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MEDICINE FINALS > RESP > Flashcards

RESP Flashcards

1
Q

What is asthma?

A

Chronic, inflammatory disease of airways causing reversible airflow obstruction, bronchospasm and excessive secretions

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2
Q

Name 5 possible triggers of asthma

A
  1. allergens e.g. house dust mite
  2. viral infections
  3. cold air
  4. drugs e.g. NSAIDs, beta blockers, aspirin
  5. exercise
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3
Q

Give 4 core symptoms of asthma

A
  1. wheeze
  2. chest tightness
  3. shortness of breath
  4. cough (nocturnal)
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4
Q

What would you expect to hear on auscultation in asthma

A

widespread, polyphonic expiratory wheeze

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5
Q

How is asthma diagnosed?

A

Diagnosis is ultimately clinical - presence of symptoms PLUS variable airflow obstruction

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6
Q

If someone had convincing clinical signs of asthma, how would you investigate them?

A
  1. trial of treatment
  2. assess response and perform spirometry
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7
Q

If a pt has convincing clinical signs of asthma but a poor response to trial of treatment, how would you continue to investigate them?

A
  1. spirometry AND bronchodilator reversibility
  2. PEF monitoring/FeNO test
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8
Q

What spirometry results would you expect in someone with asthma?

A

FEV1/FVC ratio <70%
(with bronchodilator reversibility, change of > 12% diagnostic)

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9
Q

What are you looking for on Peak flow readings with asthmatic patients?

A
  1. diurnal variation (worse in mornings - typically >20% difference)
  2. Increase in function once treatment starts
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10
Q

What lifestyle advice would you give to an asthmatic patient?

A

TAME
Technique for inhaler use
Avoidance (allergens, quit smoking, lose weight)
Monitor (peak flow)
Educate (specialist resp nurse)

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11
Q

What questions might you ask at an asthma review? (3)

A
  1. difficulty sleeping because of symptoms/cough?
  2. any asthma symptoms during day?
  3. asthma interfered with usual activities?
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12
Q

What does well-controlled asthma look like? (6)

A
  1. no daytime symptoms
  2. no night time awakening from asthma
  3. no need for rescue meds (blue inhaler)
  4. no limitations on activity
  5. normal lung function ( PEF >80% predicted)
  6. minimal side effect from meds
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13
Q

What is good inhaler technique?

A
  1. if inhaler hasn’t been used for >5 days then test the device before using
  2. check dose counter AND expiry date to see if it is running low
  3. hold inhaler upright, remove cap and check nothing is stuck in mouthpiece
  4. shake inhaler well
  5. sit up straight and tilt chin up
  6. breathe out gently and slowly away from inhaler until lungs feel empty
  7. put lips around inhaler to form tight seal
  8. breathe in slowly and steadily whilst pressing the canister once
  9. remove inhaler from mouth and seal lips
  10. hold breath for 10 secs
  11. breathe out gently, away from inhaler
  12. wait 30 secs before next puff
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14
Q

Define bronchiectasis.

A

Irreversible and abnormal dilation of the bronchi with chronic inflammatory and fibrotic changes.

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15
Q

Describe the pathogenesis of bronchiectasis.

A

Failed mucocilliary clearance and impaired immune function mean that a microbe can easily invade and cause infection. This leads to inflammation and therefore progressive lung damage. Bronchitis -> bronchiectasis -> fibrosis.

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16
Q

What can cause bronchiectasis? (3)

A
  1. Often post-infective e.g. previous pneumonia, TB or whooping cough infection.
  2. Congenital causes e.g. primary ciliary dyskinesia.
  3. 50% idiopathic.
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17
Q

Which bacteria might cause bronchiectasis? (3)

A
  1. Haemophilus influenzae.
  2. Pseudomonas aeruginosa.
  3. Staphylococcus aureus.
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18
Q

Give 6 symptoms of bronchiectasis.

A
  1. Chronic productive cough.
  2. Recurrent chest infections.
  3. Dyspnoea and wheeze.
  4. Recurrent exacerbations.
  5. Chest pain.
  6. Haemoptysis.
19
Q

What investigations might you do on someone to determine whether they have bronchiectasis?

