Respiratory Flashcards
(26 cards)
What 4 symptoms should prompt you to consider a diagnosis of asthma?
What should these symptoms be?
Wheeze
Breathlessness
Chest tightness
Cough
EPISODIC!
What features should make you consider a diagnosis of asthma? (6)
Diurnal variation
Occur in response to a trigger e.g. cold air, allergen
Occur after taking a beta-blocker or NSAID
Occur in absence of infection
History of atopy
Widespread wheeze
What are the first line tests for asthma? (3)
What tests should you consider if diagnosis not clear? (2)
Spirometry Bronchodilator reversibility FeNO Peak flow readings Direct bronchial challenge
What result would support your diagnosis of asthma for:
- Spirometry
- Bronchodilator reversibility
- FEV1/FVC ratio <70%
2. Improvement of 12% or more plus an increase in volume of 200ml (adults) or just an improvement by 12% (children)
What are the features of an acute severe asthma attack? (6)
PEFR 33-50% best or predicted Tachycardia Tachypnoea Use of accessory muscles Inability to complete sentences in one breath Oxygen sats >92%
What are the features of life-threatening asthma? (7)
Any of the below: PEFR 33% Oxygen <92% Cyanosis or confusion Hypotension Exhaustion (e.g. normal CO2) Silent chest Tachyarrhythmias
What are the stages of the MRC dyspnoea scale?
- Not troubled by breathlessness except on strenuous exercise
- SOB when hurrying or walking up a hill
- Walks slower than contemporaries
- Stops for breath after about 100m
- Too breathless to leave the house or when dressing
What symptoms should make you consider COPD in a smoker? (5)
Exertional breathlessness Chronic/recurrent cough Regular sputum production Frequent lower respiratory tract infections Wheeze
What test is formally used to diagnose COPD? And what result suggests COPD?
Spirometry and bronchodilator reversibility
Post bronchodilator FEV1/FVC <0.7
What are the stages of COPD?
- Mild - FEV1 80% or more
- Moderate - FEV1 50-79%
- Severe - FEV1 30-49%
- Very severe - FEV1 <30% OR FEV1 <50% with respiratory failure
What other investigations are required apart from spirometry in COPD? (3)
CXR - exclude other pathologies
FBC
BMI
How do you manage COPD?
- Medication (no asthmatic features v asthmatic)
- General (4)
- SABA or SAMA –> add on LABA + LAMA or LABA + ICS if asthmatic features –> LABA + LAMA + ICS
- Pneumococcal and flu vaccinations; pulmonary rehabilitation; self-management plan; stop smoking
What blood test is most important when managing an exacerbation of COPD?
ABG - determines whether they are a CO2 retainer and thus guides oxygen management
Is TLCO raised or low in COPD?
Raised
What medications cause interstitial lung disease? (5)
Nitrofurantoin Amiodarone Sulfasalazine Methotrexate Cyclophosphamide
What systemic conditions cause interstitial lung disease? (5)
Alpha anti-1-trypsin deficiency Sarcoidosis SLE Rheumatoid Systemic sclerosis
What are 3 causes of idiopathic fibrosis?
Idiopathic pulmonary fibrosis
Cryptogenic organising pneumonia
Hypersenstivity pneumonitis
What blood test, if raised, is indicative of sarcoidosis? What electrolyte abnormality would you expect to see?
ACE
Hypercalcaemia
What is characteristically seen on high-resolution CT with interstitial lung disease?
“ground-glass” appearance
What are the typical pathogens for pneumonia?
Haemophilus influenzae, streptococcus pneumoniae
Name the atypical pathogen for pneumonia:
- Vague slow onset, dry cough, erythema multiforme, transverse myelitis
- School-aged child, gradual onset, mild to moderate symptoms
- Mild headache and myalgia progressing to chills and rigors, unproductive cough, haemoptysis, can cause -itis and hyponatraeia
- Farmer who presents with a flu-like illness
- Parrot owner who has developed a cough
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Legionella pneumophilia
- Q-fever
- Chlamydia psittaci
What is the treatment for PCP pneumonia?
Co-trimoxazole (Septrin)
What special type of staining is used for TB?
What colour does it stain?
Zeihl-Neelson staining
Bright red
What is the treatment for TB? (4)
What do you need to co-prescribe?
Rifampicin - 6m
Isoniazid - 6m
Pyrazinamide - 2m
Ethambutol - 2m
Coprescribe B6 (pyridoxine) to prevent peripheral neuropathy
