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Junior Medicine > Cough > Flashcards

Cough Flashcards

1
Q

How does a lung abscess present

A

Subacute productive cough
Foul smelling sputum
Night sweats

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2
Q

Commonest cause of stridor in children

A

Laryngomalacia

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3
Q

What is taken everyday for the treatment of asthma regardless of whether the patient has symptoms

A

Inhaled corticosteroids eg beclometasone dipropionate

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4
Q

Features of moderate asthma

A

PEFR 50-75% of best or predicted
Speech normal
RR <25 / min
Pulse <110 bpm

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5
Q

Features of severe asthma

A

PEFR 33-50% of best or predicted
Can’t complete sentences
RR >25/min
Pulse >110

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6
Q

Features of life threatening asthma

A

PEFR <33% of best or predicted
O2 sats <92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

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7
Q

List conditions that lead to respiratory acidosis

A

Life threatening asthma (decompensated)
COPD
Opiate overdose
Benzodiazepines overdose
Neuromuscular disease
Obesity hypoventilation syndrome

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8
Q

List some conditions that cause respiratory alkalosis

A

Pulmonary embolism
Anxiety leading to hyperventilation
CNS disorders eg stroke, subarachnoid haemorrhage, encephalitis
Altitude
Pregnancy
Salicylate poisoning

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9
Q

Define asthma

A

Chronic inflammatory disorder of the airways secondary to T1 hypersensitivity
Symptoms are variable and recurring and manifest as reversible bronchospasm

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10
Q

CF of asthma

A

Wheezing
SOB
Worse during night or on exercise
Peak flow worse in morning
Chest tightness

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11
Q

Common asthma precipitants

A

Environmental allergens
Viral infections
Cold air
Emotion
Drugs: NSAID, B blockers
Atmospheric pollutants
Occupational pollutants

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12
Q

Features that suggest asthma diagnosis

A

Recurrent episodes
Variable symptoms
PH/FH of atopy
Recorded observation of wheeze
Variable PEF or FEV1
Absence of symptoms of an alternative diagnosis

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13
Q

2 phases of acute asthma

A

Early phase: bronchospasm due to spasmogen production - SM contraction narrows airway

Late phase due to chemotaxins attracting eosinophils and mononuclear cells

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14
Q

Features of acute severe asthma

A

RR>25
HR >110
PEF 33-50% of best
Can’t complete sentences in 1 breath

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15
Q

Features of life threatening acute asthma

A

PEF <33% of best
SpO2 <92%
Silent chest, cyanosis, or feeble resp effort
Bradycardia, hypotension or dysarhythmia
Exhaustion or confusion

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16
Q

Blood gas features that indicate a life threatening asthma attack

A

Normal PaCO2: should normally be low due to hyperventilation - raised = near fatal

Severe hypoxia

Acidosis

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17
Q

Management of acute severe asthma

A

Oxygen 15L/min by non rebreather
Salbutamol 5mg via oxygen derived nebuliser
Ipratropium bromide 0.5mg
Oral prednisolone or IV hydrocortisone
CXR required if suspecting pneumothorax

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18
Q

Management of acute life threatening asthma

A

Discuss with ICU team
Add IV magnesium sulphate
Give nebulised salbutamol
IV aminophylline

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19
Q

Management of chronic asthma

A
  1. SABA prn (less than 3x per week)
  2. Low dose ICS for all with confirmed asthma
  3. LABA eg salmeterol
    If no response from LABA stop it and increase dose of ICS
    If not enough continue LABA and increase ICS
  4. Add leukotriene receptor antagonist if further needed
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20
Q

MOA of B agonists

A

Relax bronchial SM leading to bronchodilation

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21
Q

What causes side effects of B agonists

A

Action on other B adrenoceptors eg B1 in heart leads to tachycardia
B2 in skeletal muscle leads to tremor and cramps

