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Y3 MedEd > Chronic SOB > Flashcards

Chronic SOB Flashcards

1
Q

Define asthma

A

Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

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2
Q

Patient history of asthma (7)

A

Recurrent episodes

Variation (worst in morning & evening)

History of atopy
Family History

Smoker

Occupation
Pets

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3
Q

S/s of asthma (3)

A

Cough
Wheeze
SOB

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4
Q

What should be heard on auscultation of an asthmatic

A

Wheeze

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5
Q

Ix for asthma and diagnostic criteria

A

Spirometry - FEV1: FVC <70%
PEFR - PEFR varies by, or increases by >20%, for >3 days/week over several weeks - diagnosis can be aided by a PEFR diary

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6
Q

What is the Mx of asthma

A 
In order:
SABA
SABA+ICS
SABA+ICA+LTRA
LABA+ICS±LTRA
LABA+↑ICS±LTRA
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7
Q

Which SABA is used for asthma

A

Salbutamol

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8
Q

Which ICS are used for asthma (2)

A

Beclometasone, Budesonide

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9
Q

Which LTRA is used for asthma

A

Montelukast

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10
Q

Which LABA+ICS is used for asthma

A

Symbicort (Budesonide/Formoterol)

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11
Q

Which Oral CS is used for asthma

A

Prednisolone

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12
Q

What type of drug is salbutamol

A

Short acting beta2 agonist

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13
Q

What type of drug is beclometasone

A

ICS

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14
Q

What type of drug is budesonide

A

ICS

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15
Q

What type of drug is montelukast

A

Leukotriene receptor antagonist

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16
Q

What type of drug is symbicort

A

Long acting beta agonist budesonide and ICS formorterol

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17
Q

What type of drug is prednisolone

A

Oral CS

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18
Q

Which drugs are in Symbicort

A

Budesonide/Formoterol

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19
Q

What are the criteria for acute severe asthma

A

PEF - 33-50% best or predicted
RR - >25/min
HR - >110min
Inability to complete sentences in one breath

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20
Q

What are the criteria for life threatening asthma

A

PEF - <33% best or predicted
SpO2 - <92%
PaO2 - <8kPa
Normal - PaCO2

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21
Q

Quick way to distinguish moderate, acute severe, life threatening and near fatal asthma?

A 
PEF
50-75%
PEF
33-50%
PEF
<33%
pCO2
Raised
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22
Q

Mx acute asthma

A

O2
Neb. salbutamol 5mg
Neb ipatropium bromide 0.5mg if acute-severe or life-threatening asthma with poor response to salbutamol

Oral prenisolone 40-50mg or IV hydrocortisone 100 100mg

IV MgSO4 + senior help

IV aminophylline

ITU + intubation

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23
Q

History of someone with COPD (4)

A

Age

FHx

Smoking status

Occupation

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24
Q

Presenting complaints of COPD (3)

A

SOB
Productive cough
Some wheeze

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25
Q

What is heard on auscultation of COPD (3)

A

Reduced air movement
Wheezing
Coarse crackles (hair-like crackles)

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26
Q

What is seen on general inspection of COPD (3)

A

Tar staining
Cyanosis
Barrel chest

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27
Q

What is felt on palpation of COPD (2)

A

Reduced expansion

Hyper-resonance (on percussion)

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28
Q

Does COPD cause clubbing

A

No

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29
Q

What are the cut offs for different severities of COPD

A 
> 80%
Mild
50-79%
Moderate
30-49%
Severe
< 30%
Very severe
30
Q

Ix for COPD and why (5)

A

Serial peak flow measurements
To exclude asthma if diagnostic doubt remains
Alpha-1 antitrypsin (A1AT)
If early onset, minimal smoking history or family history
Transfer factor for carbon monoxide (TLCO)
To investigate symptoms that seem disproportionate to spirometric impairment
CT scan of the thorax
To investigate abnormalities seen on a chest radiograph
To assess suitability for surgery
ECG or Echocardiogram
To assess cardiac status if features of cor pulmonale

31
Q

Mx of COPD

A

In order:
Make sure to have vaccines and stuff
SABA or SAMA

SABA + LABA or
SAMA and LAMA

LABA + LAMA or
LABA + ICS if asthmatic features

LAMA+LABA+ICS

32
Q

What type of drug is ipratropium bromide

A

Short-acting muscarinic antagonis

33
Q

Example of a short-acting muscarinic antagonist

A

Ipratropium bromide

34
Q

What type of drug is salmeterol

A

Long-acting beta antagonist

35
Q

What type of drug is tiotropium bromide

A

Long-acting muscarinic antagonist

36
Q

Example of a long-acting muscarinic antagonist

A

Tiotropium bromide

37
Q

Example of a long-acting beta antagonist

A

Salmeterol

38
Q

Indication for O2 therapy Iin COPD

A 
pO2 of 7.3 - 8 kPa and one of the following:
Secondary polycythaemia
Nocturnal hypoxaemia
Peripheral oedema
Pulmonary hypertension

or

pO2 of < 7.3 kPa

39
Q

Mx for acute IE of COPD

A

(Blue Venturi) 24% O2

Neb Salbutamol 5mg
Neb Ipatropium bromide 0.5mg

Oral prednisolone 40-50mg
IV hydrocortisone 200mg

500mg IV aminophylline

BiPAP

40
Q

What is the indication for BiPAP

A

T2 respiratory failure (e.g. COPD)

