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Flashcards in Respiratory Deck (112)
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1

List some precipitants of asthma

Cold
Exercise
Emotion, stress
Allergens (house dust, fur, occupational)
Infection
Smoking

2

Which class of blood pressure drug can exacerbate/worsen asthma?

B-blocker

3

List some symptoms and signs of asthma

Dyspnoea
Dry cough, typically worse at night
Wheeze
Chest tightness
Hyperinflated/hyperresonant chest
Reduced air entry

4

What are the clinical features of an acute severe asthma attack?

Unable to complete sentences
Pulse over 100 bpm
Resp rate over 25 breaths/min
PEFR under 50% of predicted

5

What are the clinical features of an acute life-threatening asthma attack?

Silent chest
Bradycardia
Confusion
PEFR under 33$ of predicted

6

How is asthma diagnosed using PEFR?

PEFR monitoring shows diurnal variation of greater than 20% on 3 or more days of the week for 2 weeks

7

How is asthma diagnosed on spirometry?

Obstructive pattern of spirometry with more than 15% reversibility with a bronchodilator

8

What investigations would you arrange during an acute asthma attack?

PEFR
Sputum culture
FBC, U+E, CRP, ABG
CXR

9

What lifestyle advice could you give to an asthmatic?

Stop smoking
Avoid allergens/wear protection at work
Write a trigger diary

10

What is the 1st step in therapy for asthma?

Inhaled SABA (salbutamol) PRN

11

When do you move to step 2 therapy in asthma?

If using bronchodilator excessively or having night symptoms

12

What is the 2nd step in therapy for asthma?

SABA
Add regular inhaled steroid (beclometasone)

13

What is the 3rd step in therapy for asthma?

SABA
Inhaled steroid
Increase dose of inhaled steroid or add in LABA (salmeterol)

14

What is the 4th step in therapy for asthma?

SABA
Inhaled steroid
Stop LABA if no effect/improvement and add theophylline/montelukast

15

What is the 5th step in therapy for asthma?

SABA
Inhaled steroid
4th line drug
Oral prednisolone

16

Outline treatment for acute asthma

Sit up
Give high flow O2
Nebulised salbutamol + ipratropium
IV hydrocortisone/oral prednisolone
Get an anaesthetist; oral theophylline/IV magnesium sulphate

17

What is the clinical definition of bronchitis?

Cough with sputum production on most days for 3 months in a 2 year period

18

List some symptoms and signs of COPD

Productive cough
Wheeze
Dyspnoea
Infective exacerbations

19

Describe a "pink puffer"

Breathless
Not cyanosed
Cachectic

20

What is meant by hypoxic drive in a patient with COPD?

Respiratory centres are insensitive to CO2 (because it has remained very high for a long period), so they rely on low O2 to maintain respiratory effort
Therefore giving them too much O2 would be detrimental to their breathing

21

How would you differentiate COPD from asthma on investigation?

Typically little/no bronchodilator reversibility in COPD

22

Which genetic condition predisposes to emphysema?

Alpha-1-antitrypsin deficiency

23

What is the 1st step in therapy for COPD?

Inhaled SABA (salbutamol)/inhaled SAMA (ipratropium) PRN

24

What is the 2nd step in therapy for COPD?

Regular inhaled ipratropium/tiotropium
OR
Regular inhaled salmeterol-beclometasone combo inhaler

25

What is the 3rd step in therapy for COPD?

Inhaled salmeterol
Inhaled beclometasone
Inhaled ipratropium/tiotropium
Refer to specialist

26

When would a COPD patient be put on long-term O2 therapy?

If PaO2 less than 7.4 kPa

27

Outline treatment of acute exacerbation of COPD

24-28% O2
Nebulised salbutamol + ipratropium
IV hydrocortisone
Oral prednisolone
Antibiotic if infection
Consider theophylline and/or ventilation

28

What is pneumonia?

An acute lower respiratory tract infection that causes inflammation of the lungs

29

Which organisms typically cause community acquired pneumonia (CAP)?

Strep pneumoniae
H influenzae
Mycoplasma
Staph aureus
Legionella
Moraxella, Chlamydia, Coxiella, gram -ve (atypical)

30

Which organisms typically cause hospital acquired pneumonia (HAP)?

Staph aureus
Enterobacter
Pseudomonas
Klebsiella