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Yr 3 MedEd > Resp 2: Chronic SOB > Flashcards

Resp 2: Chronic SOB Flashcards

1
Q

Give 5 features of an asthma history.

A
  • Recurrent episodes of cough, wheeze and SOB
  • Variation- worst in morning and evening
  • History of atopy, family history
  • Smoker
  • Occupation
  • Pets
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2
Q

Give 1 sign on general inspection of asthma.

What will be heard on chest auscultation in asthma.

A
  • General inspection may be normal, may be nasal polyposis

- Wheeze heard on auscultation

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3
Q

Give the 3 features of the diagnostic criteria for asthma.

A
  • FEV1:FVC ratio <70%
  • FEV1:FVC ratio is reversible, 12% pre- and post- bronchodilator spirometry.
  • PEFR varies by or increases by >20% for > 3days/ week over several weeks. Diagnosis can be aided by PEFR diary.
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4
Q

Give 3 things to check in asthma patient during GP visit

A
  • Inhaler technique
  • Inhaler adherence
  • Symptoms- adjust medication as needed
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5
Q

What are the 7 stages in asthma management?

A
  1. SABA
  2. SABA + low ICS
  3. SABA + low ICS + LTRA (leukotriene receptor antagonist)
  4. LABA+ low ICS (+ LTRA)
  5. LABA + moderate ICS (+ LTRA)
  6. Trial LMRA or Theophylline
  7. Oral CS
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6
Q

Give an example of the following:

  • SABA
  • ICS
  • LTRA
  • LABA+ ICS
  • Oral CS
A
  • SABA: Salbutamol
  • ICS: Beclometasone, Budesonide
  • LTRA: Montelukast
  • LABA + ICS (aka a MART): symbicort
  • Oral CS: prednisolone
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7
Q

Define asthma.

A
  • A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity
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8
Q

Define the following:

  • Moderate asthma
  • Acute-severe
  • Life threatening
  • Near fatal
A
  • Moderate: PEF 50-75%
  • Acute-sever: PEF 33-50%
  • Life threatening: PEF <33%
  • Near fatal: paCO2 raised
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9
Q

Give 5 investigations for a patient with acute asthma

A
  • Basic obs
  • Measure PEF
  • O2 sats and maintain SpO2 at 94- 98%
  • ABG: repeat if PaO2 less than 8kPa - unless SpO2 >92%.
  • Serum K+ and glucose
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10
Q

What are the 6 medical management steps for someone presenting with acute asthma?

A
  1. O2
  2. Neb. Salbutamol 5mg, Neb. Ipratropium Bromide 0.5mg- acute or life-threatenening.
  3. Oral prednisolone or IV Hydrocortisone
  4. IV magnesium sulphate and senior help.
  5. IV Aminophylline
  6. ITU + intubation
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11
Q

Give 3 presenting symptoms of COPD

Differentiate fine crackles and coarse crackles by sound

Give 3 general inspection signs of COPD

A
  • SOB
  • Productive cough
  • Some wheeze

Coarse: like rubbing hair between fingers: airway obstruction.
Fine: Snow-crunching sounds: air bubbling through exudate

  • Tar staining
  • Cyanosis
  • Barrel chest
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12
Q

Give the necessary FEV1/ FVC ratios and FEV1% needed to determine the following stages of COPD:

  • Mild
  • Moderate
  • Severe
  • Very severe
A

All have post-bronchodilator FEV1/FVC ratio <0.7

FEV1%

  • Mild >80%
  • Moderate 50-79%
  • Severe 30-49%
  • Very severe < 30%
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13
Q

What type of surgery shows increased survival in COPD patients.

A
  • Lung reduction surgery shows increased survival.
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14
Q

Give 5 investigations for COPD

A
  • Serial peak flow measurements: exclude asthma
  • Alpha-1 antitrypsin: if presenting with early onset, minimal smoking or family history
  • Transfer factor for carbon monoxide (TLCO): to investigate symptoms disproportionate to spirometric impairment.
  • CT thorax: also to assess suitability for surgery
  • ECG or Echocardiogram: to assess cardiac status if features of cor pulmonale
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15
Q

What are the appropriate medications for patients of the following COPD severities?
- Mild, moderate, severe, very severe

A
  1. SABA or SAMA
  2. SABA+LABA or SAMA+LAMA
  3. LABA+LAMA or LABA+ICS
  4. LAMA + LABA + ICS
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16
Q

Give examples of the following medications:

  • SABA
  • SAMA
  • LABA
  • LAMA
  • LABA+ICS
A
  • Salbutamol
  • Ipratropium bromide
  • Salmeterol
  • Tiotropium
  • Symbicort: Formoterol + budesonide
17
Q

Give two vaccinations suitable for general management of COPD.

