Can they talk
Altered conscious levels, exhaustion, arrhythmia, hypotension, cyanosis, silent chest. poor respiratory effort

Admit to 24hrs

Question 5

Asthma Severe signs?

Answer 5

PEF 33%-50%
RR >25
HR >110
Inability to complete sentences in one breayj

Question 6

A-E for asthma?

Answer 6

Basic obvs, PEFR, ABG (including K+ and Glucose)

Question 7

Near fatal asthma signs?

Answer 7

Increased pCO2

Admit to hospital

Question 8

General Treatment for acute asthma admittance?

Answer 8

1) O2
2) Neb. Salbutamol 5mg + Neb Ipratropium Bromide 0.5mg
3) PO Prednisolone 40-50mg 5days + IV hydrocortisone 100mg

If no response, senior support:
IV magnesium sulphate -> IV aminophylline -> ITU + Intubation

Question 9

Acute asthma non-admittance treatment?

Answer 9

Quadruple inhaled ICS instead of PO prednisolone. Salbutamol back to back

Question 10

What is COPD made of?

Answer 10

Emphysema and Bronchitis

Question 11

Hx for COPD?

Answer 11

SOB, productive cough e.g. white or green, some wheeze

Question 12

General Abx for COPD?

Answer 12

Amoxicillin which you then step up?

Question 13

RFs for COPD?

Answer 13

Increased Age, FHx, occupation and smoking

Question 14

Signs of COPD?

Answer 14

tar staining, cyanosis, barrel chest, reduced expansion, hyper-resonance on percussion.
Auscultation = reduced air movement, wheezing + COARSE crackles (hair-like)
Signs of RHF

Question 15

Crackle examples?

Answer 15

Fine = interstitial lung disease
Coarse = COPD + pneumonoa

Question 16

What are COPD classifications?

Answer 16

FEV/FVC 80% is mild
50-80 = moderate
30-50 = severe
<30 = very severe

Question 17

COPD investigations?

Answer 17

Spirometry
ABG
Bloods e.g. alpha1antitypsin for early onsent and minimal smoking or FHx, Hb, U&Es
CXR or further CT chest

Question 18

How to distinguish between COPD and asthma?

Answer 18

Serial peak flow measurements

Question 19

COPD management?

Answer 19

1) SABA or SAMA
2) No asthma = LABA + LAMA
2) Asthmatic or atopy features= LABA + ICS
3) LAMA + LABA + ICS

Question 20

COD management examples?

Answer 20

SABA = salbutamol
ICS = budenoside or beclometasone
LABA + ICS = Symbicort (budenoside + formoterol)
LABA = formeterol, salmeterol
LAMA = tiotrpium, ipratropium??
Oral CS = Prednisolone

Question 21

COPD general management?

Answer 21

Smoking Cessation !!
Annual influenza vaccination
pneumococcal vaccination.

Imrpoed survival = smoking cessation, long-term O2, lung volume reduction surgery

Question 22

Criteria for long-term O2?

Answer 22

pO2 <7.3kPa

or 7.3-8 with following one: secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension

Question 23

Acute COPD treatment?

Answer 23

1) 24% O2 blue venturi (don’t immediately go higher as it kills hypoxic drive)
2) Neb salbutamol 5mg + Nebiprabro 0.5mg. PO prednisolone 4-5days 40-50mg + IV hydrocortisone 200mg +/- IV amoxicillin

Senior support = IV Aminophylline

Question 24

Describe CPAP?

Answer 24

CPAP - continuous positive pressure throughout inspiration and expiration. Splints the airway open.
Treatment for Obstructive sleep apnoea (OSA) or T1RF (pneumonia/Pulmonary oedema)

Question 25

Describe BiPAP (NIV)?

Answer 25

Provides a differing air pressure throughout inspiration and expiration.
iPAP (20cmH20) to ventilate
ePAP (10cmH2O) for alveolar recruitment and removal of waste gas

Question 26

What is not a cause of respiratory clubbing?

Answer 26

COPD

Question 27

What are causes of respiratory clubbing?

Answer 27

SQCC, emypema, interstitial lung disease, cystic fibrosis

Question 28

What is interstitial lung disease examples?

Answer 28

Idiopathic pulmonary fibrosis, hypersensitivit pneumonitis, sarcoidosis

Question 29

Pulmonary fibrosis sympotoms?

Answer 29

SOBOE, dry cough and no wheeze

Question 30

RFs for pulmonary Fibrosis?

Answer 30

Animal, vegetable dusts, smoking status, occupation, drugs e.g.