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Y3 MedEd > Chronic SOB > Flashcards

Chronic SOB Flashcards

1
Q

Define asthma

A

Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

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2
Q

Patient history of asthma (7)

A

Recurrent episodes

Variation (worst in morning & evening)

History of atopy
Family History

Smoker

Occupation
Pets

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3
Q

S/s of asthma (3)

A

Cough
Wheeze
SOB

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4
Q

What should be heard on auscultation of an asthmatic

A

Wheeze

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5
Q

Ix for asthma and diagnostic criteria

A

Spirometry - FEV1: FVC <70%
PEFR - PEFR varies by, or increases by >20%, for >3 days/week over several weeks - diagnosis can be aided by a PEFR diary

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6
Q

What is the Mx of asthma

A 
In order:
SABA
SABA+ICS
SABA+ICA+LTRA
LABA+ICS±LTRA
LABA+↑ICS±LTRA
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7
Q

Which SABA is used for asthma

A

Salbutamol

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8
Q

Which ICS are used for asthma (2)

A

Beclometasone, Budesonide

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9
Q

Which LTRA is used for asthma

A

Montelukast

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10
Q

Which LABA+ICS is used for asthma

A

Symbicort (Budesonide/Formoterol)

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11
Q

Which Oral CS is used for asthma

A

Prednisolone

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12
Q

What type of drug is salbutamol

A

Short acting beta2 agonist

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13
Q

What type of drug is beclometasone

A

ICS

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14
Q

What type of drug is budesonide

A

ICS

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15
Q

What type of drug is montelukast

A

Leukotriene receptor antagonist

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16
Q

What type of drug is symbicort

A

Long acting beta agonist budesonide and ICS formorterol

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17
Q

What type of drug is prednisolone

A

Oral CS

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18
Q

Which drugs are in Symbicort

A

Budesonide/Formoterol

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19
Q

What are the criteria for acute severe asthma

A

PEF - 33-50% best or predicted
RR - >25/min
HR - >110min
Inability to complete sentences in one breath

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20
Q

What are the criteria for life threatening asthma

A

PEF - <33% best or predicted
SpO2 - <92%
PaO2 - <8kPa
Normal - PaCO2

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21
Q

Quick way to distinguish moderate, acute severe, life threatening and near fatal asthma?

A 
PEF
50-75%
PEF
33-50%
PEF
<33%
pCO2
Raised
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22
Q

Mx acute asthma

A

O2
Neb. salbutamol 5mg
Neb ipatropium bromide 0.5mg if acute-severe or life-threatening asthma with poor response to salbutamol

Oral prenisolone 40-50mg or IV hydrocortisone 100 100mg

IV MgSO4 + senior help

IV aminophylline

ITU + intubation

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23
Q

History of someone with COPD (4)

A

Age

FHx

Smoking status

Occupation

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24
Q

Presenting complaints of COPD (3)

