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Respiratory > For IPE > Flashcards

For IPE Flashcards

1
Q

Outline the MRC dyspnoea score

A

1 - not breathless unless doing strenuous exercise
2- SOB when walking on the level in a hurry or walking up a slight hill
3- walks slower than most people and stops after walking a mile at own pace
4- stops for a breath after walking about ten yards or after a few minutes of walking on the flat
5- too breathless to leave the house or breathless on getting dressed

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2
Q

Define massive haemoptysis

A

> 240ml/ 24 hours

100ml/ day for 3 consecutive days

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3
Q

Explain the management of massive haemoptysis

A

A to E assessment
Lie patient on side of the lesion
Oral transxaemic acid 5/7 or IV
stop anything that might be precipitating bleeding
Abx if signs of infection
Consider Vit K
Ct aortogram- may be able to do a bronchial artery embolisation

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4
Q

What is the wells score for a DVT?

A

Previous DVT
active cancer or treatment with 6/12
Paralysis or recent immobilisation of the LL
Bedridden or major surgery requiring anaesthetic within the last 12 weeks
unilateral calf swelling >3cm
unilateral swollen superficial veins
unilateral pitting oedema
swelling of the entire leg
localised tenderness along the deep vein system

-2 points if other diagnosis as likely

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5
Q

How do you use the wells score to assess for D dimer?

A 
<= 1 - do a d dimer 
>= 2 - d dimer and USS
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6
Q

How long is warfarin treatment continued for DVT?

A

3 months if provoked

>3 months if unprovoked

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7
Q

What is the wells score for a PE?

A

Clinically suspected DVT +3
Alternative diagnosis less likely than PE -3
Previous DVT of PE 1.5
Active cancer or treatment within 6/12
Recent bedridden within the last 12 weeks
tachycardia > 100 1.5
haemoptysis

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8
Q

How should the score of a patient on the Wells score for PE be interpreted?

A

> = 3 - high probability of a PE- CTPA and if delayed give treatment dose LMWH
1-2 - do a d dimer and then escalate if positive

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9
Q

What are the sources of a PE?

A

DVT, RV thrombosis post MI, septic emboli, fat, air or amniotic fluid embolus and neoplastic cells.

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10
Q

What scan can be used in CKD and why cant a CTPA be used?

A

V;Q matching

Contrast used in CTPA is contraindicated in renal impairment.

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11
Q

What are the signs and symptoms of a PE?

A

SOB
Pleuritic chest pain
Cough and haemoptysis
Dizziness and syncope

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12
Q

What may be seen on ECG in a PE?

A

tachycardia
RV strain
S1, Q3, T3
RBBB

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13
Q

What should be done in the case of an unprovoked PE?

A

Follow up to assess for any underlying malignancies
- CXR and consider CT chest/ abdo and pelvis
urinalysis

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14
Q

What is the consequence of multiple unprovoked PEs?

A

Leads to pulmonary hypertension and therefore may lead to right sided heart failure.

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15
Q

How is a PE treated?

A

High flow O2 if desaturating
IV access - morphine and antiemetic
LMWH at treatment dose and start warfarin at the same time aiming for an INR of 2-3

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16
Q

How does management change in a massive PE?

A

Alteplase can be given if haemodynamically unstable

10mg followed by 90mg infused over 2 hours

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17
Q

What are the contraindications to thrombolysis?

A

haemorhagic stroke, CNS neoplasia, recent trauma/surgery, Gi bleed within 1 month, known bleeding disorder

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18
Q

What is the definition of pulmonary consolidation?

A

Region of lung parenchyma that is filled with a liquid or solid

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19
Q

How can we tell the difference between an effusion and consolidation on an XR?

A

Effusions will start at the bottom and will have a mensical sign
Effusion are homogenous and consolidation are hetergenous
Effusion will cause the costophrenic angle to be lost

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20
Q

How can we tell the difference between an effusion and consolidation on physical examination?

A

Vocal fremitus and resonance is increased over consolidation and reduced over efffusion
consolidation is dull on percussion and effusion is stony dull

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21
Q

What is an empyema?

A

pus in the pleura

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22
Q

What is the treatment of empyema and when is it indicated?

A

Need to do an aspirate on aspirate would find
- pH <7.2
- purulent and turbid colour of the aspirate
Chest drain must be put in patients that meet these criteria

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23
Q

What procedure can be done in a patient with recurrent effusions?

