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Respiratory 1 Flashcards

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1
Q

Classification of asthma
PEFR
Speech
RR
Pulse

A

Moderate, severe, life threatening
PEFR 50-75%, 33-50%, <33%
Speech - normal, can’t complete sentences, silent chest
RR <25, >25, feeble respiratory effort
Pulse <110, >110, exhaustion

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2
Q

Life threatening signs (5)

A

sats <92%, normal CO2, bradycardia, dysrhythmia, hypotension

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3
Q

Mx acute asthma in secondary care

A
  1. SABA
  2. Ipratropium bromide
  3. IV magnesium sulphate
  4. IV aminophylline

Prednisolone 40-50mg

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4
Q

Criteria for discharge following asthma admission (3)

A

PEFR >75% of best or predicted
Off nebs for 12-24 hours
Inhaler technique

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5
Q

Bronchitis disease course
Sx 4

Don’t bother

A

3 weeks with cough for longer
Cough, sore throat, rhinorrea, wheeze

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6
Q

How to differentiate between pneumonia and bronchitis?
Symptoms
Signs

A

Sputum, wheeze, SOB in pneumonia
O/E: systemic features in pneum

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7
Q

Bronchitis Mx (3)

A

Analgesia
Fluid intake
Abx if CRP 20-100 - doxy

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8
Q

Acute exacerbation of COPD common bacteria (3)

A

H. influenza
Strep pneum
Moraxella catarrhalis

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9
Q

Mx COPD
(2)
Abx of choice (3)

A

Increase SABA
Pred 30mg OD 5/7
Abx - amoxi/ clarithro/ doxy

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10
Q

A1AT (alpha 1 antityrpsin deficiency) what is it?
Chromosome location

A

Emphysema/ COPD in young non smokers
Chrm 14

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11
Q

Features A1AT deficiency
(Impacts two organs)

A

Lungs - panacinar emphysema in lower lobes
Liver - cirrhosis and HCC in adults, cholestasis in children

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12
Q

A1AT - what do you see on spirometry?

A

Spirometry = obstructive

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13
Q

Prevention
Treatment of AMS (acute mountain sickness) (1)
Medication (1)
How much altitude can you gain per day (1)

A

Acetozolamide
Descent
500m per day

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14
Q

Gas findings with acute mountain sickness

A

Metabolic acidosis
Compensatory respiratory alkalosis
Increases RR and improves oxygenation

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15
Q

Acute mountain sickness can develop into? (2)

A

HAPE and HACE - high altitude pulmonary oedema and cerebral oedema

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16
Q

Mx HACE (2)

A

Descent
Dexamethasone

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17
Q

Mx HAPE (4)

A

Descent
Nifedipine, dex, acetazolamide, oxygen

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18
Q

Most common form of asbestos related lung disease
When do they form?

A

Pleural plaques
Latent period of 20-40 years

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19
Q

What is asbestosis?
When?
Don’t bother

A

Typically causes lower lobe fibrosis
15-30 years post exposure

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20
Q

Malignant disease from asbestos
Most dangerous form

A

Mesothelioma
Crocidolite blue

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21
Q

Mx mesothelioma
Prognosis

A

Palliative chemo
Poor prognosis 8-14 months

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22
Q

Mx mesothelioma
Prognosis

A

Palliative chemo
Poor prognosis 8-14 months

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23
Q

Diagnostic tests for asthma (3)
Hint: classified by age
<5yo
5-16yo
>16yo

A

< 5yo clinical judgement
5-16 - spirometry with bronchodilator reversibility test
>16 - spirometry with bronchodilator reversibility test + FeNO test

