Chronic Resp Flashcards by H Jalisi

Presentation of asthma

Cough, wheeze, SOB
Worse in morning and evening
Atopy in hx and FHx
Smoker
*chronic inflammatory airway disease characterised by intermittent airway obstruction and hyperreactivity

How well did you know this?

Not at all

Perfectly

Ix for asthma

Bloods
PEFR
- varies by/increases >20% for >3 days/weeks over several weeks
Spirometry
- FEV1:FVC<70%
- reversibility, 12% pre- and post- bronchodilator spirometry

How well did you know this?

Not at all

Perfectly

Rx pathways for asthma

SABA => SABA + ICS =>
SABA + ICS + LTRA => LABA + ICS +/- LTRA =>
LABA + increase ICS +/- LTRA => trials => oral CS

SABA (short acting B agonist) - salbutamol
ICS (inhaled CS) - beclometasone, budesonide
LTRA (leukotriene rec antagonist) - montelukast
LABA (long-acting) + ICS - symbicort (budesonide/formoterol)
oral CS - prednisolone

How well did you know this?

Not at all

Perfectly

How are acute asthma attacks classified?

Moderate
- PEF 50-75%
Acute-severe
- PEF 33-50%
Life-threatening
- PEF <33%
Near fatal
- pCO2 raised
*peak expiratory flow

How well did you know this?

Not at all

Perfectly

Ix for acute asthma attacks

Basic obs
PEF
O2 sat and maintain SpO2 at 94-98%
ABG (repeat if PaO2 <8kPa unless SpO2 <92% or PaCO2 normal/raised or pt deteriorates)
serum K+ and glucose

How well did you know this?

Not at all

Perfectly

Rx for acute asthma attack

Nebulised salbutamol 5mg
Nebulised ipratropium bromide 0.5mg
Oral prednisolone 40-50mg
IV hydrocortisone 100mg
=>
IV magnesium sulphate
Call senior help
=>
IV aminophylline
=>
ITU + intubation

How well did you know this?

Not at all

Perfectly

COPD presentation

SOB, productive cough, some wheeze
Older age
Heavy smoking status
Barrel chest
NO clubbing

How well did you know this?

Not at all

Perfectly

How is COPD classified?

All have a FEV1/FVC < 0.7

FEV1 readings:
Mild = >80%
Moderate = 50-79%
Severe = 30-49%
Very severe = <30%

How well did you know this?

Not at all

Perfectly

Ix for COPD

Spirometry (determine severity)
Bloods, ABG (check for alpha-1 antitrypsin)
ECG (assess cardiac status for cor pulmonale)
CXR (lung reduction associated with increased survival)
Serial peak flow measurements

How well did you know this?

Not at all

Perfectly

Rx based on severity

Mild => SABA/SAMA (salbutamol, ipratropium bromide)
Moderate => SABA + LABA/SAMA + LAMA (tiotropium/salmeterol)
Severe => LABA + LAMA/LABA + ICS (symbicort)
Very severe => LAMA + LABA + ICS (tiotropim + symbicort)

How well did you know this?

Not at all

Perfectly

Mx of COPD

General
- smoking cessation
- annual influenza vaccine
- pneumococcal vaccine
Improve survival
- smoking cessation
- long term O2 therapy (15hrs/day)
- lung volume reduction surgery

How well did you know this?

Not at all

Perfectly

When would a COPD pt start oxygen therapy?

1) pO2 < 7.3kPa

2) pO2 7.3-8kPa + one of the following:
- secondary polycythaemia
- nocturnal hypoxaemia
- peripheral oedema
- pulmonary HTN

How well did you know this?

Not at all

Perfectly

Acute exacerbation of COPD rx

(Blue Venturi) 24% O2
=>
Nebulised salbutamol 5mg
Nebulised ipratropium bromide 0.5mg
Oral prednisolone 40-50mg
IV hydrocortisone 200mg
=>
IV amoxicillin
=>
500mg IV aminophylline
=>
BiPaP (NIV) (type II resp. failure)

How well did you know this?

Not at all

Perfectly

Name types of interstitial lung diseases

Idiopathic pulmonary fibrosis
Hypersensitivity Pneumonitis
Sarcoidosis
Pneumoconiosis

How well did you know this?

Not at all

Perfectly

What may present in the hx of a pt with idiopathic pulmonary fibrosis?

SOBOE, dru cough, no wheeze 
Clubbing
Animal/vegetable dusts
Smoking status baad
Occupational exposure to metal/wood
Chronic microaspiration
Drugs: bleomycin, methotrexate, amiodarone

How well did you know this?

Not at all

Perfectly

Ix for idiopathic pulmonary fibrosis

Bloods, ABG, biopsy
CXR (ground-glass, reticulonodular, cor pulmonale, honeycombing)
High-res. CT (ground-glass)
Lung function tests (restrictive patterns)

How may hypersensitivity pneumonitis present?