A

Pleurodesis- insert medical talc and wait for scarring to occur which reduces the space for a effusion to build up and therefore the chance of a pleural effusion forming.-

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24
Q

What criteria is used to assess a pleural effusion and decide if its a transudate or an exudate?

A

Lights

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25
Q

What are the criteria looked at in lights criteria?

A 
Appearance
protein content 
Cholesterol content 
Pleural fluid protein to serum protein ratio
LDH content 
Pleural fluid LDH to serum LDH content
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26
Q

What are the causes of a pleural effusion transudate?

A 
Left ventricle or congestive cardiac failure
COPD
intersitial lung disease
portal hypertension
SVC obstruction
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27
Q

What are the causes of a pleural effusion exudate?

A 
malignancy 
infection
trauma
PE
oesophageal rupture 
inflammatory cause
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28
Q

Where should a needle be inserted with relation to a rib and why?

A

Upper border due to the neurovascular bundle in the lower border

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29
Q

Explain the treatment of a pleural effusion of unknown cause

A

Diagnosed via USS guided aspiration using cytology, culture and lights
- percuss the upper border and chose ICS 1 or 2 lower
May disappear as the cause is treated
do not drain until cause is well established
- bilateral can be assumed to be transudative and can just carryout drain

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30
Q

What is a haemothorax?

A

Bleeding into the pleural space

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31
Q

What is a chylothorax?

A

Chyle in the pleural space - often by disruption of the thoracic duct

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32
Q

What are the causes of a chylothorax?

A

Lymphoma and metastatic carcinoma
Traumatic injury
TB, sarcoidosis, cirhosis and amyloidosis

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33
Q

What are the symptoms of a pneumonia?

A

Cough, SOB, pleuritic chest pain, excess sputum production, fever, cyanosis and confusion

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34
Q

What will be found on examination of a patient with pnnuemonia?

A 
Dull to percust
Crackles on inspiration
Pleuritic rub if complicated by pleural effusion
Bronchial breathing 
Increased vocal resonance
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35
Q

What investigations should be done in a patient with suspected pneumonia?

A

CXR - see where is affected and cannot trigger pathway without ECG changes
sputum and blood cultures
Bloods - check for any end organ damage
basic obs - asses general unwellness

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36
Q

What score is used prognostically for pneumonia?

A 
CURB65
C- confusion
Urea >7
Resp rate >30
BP <90 <60
Over 65y/o
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37
Q

What are the common micro-organisms in CAP?

A

Strep pnuemonia
H influenza
Mycoplasma pneumonia

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38
Q

What are the common micro-organism in HAP?

A

Psuedomonas auerginosa

enterococci

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39
Q

What is the management of CURB 65?

A

1 - PO amoxicillin
2- PO doxycycline and amoxicillin
3+ - Iv co amoxiclav and doxy - should have a HIV screen and urine sample for legionellas and consider ITU referral

If in hospital require a VTE prophylaxis pathway

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40
Q

What is the follow up for Pneumonia?

A

Test for HIV in complicated or recurrent cases
Test for Ig and pneumonococcal and haemophilus IgGs
Out patient clinic in 6 weeks for re XR and make sure fully resolved

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41
Q

What are the complications of pneumonia?

A 
Abscess
Effusion
Empyema 
AF
Septicaemia 
T1 respiratory failure
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42
Q

What are the possible answers as to why treatment for pneumonia is failing?

A

CHAOS
- Complication
- Host - immunocompromised
-A- antibiotic - wrong dose, poor absorption, incorrect choice for pathogen
- O- organism- resistance to antibiotic, unexpected organism not covered by treatment
S- secondary diagnosis or wrong diagnosis - TB, PE, cancer and COPD

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43
Q

What type of pneumonia are heavy drinkers and DM more likely to suffer from?

A

Klebsiella pneumonia

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44
Q

What is the pathophysiology of bronchiectasis?

A

Permenant enlargement of the airways in the lungs - exhibit more mucus clearance and there is a predisposition to reoccurance or chronic bronchial infection

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45
Q

What are the causes of bronchiectasis?

A

Mainly CF
Primary ciliary dyskinesia or Kartageners syndrome
Damage to the airways from infection and inflammation- Pneumonia, TB and CF
Infection- measles, pertussis
RA and UC

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46
Q

What are the signs of bronchiectasis?