A

High resolution CT scan.
Spirometry - would be obstructive.
Sputum culture.
CXR.

20
Q

What is the treatment/management for bronchiectasis?

A
  1. Education/Smoking cessation.
  2. Annual influenza and pneumococcal vaccinations.
  3. Improved mucus clearance e.g. physiotherapy.
21
Q

Describe the pathogenesis of cystic fibrosis.

A

There is a defect in chromosome 7 coding CFTR protein. Cl- transport is affected and there is production of thickened mucus secretions.

22
Q

How is cystic fibrosis passed on?

A

It is an autosomal recessive condition.

1 in 25 people are carriers.

23
Q

Give 6 potential complications of CF

A
  • Malnutrition due to malabsorption.
  • Respiratory failure and cor pulmonale.
  • Weight loss and growth retardation.
  • Infertility, very common in males due to defect in vas deferens.
  • Nasal polyps.
  • Diabetes mellitus due to pancreatic insufficiency.
  • Delayed puberty.
  • Sinusitis.
  • Breathlessness
  • Finger clubbing.
  • Frequent respiratory infections (-> bronchiectasis).
24
Q

What is the management of CF?

A
  • chest physio
  • exercise
  • high calorie diet
  • CREON tablets
  • prophylactic flucloxacillin
  • bronchodilators
  • nebulised DNase
  • nebulised hypertonic saline
  • vaccines
25
Q

Which organisms commonly colonise in people with CF? How are these prevented?

A
  • staph aureus
  • pseudomonas aeruginosa

Take long term prophylactic fluclox

26
Q

How is CF diagnosed? (3)

A
  1. newborn blood spot testing
  2. sweat test (GOLD STANDARD)
  3. genetic testing for CFTR gene (during pregnancy or in blood after birth)
27
Q

How might CF present in children?

A

Meconium ileus (pathognomonic)

  • recurrent LRTI
  • failure to thrive
  • pancreatitis
  • steatorrhea
  • finger clubbing
28
Q

What is the treatment for someone with mild pneumonia (a CURB65 score of 0-1)?

A

PO amoxicillin.

29
Q

What is the treatment for someone with moderate pneumonia (a CURB65 score of 2)?

A

PO amoxicillin and clarithromyocin.

30
Q

Where should someone with moderate pneumonia (a CURB65 score of 2) be treated?

A

In hospital.

31
Q

TB disease: Where in the lung is a granuloma cavity most likely to develop?

A

Most likely to develop in the apex of the lung as there is more air and less blood supply/immune cells.

31
Q

TB disease: Where in the lung is a granuloma cavity most likely to develop?

A

Most likely to develop in the apex of the lung as there is more air and less blood supply/immune cells.

32
Q

Presentation of TB: what systemic symptoms might you see?

A

Weight loss.
Night sweats.
Anorexia.
Malaise.

33
Q

Presentation of TB: what pulmonary TB symptoms might you see?

A

Cough.
Chest pain.
Breathlessness.
Haemoptysis.

34
Q

Describe mycobacterium tuberculosis

A
  • rod shaped, waxy coat (acid-fast bacilli)
  • stain RED on Ziehl-Neelsen staining
35
Q

What is the disease course for TB?

A

Active TB
Latent TB - immune system has encapsulated infection
Secondary TB - reactivation of disease
Miliary TB - dissemniated, severe disease

36
Q

How can you prevent TB?

A

BCG vaccine
- need mantoux test first to check for latent TB

37
Q

What drugs are given in the treatment of TB?

A

Rifampicin (6 months).
Isoniazid (6 months).
Pyrazinamide (2 months).
Ethambutol (2 months).

38
Q

Give a potential side effect of Ethambutol.

A

Optic neuritis.
(eye thambutol)

39
Q

Give a potential side effects of Isoniazid.

A

peripheral neuropathy (im so numb a zid)

40
Q

Give a potential side effects of Rifampicin.

A

red urine

41
Q

Give a potential side effects of Pyrazinamide.

A

hyperuricaemia -> gout

pyramids = old
old = henry VII
henry ViiI = GOUT

42
Q

How do you treat a PE?

A

DOAC for at least 3 months
- 6m if unprovoked

MEDICINE FINALS (19 decks)

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