Corrections pt. 2 - Respiratory Flashcards
What is the investigation of choice to investigate suspected lung cancer?
CT
How can lung cancer affect platelets?
Can cause RAISED platelets
What medications are available for smoking cessation?
1) Nicotine replacement therapy (NRT)
2) Bupropion
3) Varenicline
NICE state that clinicians should not favour one medication over another.
Can you offer NRT, varenicline and bupropion in combination?
NO
Adverse effects of NRT?
nausea & vomiting, headaches and flu-like symptoms
What NRT can be offered to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past?
NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray).
What class of drug is varenicline?
a nicotinic receptor partial agonist
When should varenicline be started in smoking cessation?
Should be started 1 week before the patients target date to stop.
Common adverse effects of varenicline?
Nausea is the most common adverse effect.
Other common problems include headache, insomnia, abnormal dreams
Who should varenicline be used with CAUTION in for smoking cessation?
Patients with a history of depression or self-harm.
Contraindications for varenicline?
Pregnancy & breastfeeding.
What class of drug is bupropion?
a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
When should bupropion be started in smoking cessation?
should be started 1 to 2 weeks before the patients target date to stop
Contraindications for Bupropion?
1) epilepsy (small risk of seizures)
2) pregnancy
3) breastfeeding
4) (having an eating disorder is a relative contraindication)
1st line interventions for smoking cessation in pregnant women?
1) CBT
2) Motivational interviewing
3) Structured self-help and support from NHS Stop Smoking Services
If fails –> NRT
Describe the weakness in Lambert-Eaton syndrome
1) Weakness in proximal muscles
- commonly seen in lower limbs
- gradually pogresses from proximal to distal muscle groups and in the cranial direction.
2) Weakness improves with prolonged exertion (CONTRAST to myasthenia gravis)
3) Hyporeflexia
4) Autonomic dysfunction: blurry vision, dry mouth, orthostatic hypotension, impaired sweating and constipation.
Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems?
Consider bronchiectasis
What type of lung cancer are cavitating lesions more commonly seen in?
Squamous cell carcinoma
Give the stepwise management of an asthma attack
1) O2
2) Salbumatol nebuliser
3) Ipratropium bromide nebuliser
4) Hydrocortisone IV or oral Prednisolone
5) Magnesium sulphate IV
6) Aminophylline / IV salbutamol
How many lobes does the right lung consist of?
3: superior, middle, and inferior lobes
How many lobes does the left lung consist of?
2: superior and inferior lobes.
Features of a lung abscess?
1) subacute presentation: symptoms may develop over weeks
2) systemic features such as night sweats and weight loss may be seen
3) fever
4) productive cough: often foul smelling sputum
5) chest pain
6) SOB
7) dull percussion & bronchial breathing
8) clubbing may be seen
What do lung abscesses most commonly form 2ary to?
Aspiration pneumonia –> poor dental hygiene, previous stroke and reduced consciousness are some of the risk factors for this
Give 3 organisms causing lung abscess
1) staph. aureus
2) klebsiella pneumonia
3) pseudomonas aeruginosa