A

Recurrent infections = psuedomonas or haemophilus influenzae
Excessive sputum production = haemoptysis - breathlessness with wheeze
Caused by obstruction of the airways due to scarring of the bronchioles

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47
Q

What are the investigation useful in bronchiectasis?

A

Spirometry will show an obstructive picture
O2 sats reduced
XR
CT will show ring sign and tram tracking on bronchoscopy

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48
Q

What is the diagnostic feature on CT on bronchiectasis?

A

Bronchioles 1.5 times wider than surrounding vessels

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49
Q

What is the treatment and management of bronchiectasis?

A

Treat the symptoms to make life easier
- Abx course - longer than normal and patients should have a rescue pack at home to start if they are feeling unwell.
- patients should have a supply of sputum culture pots for if sputum changes
Physio
Inhaled therapy to make easier to breath and reduce SOB- inhaled saline to break up mucus and make more liquidy

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50
Q

What is interstitial lung disease?

A

Number of different conditions that are characterised by chronic inflammation or fibrosis in the interstitium

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51
Q

What are the risk factors for interstitial lung disease?

A 
Smoking 
Occupation 
Keeping birds 
Can be drug induced 
previous infection
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52
Q

What are the signs and symptoms of interstitial lung disease?

A 
dyspnoea on exertion
non productive cough
abnormal breathing sounds- fine inspiratory crackles
clubbing 
reduced chest expansion
May have signs of pulmonary hypertension
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53
Q

What investigations are carried out on patients who have interstitial lung disease?

A 
O2 saturations 
Arterial blood gas
Restrictive pattern on spirometry
CXR or CT -
> Diffuse opacificiation throughout affected areas of the lung
> Ground glass appearance on XR
> Honey combing appearance on CT
Biopsy and histology to confirm
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54
Q

What is the management of interstitial lung disease?

A 
Refer to specialist clinic
Stop smoking
pulmonary rehab
O2 for ease of living
pallative care
Prednisolone 
N acetylcysteine
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55
Q

What further testing can be done in those with intersitial lung disease?

A
  • Test for SLE
    -RhF
  • ANCA and anti-GBM
    ACE and IgG to serum precipitants
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56
Q

What is pulmonary firbosis?

A

Fibrosis within the lungs due to previous damage or trauma but may also be idiopathic

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57
Q

What are the S&Ss of pulmonary fibrosis?

A 
dry cough 
exertional SOB
WL 
flu like symptoms 
cyanosis 
finger clubbing
fine inspiratory crackles
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58
Q

On spirometry what is someone with pulmonary fibrosis likely to have?

A

Restrictive deficit

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59
Q

What is sarcoidosis?

A

Rare multi organ condition that leads to a non caesating granulomatous infection
Very commonly affects the lungs

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60
Q

What are the signs and symptoms of sarcoidosis?

A 
Lymphadenopathy
Erythema nodosum
Persistent dry cough 
Hepatosplenomegaly 
Enlargement of the lacrimal and parotid glands
General malaise and aches in the bones
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61
Q

What may be seen in blood tests in someone with sarcoidosis?

A

Increased Ca
Increased ACE
Lymphopenia

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62
Q

What changes may be seen on a CXR of a patient with sarcoidosis?

A 
Normal 
Bilateral lymphadenopathy
Lymphadenpathy and parenchymal lung disease
Parenchymal lung disease
Lung fibrosis
63
Q

What would a biospy of a patient with sarcoidosis show?

A

Non caesating granulomas

64
Q

What investigation should be carried out in a patient with saroidosis suffering from a headache and why?

A

CT or MRI head

Risk of neuro sarcoidosis

65
Q

What is the treatment of sarcoidosis and what is the indication for these?

A

Analgesia - relieve symptoms
Corticosteriods - help suppress the immune system
> indications - parencymal lung disease, uveitis, hypercalcaemia, neurological or cardiac involvement

66
Q

What is asbestosis?

A

Restrictive lung deficit caused by inhalation of asbestos particles

67
Q

What are the signs and symptoms of asbestosis?

A

Dyspnoea - progressing to shortness of breath at rest
Bibasal fine inspiratory crackles
Clubbing
May lead to cor pulmonale and heart failure signs
May have pleural effusion

68
Q

What is important about pleural plaques in relation to asbestos?

