Respiratory Flashcards
(36 cards)
COPD management?
SABA or SAMA (ipratropium) first line as PRN
If remains breathless, determine if has asthmatic/steroid responsive symptoms:
- Previous diagnosis of asthma or atopy
- High eosinophils
- Variation in FEV1 over time (at least 400ml)
- Diurnal peak expiratory flow variation.
No asthma features
- Add LAMA and LABA regularly
Asthma features:
- Add LABA and ICS
For both, if no improvement: LAMA, LABA and ICS regularly along with SABA PRN
Moculytics - if chronic cough
Theophylline if the above doesn’t work/can’t tolerate
Prophylactic abx - azithromycin in some pts
Deep sea diving rules for those whom have had pneumothoraxes?
Avoid life long unless had pleurectomy
Peripheral tingling during exercise makes what diagnosis more likely?
Dysfunctional breathing
Restrictive picture on spirometry?
Ratio >70% and FVC decreased, FEV1 normal/reduced
Bronchiectasis and eosinophilia in a question likely allude to what?
Allergic bronchopulmonary aspergillosis - allergic reaction to aspergillus
CURB-65 score factors?
C Confusion (abbreviated mental test score <= 8/10)
U urea > 7 mmol/L
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
(in primary care take away U)
CURB score thresholds?
consider home-based care for patients with a CURB65 score of 0 or 1 - low risk (less than 3% mortality risk)
consider hospital-based care for patients with a CURB65 score of 2 or more - intermediate risk (3-15% mortality risk)
consider intensive care assessment for patients with a CURB65 score of 3 or more - high risk (more than 15% mortality risk)
Asthma treatment guidelines?
- Newly-diagnosed asthma
- Short-acting beta agonist (SABA) - Not controlled on previous step OR Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking
- SABA + low-dose inhaled corticosteroid (ICS) - If not controlled:
- SABA + low-dose ICS + leukotriene receptor antagonist
(LTRA) - Next:
- SABA + low-dose ICS + long-acting beta agonist (LABA)
- Continue LTRA depending on patient’s response to LTRA - Next:
- SABA +/- LTRA
- Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS - Next:
- SABA +/- LTRA + medium-dose ICS MART
OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA - Next:
- SABA +/- LTRA + one of the following options:
– increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART)
– a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline)
seeking advice from a healthcare professional with expertise in asthma
Urgent CXR for cancer in primary care for which patients?
Offer an urgent chest x-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:
- cough
- fatigue
- shortness of breath
- chest pain
- weight loss
- appetite loss
Consider an urgent chest x-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over with any of the following:
- persistent or recurrent chest infection
- finger clubbing
- supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- chest signs consistent with lung cancer
- thrombocytosis
In pleural aspiration what does the pH level determine?
If below 7.2 then chest drain should be placed if they are ?infection
Criteria for discharge in an asthmatic exacerbation?
- The patient being stable on their discharge medication (i.e no nebulisers or oxygen) for 12-24 hours
- The inhaler technique being checked and recorded
- PEF >75% of the best or predicted.
Criteria for moderate asthma attack?
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
Criteria for severe asthma attack?
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
Criteria for life-threatening asthma attack?
PEFR < 33% best or predicted Oxygen sats < 92% 'Normal' pC02 (4.6-6.0 kPa) Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma
Causes of an obstructive picture on siprometry?
COPD
Asthma
Bronchiectasis
Common causes of bilateral hilar lymphadenopathy?
Sarcoidosis and TB
Do you follow-up/monitor pleural plaques?
Nah.
Benign. They are not associated with cancer.
When would you start BiPAP for COPD exacerbation?
Acidosis
If COPD exacerbation still getting worse despite NIV what is next course of action?
ITU
Contraindications to bupropion?
epilepsy, pregnancy and breast feeding.
Having an eating disorder is a relative contraindication
Smoking cessation drugs to offer? Can you combine?
NRT, varenicline or bupropion
Not in any combination
When talking acid-base status, if there has been some effort to compensate but it is still abnormal that is called?
partially compensated
Exudate and transudate protein level, what is lights criteria?
exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
Most common SEs of varenicline?
Nausea
