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Year 3 TCDs > Asthma > Flashcards

Asthma Flashcards

1
Q

What are 3 important questions to ask during an asthma annual review?

A
  1. In the last month/week have you had difficulty sleeping because of your asthma (including cough, SOB)?
  2. Have you had your usual asthma symptoms (cough, SOB, chest tightness, wheeze) during the day?
  3. Has your asthma interfered with your usual daily activities?
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2
Q

What are the characteristics of vesicular breathing?

A
  1. Normal sound on most of the lung
  2. Soft
  3. Low pitch
  4. Inspiration longer than expiration
  5. No gap between both phases
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3
Q

What are the characteristics of bronchial breathing?

A
  1. Abnormal in majority of lung that is far from main airways
  2. Loud and tubular quality
  3. High pitched
  4. Inspiratory and expiratory phases equal
  5. Definite gap between both phases
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4
Q

In what conditions is bronchial breathing heard?

A
  1. Consolidation
  2. Lobar Collapse with patent bronchus
  3. Lung Cavity

(Think “3Cs”)

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5
Q

What are the characteristics of a wheeze?

A
  1. Continuous and musical quality
  2. Expiratory usually
  3. Indicates narrowing of airways either due to bronchospasm or secretions in small airways
  4. Low pitch or high pitch
  5. High pitch polyphonic or monophonic
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6
Q

When is a high pitch wheeze heard?

A

Due to smaller airways narrowing in bronchospasm (i.e. asthma)

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7
Q

When is a low pitch wheeze heard?

A

When smaller airways narrow due to secretions (i.e. chronic bronchitis)

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8
Q

When is a polyphonic wheeze heard?

A

When there is variable degree of bronchospasm (i.e. asthma) and is more commonly heard

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9
Q

When is a monophonic wheeze heard?

A

When there’s a localized obstruction

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10
Q

What are the characteristics of crackles?

A
  1. Interrupted and non-musical quality
  2. Inspiratory usually
  3. Peripheral airway collapse on expiration due to interstitial fibrosis or secretions/fluid
  4. During inspiration, rapid air entry abruptly opens these collapsed smaller airways + alveoli producing a crackling noise
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11
Q

What conditions have the following crackles:

  1. Early inspiration
  2. Mid-inspiration
  3. End-inspiration
  4. Biphasic
A
  1. Small airway disease (i.e. bronchiolitis)
  2. Pulmonary oedema
  3. Pulmonary fibrosis, pulmonary oedema, COPD, resolving pneumonia, lung abscess, tuberculous lung cavities
  4. Bronchiectasis
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12
Q

What are the conditions that produce fine crackles?

A
  1. Bronchiolitis
  2. Pulmonary oedema
  3. Pulmonary fibrosis
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13
Q

What are the conditions that produce coarse crackles?

A
  1. COPD
  2. Bronchiectasis
  3. Resolving pneumonia
  4. Lung abscess
  5. Tuberculous lung cavities
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14
Q

What are the characteristics of pleural rub?

A
  1. Caused by inflammation of the visceral and/or parietal pleura
  2. Low pitched/grating sound
  3. Heard in inspiration when visceral and parietal pleura slide over one another
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15
Q

What conditions do you get pleural rub in?

A
  1. Consolidation
  2. Pulmonary infarction (i.e. PE)
  3. Uremia
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16
Q

List 5 conditions, other than asthma, where you can hear a wheeze on auscultation

A
  1. COPD
  2. Pulmonary disease
  3. Cardiac failure
  4. Eosinophilic lung disease
  5. Foreign body aspiration
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17
Q

What should you recommend for patients with exercise-induced asthma?

A

Take their bronchodilator (short-acting B2 agonist - salbutamol) inhaler with them and use it just before exercise to prevent an attack

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18
Q

Why it is particularly important to have the flu vaccination when you have asthma? What other vaccinations would you recommend for patients with chronic asthma?

A

Flu can be more serious for people with asthma, even if their asthma is mild or their symptoms are well-controlled by medication. This is because people with asthma have swollen and sensitive airways, and influenza can cause further inflammation of the airways and lungs. Influenza infection in the lungs can trigger asthma attacks and a worsening of asthma symptoms. It also can lead to pneumonia and other acute respiratory diseases.

A one-off vaccination against Pneumococcal disease is also recommended

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19
Q

Define the term peak expiratory flow rate

A

The maximal rate that a person can exhale during a short maximal expiratory effort after a full inspiration

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20
Q

How do you predict someone’s peak flow?

A

Calculated using the patient’s sex and height

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21
Q

How do you record serial readings of peak flow and for how long?