A

Benign condition that under goes no malignant change

Generally seen 20-40 years after exposure

69
Q

What will be seen on lung function testing in a patient with asbestosis?

A

Restrictive deficit`

70
Q

What will be seen in imaging of a patient with asbestosis?

A 
CXR 
- Reticular opacities 
- may have pleural plaques
CT
- reticulation, honey comb fibrosis and signs of bronchiectasis
71
Q

What is the management of a patient with asbestosis?

A

Smoking cessation
prevent further exposure to asbestosis
Home o2 for hypoxic patients
Vaccinations

72
Q

What are the different types of pneumothorax

A 
Spontaneous 
- primary
-secondary
Traumatic 
Iatrogenic
Tension
73
Q

What are the risk factors for a spontaneous pneumothorax?

A 
lung disease
smoking
male
diving 
connective tissue diseases
74
Q

What are the signs and symptoms of a pneumothorax?

A 
Sudden onset dyspnoea
Pleuritic chest pain
reduced chest expansion
silent over affected lung 
hyper resonant to percussion
75
Q

What is the treatment of a spontaneous pneumothorax

A

look up guidelines

76
Q

When should surgery be considered in a pneumothorax?

A

Bilateral

failed to inflate after 48 hours

77
Q

What is the pathophysiology behind a tension pneumothorax??

A

Air enters the pleural space on inspiration through a tear in the parencyma but cannot exit on expiration leading to pressure building up and compressing the structures in the thorax

78
Q

What are the signs of a tension pneumothorax?

A

Tracheal deviation away from the affected side
May get movement of the apex beat - mediastinal shift can lead to cardiac arrest
Patients will be haemodynamically unstable with increased HR, respiratory distress, hypotension and SVC obstruction

79
Q

What is the management of a tension pneumothorax?

A

Remove air as fast as possible
Insert large bore cannula into the 2 ICS MCL
Then place a chest drain into the 5 ICS MAL

80
Q

Define COPD

A

Progressive, not fully reversible obstructive lung disease associated with smoking
Encompasses chronic bronchitis and emphysema
Doesnt change dramatically day on day

81
Q

Explain the pathophysiology behind COPD

A 
Mucus gland hyperplasia
Loss of cilial function
Chronic inflammation 
Fibrosis of small airways 
Alveolar wall disruption causing irreversible enlargement of air space distal to the terminal bronchioles
82
Q

What are the signs and symptoms of COPD?

A 
Chronic SOB- minimal diurnal variation
productive cough
wheeze 
cyanosis 
hypertrophy of the accessory muscles
Barrel chest 
reduced lung expansion- decreased breath sounds 
May have cor pulmonale
83
Q

What does lung function test show in COPD?

A

Obstructive

FEV1:FVC = <0.7

84
Q

What is the management of COPD?

A

Care care bundle for COPD with multidisciplinary team to improve QoL

  • Stop smoking
  • Encourage exercise and give physio to increase exercise tolerance
  • Pulmonary rehab
  • Bronchodilators - short acting muscarinics antagonists, Short acting B agonists
  • Mucolytic therapies
  • Add inhaled corticosteriods
  • Add LAMA and LABA
  • Surgical volume reduction
85
Q

What are the indications for O2 therapy?

A

PO2 consistently less than <7.3
Levels <8kPa if signs of heart failure or PHTN

Must not be smoker and Co2 retainers

86
Q

What are the complications of COPD?

A 
Acute exaccerbation
polycythemia 
Respiratory failure 
HF
pneumothorax
87
Q

What are the most common infections in COPD?

A

Haemophilus influenzae
Strep pneumonia
Moraxella Catarrhalis

88
Q

What are the signs and symptoms of infective exaccerbations of COPD?

A

Increased SOB with reduced exercise tolerance
Increased cough with increased sputum volume and change in colour
Increased wheeze and chest tightness
infective signs - fever, confusion and night tightness

89
Q

What is the treatment for infective exaccerbations of COPD?

A

Neb Salbutamol and iatropium bromide
steriods - 30mg prednisolone STAT and then 7 days PO
Consider aminophylline
O2 and NIV
Only ABx if sputum culture or infective signs

90
Q

What is the condition associated with early onset COPD?

A

Alpha 1 anti-trypsin deficiency

91
Q

How does A1ATD present?

