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Year 3 MedEd > Resp2 > Flashcards

Resp2 Flashcards

Chronic SOB

1
Q

What is the definition of asthma?

A

A chronic inflammatory airway disease with intermittent airway obstruction and hyper-reactivity

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2
Q

What are the associations with asthma?

A 
Worse in the morning and night
Hx atopy/eczema
FHx
Smoker
Pets
Occupation
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3
Q

What can be seen on examination of a Pt with asthma?

A

May be normal
Nasal polyposis
Wheeze

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4
Q

What investigations would you do on a Pt with asthma?

A

Peak expiratory flow rate
Spirometry (FEV1:FVC ratio)
Bloods

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5
Q

What does an FEV1:FVC ratio of <0.7 indicate?

A

An obstructive pulmonary disease

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6
Q

What are the types of obstructive pulmonary diseases?

A

Asthma

COPD

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7
Q

What is the order of treatment for asthma (in accordance to the BTS guidelines)?

A 
SABA
SABA + ICS
LABA + ICS
Trials (LTRA, LAMA, theophylline)
\+OCS
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8
Q

When should you consider moving up to the next step of treatment (in accordance to the BTS guidelines)?

A

If the Pt needs to use the SABA 3+ times in a week

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9
Q

What are the 4 categories of acute asthma?

A

Moderate
Acute-severe
Life threatening
Near fatal

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10
Q

How do you define moderate asthma?

A

If the PEF is 50-75%

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11
Q

How do you define acute-severe asthma?

A

If the PEF is 33-50%

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12
Q

How do you define life threatening asthma?

A

If the PEF is <33%

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13
Q

How do you define near fatal asthma?

A

If the pCO2 is raised

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14
Q

What investigations would you do on a Pt with acute asthma?

A 
Basic obs
PEF
O2 sat
ABG
Serum K+ and glucose
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15
Q

A patient has come in with an exacerbation of asthma. What is the first treatment you would administer?

A

Oxygen.

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16
Q

A patient has come in with a moderate exacerbation of asthma. Oxygen has been administered. What is the next line of management?

A

Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 100mg

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17
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen has been administered. What is the next line of management?

A 
Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 100mg
Neb ipratropium bromide 0.5mg
(Same for life threatening exacerbation)
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18
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen, salbutamol, prednisolone, hydrocortisone, and ipratropium bromide has been administered and the patient has not recovered. What is the next line of management?

A

IV magnesium sulphate AND call for senior help

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19
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen, salbutamol, prednisolone, hydrocortisone, ipratropium bromide, and magnesium sulphate has been administered and the patient has not recovered. A senior has arrived to help. What is the next line of management?

A

IV aminophylline

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20
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen, salbutamol, prednisolone, hydrocortisone, ipratropium bromide, magnesium sulphate, and IV aminophylline has been administered and the patient has not recovered. A senior has arrived to help. What is the next line of management?

A

ITU and intubate

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21
Q

A 17 year-old girl presents to the local A&E complaining of worsening shortness of breath, despite use of what she describes as her ‘blue inhaler’. On examination her oxygen saturations are 95%, she is afebrile and has a BP of 101/67. The attending physician takes an ABG and the results are shown below. Grade the severity of this patient’s asthma attack.

pH: 7.25
pCO2: 7.4 kPa (4.5-6.0)
pO2: 10.4 kPa (>10.5)
HCO3: 23 mmol/l

A. I cannot tell from the information available
B. Moderate
C. Acute severe
D. Life threatening
E. Near fatal
A

E. Near fatal

Her pCO2 is raised, classifying this exacerbation as near fatal.

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22
Q

A 26-year-old bus driver presents to the GP complaining of a worsening shortness of breath. On examination, the patient is afebrile, has a BP of 110/85 and has a marked wheeze on auscultation. The only medications the patient is on is a blue inhaler. What is the next most appropriate treatment step as per the treatment guidelines for this condition?

A. Replace the blue inhaler with a brown, low-dose inhaled corticosteroid
B. Replace the blue inhaler with a long-acting beta-agonist medication
C. Replace the blue inhaler with a long-acting muscarinic agonist medication
D. Add an inhaled low-dose corticosteroid to her medications, taken OD
E. Add oral corticosteroid tablets to her medications, taken OD

A

D. Add an inhaled low-dose corticosteroid to her medications, taken OD

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23
Q

What is the definition of COPD?

