lungs

Question 1

nebuliser vs inhaler

Answer 1

inhaler - hand held usually with a spcer

nebs- a machine that attached to a mask that turns liquid into a mist , usually in more sever condtions and in hospitals but some people can have nebs at home

Question 2

COPD exacerbation what to give

Answer 2

1. oxygen (need to check if they are a retainer or not because not all copd patients are retainers)
2. bronchodilators (salbutomol/ipatrorpium)
3. steroids

Question 3

why is PE so hard to diagnose

Answer 3

can give a normal chest x ray

Question 4

PERC SCORE

Answer 4

used to rule out PE definitvely

basically its if you really doubt a PE but you really want to make sure. as long as its zero, it means very low PE chance no need to do anythign. but if even one postive do a dimer

age >50
sats on room air <95
tachy >100
unilateral leg swelling
hempomptysos
hormone oestrogen use (not progesterone)
prior dvt or pe

Question 5

what do you ALWAY ASK IN PATIENT IF SUSPECT PE

Answer 5

S.O.B
CHEST PAIN
INSPIRATORY PAIN
HEMOMPTYSIS!!!!

Question 6

wells score interpatation

Answer 6

> 4 PE is likely order imaging
<4 PE is unlikely but do a d dimer to rule out

Question 7

CI to ct Pa

Answer 7

contrast allergy

Question 8

PERC VS WELLS

Answer 8

WELLS very high suspiciosn
PERC - very low

Question 9

antibiotics given in pneumonia (just goofgle|)

Answer 9

usually would be amox but if allergic then move to macrolides like clarithromycin OR

doxycycline

Question 10

Peak flow what is it and why

Vs spirometer

Answer 10

A device used to see how much air you can forcibly exhale from your lungs in 2 seconds

Take a deep breath in and then forcibly exhale for 2 seconds

We use it to diagnose asthma? but also to monitor as you do it regularly to see if getting better or worse

Spirometer is more reliable
More expensive

You generally do a peak flow first then spirometery confirms

Question 11

What does an ABG show you and why would you perform it

Answer 11

Shows you if patient is hypoxic
Gives you lactation
Gives you bircarb and co2 levels

Perform it if a person looks clinically unwell or is respiratory conditions and also kidney conditions but also others like heart failure etc

Question 12

ways to diagnose

Answer 12

FeNo
eosiniphilia
spiromeery

Question 13

meds you should be wary of in astham

Answer 13

BB
NSAIDS

Question 14

Definition astha

Answer 14

acute inflammation of airways, that is reversible cause bronchial hyperreactivity with mucouse secretion

Question 15

will you airways be the same after years of astham

Answer 15

no due to the chronic inflammation there will be remodeling

Question 16

RF ASTHAM

Answer 16

ATOPY-exzema, rhnitis
FH
premature
Respiratory infections in infancy
Prematurity and low birth weight
Obesity

Question 17

symptoms asthma

Answer 17

chets pain
dyspnea
wheezing
cough

Question 18

why is asthma worse at night

Answer 18

beacsue you are sleeping on you rback so more tagantion but we dont know really the reason why

Question 19

if you suspect asthma what would you start of with

Answer 19

FEno or eosiniphils level

then spriomteryr with revrsibility test

direct bronhcical challenge

note that all these tests can be falsley negative in paitents treated with inhaled CS

Question 20

INVESTIGATIONS FOR ASTHMA ATTACK

Answer 20

ABG - to see hypoxia and co2 levels
x ray - want to see if any trigger for the attack or any complication such as pneumothorax

Question 21

what should the co2 level be in asthma

Answer 21

low due to hyperventilation but if its high it means near fatal

Question 22

management of asthma attack

Answer 22

salbuotmol nebulized if that does not work or its a sever attack you can addyo on to ipratropium (anitcholinergic)

Give prednisolone 40-50mg orally, or IV hydrocortisone if the patient is unable to swallow

Can consider IV magnesium sulphate and/or aminophylline if the patient is not responding to nebulisers

If the patient continues to deteriorate despite maximal therapy, they may require intubation and ventilation in an intensive care setting (for example in cases of severe hypoxia or exhaustion)

Question 23

effect of adrenaline on airways

Answer 23

dilates

Question 24

nomral technique for inhaler at home

Answer 24

take 1 puff every 30/60 secnds upo to 10 puffs if not better ambulance

Question 25

Bad signs of asthma

Answer 25

bradycardia

bradypnea
hypotensive

hypercapnea
silent chest

Question 26

normal sp02

Answer 26

94-98%

Question 27

Remember, a ‘normal’ PaCO2 in an asthma exacerbation is not reassuring. A normal or raised PaCO2 is significantly concerning as this indicates that the patient is becoming tired and is failing to ventilate effectively. These patients need urgent discussion with a senior clinician and critical care.

Question 28

doses of cs to give in astham

Answer 28

40/50 mg pred
iv hydrocortison - 100mg

Continue prednisolone 40-50mg daily for at least five days after the exacerbation or until recovery.

Question 29

when would we consider giving mg so4

Answer 29

Consider giving a single dose of IV magnesium sulphate (1.2-2g infusion) to patients with:

Acute severe asthma who have not had a good initial response to inhaled bronchodilator therapy
Life-threatening or near-fatal asthma
Magnesium sulphate should only be used following consultation with a senior clinician.

Question 30

when to give aminothyilline

Answer 30

should only be given by a senior clinician

Question 31

in terms of giving fluids whats the limit

Answer 31

can give up to 4 times boluse (which adds up to 2000 in nomral patients of 1000 in heart failure/kidney failure

Question 32

Investigations