A

May affect liver but always affects the lungs
Lung disease presents in <30y/o (earlier again if smokers)- tends to affect the upper lobe
Liver disease - not all patients
- Neonates - increased risk of hepatitis and jaundice
- Adults - develop liver failure and increased risk of hepatocellular carcinoma

92
Q

What is the treatment A1ATD?

A

No smoking and reduced alcohol intake
Manage COPD and liver disease - young patients may eventually need a transplant
Hepatocellular carcinoma screening
Recombinant A1AT therapy

93
Q

What is CF?

A

Auto R disease caused by abnormal genes for the cystic fibrosis transmembrane conductance regulator which would normally allow Cl ions through

94
Q

In what organs does CF present?

A

Lungs
Pancreas
Bowel
Vas deferens- do not form leading to male infertility

95
Q

What are the problems in the lungs of a patient with CF?

A

Thick stagnant mucus leads to recurrent infections and the development of bronchiectasis
can get an obstructive picture on lung function testing

96
Q

What sort of acid: base imbalance do people with CF get and why?

A

Hypokalaemia hypochloraemia metabolic acidosis
> due to the loss of Cl - cannot diffuse back in from the skin and therefore Na is pulled out using the gradient and as a result the kidney absorbs more Na and losses more K

97
Q

What is used in the diagnosis of CF?

A

Heal prick test at 5-9 days old
Sweat production
Genetic testing can help choose treatment
Faecal elastase reduced in pancreatic insufficiency

98
Q

What is used to measure the severity of an infection in a CF?

A

Lung function and weight

> lung function will show when they can be considered for transplant

99
Q

Explain the problems with CF patient’s pancreas

A

Insufficiency of exocrine enzymes - need creon supplements to digest and maintain weight
May get a transient diabetes- diagnosis made by insertion of a device that gives reading over 5 days
Increased risk of pancreatitis

100
Q

What problems occur in the bowel of a patient with CF and how should these be managed?

A

Intestinal obstruction at the ileocaecal junction- build up of mucus and stop of feacal movement
DIOS- distal intestinal obstruction syndrome - presents with pain in abdomen, vomitting, reduced bowel sounds, tender when palpation the RIF- treated with laxatives
Meconium ileus - blockage of the ileus due to very concentrated meconium- present with vomitting bile and reculance to feed - treated with an enema and may need to drain bile in the stomach.

101
Q

Explain Cf in the liver

A

Affects the passage of bile from the liver and gall bladder to the intestine

  • bile is dehydrated and more acidic than normal
  • more likely to get gallstones due to stasis
  • Fatty stool
  • obstruction of the outflow tracts can lead to fatty liver disease and then cirrhosis
102
Q

What is the management and treatment CF?

A

Physio
Home nebulisers and mucolytics
Diet and advice on supplements - creon
Prophylaxtic antibiotics and prompt treatment of infections
Vaccines - influenzae and pneumococcal
Stay away from CF patients
Avoid jaccuzzis due to risk of psuedomonas
Supplements of fat soluble vitamins
Increased risk of osteoporosis so consider Vit D and Ca

103
Q

What is primary ciliary dyskinesia?

A

Auto R inherited condition causing immobility and poor mucus clearance in the lungs

104
Q

What are the features of Kartenger’s syndrome?

A

Primary ciliary dyskinesia
Situs invertus and dextrocardia
Bronchiectasis
Abnormal frontal sinuses leading to chronic sinusitis

105
Q

What are the signs and symptoms of Kartenger’s sydnrome?

A 
Neonatal respiratory distress
nasal polyps 
COPD or bronchiectasis 
Infertility in both sexes
Signs of situs invertus
106
Q

What is seen on imaging with patient with Kartgeners?`

A

CXR - detrocardia, lung over inflation, bronchial wall thickening and peribronchial infiltate
CT - bronchiectasis and involvement of the peribronchial sinuses
lung function test - obstructive due to blocking of the airways by mucus

107
Q

What is the management and treatment of Kartgener’s syndrome?

A

Long term ABx
inhaled bronchodilators
Mucolytics and chest physio
Vaccines

108
Q

What are the different types of lung cancer?

A
  • Small cell
  • Non small cell
  • Mesothelioma
109
Q

What are the signs and symptoms of lung cancer?

