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Z Year3 Conditions > RESP (asthma, COPD, sarcoidosis) > Flashcards

RESP (asthma, COPD, sarcoidosis) Flashcards

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1
Q

What is chronic asthma?

A

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

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2
Q

What are the symptoms and signs of asthma?

A
  • cough
  • wheeze (heard on auscultation)
  • shortness of breath
  • worse in morning and evening
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3
Q

What are the investigations for asthma?

A
  1. Spirometry: (FEV1:FVC ratio)
  2. PEFR (peak expiratory flow rate)
  3. Bloods
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4
Q

What is the criteria for diagnosis of asthma?

A
  1. FEV1: FVC <70%
  2. Reversibility: 12% pre- and post-bronchodilator spirometry
  3. 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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5
Q

What is the order of medication plan in chronic asthma?

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. LABA + ICS ± LTRA
  5. LABA + increase ICS ±LRTA
  6. Trials
  7. Oral CS
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6
Q

What should you check on each trip to the GP with chronic asthma?

A
  • Inhaler technique
  • Inhaler adherence
  • Symptoms (adjust medication as needed)
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7
Q

What is conservative management for chronic asthma?

A
  1. Weight loss

2. Smoking cessation

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8
Q

What is LABA?

A

Long Acting Beta-2 Agonist

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9
Q

What is SABA?

A

short acting Beta-2 agonist

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10
Q

What is ICS?

A

inhaled corticosteroid

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11
Q

What is LTRA?

A

oral Leukotriene receptor antagonist

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12
Q

What is LMRA?

A

Long acting muscarinic receptor antagonist

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13
Q

What is an example of SABA?

A

salbutamol

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14
Q

What is an example of ICS?

A

Beclometasone, Budesonide

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15
Q

What is an example of LTRA?

A

Montelukast

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16
Q

What is an example of LABA + ICS?

A

Symbicort (Budesonide/Formoterol)

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17
Q

What is an example of an oral CS?

A

prednisolone

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18
Q

What are the risk factors for acute asthma exacerbation?

A
  • History of previous asthma attacks
  • Poor control
  • Inappropriate or excessive SABA use
  • Old age
  • Female
  • High blood eosinophil count
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19
Q

What are the symptoms of an acute asthma exacerbation?

A
  1. Increase shortness of breath (can’t finish sentence)
  2. Cough
  3. Wheeze
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20
Q

What is the PEF for different types of acute asthma exacerbation?

A

Moderate: 50-70%
Acute-severe: 33-50%
Life threatening: <33%
Near fatal: pCO2 raised

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21
Q

What are the other signs of an acute asthma exacerbation?

A
  • Tachypnoea
  • Tachycardia
  • Silent chest
  • Accessory muscle use
  • Sleep disturbance
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22
Q

What are the investigations for an acute asthma exacerbation?

A
  1. Basic Obvs (HR, SpO2)
  2. ABG: *repeat ABG if PaO2 <8kPa, unless SpO2 >92%; or initial PaCO2 is normal or raised; or if patient deteriorates or PEF <50%
  3. PEF
  4. Pulse Oximetry
  5. Chest X ray
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23
Q

What is the management plan of acute asthma exacerbation?

Study These Flashcards
A
  1. O2
  2. Neb Salbutamol 5mg
  3. Neb. Ipratorpium Bromide 0.5mg (acute-severe/life threatening)
  4. Oral Prednisolone 40-50mg + IV Hydrocortisone 100mg
  5. IV Magnesium sulphate + SENIOR Help
  6. IV Aminophylline
  7. ITU + Itubation
24
Q

What is COPD?

Study These Flashcards
A

preventable and treatable disease state characterised by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis (CHRONIC)