A
  • Influenza, pneumococcal
18
Q

What are the guideline indications for O2 therapy in COPD?

A

pO2 < 7.3kPa or pO2 7.3-8kPa with one of

  • Secondary polycythaemia
  • Nocturnal hypoxaemia
  • Peripheral oedema
  • Pulmonary hypertension
19
Q

What are the 6 management steps for infective exacerbation of COPD.

A
  1. Blue Venturi 24% O2
  2. Neb. Salbutamol 5mg, Neb. Ipratropium bromide 0.5mg
  3. oral Prednisolone 40-50 mg or IV hydrocortisone 200mg
  4. IV amoxicillin
  5. 500mg IV Aminophylline
  6. BiPAP -
20
Q

Differentiate use of BiPAP and CPAP

A

CPAP: type 1 respiratory failure: continuous positive airway pressure, e.g. sleep apnoea.
BiPAP (bi-level PAP): type 2 respiratory failure e.g. COPD

21
Q

What is the definition of Interstitial lung disease?

Give 4 examples of interstitial lung diseases.

A
  • Term for group of disorders causing scarring (fibrosis) of the lungs. Scarring causes stiffness.
  • Idiopathic pulmonary fibrosis
  • Hypersensitivity pneumonitis/ extrinsic allergic alveolitis
  • Sarcoidosis
  • Pneumoconiosis
22
Q

Give 2 positive and 1 negative symptom of idiopathic ILD

A
  • SOB on exertion
  • Dry cough
  • No wheeze
23
Q

Give 3 drugs that cause ILD

A
  • bleomycin
  • Methotrexate
  • Amiodarone
24
Q

Give 1 general inspection and 1 auscultation finding in ILD.

What other finding may be present?

A
  • Clubbing
  • Bi-basal fine inspiratory crepitations

May also be signs of RHF

25
Q

What is the gold standard investigation for idiopathic ILD?
What is usually the most appropriate investigation for ILD?
What pattern will be seen in lung function tests?

A
  • Gold: biopsy, but not always appropriate.
  • High Resolution CT usually appropriate: shows ground-glass
  • Restrictive pattern in lung function test.
26
Q

Give 5 occupations causing hypersensitivity pneumonitis

A
  • Mushroom worker
  • Bird-keeper
  • Farmer
  • Plumber
  • Malt worker
27
Q

Give a sign of hypersensitivity pneumonitis on general inspection

A
  • mild pyrexia. Symptoms mimic atypical pneumonia
28
Q

Give 4 signs of ILD on chest x-ray

A
  • ground glass
  • reticulonodular shadowing
  • cor pulmonale
  • honeycombing
29
Q

What is the aetiology of pneumoconiosis?

A
  • Inhalation of dust particles- coal dust, silica, asbestos- (blue asbestos more toxic than white).
  • Causes large nodules of dust particles surrounded by collagen and dying macrophages.
30
Q

Give 3 ways dust particles cause damage in pneumoconiosis

A
  • Direct cytotoxicity of particles
  • particle ingestion by macrophages = free radical production
  • Pro-inflammatory cytokines from macrophages
31
Q

Give two complications of chronic asbestos exposure.

A
  • Asbestosis: a type of pneumoconiosis

- Mesothelioma: may present with pleuritic chest pain.

32
Q

Give general inspection findings and auscultation findings of asbestosis and silicosis

What other finding may be present?

A

Asbestosis:
- Clubbing, bibasal inspiratory crepitations

Silicosis;
- No general inspection signs, reduced breath sounds.

Both may have signs of RHF

33
Q

Give the CXR findings in simple and complicated ILD.

What would a CT show?

What do lung function tests show?

A

Simple (asymptomatic): micro-nodular mottling
Complicated (symptomatic): bilateral lower zone reticulonodular shadowing and pleural plaques (+ fibrotic changes in asbestosis).
Eggshell calcification in silicosis.

CT shows fibrotic changes

Lung function shows restrictive pattern.

34
Q

What is the definition of sleep apnoea?

A
  • recurrent collapse of pharyngeal airway and apnoea during sleep (>10s airflow cessation). Followed by arousal from sleep.
35
Q

Give 3 presenting symptoms of sleep apnoea

Give 3 history factors in sleep apnoea

A
  • Chronic fatigue
  • Unrefreshed sleep
  • Snoring
  • Obesity, smoker, alcohol
  • Enlarged tonsils
  • macroglossia
  • Marfan’s syndrome
36
Q

Give 2 investigations for sleep apnoea

A
  • Sleep study: polysomnography- airflow monitoring, respiratory effort, pulse oximetry and heart rate
  • TFTs

Yr 3 MedEd (31 decks)

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