Resp 2: Chronic SOB Flashcards
Give 5 features of an asthma history.
- Recurrent episodes of cough, wheeze and SOB
- Variation- worst in morning and evening
- History of atopy, family history
- Smoker
- Occupation
- Pets
Give 1 sign on general inspection of asthma.
What will be heard on chest auscultation in asthma.
- General inspection may be normal, may be nasal polyposis
- Wheeze heard on auscultation
Give the 3 features of the diagnostic criteria for asthma.
- 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.
Give 3 things to check in asthma patient during GP visit
- Inhaler technique
- Inhaler adherence
- Symptoms- adjust medication as needed
What are the 7 stages in asthma management?
- SABA
- SABA + low ICS
- SABA + low ICS + LTRA (leukotriene receptor antagonist)
- LABA+ low ICS (+ LTRA)
- LABA + moderate ICS (+ LTRA)
- Trial LMRA or Theophylline
- Oral CS
Give an example of the following:
- SABA
- ICS
- LTRA
- LABA+ ICS
- Oral CS
- SABA: Salbutamol
- ICS: Beclometasone, Budesonide
- LTRA: Montelukast
- LABA + ICS (aka a MART): symbicort
- Oral CS: prednisolone
Define asthma.
- A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity
Define the following:
- Moderate asthma
- Acute-severe
- Life threatening
- Near fatal
- Moderate: PEF 50-75%
- Acute-sever: PEF 33-50%
- Life threatening: PEF <33%
- Near fatal: paCO2 raised
Give 5 investigations for a patient with acute asthma
- 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
What are the 6 medical management steps for someone presenting with acute asthma?
- O2
- Neb. Salbutamol 5mg, Neb. Ipratropium Bromide 0.5mg- acute or life-threatenening.
- Oral prednisolone or IV Hydrocortisone
- IV magnesium sulphate and senior help.
- IV Aminophylline
- ITU + intubation
Give 3 presenting symptoms of COPD
Differentiate fine crackles and coarse crackles by sound
Give 3 general inspection signs of COPD
- 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
Give the necessary FEV1/ FVC ratios and FEV1% needed to determine the following stages of COPD:
- Mild
- Moderate
- Severe
- Very severe
All have post-bronchodilator FEV1/FVC ratio <0.7
FEV1%
- Mild >80%
- Moderate 50-79%
- Severe 30-49%
- Very severe < 30%
What type of surgery shows increased survival in COPD patients.
- Lung reduction surgery shows increased survival.
Give 5 investigations for COPD
- 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
What are the appropriate medications for patients of the following COPD severities?
- Mild, moderate, severe, very severe
- SABA or SAMA
- SABA+LABA or SAMA+LAMA
- LABA+LAMA or LABA+ICS
- LAMA + LABA + ICS
Give examples of the following medications:
- SABA
- SAMA
- LABA
- LAMA
- LABA+ICS
- Salbutamol
- Ipratropium bromide
- Salmeterol
- Tiotropium
- Symbicort: Formoterol + budesonide
Give two vaccinations suitable for general management of COPD.
- Influenza, pneumococcal
What are the guideline indications for O2 therapy in COPD?
pO2 < 7.3kPa or pO2 7.3-8kPa with one of
- Secondary polycythaemia
- Nocturnal hypoxaemia
- Peripheral oedema
- Pulmonary hypertension
What are the 6 management steps for infective exacerbation of COPD.
- Blue Venturi 24% O2
- Neb. Salbutamol 5mg, Neb. Ipratropium bromide 0.5mg
- oral Prednisolone 40-50 mg or IV hydrocortisone 200mg
- IV amoxicillin
- 500mg IV Aminophylline
- BiPAP -
Differentiate use of BiPAP and CPAP
CPAP: type 1 respiratory failure: continuous positive airway pressure, e.g. sleep apnoea.
BiPAP (bi-level PAP): type 2 respiratory failure e.g. COPD
What is the definition of Interstitial lung disease?
Give 4 examples of interstitial lung diseases.
- Term for group of disorders causing scarring (fibrosis) of the lungs. Scarring causes stiffness.
- Idiopathic pulmonary fibrosis
- Hypersensitivity pneumonitis/ extrinsic allergic alveolitis
- Sarcoidosis
- Pneumoconiosis
Give 2 positive and 1 negative symptom of idiopathic ILD
- SOB on exertion
- Dry cough
- No wheeze
Give 3 drugs that cause ILD
- bleomycin
- Methotrexate
- Amiodarone
Give 1 general inspection and 1 auscultation finding in ILD.
What other finding may be present?
- Clubbing
- Bi-basal fine inspiratory crepitations
May also be signs of RHF