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24
Q

FeNO interpretation

Study These Flashcards
A

adults = > 40 positive
children => 35 positive

25
Spirometry interpretation
FEV1/FVC ratio < 70% = obstructive
26
Reversibility test - if FEV1 has improved by ? in a volume of ?
Positive if FEV1 has improved by 12% or more in a volume of 200mls of more
27
Chronic asthma adults mx (7)
1. SABA 2. SABA + ICS 3. SABA + ICS + leukotriene receptor antagonist (LTRA) 4. SABA + ICS + LABA (if LTRA effective then to continue) 5. SABA +/- LTRA + MART with low dose ICS 6. SABA +/-LTRA + MART with medium dose ICS 7. SABA +/-LTRA AND MART with high dose ICS OR LAMA OR Theophylline
28
What is a MART
ICS and LABA
29
Low medium and high dose ICS What are the doses
<= 400mcg 400-800 >800
30
When to refer an asthmatic patient to secondary care? (3) How many courses of steroids? What step on the pathway How many prescriptions in 1 year
> 2 courses of steroids in 12 months On step 4 of tx pathway > 12 SABA prescriptions in 1 year
31
Occupational asthma common cause
Isocyanates (spray paint and foam moulding)
32
How often should we consider stepping down treatment for asthma? How much do you reduce steroids by?
Every 3 months 25-50% at a time
33
What is bronchiectasis?
Permanent dilatation of the airways secondary to chronic infection or inflammation
34
Mx bronchiectasis (3)
Physio Postural drainage Immunisations
35
Bronchiectasis common causes (4)
H. influenza Psuedomonas aeruginosa Klebsiella Strep pneum
36
Suspected COPD Ix (3) and expected results of each
1. post bronchodilator spirometry: FEV1/FVC <70% 2. CXR hyperinflation, bullae, flat hemidiaphragm 3. FBC - to r/o polycythaemia
37
Severity of COPD (stages) Post-bronchodilator FEV1/FVC FEV1 (of predicted)
FEV1 of predicted Stage 1 Mild >80 Stage 2 Moderate 50-79 Stage 3 Severe 30-49 Stage 4 Very severe <30 Post bronchodilater ratio FEV1/FVC < 0.7 for all
38
LTOT criteria (5) FEV1 ? Consider at FEV1 of
FEV1<30% predicted Consider if 30-49% Cyanosis Polycythaemia Peripheral oedema Raised JVP Sats <92%
39
What pO2 to offer LTOT? pO2 of ? Or p O2 of with (3) How many ABGs are needed and how far apart? Whilst on what?
pO2 <7.3 7.3-8 with either: secondary polycythaemia peripheral oedema pulmonary hypertension x2 ABG need to have been done three weeks apart whilst on optimum COPD treatment
40
Smoking and LTOT
Do not offer LTOT to people who continue to smoke following: 1. Being offered smoking cessation advice rx 2. Referral to specialist stop smoking services
41
LTOT risk assessment (2)
1. Risk of falls from tripping over equipment 2. Risk of burns and fires for those that live with someone who smokes
42
COPD general mx (4)
Smoking cessation advice Influenza vaccine annual One off pneumococcal vaccination Pulmonary rehabilitation
43
Mx COPD (4) 2nd step is determined by?
1. SABA OR SAMA 2nd step is determined by whether the patient has asthmatic features/ features suggesting steroid responsiveness NO asthmatic features: 2. add LABA + LAMA Asthmatic features 2. LABA+ICS All patients 3. LABA+ICS+LAMA 4. PO theophylline
44
When should a theophylline dose be reduced? (2) (which two types of abx)
If on macrolides or fluoroquinolone abx
45
Prophylactic abx of choice in COPD
Azithromycin
46
Churg Strauss correct name What is it?
Eosinophillic granulomatosis with polyangitis Small to medium vessel vasculitis
47
Eosinophillic granulomatosis with polyangitis Features (4) ANCA type
Asthma Eosinophillia Paranasal sinusitis Mononeuritis multiplex pANCA Way to remember - Patrick --> cat, breathes funny --> asthma, wet nose --> sinusitis --> Patrick there P-ANCA
48
Wegener's correct name
Granulomatosis with polyangitis
49
Granulomatosis with polyangitis What is it? Impacts which organs? (2) ANCA
Vasculitis Lung and kidney c-ANCA
50
Granulomatosis with polyangitis/ Wegeners Features (5)
Epistaxis Nasal crusting Haemoptysis Glomerulonephritis Saddle shaped nose Way to remember Wegeners - Nazi Nazi - begins with N - nasal crusting, Nose saddle shaped, Nose + cough bleeds, reNal issues - Not Patrick therefore C-ANCA
51
What can precipitate Churg Strauss?
LTRA
52
CXR of Granulomatosis with polyangitis (1) Renal biopsy findings: (1)
Cavitating lesions Epithelial crescents in Bowman's capsules
53
Mx Wegener's (3)
Steroids Cyclophosphamide Plasma exchange
54
Bird fancier's lung (avian proteins) Farmers lung Malt workers lung Mushroom worker's lung Can cause which disease?
Extrinsic allergic alveolitis
55
Extrinsic allergic alveolitis XR findings (1) Bronchoalveolar lavage (1) Blood (1) (eosinophils - high or low) Mx (1)
Upper/mid zone fibrosis Lymphocytosis No eosinophillia Mx steroids
56
Haemoptysis Systemically unwell Fever Nausea Glomerulonephritis = which condition?
Goodpastures
57
SOB, AF, malar flush, mid-diastolic murmur = which condition?
Mitral stenosis
58
Long hx of cough and daily purulent sputum production = which condition?
Bronchiectasis
59
PMH TB, haemoptysis, CXR rounded opacity = which condition?
Aspergilloma

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