A

SOB
Productive cough
Some wheeze

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25
What is heard on auscultation of COPD (3)
Reduced air movement Wheezing Coarse crackles (hair-like crackles)
26
What is seen on general inspection of COPD (3)
Tar staining Cyanosis Barrel chest
27
What is felt on palpation of COPD (2)
Reduced expansion | Hyper-resonance (on percussion)
28
Does COPD cause clubbing
No
29
What are the cut offs for different severities of COPD
``` > 80% Mild 50-79% Moderate 30-49% Severe < 30% Very severe ```
30
Ix for COPD and why (5)
Serial peak flow measurements To exclude asthma if diagnostic doubt remains Alpha-1 antitrypsin (A1AT) If early onset, minimal smoking history or family history Transfer factor for carbon monoxide (TLCO) To investigate symptoms that seem disproportionate to spirometric impairment CT scan of the thorax To investigate abnormalities seen on a chest radiograph To assess suitability for surgery ECG or Echocardiogram To assess cardiac status if features of cor pulmonale
31
Mx of COPD
In order: Make sure to have vaccines and stuff SABA or SAMA SABA + LABA or SAMA and LAMA LABA + LAMA or LABA + ICS if asthmatic features LAMA+LABA+ICS
32
What type of drug is ipratropium bromide
Short-acting muscarinic antagonis
33
Example of a short-acting muscarinic antagonist
Ipratropium bromide
34
What type of drug is salmeterol
Long-acting beta antagonist
35
What type of drug is tiotropium bromide
Long-acting muscarinic antagonist
36
Example of a long-acting muscarinic antagonist
Tiotropium bromide
37
Example of a long-acting beta antagonist
Salmeterol
38
Indication for O2 therapy Iin COPD
``` pO2 of 7.3 - 8 kPa and one of the following: Secondary polycythaemia Nocturnal hypoxaemia Peripheral oedema Pulmonary hypertension ``` or pO2 of < 7.3 kPa
39
Mx for acute IE of COPD
(Blue Venturi) 24% O2 Neb Salbutamol 5mg Neb Ipatropium bromide 0.5mg Oral prednisolone 40-50mg IV hydrocortisone 200mg 500mg IV aminophylline BiPAP
40
What is the indication for BiPAP
T2 respiratory failure (e.g. COPD)
41
What is the indication for CPAP
T1 respiratory failure (e.g. sleep apnoea) | or atelectasis
42
Define ILD
Interstitial lung disease (ILD) is an umbrella term for a large group of disorders that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe
43
What are the 4 causes of ILD
Idiopathic Pulmonary Fibrosis Hypersensitivity Pneumonitis / EAA Sarcoidosis Pneumoconiosis
44
Common patient history for IPF (4)
Animal/vegetable dusts Smoking status Occupation Drugs Bleomycin Methotrexate Amiodarone
45
Which drugs cause IPF (3)
Drugs Bleomycin Methotrexate Amiodarone
46
Main presenting complaints (2) and one thing not in the PC of IPF
SOBOE Dry cough No wheeze
47
Main sign on general inspection of IPF
Clubbing
48
Main sign on auscultation of IPF
Bi-basal, fine, inspiratory crepitations
49
Ix for IPF (6)
Biopsy is diagnostic but CT is usually most appropriate Bloods, ABG, BIOPSY CXR – ground-glass, reticulonodular, cor pulmonale, honeycombing High-resolution CT - ground-glass Lung function tests (restrictive pattern)
50
What pattern is seen in lung FT of IPF
Restrictive
51
What is seen in CXR (4) and CT in IPF
CXR – ground-glass, reticulonodular, cor pulmonale, honeycombing CT - ground glass
52
History of hypersensitivity pneumonitis (2)
Keep pets ``` Occupation Pick mushrooms Bird-keeper Farmer Plumber Malt-worker ```
53
PC of hypersensitivity pneumonitis (3)
SOBOE Dry cough Fever
54
General inspection features of EAA (2)
Clubbing (rare) | Mild pyrexia*
55
Auscultation features of EAA
Bi-basal, fine, inspiratory crepitations
56
Ix for EAA (4)
Bloods, ABG CXR – often normal* High-resolution CT - ground-glass Lung function tests (restrictive pattern) Broncho-alveolar lavage – increased cellularity
57
History of pneumoconiosis (3)
Occupation Coal-worker Builder Long latency Asymptomatic
58
PC of pneumoconiosis
SOB | Dry cough
59
What can pneumoconiosis be divided into
Asbestosis - builder | Silicosis - coal - worker
60
Auscultation features of asbestosis (2)
Bi-basal, inspiratory crepitations
61
Auscultation features of silicosis (2)
Decreased breath sounds
62
General inspection signs of asbestosis
Clubbing
63
General inspection signs of silicosis
None
64
Ix and results of pneumoconiosis (3)
CXR: Simple = micro-nodular mottling Complicated = bilateral lower zone reticulonodular shadowing and pleural plaques (asbestosis is fibrotic changes, not just plaques)* CT – fibrotic changes Lung function tests (restrictive pattern)
65
What is seen in the CXR of simple pneumoconiosis
Simple = micro-nodular mottling
66
What is seen in the CXR of complicated pneumoconiosis
Complicated = bilateral lower zone reticulonodular shadowing and pleural plaques (asbestosis is fibrotic changes, not just plaques)*
67
What is seen in the CT of pneumoconiosis
Fibrotic changes
68
What pattern is seen in the lung FT of pneumoconiosis
Restrictive
69
Define sleep apnoea
Characterised by recurrent collapse of pharyngeal airway and apnoea (cessation of airflow for >10s) during sleep; followed by arousal from sleep
70
RF for sleep apnoea (8)
Obesity, smoker, alcohol Fatigue Truck Driver Enlarged tonsils Macroglossia Marfan’s syndrome
71
PC of sleep apnoea (3)
Chronic fatigue Unrefreshed sleep Snoring
72
Ix for sleep apnoea (2)
Sleep study | TFTs

Y3 MedEd (34 decks)

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