A

For diagnosis 2-4 weeks, twice daily (NICE 2017)

For Occupational Asthma it may require 2-4 hourly reading over several weeks

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22
Q

What on the peak flow chart would indicate asthma that is well-managed?

A

Less variation between peaks and trough levels

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23
Q

What are asthma triggers?

A
  1. Cold weather
  2. Allergies
  3. Smoke, pollen, pollution, mould/damp
  4. Atopic (combo of eczema, hayfever + asthma)
  5. Cold/flu (chest infections)
  6. Medicines (i.e. NSAIDs, aspirin)
  7. Emotions (laughter, stress)
  8. Exercise
  9. Occupational asthma
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24
Q

What is the pathophysiology of asthma?

A
  1. Submucosal gland hypertrophy + hyperplasia
  2. Goblet cells metaplasia -> more mucus production
  3. Infiltration by eosinophils + neutrophils
  4. Oedema
  5. Smooth muscle hypertrophy + hyperplasia
  6. Thickening of basement membrane
  7. Epithelial desquamation
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25
Q

What is asthma?

A

Chronic condition that causes the airways to narrow and swell resulting in wheezing and difficulty breathing

In asthma the airways are sensitive to triggers that causes the airways to inflame

26
Q

What occurs in metabolic acidosis?

A

Reduced HCO3- concentration in the blood due to increased H+ production, decreased excretion, or loss of bicarbonate

27
Q

What are the 4 main causes of metabolic acidosis?

A
  1. Diabetic ketoacidosis
  2. Lactic acidosis
  3. Renal failure
  4. Chronic diarrhea
28
Q

What occurs in metabolic alkalosis?

A

Increased HCO3- in the blood due to excess alkali intake, loss of gastric acid or K+ depletion

29
Q

What occurs in respiratory acidosis?

A

CO2 retention (increased) that may be due to primary lung pathology (i.e. pneumonia) or other respiratory diseases

30
Q

What occurs in respiratory alkalosis?

A

Fall in pCO2 as a result of hyperventilation

31
Q

What is the FEV1/FVC ratio in obstructive lung disease?

A

< 70%

32
Q

What is the FEV1/FVC ratio in restrictive lung disease?

A

> 70% with individual values each <80% of predicted values

33
Q

How do you diagnose asthma?

A
  1. Spirometry -> ratio < 70% (obstructive disorder)
  2. Peak flow -> look for variability
  3. FBC -> look at eosinophil count (for eosinophilic asthma)
  4. Chest xray -> usually normal/hyperinflated
34
Q

What is a FeNO test?

A

It’s a simple test to see how much nitric oxide – a substance that can be found in high amounts in people who have sensitive airways – is in your breath.

A result > 40ppb of nitric oxide on patient’s breath indicates asthma

35
Q

What is the treatment for asthma?

A
  1. Give short-acting b2 agonist (salbutamol) + steroid inhaler (beclomethasone)
  2. Atrovent (ipratropium bromide) nebulizer + salbutamol nebuliser
  3. Prednisolone/hydrocortisone IV
  4. O2 therapy
  5. Magnesium + aminophylline (bronchodilators)
  • In community give beclomethasone as an inhaler
36
Q

What is a side effect of b2 agonists?

A

Tachycardia

37
Q

If FEV1 and FVC are both < 80% but the ratio is < 70% what is this disorder?

A

A mixed disorder

38
Q

If a nebulizer isn’t available, what other treatment is just as effective for a patient having an acute asthma attack?

A

6 puffs of salbutamol via a spacer

39
Q

In addition to the medicinal treatment for asthma what else should be done during an attack?

A
  1. Insert an IV cannula (if there’s poor response to oral bronchodilators)
  2. Ensure patient is sitting upright
  3. Document all treatments including route, dose, time
40
Q

What does the RIP mnemonic stand for when analyzing chest x-rays?

A

Rotation: The spinous process should be at the midpoint between the heads of both clavicles

Inspiration: 5-7 ribs should be visible anteriorly

Penetration: Is the spine visible behind the heart?

41
Q

Does asthma treatment change in pregnancy?

A

No the patient can continue all their normal asthma medications

42
Q

List 6 contraindications for spinal anaesthesia

A
  1. Patient refusal
  2. Infection at injection site
  3. Uncorrected hypovolemia
  4. True allergy to any of the drugs
  5. Increased intracranial pressure
43
Q

What is a feature of acute severe asthma?

A

Peak flow 33-50% of best/predicted

44
Q

A 45 year old man comes in wheezing and short of breath. On examination you can hear breath sounds in his left lung but you cannot hear any breath sounds in his right lung. What is the most likely diagnosis?