A

Often insipid
Any respiratory symptom- Chronic cough, wheeze, haemoptysis
Chest pain and SOB
SVC obstruction - facial swelling, visible vein in the neck and raised JVP
Horner’s syndrome- Miosis, ptosis and ipsilateral anhydrosis
Hoarse voice with or without bovine cough

110
Q

What paraneoplastic syndrome may present with lung cancer?

A 
Cushing syndrome 
Hypercalcaemia 
Thromboembolism
SIADH
Prolactinaemia
111
Q

What are the sites that lung cancer common metastasize to?

A 
Liver
Adrenal gland
Bone 
Pleura
Brain 
Other lung
112
Q

What are the investigations needed in a patient with suspected lung cancer?

A

Blood tests - FBC, U&Es, LFTs, Ca and INR
CXR - lymph node enlargement, pleural effusion, collapse, bony secondarys, pulmonary opacificities
Staging CT - spiral CT of thorax, abdomen and pelvis
PET scan for mets
Histology and biospy - Biopsy can be done under USS or CT guidance

113
Q

What is the WHO performance scale?

A

0- normal
1 -restriction of strenuous activity but able to carry out light work
2 -Ambulatory and capable of all self care but unable to carry out any work activities - up and about >50% working hours
3 - capable of only limited self care - confined ton bed or chair more than 50% waking hours
4 - completely disabled - totally confined to bed or chair
5 - dead

114
Q

What are the palliative management options for lung cancer?

A

Stenting
Radiotherapy and dexamethasone to shrink cancer
Pleuroadhesis - reduce pleural space to reduce risk of the pleural effusion
chest physio and breathing exercises

115
Q

What is mesothelioma?

A

tumour of the mesothelial cell of the lung

116
Q

Where do mesothelioma occur?

A

Peritoneum, pericardium, testes, abdo organs

117
Q

What are the signs and symptoms of mesothelioma?

A 
Chest pain - progressive, pleuritic, dull and diffuse
dyspnoea and cough
weight loss and anorexia
pleural effusion 
haemoptysis
118
Q

What are the investigations for suspected for mesothelioma?

A

CXR and CT - pleural mass or masses, pleural effusion, damage to the rib cage, lymphadenopathy and sign of asbestos exposure
PET - pick up mets
USS guided biopsy

119
Q

What are the treatment options of mesothelioma?

A

Surgery - debulking to remove most in pallative
Chemo- cisplatin
Radiotherapy- pain control in large tumours

120
Q

What is atopic triad?

A

asthma, atopic dermatitis and allergic rhinits

121
Q

What is the pathophysiology of asthma?

A

Airway damage which leads to shedding and subepithlelial fibrosis with BM thickening
Inflammatory reaction characterised by eosinophils, T lymphocytes and mast cells
Cytokines increase inflammatory response
Increase number of mucus secreting goblet cells and smooth muscle hyperplasia and hypertrophy

122
Q

What are the signs and symptoms of asthma?

A

Cough with diurnal variation- cough at night indicates poor control
Polyphonic wheeze
SOB triggered by stimuli

123
Q

What are some of the trigger for asthma?

A

NSAIDs, B blockers, cold weather, exercise, stress allergens and smoking

124
Q

What are the differentials for a wheeze?

A

Bronchitis, pulmonary oedema, FB, allergic reaction, GORD, COPD. vocal cord dysfunction

125
Q

How is the diagnosis of asthma made?

A 
Reduced FEV 1:FVC ratio and reduced peak expiratory flow
FEV1 will increase after salbutamol
Bronchoalevolar challenge 
induced sputum - eosinophillia
Skin prick test for atopy
Total IgE 
FENO
126
Q

What is the management of occupational asthma?

A

Serial measurement of PEF recommendation at work and at home
Refer to specialist

127
Q

What are the features of well controlled asthma?

A 
No exaccerbations 
No PRN salbutamol
No night waking 
<20% dirunal variation
normal lung fucntion
128
Q

What is the management of asthma?

A

1 - SABA
2 - SABA and ICS
3- SABA, ICS and montelukast
4- Add LABA

129
Q

What are the differentials of eosinophilia?

A 
Parasite infection
Atopy
SLE
lymphoma 
vasculitis
130
Q

How should asthma be managaed?

A

Every patient should have a care management plan and a PEFR
Quit smoking
Avoid allergens
Weight reduction
Taught about inhaler technique and compliance

131
Q

What are the features of a mild asthma attack?