Acute +/- chronic hx
Keeps pets
SOBOE, dru cough, fever
*Picks mushrooms, birdkeeper, farmer, plumber, maltworker

Ix for hypersensitivity pneumonitis

Bloods, ABG
CXR (ground-glass)
High res. CT (ground-glass)
Broncho-alveolar lavage (increased cellularity)
Lung function tests (restrictive pattern)

How may pneumoconiosis present?

SOB, cough
Asymptomatic generally
Long latency
Coal worker, builder (silicosis, asbestosis)

Ix for pneumoconiosis

CT (fibrotic changes)
CXR (micronodular mottling => bilateral lower zone reticulonodular shadowing + pleural plaques
Lung function tests (restrictive patterns)

How may CXR differentiate between silicosis and asbestosis?

Asbestosis
- fibrotic changes, not just plaques
Silicosis
- eggshell calcification, micronodular shadowing

Presentations of sleep apnoea

Chronic fatigue
Truck driver
Unrefreshed sleep
Snoring
Obesity, smoker, alcohol
Enlarged tonsils, macroglossia, Marfan's syndrome

Ix and Rx for sleep apnoea

TFTs
sleep study: airflow monitoring, HR, pulse ox., resp. effort

lose weight
CPAP if real bad (damn)

What is sleep apnoea?

Recurrent collapse of pharyngeal airway and apnoea (cessation of airflow for 10s) during sleep, followed by arousal from sleep

A 17 year-old girl presents to the local A&E complaining of worsening shortness of breath, despite use of what she describes as her ‘blue inhaler’. On examination her oxygen saturations are 95%, she is afebrile and has a BP of 101/67. The attending physician takes an ABG and the results are shown below. Grade the severity of this patient’s asthma attack. pH 7.25 pCO2 7.4 kPa (4.5-6.0) pO2 10.4 kPa (>10.5) HCO3 23 mmol/l a) I cannot tell from the information available b) Moderate c) Acute severe d) Life threatening e) Near fatal

e) Near fatal

A 26-year-old bus driver presents to the GP complaining of a worsening shortness of breath. On examination, the patient is afebrile, has a BP of 110/85 and has a marked wheeze on auscultation. The only medications the patient is on is Salbutamol, PRN. What is the next most appropriate treatment step as per the treatment guidelines for this condition? a) Replace the blue inhaler with a brown, low-dose inhaled corticosteroid b) Replace the blue inhaler with a long-acting beta-agonist medication c) Replace the blue inhaler with a long-acting muscarinic agonist medication d) Add an inhaled low-dose corticosteroid to her medications, taken OD e) Add oral corticosteroid tablets to her medications, taken OD

d) Add an inhaled low-dose corticosteroid to her medications, taken OD

A 72-year-old man attends the GP complaining of increased shortness of breath and a cough productive of clear sputum. The GP notes the gentleman has a history of diagnosed COPD and decides to review his medications. The man hands the GP two inhalers, one a SABA and the other a LABA. After conducting spirometry, the GP calculates an FEV1 of 40% expected. What is the next most appropriate treatment step? a) Replace the SABA with a LAMA b) Replace the LABA with an LAMA c) Add a LAMA d) Add an ICS e) I need to conduct more tests to determine what medications to review

a) Replace the SABA with a LAMA

Which of the following is NOT a respiratory cause of clubbing? a) Squamous cell lung cancer b) Interstitial lung disease c) COPD d) Cystic fibrosis e) An empyema (lung abcess)

c) COPD

A 65-year-old man with a medical background of benign prostatic hyperplasia, presents to the GP with a 1 week history of worsening shortness of breath on exertion. He has a temperature of 38.5C, reports no weight loss but does mention some mild fatigue from his ‘pet pigeons keeping him up all night’ recently. On auscultation, the GP can determine fine, bi-basal inspiratory crackles. What is the most likely diagnosis? a) COPD b) Lung cancer c) Bronchiectasis d) Hypersensitivity pneumonitis e) Idiopathic pulmonary fibrosis

d) Hypersensitivity pneumonitis

A tall 26-year-old woman comes into the GP complaining of chronic fatigue. Upon further questioning she reports that she ‘can never get a good night’s sleep’ and that she tends to fall asleep a lot at her workplace as a call centre customer service representative. She also mentions that she thinks it may have something to do with a condition her mother had. The only significant finding upon examination is patches of stretchy skin, especially around the neck area. What is the most likely underlying condition leading to disrupted sleep? a) Obesity b) Bad sleeping position c) Marfan’s syndrome d) Down’s syndrome e) Chronic fatigue syndrome

c) Marfan's syndrome | * leading to sleep apnoea