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 asthma

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 ~ not first line usually done when those above have not given a conclusive answer

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

what are rhonchi examples

Answer 32

mucous in the airways, heard best centrally rather than peripherally as its usually the larger airways affected.

any condition with secretions in the lungs copd
bronchiactasis
pneumonia
CF

Question 33

rhocnhi and coughing

Answer 33

can be cleared if cough as its mucous

Question 34

monophonci vs polyphonic wheeze

Answer 34

one airway vs multiple airways (asthma /COPD)

Question 35

veiscular breathing

Answer 35

normal
no pause between

inspiration longer than expiration and louder

expiration quieter (because its passive)

Question 36

what transmits sounds better

Answer 36

solids and fluids increases transmission

Question 37

are crackles affected by coughin

Answer 37

depends on the cause
e.g if due to secretions then if you cough it can clear the crackles or they improve! as youve mobilised the mucous

but if its edema - the fluid has no where to go

Question 38

kussmaul breathing

Answer 38

associated with metabolic acidosis hence DKA,
BODY IS TRYING TO COMPENSATE BY REPSIRATORY ALKOSLOSIS TO BLOW OF THAT EXCESS CO2 BY A DEEP LABOURED BREATHING

Question 39

PHYSIOLOGY OF BREATHING IN MEATBOLIC ACIDOSS

Answer 39

initially the body hyperventilates shallow and quick to get rid of the co2 but this cant be maintained and eventually breathing becomes slower and deeper. this is what we call kussmaul.