A

No features of a severe asthma attack

PEFR >75%

132
Q

What are the features of a moderate asthma attack?

A

No features of a severe asthma attack

PEFR 50-75%

133
Q

What are the features of a severe asthma attack?

A

PEFR 33-50%
cannot complete a sentence in one breath
HR >110
RR>25

134
Q

What are the features of a life threatening asthma attack?

A

PEFR <33%
sats <92% or ABG <8kPa
Cyanosis, poor resp effort, near or fully silent chest
Exhaustion, confusion, hypotension and arrhthymia
Normal PCO2

135
Q

What are the features of near fatal asthma attack?

A

Rising CO2

136
Q

What is the management of asthma attacks?

A

A to E
Aim for SpO2 94-98% - titrate to needs
5mg neb salbutamol - can be done back to back but be warry of increased HR
40mg prednisolone PO or 100mg Hydrocortisone

IF SEVERE
- neb iatropium bromide

IF LIFE THREATENING OR NEAR FATAL

  • Urgent ITU referral
  • Portalable CXR
  • consider aminophylline
137
Q

What are the features for safe discharge after exacerbation?

A 
PEFR >75%
stopped nebs and on TTO for 24 hours 
in patient review by asthma nurse 
PROVIDE
PEFR meter and written asthma plan
at lead 5 days oral prednisolone 
GP follow up within 2 days 
Resp clinic follow up within 4 weeks
138
Q

What is the bacteria causing Tb?

A

Mycobacterium Tuberculosis

139
Q

What are the signs and symptoms of TB?

A 
Pleuritic chest pain
SOB
Coughing - yellow/green sputum
WL
fever, malaise and night sweats
140
Q

What are the non resp symptoms of TB?

A

Erythema nodosum
Lymphadenopathy
Meningitis
Pericardial effusion

141
Q

How does military Tb spread?

A

Through the pulmonary venous system

142
Q

What are the investigations for suspected TB?

A

CXR - areas of consolidation and cavitation
Blood tests - test for HIV
Sputum samples - 3 should be done ideally from morning samples - culture for acid fast bacteria

143
Q

What is the management of TB?

A

Patient should be quarantined
If unsure treat as pnuemonia until proven otherwise
If suspicious start RIPE treatment - need visual acuity, LFTs and consider directly observed therapy
> Pyridoxine as prophylaxis against peripheral neuropathy

144
Q

What is OSA?

A

Muscles relax when sleeping and if patients have excess weight on their neck then their airway will collapse which are terminated by partial arousal

145
Q

What are the risk factors for OSA?

A

Increasing age, neuromuscular disease and use of sedatives

146
Q

What are the signs and symptoms of OSA?

A

Snoring
Waking in the night
nocturia
excessive day time sleepiness - Epworth scale

147
Q

How is OSA diagnosed?

A

Sleep studies - overnight pulse oximetry
Limited sleep studies - monitor movement, snoring, O2 sats, heart rate, abdo and chest movement and limb movement
Polysomnography - EEG and EMG to limited sleep study

148
Q

What is the treatment of OSA?

A

Treatment based on symptoms and QoL rather than investigations
Lifestyle - decreased weight, sleep on side and avoid sedatives
Monitor BP
Treat snoring with mandibular advancement devices
Significant - consider CPAP

149
Q

What is the difference between the 2 types of resp failure?

A

Type 1 - low O2 only

Type 2 - Low O2 and high CO2

150
Q

What are some causes of type 1 resp failure?

A

Pneumonia, PE, pulmonary oedema, asthma, ARDS

Treat with CPAP

151
Q

What are some causes of type 2 resp failure?

A

Sedative drugs, flail chest, end stage pulmonary fibrosis

treat with NIV

152
Q

What is the pathophysiology behind anaphylaxis?

A

IgE binds to antigen which leads to mast cell and basophil increased leading to increased histamine release and body response

153
Q

What are the signs and symptoms of anaphylaxis?

A

itching, urticaria and angioedema, hoarseness, progressive stridor and bronchial obstruction, monophonic wheeze, chest tightness from bronchospasm

154
Q

What is the management of an anaphylaxis?

A

Remove trigger and maintain airway - 100% sats
IM adrenaline - 1:1000 0.5 grams - can be repeated every 5 minutes
200mg hydrocortisone
10mg IV chlorphenamine

give salbutamol to control bronchospams

Respiratory (1 decks)

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