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Resp Flashcards

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1
Q

Wells criteria

A

Tachy > 100
Malignancy
Haemoptysis

PE most likely
DVT s + s
DVT/PE history
Immobilization of 3 days or surg in last 4 weeks

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2
Q

Allergic rhinitis frequency

A

Intermittent - <4d/week or <4 consecutive weeks

persistent - 4+ days/week AND >4 consecutive weeks

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3
Q

Types of rhinitis

A

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

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4
Q

symptoms of allergic rhinitis

A

congestion, rhinitis, sneezing, itching
CHRONIC COUGH
itchy eyes (conjunctivitis)

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5
Q

physical exam for allergic rhinitis

A
  • 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
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6
Q

ix and mx of allergic rhinitis

A

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

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7
Q

antihistamines

A

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)

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8
Q

how long can you use a nasal antihistamine for

A

4 weeks otherwise risk of rebound

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9
Q

common triggers for allergy/anaphylaxis

A

medications
latex
bee stings
food
- wheat, dairy, eggs, fish, peanuts, tree nuts, shellfish, soy

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10
Q

what to do with penicillin allergy

A

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

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11
Q

diagnosis of anaphylaxis

A

acute onset of cutaneous AND either resp or low BP

acute onset of 2 of following
- resp
- low BP
- GI
- cutaneous

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12
Q

management of anaphylaxis

A
  • 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

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13
Q

Allergic conjunctivitis

A

artificial tears 4-6x daily
anti-histamine drops (pataday OD)
lotemax steroid drops 1-2 weeks

oral antihistamine if associated allergy sx

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14
Q

COPD definition

A
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15
Q

COPD symptoms and signs

A

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

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16
Q

clubbing associated with what respiratory diseases

A

lung cancer
bronchiectasis
pulmonary fibrosis

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17
Q

differentials for COPD

A

asthma
pneumonia
bronchiectasis
A-1 AT
HF
lung cancer
r/o TB

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18
Q

when do you consider alpha-1 anti trypsin testing?

A

early onset (<65yo), FHx, less than 20 pack year smoke history, poorly controlled asthma despite medical therapy

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19
Q

investigations for COPD

A

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

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20
Q

chronic bronchitis definition

A

cough and sputum for >3month/year for 2 years

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21
Q

COPD pharmacotherapy

A

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)

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22
Q

SABA and SAMA names & combo inhaler name

A

SABA - Ventolin (also generic terbutaline)

SAMA - ipratropium aka atrovent

SABA + SAMA - Combivent respimat

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23
Q

LABA, LAMA and combo (LABA/LAMA, LABA/ICS, LABA/LAMA/ICS) names

A

LABA - serevent
LAMA - Spiriva
LABA + LAMA - complicated names
LABA + ICS - Symbicort & Breo & Advair
LABA + LAMA + ICS - Trelegy

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24
Q

COPD Exacerbations define mild, moderate, severe classes

A

mild - no steroids/abs needed
moderate - abs +/- steroid needed + tachycardia/hypoxia/tachypnea
severe - hospital/ER needed + hypercapnia and acidotic