41
Q

What is the indication for CPAP

A

T1 respiratory failure (e.g. sleep apnoea)

or atelectasis

42
Q

Define ILD

A

Interstitial lung disease (ILD) is an umbrella term for a large group of disorders that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe

43
Q

What are the 4 causes of ILD

A

Idiopathic Pulmonary Fibrosis
Hypersensitivity Pneumonitis / EAA
Sarcoidosis
Pneumoconiosis

44
Q

Common patient history for IPF (4)

A

Animal/vegetable dusts

Smoking status

Occupation

Drugs
Bleomycin
Methotrexate
Amiodarone

45
Q

Which drugs cause IPF (3)

A

Drugs
Bleomycin
Methotrexate
Amiodarone

46
Q

Main presenting complaints (2) and one thing not in the PC of IPF

A

SOBOE
Dry cough
No wheeze

47
Q

Main sign on general inspection of IPF

A

Clubbing

48
Q

Main sign on auscultation of IPF

A

Bi-basal, fine, inspiratory crepitations

49
Q

Ix for IPF (6)

A

Biopsy is diagnostic but CT is usually most appropriate

Bloods, ABG, BIOPSY

CXR – ground-glass, reticulonodular, cor pulmonale, honeycombing

High-resolution CT - ground-glass

Lung function tests (restrictive pattern)

50
Q

What pattern is seen in lung FT of IPF

A

Restrictive

51
Q

What is seen in CXR (4) and CT in IPF

A

CXR – ground-glass, reticulonodular, cor pulmonale, honeycombing

CT - ground glass

52
Q

History of hypersensitivity pneumonitis (2)

A

Keep pets

Occupation
Pick mushrooms
Bird-keeper
Farmer
Plumber
Malt-worker
53
Q

PC of hypersensitivity pneumonitis (3)

A

SOBOE
Dry cough
Fever

54
Q

General inspection features of EAA (2)

A

Clubbing (rare)

Mild pyrexia*

55
Q

Auscultation features of EAA

A

Bi-basal, fine, inspiratory crepitations

56
Q

Ix for EAA (4)

A

Bloods, ABG

CXR – often normal*

High-resolution CT - ground-glass

Lung function tests (restrictive pattern)
Broncho-alveolar lavage – increased cellularity

57
Q

History of pneumoconiosis (3)

A

Occupation
Coal-worker
Builder

Long latency

Asymptomatic

58
Q

PC of pneumoconiosis

A

SOB

Dry cough

59
Q

What can pneumoconiosis be divided into

A

Asbestosis - builder

Silicosis - coal - worker

60
Q

Auscultation features of asbestosis (2)

A

Bi-basal, inspiratory crepitations

61
Q

Auscultation features of silicosis (2)

A

Decreased breath sounds

62
Q

General inspection signs of asbestosis

A

Clubbing

63
Q

General inspection signs of silicosis

A

None

64
Q

Ix and results of pneumoconiosis (3)

A

CXR:
Simple = micro-nodular mottling
Complicated = bilateral lower zone reticulonodular shadowing and pleural plaques (asbestosis is fibrotic changes, not just plaques)*

CT – fibrotic changes

Lung function tests (restrictive pattern)

65
Q

What is seen in the CXR of simple pneumoconiosis

A

Simple = micro-nodular mottling

66
Q

What is seen in the CXR of complicated pneumoconiosis

A

Complicated = bilateral lower zone reticulonodular shadowing and pleural plaques (asbestosis is fibrotic changes, not just plaques)*

67
Q

What is seen in the CT of pneumoconiosis

A

Fibrotic changes

68
Q

What pattern is seen in the lung FT of pneumoconiosis

A

Restrictive

69
Q

Define sleep apnoea

A

Characterised by recurrent collapse of pharyngeal airway and apnoea (cessation of airflow for >10s) during sleep; followed by arousal from sleep

70
Q

RF for sleep apnoea (8)

A

Obesity, smoker, alcohol

Fatigue

Truck Driver

Enlarged tonsils
Macroglossia
Marfan’s syndrome

71
Q

PC of sleep apnoea (3)

A

Chronic fatigue
Unrefreshed sleep
Snoring

72
Q

Ix for sleep apnoea (2)

A

Sleep study

TFTs

Y3 MedEd (34 decks)

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