resp Flashcards
Classification / severity scale of asthma
- Mild / Moderate
- Severe
- Life threatening
4 immediate management options for severe asthma exacerbation in young adult
- Salbutamol MDI via spacer 12 puffs
- Ipratropium MDI via spacer 8 puffs
- Prednisolone PO 1mg / kg
- Supplemental oxygen to titrate saturations 92-94%
Mx pertussis
- Notify the case to the department of health
- Tx with Azithromycin 500mg on day 1 followed by 250mg daily days 2-5
- Immunise with dTpa vaccination
- Tx all household members
- Keep home until completed 5 days abx
- Vaccinate all household contacts who have not had dTpa booster within last 10 years
Hx questions for cough
- Preceding URTI
- Paroxysmal cough
- Post-tussive vomiting
- Onset of cough - gradual vs sudden
- Exposure to contacts with similar sx
- Recent overseas travel
- FMHx asthma or atopy
- Wheeze / stridor
- Nocturnal cough
- Possibility of FB inhalation
- Fever / rash / systemic sx
Mx acute rhinosinusitis
- Regular simple analgesia - Panadol / Nurofen
- Saline nasal irrigation
- Intranasal corticosteroid spray Nasonex
- Intranasal ipratropium
- Intranasal decongestant for max 3-5 days
Mx acute bacterial sinusitis
Self limiting condition
Supportive care
Abx rarely make a difference to recovery time
Shared discussion with pt
- Amoxicillin 500mg TDS for 5 days
Optimisation of lung function in bronchiectasis
- Early tx of infective exacerbation with abx
- Immunisation - influenza / pneumococcal
- Minimise exposure to cases of resp infections
- Pulmonary rehab
- Regular 30 minutes exercise / daily
- Improving mucous clearance with chest physio
Obstructive spirometry pattern
Reduced FEV1
FEV1/FVC below predicted range
Restrictive spirometry pattern
Reduced FEV1
FEV1/FVC normal or increased
Sarcoidosis features on physical examination
- Erythema nodosum
- Peripheral lymphadenopathy
- Acute polyarthritis / migratory polyarthritis
- Uveitis
- Splenic enlargement
- Parotid gland swelling
- Hepatomegaly
- Heart failure
- Sinusitis
Classic CXR finding for sarcoidosis
Bilateral hilar lymphadenopathy
DDx for restrictive lung disease
- Asbestosis
- Bronchitis
- Coal worker’s pneumoconiosis
- Hypersensitivity pneumonitis
- Idiopathic pulmonary fibrosis
- Lymphocytic interstitial pneumonia
- Obesity
Physical examination findings for restrictive lung disease
- Crackles or velcro rales
2. Clubbing of digits
Contraindications to spirometry
- Haemoptysis of unknown cause
- Bronchodilator use prior to assessment
- Pneumothorax
- Unstable angina
- Recent MI
- Recent eye surgery
- Active TB
Other than CXR, 2 investigations to confirm dx of TB
- Sputum culture or PCR for mycobacterium tuberculosis
2. Sputum acid-fast bacilli smear
What are the 4 questions used to assess asthma control level?
- Daytime symptoms
- Need for SABA reliever
- Any limitation of activity
- Symptoms during night or on waking
Reasons for poor response to asthma medication / mx
- Correct inhaler technique
- Is the current tx appropriate
- Is there a written Asthma Action Plan that the patient is able to appropriately follow?
- Are the symptoms due to ashtma?
- Is the person exposed to unidentified triggers?
Other than medication adjustment, long term mx features to improve asthma control
- Assure proper inhaler technique
- Avoid exposure to triggers
- Maintain optimal body weight
- Regular exercise, 30 minutes daily
- Regular review to assess control and perform spirometry
- Keep diary of PEFR
- Encourage compliance with medications
- Annual influenza immunisation
- Prepare Asthma Action Plan
Physical examination findings to assess level of asthma severity
- Ability to speak full sentences
- Conscious state
- Use of accessory muscles of respiration
- Oxygen saturations
- Cyanosis
- Absence of breath sounds on auscultation
- HR
Immediate steps in asthma mx
- Salbutamol MDI with spacer 6-12 puffs
- Ipratropium MDI with spacer 4 puffs
- Prednisolone 1mg/kg daily
- Supplemental oxygen to maintain sats >94%
- IV access
- Sit upright
Features in hx that would prompt you to prescribe a preventer to manage asthma
- episode of life threatening asthma requiring hospitalisation or ICU
- more than 2 ED presentations due to asthma
- requiring oral steroid > twice for control
- flare up of asthma more than once / 6 weeks
- night symptoms > twice / month
- asthma symptoms disrupting activity
- asthma symptoms disrupting sleep