A

Chronic airway obstruction that is not fully reversible, encompassing emphysema and chronic bronchitis.

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24
Q

What signs on general inspection may indicate COPD?

A

Tar staining
Cyanosis
Barrel chest
Tripod-ing

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25
What signs on palpation and percussion may indicate COPD?
Reduced expansion | Hyper-resonance
26
What signs on auscultation may indicate COPD?
Reduced air movement Wheezing Coarse (hair-like) crackles
27
What FEV1 percentage indicates a mild COPD?
>80%
28
What FEV1 percentage indicates a moderate COPD?
50-79%
29
What FEV1 percentage indicates a severe COPD?
30-49%
30
What FEV1 percentage indicates a very severe COPD?
<30%
31
What investigations would you do on a Pt with COPD?
``` Spirometry Bloods ABG CXR Serum alpha-1 antitrypsin ```
32
What is the management for mild COPD?
SABA or SAMA
33
What is the management for moderate COPD?
SABA+LABA or SAMA+LAMA
34
What is the management for severe COPD?
LABA+LAMA or LABA+ICS
35
What is the management for very severe COPD?
LABA+LAMA+ICS
36
What other management is available for COPD?
``` Smoking cessation Annual influenza vaccination Pneumococcal vaccination Smoking cessation Long term 02 therapy (15hr/day) Lung volume reduction surgery ```
37
When should you give long-term O2 therapy?
``` If the pO2 < 7.3 kPa If the pO2 7.3-8.0 kPa AND they have: -secondary polycythaemia -nocturnal hypoxaemia -peripheral oedema -pulmonary hypertension ```
38
What is the first line management of a Pt with IE-COPD?
20% O2 (via a blue Venturi mask)
39
A patient with IE-COPD has been put on a blue Venturi mask. What is the next line of management?
Neb salbutamol 5mg Oral prednisolone 40-50mg IV hydrocortisone 200mg Neb ipratropium bromide 0.5mg
40
A patient with IE-COPD has been put on a blue Venturi mask. The patient has been given salbutamol, predmisolone, hydrocortisone, and ipratropium bromide. What is the next line of management?
IV amoxicillin
41
A patient with IE-COPD has been put on a blue Venturi mask. The patient has been given salbutamol, predmisolone, hydrocortisone, ipratropium bromide, and amoxicillin. What is the next line of management?
500mg IV aminophylline
42
A patient with IE-COPD has been put on a blue Venturi mask. The patient has been given salbutamol, predmisolone, hydrocortisone, ipratropium bromide, amoxicillin and aminophylline. What is the next line of management?
BiPAP
43
When do you give a Pt CPAP or BiPAP?
CPAP- T1RF eg. sleep apnoea | BiPAP- T2RF eg. COPD
44
A 72-year-old man attends the GP complaining of increased shortness of breath and a cough productive of clear sputum. The GP notes the gentleman has a history of diagnosed COPD and decides to review his medications. The man hands the GP a SABA and a LABA. After conducting spirometry, the GP calculates an FEV1 of 40% expected. What is the next most appropriate treatment step? ``` A. Replace the SABA with a LAMA B. Replace the LABA with an LAMA C. Add a LAMA D. Add an ICS E. I need to conduct more tests to determine what medications to review ```
A. Replace the SABA with a LAMA
45
Which of the following is not a respiratory cause of clubbing? ``` A. Squamous cell lung cancer B. Interstitial lung disease C. COPD D. Cystic fibrosis E. An empyema (lung abscess) ```
C. COPD
46
What are the respiratory causes of clubbing?
Malignancy Empyema/suppurative lung disease Interstitial lung disease Cystic fibrosis
47
What is the definition of interstitial lung disease?
ILD is an umbrella term for a large group of disorders causing lung tissue fibrosis.
48
Name some ILDs
Idiopathic pulmonary fibrosis Hypersensitivity pneumonitis/extrinsic allergic alveolitis Sarcoidosis Pneumoconiosis
49
What might a Pt with idiopathic pulmonary fibrosis present with?
SOBOE Dry cough No wheeze
50
What questions should you ask a Pt with IPF?