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22
Q

How long do SABAs work for as oppose to LABAs

A

SABA - 4-6hrs
LABA - >12hrs

23
Q

MOA of ICS

A

Reduce exacerbations due to anti inflammatory side effects

24
Q

Side effects of ICS

A

Oral candidiasis
Pneumonia

25
MOA of LTRA
Block the effects of leukotrienes in the airways benefitting the actions of the ICS
26
Side effects of LTRA
Thirst GI disturbance Churg strauss syndrome
27
MOA of theophylline / aminophylline
Relax SM so dilate airways but also reduce exacerbations
28
Side effects of theophylline / aminophylline
Dose related In high dose can get headache, insomnia, nausea, tachycardia and arrhythmias
29
Pathophysiology of COPD
Progressive airflow limitation that is not fully reversible associated with abnormal inflammatory response of the lungs to nitrous oxide particles or gases Airflow limitation is due to decreased outflow pressure + increased airway resistance
30
What is emphysema
Dilation of any part of the respiratory acinus with destructive changes in alveolar walls Absence of scarring
31
What is chronic bronchitis
Daily cough with sputum for at least 3mo per year for 2yrs Abnormal amounts of mucus causes plugging of the airway lumen Hypersecretion is due to hypertrophy and hyperplasia of bronchial mucus secreting glands
32
What is bronchiolitis
Cigarette smokers also develop inflammation of the airways <2mm in diameter eg the bronchioles with macrophage and lymphoid cell infiltration
33
COPD risk factors
Cigarette smoke exposure Occupational exposure to dusts A1-antitrypsin deficiency Recurrent childhood chest infections Low socioeconomic status Asthma
34
How does cigarette exposure predispose COPD
Stimulates neutrophils to produce elastase - this can inactivate a-1-antitrypsin and directly cause mucus gland hypertrophy
35
CF of COPD
Productive morning cough Increased amount of LRTIs Slowly progressive dyspnoea and wheezing Resp failure Chronic right heart failure occurs late
36
Signs of COPD
Mild disease: - widespread wheeze Severe disease: - tachypnoea, hypoxia - hyperinflation -poor chest expansion - hyperresonant throughout chest - decreased breath sounds
37
Complications of COPD
Acute exacerbations (infective or non) Secondary polycythaemia Cor pulmonale Pneumothorax Lung carcinoma
38
Investigations for suspected COPD
- post bronchodilator spirometry : FEV1/FVC ratio less than 70% - CXR - hyperinflation, bullae, flat hemidiaphragm FBC BMI
39
How to calculate the severity of COPD
Use FEV1 >80% of predicted = mild 50-79% of predicted = moderate 30-49% of predicted - severe <30% = very severe
40
Medical management of long term COPD
SABA or SAMA If no features of asthma or steroid responsiveness: LABA +LAMA Add ICS if still symptomatic or ongoing exacerbations If features of asthma / steroid responsiveness: add LABA +ICS + LAMA (exacerbations)
41
When is pulmonary rehabilitation considered
If a person is functionally disabled by COPD Increases exercise capacity, decreases breathlessness and improves QOL 3 sessions per week for 6 weeks: physical, educational and behavioural
42
When to consider long term oxygen therapy for patients with COPD
Assess for LTOT if patients have SpO2 <92% on air, FEV1 <30% of predicted, cyanosis, secondary polycythaemia or cor pulmonale Assess while at their best Must not be smokers Increases survival if used for >15hr / day
43
Management of pneumothorax
If <2cm and no SOB - consider discharge If not aspiration attempted If >2cm or SOB or patient is >50 - chest drain
44
Indications for placing a chest tube in pleural infection
- patients with frankly purulent or turbid / cloudy pleural fluid on sampling - presence of organisms identified by gram stain and / or culture from a non purulent pleural fluid sample - pleural fluid <7.2 pH
45
Management of acute bronchitis
Analgesia Fluid intake Doxycycline (not in children or pregnant women) Amoxicillin
46
Investigation of choice for idiopathic pulmonary fibrosis
CT scan
47
When is BIPAP used vs CPAP
BIPAP is used in acute T2 respiratory failure and COPD CPAP in T1 respiratory failure and pulmonary oedema
48
How to recognise lung collapse on X-ray
Trachea is pulled towards the opacity
49
What type of lung cancer presents with central weight gain, thinner and fragile skin
Small cell lung cancer as it secretes ACTH and can cause Cushing’s syndrome
50
What paraneoplastic syndrome is associated with squamous cell lung cancer
PTH related protein secretion
51
Management of a secondary pneumothorax <1cm
Admit and give oxygen for 24 hours and review
52
X ray findings in heart failure (ABCDE)
Alveolar oedema (bat’s wings) Kelley B lines (interstitial oedema) Cardio eagle Dilated upper lobe vessels Effusion (pleural)
53
What does normal PaCO2 on ABG in asthma attack indicate
Exhaustion Suggests it is a life threatening attack
54
Panic attack results on ABG
Hyperventilation which causes respiratory alkalosis (high pH, low CO2) PO2 will be normal as no issues with gas exchange No metabolic compensation as attack resolves rapidly

Junior Medicine (6 decks)

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