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Respiratory System > Obstructive Diseases > Flashcards

Obstructive Diseases Flashcards

1
Q

risk factors of COPD

A

tobacco smoking
occupational exposure to noxious particles
alpha-1-antitrypsin deficiency
MH of asthma/recurrent infection in childhood

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2
Q

symptoms of COPD

A

chronic productive cough
dyspnoea
wheeze
reduced exercise tolerance

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3
Q

signs of COPD

A

cyanosis
hyperinflation of chest - Barrel appearance
use of accessory muscles
purse lips during breathing

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4
Q

differentials of COPD

A

asthma
bronchitis
cor pulmonale
congestive heart failure

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5
Q

definition of COPD

A

an irreversible obstruction of airways that comprises of both chronic bronchitis and emphysema

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6
Q

gold standard investigation of COPD

A

spirometry

  • shows FEV1:FVC <0.7
  • no improvement with SABA
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7
Q

additional investigations of COPD

A

bloods - FBC, U+E, CRP and serum alpha-1 antitrypsin
sputum cultures
CXR and CT thorax
ECG

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8
Q

conservative management of COPD

A

smoking cessation
annual influenza vaccinations
pulmonary rehabilitation

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9
Q

long-term medical management of COPD

A

step 1: SABA or SAMA
step 2: if no asthma or steroid responsiveness = LABA/LAMA or if have asthmatic/steroid response, LABA and ICS
step 3: LAMA, LABA and ICS
step 4: refer to specialist

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10
Q

additional medical management of COPD

A

nebulisers
long-term oxygen therapy
oral theophylline

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11
Q

management of COPD exacerbations (if can remain home)

A

ICS with prednisolone

if have signs of infection, antibiotics

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12
Q

management of acute COPD exacerbations

A 
carry out CXR and ECG
bloods - FBC, U+E, ABG 
sputum cultures 
maintain O2 sats (88-92%)
provide nebulised bronchodilators 
oral and IV steroids
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13
Q

management if not responding to 1st line hospital treatment

A

IV aminophylline
non-invasive ventilation
referral to HDU/ICU

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14
Q

define asthma

A

a paroxysmal and reversible obstruction of the trachea and bronchi that occurs due to increased responsiveness of airways to induce narrowing

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15
Q

describe asthma pathophysiology

A

disease of the lung airways mediated by immune system, triggering inflammation, bronchospasms and excessive mucous secretion

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16
Q

risk factors of asthma

A 
familial history of asthma 
maternal smoking in pregnancy
occupational hazards
poor diet 
obesity
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17
Q

symptoms of asthma

A 
wheeze
dyspnoea 
nocturnal cough
chest tightness 
symptoms worse in morning/night
FH or MH of atopy
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18
Q

signs of asthma

A 
tachypnoea 
hyperinflated chest
hyper-resonance on chest percussion
decreased air entry
wheeze on auscultation
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19
Q

signs of severe asthma attack

A

inability to speak in complete sentences
respiratory rate >25
peak flow 33-50%

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20
Q

sings of life threatening asthma attack

A 
silent chest
confusion 
bradycardia 
cyanosis
exhaustion
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21
Q

investigations in chronic asthma

A

peak flow

spirometry - FEV1/FVC < 0.7 that improves with use of SABA

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22
Q

investigations in acute asthma

A

ABG - check for respiratory failure
routine bloods - FBC and CRP to check for infection
CXR

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23
Q

management of acute asthma attack

A 
ensure patent airway
ensure O2 sats 94-98%
salbutamol and ipratropium nebulisers
oral prednisolone or IV hydrocortisone if severe
IV MgSO4 (if severe)
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24
Q

if no response to nebulisers in acute asthma attack, what are next steps?

A

IV aminophylline
ICU admission
invasive ventilation

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25
Q

conservative management in chronic asthma

A

smoking cessation
avoid precipitating factors
review inhaler technique

26
Q

pharmacological management of chronic asthma

A

step 1: SABA
step 2: SABA and ICS
step 3: either LABA or increased ICS dose
step 4: oral leukotriene receptor antagonists, high-dose ICS and SABA/LABA

27
Q

differentials of asthma

A 
GORD
ABPA
bronchiectasis
heart failure 
malignancy
28
Q

risk factors of paediatric asthma

A 
premature birth
low birth weight
FH of asthma/atopic disease
exposure to tobacco smoking
maternal smoking
respiratory infection
29
Q

clinical features of asthma in children

A

wheeze
shortness of breath (dyspnoea)
cough (dry and brought on by exercise)

30
Q

differential diagnosis of paediatric asthma

A 
cystic fibrosis
TB
foreign body aspiration
pertussis
bronchitis
31
Q

investigations in paediatric asthma

A

peak expiratory flow
spirometry
- FEV1 must improve >14% with use of ICS to indicate asthma