Smoking status Occupation (metal/wood exposure) Exposure to animals/vegetable dust Drugs (bleomycin, methotrexate, amiodarone)
51
What would you look for on examination of a Pt with IPF?
Clubbing Bi-basal, fine, inspiratory crackles RHF (late stage ILD)
52
What investigations would you do on a Pt with IPF?
Bloods ABG Biopsy- gold standard, not always appropriate CXR- for late presentation High-res CT- usually appropriate, esp early presentation PFTs
53
What would you see in a CXR of a Pt with IPF?
Ground-glass appearance Reticulonodular appearance Cor pulmonale Honeycombing appearance
54
What would you see in a HRCT of a Pt with IPF?
Ground-glass appearance
55
What might a Pt with hypersensitivity pneumonitis present with?
SOBOE Dry cough Fever
56
What questions should you ask a Pt with HSP?
Inhalation of antigenic organic dusts - Farmer's: mouldy hay w/ thermophilic actinomycetes - Bird fancier's: feathes/bird droppings - Mushroom worker's: compost w/ thermophilic actinomycetes - Malt worker's: mouldy barley w/ aspergillus clavatus - Humidifier lung: water-containing bacteria
57
What signs should you see in a Pt with HSP?
Clubbing Mild pyrexia Bi-basal fine inspiratory crackles
58
What investigations would you do on a Pt with HSP?
``` Bloods ABG CXR High res CT Lung function tests Broncho-alveolar lavage ```
59
What would a high res CT show for a Pt with HSP?
Ground-glass appearance
60
What is pneumoconiosis?
Inhalation of coal/silica/asbestos dust | Nodules of collagen and dying macrophages form around the particles
61
What might a Pt with pneumoconiosis present with?
SOB | Dry cough
62
What signs should you see in a Pt with asbestosis?
Clubbing Bi-basal inspiratory crackles Signs of RHF
63
What signs should you see in a Pt with silicosis?
Decreased breath sounds | Signs of RHF
64
What investigations would you do on a Pt with pneumoconiosis?
CXR CT Lung function tests- restrictive pattern
65
What would you see in a CXR of a Pt with pneumoconiosis?
Simple- micro-nodular mottling | Complicated- bilateral lower zone reticulonodular shadowing and pleural plaques
66
What would you see in a CT of a Pt with pneumoconiosis?
Fibrotic changes
67
A 65-year-old man with a medical background of benign prostatic hyperplasia, presents to the GP with a 1 week history of worsening shortness of breath on exertion. He has a temperature of 38.5C, reports no weight loss but does mention some mild fatigue from his ‘pet pigeons keeping him up all night’ recently. On auscultation, the GP can determine fine, bi-basal inspiratory crackles. What is the most likely diagnosis? ``` A. COPD B. Lung cancer C. Bronchiectasis D. Hypersensitivity pneumonitis E. Idiopathic pulmonary fibrosis ```
D. Hypersensitivity pneumonitis
68
What is the definition of sleep apnoea?
Recurrent collapse of the pharyngeal airway and apnoea during sleep, followed by arousal from sleep.
69
What may a Pt with sleep apnoea present with?
``` Chronic fatigue Snoring Unrefreshed sleep Obesity Truck driver Macroglossia Marfan's ```
70
What investigations would you do on a Pt with sleep apnoea?
``` Sleep studies (polysomnography) TFTs ```
71
A tall 26-year-old woman comes into the GP complaining of chronic fatigue. Upon further questioning she reports that she ‘can never get a good night’s sleep’ and that she tends to fall asleep a lot at her workplace as a call centre customer service representative. She also mentions that she thinks it may have something to do with a condition her mother had. The only significant finding upon examination is patches of stretchy skin, especially around the neck area. What is the most likely underlying condition leading to disrupted sleep? ``` A. Obesity B. Bad sleeping position C. Marfan’s syndrome D. Down’s syndrome E. Chronic fatigue syndrome ```
C. Marfan’s syndrome

Year 3 MedEd (29 decks)

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