A

Foreign body aspiration

45
Q

Practice prescribing a preventer inhaler. The patient uses a metered dose inhaler via a spacer. The patient has no known drug allergies.

A

Beclomethasone ‘clenil’ 200ug MDI
Route: Inhaler
Dose: 1 puff

46
Q

What are the ethical principles?

A
  1. Autonomy
  2. Consent
  3. Beneficence
  4. Non-malificence
  5. Justice
47
Q

What are the 5 principles of the Mental Capacity Act 2005?

A
  1. Presumption of consent
  2. Ensure all practical steps are taken
  3. Unwise decisions don’t mean they lack capacity
  4. Consider best interests
  5. Least restrictive intervention
48
Q

What does the patient need to be able to do to show they have capacity?

A
  1. Understand info
  2. Retain info
  3. Use info
  4. Communicate the decision
49
Q

Name conditions that can cause shortness of breath

A
  1. Heart failure
  2. Panic attack
  3. Pneumothorax
  4. Foreign body aspiration
  5. DKA
  6. Interstitial lung disease
  7. Asthma
  8. PE
  9. Acute exacerbation of asthma/COPD
  10. Anaphylaxis
50
Q

Go through the ABCDE approach

A

Airway: Patent airway? Non-rebreathe mask (15L), nasopharyngeal/oropharyngeal airways

Breathing: Resp rate (most sensitive sensor of disease), polyphonic end-expiration wheeze (smaller bronchioles are narrowed), O2 sats

Circulation: Pulse, BP, cap refill, listen to chest

Disability: Blood glucose

51
Q

What is the treatment used for asthma and the signs in a respiratory exam that indicate this disease?

A

B2 agonist nebuliser

  • Increased respiratory rate + use of accessory muscles
  • Wheeze
  • White, viscous sputum
52
Q

What is the treatment used for pulmonary oedema and the signs in a respiratory exam that indicate this disease?

A

Loop diuretics/continuous positive air pressure (CPAP)

  • Fine basal crackles
  • Sacral + pedal oedema
  • Increased JVP
  • Frothy, pink sputum

** Remember this is fluid IN the lung tissue (parenchyma)

53
Q

What is the treatment used for tension pneumothorax and the signs in a respiratory exam that indicate this disease?

A

Chest drain

  • Deviated trachea + mediastinum away from affected side
  • Decreased breath sounds on affected side
  • Hyper-resonant percussion on affected side
  • Asymmetrical chest expansion
54
Q

What is the treatment used for massive hemothorax and the signs in a respiratory exam that indicate this disease?

A

Chest drain

  • Dull on percussion
  • Decreased breath sounds
  • Hypotensive (hypovolemic)
  • Asymmetrical chest expansion
55
Q

Compare a severe vs life-threatening acute asthma attack

A

Severe:

  • Unable to complete sentences in 1 breath
  • Resp rate ≥ 25/min
  • Pulse rate ≥ 110/min
  • Peak expiratory flow (PEF) 33-50% of predicted/best

Life-threatening:

  • PEF ≤ 33% of predicted/best
  • Silent chest, cyanosis, feeble respiratory effort
  • Arrhythmia/hypotension
  • Exhaustion, confusion, coma
  • ABGs: Normal/high PaCO2 > 4.6kPa; PaO2 < 8kPa or SaO2 < 92%
56
Q

What is the management of someone with an acute asthma attack?

A
  1. Salbutamol 5mg nebulised with O2 + prednisolone 30mg PO
  2. If PEF remains < 75% repeat salbutamol every 15-30min + ipratropium
  3. Monitor O2 sats, resp rate, heart rate
  4. Consider single dose of magnesium sulphate 1.2-2g IV over 20min without good initial response/life-threatening
57
Q

What kind of drug is ipratropium and what are its side effects?

A

Anticholinergic

SE: urinary retention, dry mouth, acute closed angle glaucoma

58
Q

What is the most effective treatment for asthma?

A

Corticosteroids (reduce inflammation)

59
Q

What are the side effects of salbutamol?

A

Hypokalemia

60
Q

What procedures require you to get written consent from the patient?

A

In general, higher risk procedures (i.e. fertility treatment, surgery)

  1. the investigation or treatment is complex or involves significant risks
  2. there may be significant consequences for the patient’s employment, or social or personal life
  3. providing clinical care is not the primary purpose of the investigation or treatment
  4. the treatment is part of a research programme or is an innovative treatment designed specifically for their benefit

Year 3 TCDs (24 decks)

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