32
Q

conservative management of paediatric asthma

A

recommend adults in living environment cease smoking
identify and reduce exposure to environmental triggers
promote and advise healthy and active lifestyle

33
Q

when are medical interventions considered in paediatric asthma

A

when symptoms causing significant impact on QoL

34
Q

medical management of paediatric asthma

A

step 1: SABA
step 2: SABA + low dose ICS
step 3: SABA, ICS and LABA/LTRA
step 4: addition of theophylline

35
Q

when do you utilise LABA vs. LTRA in paediatric asthma

A

inhaled LABA in >5 year old

LTRA in < 5 years

36
Q

define obstructive sleep apnoea

A

occurs when there is intermittent closure and collapse of the upper airway, causing apnoeic episodes during sleep that cease with partial waking

37
Q

name the two categories of sleep obstructive apnoea

A

apnoea if intermittent collapse >10s

hypnoea if intermittent collapse <10s

38
Q

risk factors in obstructive sleep apnoea

A 
male sex
smoking 
obesity 
sedative drugs
FH of obstructive sleep apnoea
39
Q

clinical features of obstructive sleep apnoea

A 
excessive sleepiness in the daytime 
lack of concentration 
morning headaches
decreased libido 
restless/poor quality sleep
loud snoring
40
Q

differentials of obstructive sleep apnoea

A

depression
narcolepsy
excessive alcohol consumption
hyperthyroidism

41
Q

investigations of obstructive sleep apnoea

A

polysomnography (sleep study)
blood pressure
bloods - ABG and TFTs (exclude hyperthyroidism)
pulse oximetry during sleep
Epworth Questionnaire (if score >11 = abnormal)

42
Q

what are the requirements of diagnosis for obstructive sleep apnoea

A

> 5 episodes of waking respiratory events per hour of sleep

43
Q

conservative management of obstructive sleep apnoea

A

weight loss
education of patient and family on OSA
good sleep hygiene and lying on side
avoidance of stressful situations and triggers

44
Q

medical management of obstructive sleep apnoea

A

modafinil to aid excessive daytime sleepiness

continuous positive airway pressure (CPAP)

45
Q

requirements for surgery in obstructive sleep apnoea

A

failure of CPAP and oral appliances can indicate consideration of tonsillectomy or polypectomy

46
Q

common complications of obstructive sleep apnoea

A

risk of accidents due to ⬇️ concentration and ⬆️ sleepiness
hypertension
psychological consequences

47
Q

define cystic fibrosis

A

an autosomal recessive disorder that causes mutations within the CFTR gene on chromosome 7

48
Q

result of the CFTR gene mutation in cystic fibrosis

A

mutation causes dysfunction of the CFTR gene that reduces chlorine ion absorption, causing sweat to contain high sodium levels and increase viscosity of other secretions

49
Q

risk factors of cystic fibrosis

A

known carrier status of parents
FH of cystic fibrosis
caucasian descent

50
Q

clinical features of CF in neonates

A

failure to thrive
malabsorption
recurrent/persistent chest infections
rectal prolapse

51
Q

clinical features of CF in children

A 
cough, wheeze and haemoptysis 
bronchiectasis 
recurrent lower resp tract infections 
pancreatic insufficiency
distal intestinal obstruction
male infertility 
clubbing
osteoporosis
52
Q

differential diagnosis of CF

A

malignancy

53
Q

investigations of CF in neonates

A

heel prick (day 5-9)
sweat test - Na and CL >60mmol/L
faecal elastase
genetic screening

54
Q

investigations of CF in children

A

sputum culture/throat swab if have presentation of resp tract infection
spirometry
faecal fat and elastase test

55
Q

common blood tests carried out in CF

A

FBC, U+Es, LFTs, clotting, vitamin A,D+E and glucose tolerance

56
Q

imaging modalities used in CF

A

abdominal US - signs of liver cirrhosis, chornic pancreatitis or distal intestinal obstruction
CXR - hyperinflation and bronchiectasis

57
Q

conservative management of CF

A

education on condition and support groups
psychosocial, fertility and genetic counselling
dietician
chest physiotherapy
screening for complications

58
Q

medical management of CF

A 
GI insufficiency:
insulin replacement 
oral pancreatic enzyme (creon)
fat-soluble vitamin supplements 
ursodeoxycholic acid

respiratory infections:
antibiotics
nebulised mucolytics
bronchodilators

59
Q

management of advanced lung disease in CF

A

home oxygenation and CPAP
lung transplant
diuretics (signs of cor pulmonale)
postural drainage

60
Q

common complications of CF

A

diabetes development
liver disease
infections

Respiratory System (9 decks)

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