25
What are the risk factors for COPD?
1. Age 2. Cigarette smoking 3. Genetic factors
26
What are the symptoms of COPD?
1. SOB 2. Productive cough 3. Some wheeze
27
What are the general inspection signs of COPD?
1. Tar Staining 2. Cyanosis 3. Barrel Chest
28
What do you find in palpitation for COPD?
1. Reduced expansion | 2. Hyper resonance (on percussion)
29
What do you find in auscultation for COPD?
1. Reduced air movement 2. Wheezing 3. Coarse crackles 4. Distant breath sounds on auscultation
30
What are the investigations for COPD?
1. Spirometry 2. A1At and TfCO 3. Bloods ABG 4. CXR
31
What is mild COPD?
Post-bronchodilator FEV1/FEVC <0.7 + FEV1 = > 80%
32
What is moderate COPD?
Post-bronchodilator FEV1/FEVC | <0.7 + FEC1 50-79%
33
What is severe COPD?
Post-bronchodilator FEV1/FEVC | <0.7 + FEV1 30-49%
34
What is very severe COPD?
Post-bronchodilator FEV1/FEVC | <0.7 + FEV1 <30%
35
What is the treatment for mild COPD?
SABA or SAMA • Inhaled short-acting beta agonist (e.g. salbutamol) • Inhaled short-acting muscarinic antagonist (e.g. ipratropium bromide)
36
What is the treatment for moderate COPD?
SABA + LABA or SAMA + LAMA • Inhaled short-acting beta agonist (e.g. salbutamol) • Inhaled long-acting beta agonist (e.g. salmeterol)
37
What is the treatment for severe COPD?
LABA + LAMA or LABA + ICS • Inhaled long-acting beta agonist (e.g. salmeterol) • Inhaled long-acting muscarinic antagonist (e.g. tiotropium)
38
What is the treatment for very severe COPD?
LAMA + LABA + ICS • Inhaled long-acting muscarinic antagonist (e.g. tiotropium) • Inhaled corticosteroid / long-acting beta agonist combination (e.g. Symbicort)
39
What is the general management for COPD?
1. Smoking cessation 2. Annual influenza vaccination 3. Pneumococcal vaccination
40
What is the other options for management of COPD?
- Long term O2 therapy (15hrs/day) | - Lung volume reduction therapy
41
When do you do Long term O2 therapy for COPD?
``` When pO2 <7.3kPA or pO2 of 7.3 - 8 kPa and one of the following: • Secondary polycythaemia • Nocturnal hypoxaemia • Peripheral oedema • Pulmonary hypertension ```
42
What can cause acute COPD?
infective exacerbation
43
What are the investigations for acute COPD?
1. ABG 2. Pulse oximetry 3. ECG 4. FBC w platelets 5. U + E _ C 6. CRP 7. CXR 8. Sputum microscopy 9. Vit D
44
What is the treatment for acute COPD exacerbation?
1. Blue Venturi 24% O2 2. Neb. Salbutamol, 5mg +Neb. Ipratropium Bromide, 0.5mg +Oral Prednisolone 40-50mg + IV Hydrocortisone 200mg 3. IV Amoxicillin 4. 500mg IV aminophylline 5. BiPAP (NIV)
45
What is sarcoidosis?
chronic granulomatous disorder of unknown aetiology, commonly affecting the lungs, skin, and eyes
46
What are the risk factors for sarcoidosis?
1. Age 20-40 2. FHx sarcoidosis 3. Scandinavian heritage 4. History of exposure to beryillium
47
What are the symptoms of sarcoidosis?
1. Cough 2. Progressive Dyspnoea 3. Chronic fatigue 4. Arthralgia 5. Wheezing 6. Rhonci 7. Lympadenopathy 8. Photophobia 9. Red painful eye 10. Blurred vision
48
What are the investigations for sarcoidosis?
1. CXR 2. FBC 3. Serum urea 4. Creatinine 5. liver enzymes 6. serum calcium 7. PFTs 8. ECG 9. PPD
49
What is stage 1 of sarcoidosis?
bilateral hilar lymphadenopathy
50
What is stage II of sarcoidosis?
bilateral hilar lymphadenopathy plus pulmonary infiltrates
51
What is stage III of sarcoidosis?
pulmonary infiltrates without hilar lymphadenopathy
52
What is stage IV of sarcoidosis?
extensive fibrosis with distortion
53
How do you treat sarcoidosis stage 1?
No treatment
54
When do you use corticosteroids for sarcoidosis?
1. Parenchymal lung disease 2. Uveitis 3. Hypercalcaemia 4. Neurological or cardiac involvement
55
What corticosteroids do you use for sarcoidosis?
- Prednisolone 40mg/24 h 4-6 weeks (decrease over 1 year) | - SEVERE: IV methylpredinisolone or immunosuppressant
56
What is the prognosis of sarcoidosis?
60% of patients with thoracic sarcoidosis resolve over 2 years, 20% respond to steroid therapy

Z Year3 Conditions (13 decks)

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