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25
most common causes of COPDE?
infections (50%) MI, PE, HF, anemia irritants
26
someone is high risk for a COPDE if?
they have had 1+ severe episodes or 2+ moderate episodes in the last year
27
Management of COPDE
Symptoms present >48h? Treat *ABG to titrate O2 (keep >90%) *Duo nebs 3mL solution 3x q20-60min (salbutamol + ipratropium) *40mg prednisone x 5d (no taper needed) *antibiotics - simple (FEV >50, mild/moderate) - amoxicillin 500mg TID or doxy x 5-7d - complicated (FEV <50, severe, cardiac dx)- augmentin 875mg BID x 7-10d or levo - pseudomonas (FEV <35, chronic steroids, chronic purulence)- cipro Pulm rehab
28
Respiratory failure Type 1 vs. Type 2
Type 1: Hypoxemic (gas exchange issue) - PaO2 <60 (normal is 80-100) - normal or low CO2 - pneumonia, CHF, PE, COVID - tx: CPAP Type 2: Hypercapnic (ventilation issue) - PaO2 low or normal - PaCO2 is >45mmHg - COPDE, asthma, OHS, opioids/benzos (CNS depression) - tx: BiPAP
29
What criteria needs to be met per GOLD 2024 guideline to add ICS in severe COPD management? What is risk of adding ICS if eosinophils are <100?
blood eisinophils > 300 Risk of pneumonia/recurrent infections
30
GOLD 2024 COPD tx guidelines
GOLD A: mMRC 1, CAT <10, 0-1 exacerbation GOLD B: mMRC 2, CAT >10, 0-1 exacerbation GOLD E: 2 moderate exacerbations or 1 severe in the last year
31
Which bug are COPD patients more at risk of?
pseudomonas consider adding on pip-tazo or merepenem for these patients (ex: pneumonia)
32
asthma symptoms
COUGH wheeze SOB chest tightness symptoms worse at night & early morning
33
Asthma severity
intermittent (<2d/week of sx and reliever use) mild persistent (>2d/week or sx and reliever use) moderate persistent - daily use severe persistent - multiple times a day use
34
Investigations for asthma
spirometry looking at FEV1/FVC <0.8 and reversibility (should be >12% or 200mL post bronchodilator) can try methacholine challenge peak flow monitoring
35
two types of asthma triggers
allergic inflammatory (dust mites, pollen, dander) non-inflammatory (smoke, perfume, exercise, cold air, chemicals)
36
GINA guidelines stepwise management
- Start with Symbicort prn or SABA + low dose ICS - ICS alone + SABA - ICS - LABA prn and maintenance (low, med, high dose) - consider adding on LTRA - step 5 referral for biologics and LAMA
37
which meds to avoid with asthma
BB NSAIDs Aspirin
38
Explain asthma action plan
Green zone - PEF > 80% Yellow - PEF 50-80% seek help Red - <50%
39
Self management for an exacerbation
increase reliever 2 puffs q 4-6 h prn increase ICS x 4 dosage for 48h to see if this improves, if not, see MD or if PEF < 60%
40
Hospital management of asthma exacerbation
ABCs Salbutamol 4-8puffs q20min x3 --> q1-4h Prednisone 40mg po od x 5d If severe consider atrovent & magnesium discharge once no SABA for 4 hours, PEF > 60%, O2 94% on RA discharge with 5d steroids and inhalers
41
which conditions worsen asthma
GERD allergic rhinitis
42
cough differentials
intrathoracic: - asthma - COPD - bronchiectasis - CF - TB - lung cancer extrathoracic: - chronic allergic rhinitis - GERD - medications (ace-i)
43
community acquired pneumonia definition
not hospitalized within the last 14 days or hospitalized less than 48 hours ago (check this)
44
risk factors for pneumonia
elderly smoking recent antibiotic use (<3months) hospitalization in last 3 months comorbid conditions
45
pneumonia symptoms & diagnosis
fever, chills, sweating SOB pleuritic chest pain cough sputum production hemoptysis (necrotising, TB, gram negative) WL PLUS ausculatory - bronchial breath sounds + crackles PLUS opacity on chest xray
46
physical exam findings in pneumonia
decreased chest wall expansion dull percussion note bronchial breath sounds crackles diminished air entry pleural rub egophony and whispering pectoriloquy increased tactile vocal fremitus
47
investigations for pneumonia
all patients should have PA/lateral chest xray if hospitalized - CBC w diff, CRP, electrolytes, Cr, glucose, ALT?, ABG, blood/sputum cultures if severe influenza test (if positive give oseltimivir) COVID test
48
