Resp Flashcards
Wells criteria
Tachy > 100
Malignancy
Haemoptysis
PE most likely
DVT s + s
DVT/PE history
Immobilization of 3 days or surg in last 4 weeks
Allergic rhinitis frequency
Intermittent - <4d/week or <4 consecutive weeks
persistent - 4+ days/week AND >4 consecutive weeks
Types of rhinitis
allergic: seasonal vs. perennial
non-allergic: irritants (perfume, smoke, weather)
atrophic: elderly (thinning mucosa)
hormonal: pregnancy, period, hypothyroid
drug related: decongestants, BB, ace-inhibitors
vasomotor, alcohol and food induced
symptoms of allergic rhinitis
congestion, rhinitis, sneezing, itching
CHRONIC COUGH
itchy eyes (conjunctivitis)
physical exam for allergic rhinitis
- signs of mouth breathing
- cobblestoning of tarsal conjuctiva & oropharangyeal wall
- venous stasis (allergic shiners)
- septal deviation
- turbinate hypertrophy
- pallor/erythema
- nasal discharge
- signs of asthma and eczema
ix and mx of allergic rhinitis
skin prick testing or IgE for allergens
intermittent:
- oral or nasal AH first
- nasal steroid
- nasal steroid + AH
persistent: straight to steroid
- nasal steroid +/- nasal AH
- oral AH + nasal steroid
- try decongestant
- oral steroids for retractable
eyes: (check this)
- AH drops (olapatidine)
- steroid drops or intranasal steroid
- oral AH
try saline irrigation
cromoline before exposure
antihistamines
first generation - shorter half life & sedating
- diphenhydramine (Benadryl)
- dimenhydrinate (gravol)
- promethazine (anti-emetic)
second generation (non-sedating, longer duration, od dosing)
- loratidine (Claritin)
- fexofenadine (Allegra)
- ceritizine (Reactine)
- desloratidine (Aerius)
- levocetirizine (Xyzal)
how long can you use a nasal antihistamine for
4 weeks otherwise risk of rebound
common triggers for allergy/anaphylaxis
medications
latex
bee stings
food
- wheat, dairy, eggs, fish, peanuts, tree nuts, shellfish, soy
what to do with penicillin allergy
do a skin test or oral challenge
low risk if:
- >5 years ago since reaction
- no tx needed at time
- no severe features of rxn
diagnosis of anaphylaxis
acute onset of cutaneous AND either resp or low BP
acute onset of 2 of following
- resp
- low BP
- GI
- cutaneous
management of anaphylaxis
- ABCs, fluid
- epinephrine 1:1000 (or 1:10K for severe) - 0.5mg IM
- Benadryl - 0.25- 0.5
- prednisone or methylprednisolone
- salbutamol
- anti-histamine
monitor up to 72h for bi-phasic reaction
Allergic conjunctivitis
artificial tears 4-6x daily
anti-histamine drops (pataday OD)
lotemax steroid drops 1-2 weeks
oral antihistamine if associated allergy sx
COPD definition
COPD symptoms and signs
chronic bronchitis sx:
- cough, wheeze, chest tight, sputum
emphysema sx:
- SOB, reduced exercise tolerance, freq resp infections
symptoms: mMRC and CAT tools
signs:
- barrel chest
- wheeze, prolonged expiration
- purse lip breathing, tripod, accessory muscles
clubbing associated with what respiratory diseases
lung cancer
bronchiectasis
pulmonary fibrosis
differentials for COPD
asthma
pneumonia
bronchiectasis
A-1 AT
HF
lung cancer
r/o TB
when do you consider alpha-1 anti trypsin testing?
early onset (<65yo), FHx, less than 20 pack year smoke history, poorly controlled asthma despite medical therapy
investigations for COPD
spirometry <0.7 after bronchodilator
GOLDs criteria
- FEV1 > 80 - mild
- 50-80 - moderate
- 30-50 - severe
- <30 - very severe
mMRC scale for symptom severity
COPD Assessment Test
Can consider:
- x-ray - hyperinflation, exclude pneumonia/cancer/HF
- chest CT - r/o lung cancer & bronchiectasis
chronic bronchitis definition
cough and sputum for >3month/year for 2 years
COPD pharmacotherapy
SABA prn all patients
MILD: FEV1 >80%, mMRC 1, CAT < 10, no exacerbations in last year
- LABA OR LAMA
- LAMA + SABA is preferred combo (uptodate)
MODERATE: FEV1<80%, mMRC 2+, CAT 10+, 1 exacerbation in the last year
- LABA + LAMA
- escalate - add on ICS
SEVERE: FEV1<80%, mMRC 2+, CAT 10+, either 1 severe or 2 moderate exacerbations
- LABA + LAMA + ICS therapy (if blood eosinophils are over 300)
- add on: oral therapies (azithromycin + NAC)
SABA and SAMA names & combo inhaler name
SABA - Ventolin (also generic terbutaline)
SAMA - ipratropium aka atrovent
SABA + SAMA - Combivent respimat
LABA, LAMA and combo (LABA/LAMA, LABA/ICS, LABA/LAMA/ICS) names
LABA - serevent
LAMA - Spiriva
LABA + LAMA - complicated names
LABA + ICS - Symbicort & Breo & Advair
LABA + LAMA + ICS - Trelegy
COPD Exacerbations define mild, moderate, severe classes
mild - no steroids/abs needed
moderate - abs +/- steroid needed + tachycardia/hypoxia/tachypnea
severe - hospital/ER needed + hypercapnia and acidotic
