Respiratory Flashcards Preview

Clinical exam - long cases > Respiratory > Flashcards

Flashcards in Respiratory Deck (11)
Loading flashcards...
1
Q

Who should be commenced on regular ICS/LABA combination Rx?

A

COPD with FEV1 < 50% AND 2 or more exacerbations in the past 12 months

2
Q

What is the recommended vaccination regime for COPD patients?

A

Annual flu shot

Pneumovax

  • At time of Dx, then at least 5 years later
  • 3rd dose 5yrs after the 2nd dose, if pt not previously vaccinated at time of COPD Dx
3
Q

At what FEV1 should theophyilline be considered?

A

FEV<40% (severe)

4
Q

What are the criteria for home O2?

A

PaO2≤55mmHg, or PaO2≤59 PLUS polycythaemia, pulmonary HTN or right heart failure

5
Q

What investigations are relevant in pulmonary arterial hypertension?

A
  • Cardiopulmonary exercise test: assessment of exercise capacity
  • LFTs: PAH Rx may affect LFTs
  • NT-pro-BNP: elevation predictive of 1yr mortality
6
Q

How are CMV-negative recipients of CMV-negative lungs managed when they require blood products?

A

Leucoreduced or blood from CMV-negative donors

7
Q

What needs to be monitored post lung transplant?

A
HTN
Hypercholesterolaemia
DM (higher in CF)
Vaccinations (no live vaccines)
Cancers
- Skin checks yearly
Pregnancy
- Unsafe with mycophenolate and mTOR inhibitors
Drug monitoring
- Therapeutic drug monitoring
CYP450 inhibitors (CNI and mTORi are substrates)
- Verapamil, diltiazem
- Amiodarone
- Macrolides
- Ciprofloxacin
- Azoles
- HIV antiretrovirals
- Glucocorticoids
- Grapefruit juice
CYP450 inducers
- Carbamazepine
- Phenytoin
- Rifampin
- Glucocorticoids

Rejection

  • Acute cellular rejection (T-cells) => steroids or T-cell depleting antibodies
  • Humoral rejection (B-cell mediated) => IVIG, plasmapheresis
  • Bronchiolitis obliterans

CMV

  • Prophylaxis with valgancyclovir
  • Alternatives are cidofovir or foscarnet in resistant CMV

PCP
- Bactrim

Fungal infection (candida, aspergillus)

  • Oral azoles for candida
  • Voriconazole for aspergillus
8
Q

What drugs may interact with mycophenolate?

A

Decrease concentration

  • Bile acid sequestrants
  • Antacids
  • PPI
  • Antacids
  • Rifampin

Increase concentration

  • Acyclovir
  • Valacyclovir
9
Q

How is obesity hypoventilation syndrome diagnosed?

A

BMI ≥ 30 and daytime PaCO2 ≥ 45 mmHg in the absence of other causes of hypoventilation:

  • COPD, ILD
  • Kyphoscoliosis, neuromuscular disease, electrolyte disturbance
  • Cerebrovascular disease
  • Hypothyroidism
  • Congenital alveolar hypoventilation syndrome
  • Sedatives/hypnotics/opiates/EtOH
10
Q

What are the diagnostic tests in cystic fibrosis?

A

Sweat test

  • Sweat Na ≥ 60 is confirmatory
  • Sweat Na 30-59 should be referred for further testing

Immunoreactive trypsinogen
- Heel stick dried blood spot at birth

Genetic testing
- Mainly ΔF508

11
Q

What are the components of cystic fibrosis management?

A

Respiratory

  • ABx for acute LRTIs
  • Flutter valve or other Positive Expiratory Pressure (PEP) device
  • Mucolytics (N/saline, hypertonic saline, mannitol, dornase alfa)
  • Inhaled tobramycin if Pseudomonas positive
  • Alternate day corticosteroids if severe
  • Azithromycin 3 times weekly
  • Homozygous ΔF508 => Lumacaftor/ivacaftor
  • G551D => Ivacaftor monotherapy

Lung transplant
- Check for Burkholderia cepacia, as this is a C/I

Exocrine dysfunction

  • Creon
  • PPI/H2 antagonist improves creon function
  • Vit A/D/E/K
  • Dietitian for high caloric, high fat diet
  • May need gastrostomy

Endocrine dysfunction
- OHAs and insulin

Liver disease
- Ursodeoxycolic acid

GORD
- PPI/H2 antagonist

Distal Intestinal Obstructive Syndrome
- Monitor bowel patterns

Intussusception
- May need surgical intervention

Fertility
- Bilateral absence of vas deferens, aka obstructive azoospermia

Osteoporosis
- Ca intake, Vit D level, DEXA, exercise prescription

Depression
- CBT, psychologist, psychiatrist, community groups, antidepressants