Resp 2 Flashcards
How does Asthma typically present?
Younger person
Cough, SOB, wheeze
Time dependent
FHx, Hx of atopy
Recurrent Episodes
How would you diagnose Asthma?
FEV1:FVC Ratio <70% with 12% reversibility post-bronchodilator spirometry
PEFR variation
Bloods
How would you treat chronic Asthma?
1) SABA (Salbutamol)
2) SABA + ICS (Beclometasone)
3) SABA + ICS + Leukotriene Receptor Antagonist (Montelukast)
4) LABA + ICS (Symbicort = Budeosine + Formoterol) + LTRA
5) LABA + More ICS + LTRA
6) Trial Medicines
7) Oral CS (Prednisolone)
How do you determine the severity of an acute asthma attack?
Measure PEF
50-75% = Moderate
33-50% = Acute-Severe
Life Threatening = <33%
Hypercapnia = Near fatal
What % should you aim to maintain sats at during an Acute Asthma Attack?
94-98%
How should you manage a patient experiencing an Acute Asthma Attack?
O2
Nebulised SABA (+Ipratropium in severe case)
Oral Prednisolone/IV Hydrocortisone
IV Magnesium Sulphate + Senior help
IV Aminophylline
ITU + Intubation
How do typical COPD patients present?
SOB
Productive Cough
Some Wheeze
Long-term smoker
Older
What would you look for on examination of a potential COPD patient?
Tar Staining, Cyanosis, Barrel Chest
Reduced expansion + Hyper-resonance
Wheezing, Coarse crackles
Signs of RHF
How would you diagnose someone with COPD?
Post-bronchodilator FEV1/FVC < 0.7
Severity depends on FEV1%
>80% = Mild
50-79% = Moderate
30-49% = Severe
<30% = Very Severe
How would you investigate a suspected case of COPD?
Spirometry
Bloods, ABG
CXR
How would you manage a patient with COPD?
Mild - SABA
Moderate - SABA + LABA
or SAMA (muscarinic) + LAMA
Severe - LABA + LAMA
or LABA + ICS
Very Severe - LAMA + LABA + ICS
Describe the long-term therapy guidelines in patients with COPD.
Smoking Cessation, Influenza Vaccinations and Pneumococcal Vaccination
Long term O2 therapy
Lung Volume reduction surgery
When would you prescribe a COPD patient long term O2 therapy?
PO2 < 7.3 kPa
or
PO2 of 7.3kPa - 8kPa +
Secondary Polycythaemia
Nocturnal Hypoxaemia
Peripheral Oedema
Pulmonary Hypertension
How would you manage an infective exacerbation of COPD?
24% O2 - Blue venturi mask
Neb. Salbutamol + Ipratropium Bromide w/ IV/Oral steroids
IV Amoxicillin
IV Aminophylline
BiPAP (for T2 Resp. Failure)
What is Interstitial Lung Disease?
Umbrella term for conditions causing Pulmonary Fibrosis.
This scarring causes stiffness, which restrict breathing.
Diseases include:
Idiopathic Pulmonary Fibrosis
Hypersensitivity Pneumonitis
Sarcoidosis
Pneumoconiosis
How would a typical Idiopathic Pulmonary Fibrosis patient present?
SOB on exertion, dry cough, no wheeze
Smoker, exposed to animal/vegetable dusts.
Occupational exposure to metals/wood
Drugs
Which drugs may cause Idiopathic Pulmonary Fibrosis in patients?
Bleomycin
Methotrexate
Amiodarone
What are the signs of Idiopathic Pulmonary Fibrosis on examination?
Clubbing
Bi-basal, fine, insipratory crepitations
Signs of RHF
How would you investigate a suspected case of Idiopathic Pulmonary Fibrosis?
Bloods, ABG, Biopsy
CXR - ground-glass, reticulonodular, cor pulmonale, honeycombing
High resolution CT - ground Glass appearance
Lung function tests (restrictive pattern)
How would a typical Hypersensitivity Pneumonititis patient present?
SOB on exertion, Fever, Dry Cough
Have pets
Occupations:
Pick Mushrooms
Bird-Keeper
Farmer
Plumber
Malt-Worker
What would you see on examination of a patient with Hypersensitivity Pneumonitis?
Clubbing (rare)
Mild Pyrexia
Bi-basal, fine, inspiratory crepitations
How would you investigate a suspected case of Hypersensitivity Pneumonitis?
Bloods, ABG
CXR (May be normal)
CT - Ground Glass
LFTs
Broncho-alveolar lavage
How would a patient with Pneumoconiosis typically present?
SOB, dry cough
Coal-worker/Builder
Long Latency
Asymptomatic
Asbestos exposure may lead to both Asbestosis (a form of pneumoconiosis) and mesothelioma
How would investigate someone with possible Pneumoconiosis?
CXR - Simple = Micro-nodular mottling
Complex = Bilateral lower zone reticulonodular shadowing and pleural plaques.
CT - Fibrotic changes
LFTs
Define Sleep Apnoea.
Recurrent collapse of pharyngeal airway and apnoea during sleep, followed by arousal from sleep.
How would a patient with Sleep Apnoea typically present?
Chronic fatigue, unrefreshed after sleep, snoring
Obese smoker who drinks.
Fatigued truck driver
May have Marfan’s, enlarged tonsils or macroglossia.
How would you investigate a possible case of Sleep Apnoea?
Sleep Study
TFTs