duration of antibiotic treatment in pneumonia CAP
minimum 5 days - 5-7 days for mild/moderate moderate/severe 7-14 days should respond within 3 days of treatment
49
if influenza test is positive, what do you do?
treat with oseltamivir 5d course if within 48h symptom onset IF: - 65+ - pregnant - chronic conditions - live in LTC Prophylaxis is 10d course 75mg po
50
CAP Pneumonia patient with no comorbidities, what antibiotic do you choose?
Amoxicillin 1g TID x 7 days OR doxycycline 100mg BID x 1 day and then OD
51
CAP patient with comorbities or HAP, which antibiotic?
Amoxicillin 1 g TID or augmentin 875mg BID PLUS doxy or azithro or clarithro
52
Which antibiotic for suspected aspiration pneumonia?
Augmentin or clindamycin
53
Types of pneumonia
Community-Acquired Pneumonia (CAP): Acquired outside hospitals/long-term care. Hospital-Acquired Pneumonia (HAP): >48 hours after hospital admission. Ventilator-Associated Pneumonia (VAP): >48 hours after intubation.
54
CAP vs. HAP pathogens
CAP Pathogens: Streptococcus pneumoniae, Haemophilus influenzae, atypicals (e.g., Mycoplasma, Chlamydophila), viruses. HAP/VAP: Pseudomonas, MRSA, Klebsiella, Enterobacter.
55
Which scoring systems to use for pneumonia (to tell you inpatient vs. outpatient treatment recommendation)?
in office use CRB-65 - confusion, RR > 30, BP <90 or Diastolic <60, 65+ in ER use PSI - much more complex but accurate predictor of mortality
56
viral pharyngitis symptoms
cough hoarseness sore throat fatigue tonsilar hypertrophy erythema of pharynx conjunctivitis
57
bacterial pharyngitis symptoms
fever >38 very sore throat no cough or conjunctivitis tonsilar edema and exudate petechiae on palate
58
Complications of GAS
suppurative - AOM - sinusitis - peritonsillar abscess - bacteremia, meningitis, mastoiditis non-suppurative - PSGN - acute rheumatic fever
59
CENTOR criteria for strep throat
Cough (absence) Exudate Nodes (anterior swollen) Temp > 38 OR - Age 3-14 +1; 45 gets -1 2+ will do rapid test (can consider throat culture) and if positive will treat
60
if strep rapid test comes back negative in a kid, what do you do?
throat culture because of false negative and risk of complications
61
antibiotic stewardship for strep throat
typically self limiting 3-5 days but treat due to complications - wait until culture results come back and treat by day 9 (no increased risk)
62
treatment for strep throat
penicillin V or amoxicillin if allergic - azithromycin or clindamycin
63
rhino sinusitis management
wait 10 days to see - try nasal saline, steam, 3d of decongestants, nasal steroid and watch improvement if worsening - bacterial so prescribe amoxicillin or augmentin (or doxy or clarithro if allergic) x 10-14d chronic sinusitis > 3 months - nasal steroids and saline rinse - if nasal polyps prescribe oral steroids - antibiotics as needed
64
Common cold management
Acetaminophen and ibuprofen Zinc lozenges Echinacea 2000-3000mg OD Nasal decongestants Antitussives on average 4-6 colds/year
65
Mono symptoms (can seem v similar to strep throat)
- prolonged malaise and fatigue - sore throat (can be exudative) - low grade fever - nausea, anorexia (no vomiting) - cough - ocular and chest pain - photophobia - LAD (posterior cervical) - significant tonsillar enlargement - rash if given amoxicillin or ampicillin - periorbital edema - palatal petechiae - hepatosplenomegaly uncommon to have arthralgia, myalgia or chills
66
Investigations for mono
EBV monospot CBC (high WBC, not anemia) ESR (will be high for EBV, not strep throat) Mild increase in LFTs (if super high consider viral hepatitis)
67
How to differentiate strep throat from mono
can do rapid antigen test for strep throat, mono spot and ESR will be high for mono
68
management of mono
- monitor respiratory obstruction from tonsils - consider steroids if concerned about obstruction - no physical activity for 3 weeks (can return to non-contact after 3 weeks, otherwise 4 weeks) - trend WBC to normal - no meds (no acyclovir)
69
What are late findings in mono
palatal petechiae hepatosplenomegaly splenic tenderness

FM Notes (14 decks)

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