Corrections - Respiratory Flashcards
What is the new stepwise management for asthma under the 2017 NICE guidelines for adults?
1) SABA
2) SABA + low dose ICs
3) SABA + low dose ICS + leukotriene receptor antagonist (LTRA)
4) SABA + low dose ICE + LABA (+ review of LTRA, continue depending on patient’s response)
5) SABA +/- LTRA, switch ICS/LABA for maintenance and reliever therapy (MART) that includes a low dose ICS
RR in moderate vs severe acute asthma?
Moderate - <25/min
Severe - >25/min
Pulse in moderate vs severe acute asthma?
Moderate - <100 bpm
Severe - >100 bpm
PEFR in moderate, severe and life-threatening acute asthma?
Moderate - 50-75%
Severe - 33-50%
Life-threatening - <33%
Describe FEV1 in obstructive vs restrictive lung disease
Obstructive - significantly reduced
Restrictive - reduced
Describe FVC in obstructive vs restrictive lung disease
Obstructive - reduced or normal
Restrictive - significantly reduced
Describe FEV1% (FEV1/FVC) in obstructive vs restrictive lung disease
Obstructive - reduced
Restrictive - normal or increased
Give some important causes of haemoptysis
1) Lung cancer
2) Pulmonary oedema
3) Tuberculosis
4) Pulmonary embolism
5) LRTIs
6) Bronchiectasis
7) Mitral stenosis
8) Aspergilloma
9) Granulomatosis with polyangiitis
10) Goodpasture’s syndrome
What else should you look out for in haemoptysis if lung cancer is potential cause?
- Smoking history
- Symptoms of malignancy; weight loss, anorexia, fatigue
What else should you look out for in haemoptysis if pulmonary oedema is potential cause?
- Dyspnoea
- Bibasal crackles
- S3 gallop on cardiac auscultation
What else should you look out for in haemoptysis if TB is potential cause?
- Fever
- Night sweats
- Anorexia
- Weight loss
What else should you look out for in haemoptysis if a PE is potential cause?
- Pleuritic chest pain
- Tachycardia
- Tachypnoea
- History of travel/surgery/immobilisation
What else should you look out for in haemoptysis if a LRTI is potential cause?
Usually acute history of purulent cough
What else should you look out for in haemoptysis if bronchiectasis is potential cause?
Usually long history of cough and daily purulent sputum production (i.e. PRODUCTIVE cough)
What else should you look out for in haemoptysis if mitral stenosis is potential cause?
- Dyspnoea
- Atrial fibrillation
- Malar flush on cheeks
- Mid diastolic murmur
What else should you look out for in haemoptysis if aspergilloma is potential cause?
- Often past history of tuberculosis.
- Haemoptysis may be severe
- Chest x-ray shows rounded opacity
What is there often a history of in aspergilloma?
TB
What may CXR show in aspergilloma?
Rounded opacity
What else should you look out for in haemoptysis if granulomatosis with polyangiitis is potential cause?
- Upper respiratory tract: epistaxis, sinusitis, nasal crusting
- Lower respiratory tract: dyspnoea, haemoptysis
- Glomerulonephritis
- Saddle-shape nose deformity
What else should you look out for in haemoptysis if Goodpasture’s syndrome is potential cause?
- Systemically unwell: fever & nausea
- Glomerulonephritis
What are pleural plaques?
fibrous thickening on the pleura (the lining of the lungs)
What are pleural plaques often associated with?
Asbestos exposure (e.g. boiler engineer)
Are pleural plaques malignant?
No - don’t undergo malignant chance so NO follow up needed
What is the most common form of asbestos-related lung disease?
Pleural plaques