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Z Year3 Conditions > RESP (asthma, COPD, sarcoidosis) > Flashcards

RESP (asthma, COPD, sarcoidosis) Flashcards

1
Q

What is chronic asthma?

A

a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

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2
Q

What are the symptoms and signs of asthma?

A
  • cough
  • wheeze (heard on auscultation)
  • shortness of breath
  • worse in morning and evening
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3
Q

What are the investigations for asthma?

A
  1. Spirometry: (FEV1:FVC ratio)
  2. PEFR (peak expiratory flow rate)
  3. Bloods
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4
Q

What is the criteria for diagnosis of asthma?

A
  1. FEV1: FVC <70%
  2. Reversibility: 12% pre- and post-bronchodilator spirometry
  3. PEFR varies by, or increases by >20%, for >3 days/week over several weeks - diagnosis can be aided by a PEFR diary
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5
Q

What is the order of medication plan in chronic asthma?

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. LABA + ICS ± LTRA
  5. LABA + increase ICS ±LRTA
  6. Trials
  7. Oral CS
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6
Q

What should you check on each trip to the GP with chronic asthma?

A
  • Inhaler technique
  • Inhaler adherence
  • Symptoms (adjust medication as needed)
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7
Q

What is conservative management for chronic asthma?

A
  1. Weight loss

2. Smoking cessation

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8
Q

What is LABA?

A

Long Acting Beta-2 Agonist

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9
Q

What is SABA?

A

short acting Beta-2 agonist

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10
Q

What is ICS?

A

inhaled corticosteroid

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11
Q

What is LTRA?

A

oral Leukotriene receptor antagonist

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12
Q

What is LMRA?

A

Long acting muscarinic receptor antagonist

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13
Q

What is an example of SABA?

A

salbutamol

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14
Q

What is an example of ICS?

A

Beclometasone, Budesonide

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15
Q

What is an example of LTRA?

A

Montelukast

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16
Q

What is an example of LABA + ICS?

A

Symbicort (Budesonide/Formoterol)

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17
Q

What is an example of an oral CS?

A

prednisolone

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18
Q

What are the risk factors for acute asthma exacerbation?

A
  • History of previous asthma attacks
  • Poor control
  • Inappropriate or excessive SABA use
  • Old age
  • Female
  • High blood eosinophil count
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19
Q

What are the symptoms of an acute asthma exacerbation?

A
  1. Increase shortness of breath (can’t finish sentence)
  2. Cough
  3. Wheeze
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20
Q

What is the PEF for different types of acute asthma exacerbation?

A

Moderate: 50-70%
Acute-severe: 33-50%
Life threatening: <33%
Near fatal: pCO2 raised

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21
Q

What are the other signs of an acute asthma exacerbation?

A
  • Tachypnoea
  • Tachycardia
  • Silent chest
  • Accessory muscle use
  • Sleep disturbance
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22
Q

What are the investigations for an acute asthma exacerbation?

A
  1. Basic Obvs (HR, SpO2)
  2. ABG: *repeat ABG if PaO2 <8kPa, unless SpO2 >92%; or initial PaCO2 is normal or raised; or if patient deteriorates or PEF <50%
  3. PEF
  4. Pulse Oximetry
  5. Chest X ray
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23
Q

What is the management plan of acute asthma exacerbation?

A
  1. O2
  2. Neb Salbutamol 5mg
  3. Neb. Ipratorpium Bromide 0.5mg (acute-severe/life threatening)
  4. Oral Prednisolone 40-50mg + IV Hydrocortisone 100mg
  5. IV Magnesium sulphate + SENIOR Help
  6. IV Aminophylline
  7. ITU + Itubation
24
Q

What is COPD?

A

preventable and treatable disease state characterised by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis (CHRONIC)

25
Q

What are the risk factors for COPD?

A
  1. Age
  2. Cigarette smoking
  3. Genetic factors
26
Q

What are the symptoms of COPD?

A
  1. SOB
  2. Productive cough
  3. Some wheeze
27
Q

What are the general inspection signs of COPD?

A
  1. Tar Staining
  2. Cyanosis
  3. Barrel Chest
28
Q

What do you find in palpitation for COPD?

A
  1. Reduced expansion

2. Hyper resonance (on percussion)

29
Q

What do you find in auscultation for COPD?

A
  1. Reduced air movement
  2. Wheezing
  3. Coarse crackles
  4. Distant breath sounds on auscultation
30
Q

What are the investigations for COPD?

A
  1. Spirometry
  2. A1At and TfCO
  3. Bloods ABG
  4. CXR
31
Q

What is mild COPD?

A

Post-bronchodilator FEV1/FEVC
<0.7
+ FEV1 = > 80%

32
Q

What is moderate COPD?

A

Post-bronchodilator FEV1/FEVC

<0.7 + FEC1 50-79%

33
Q

What is severe COPD?

A

Post-bronchodilator FEV1/FEVC

<0.7 + FEV1 30-49%

34
Q

What is very severe COPD?

A

Post-bronchodilator FEV1/FEVC

<0.7 + FEV1 <30%

35
Q

What is the treatment for mild COPD?

A

SABA or SAMA
• Inhaled short-acting beta agonist (e.g. salbutamol)
• Inhaled short-acting muscarinic antagonist (e.g. ipratropium bromide)

36
Q

What is the treatment for moderate COPD?

A

SABA + LABA or SAMA + LAMA
• Inhaled short-acting beta agonist (e.g. salbutamol)
• Inhaled long-acting beta agonist (e.g. salmeterol)

37
Q

What is the treatment for severe COPD?

A

LABA + LAMA or LABA + ICS
• Inhaled long-acting beta agonist (e.g. salmeterol)
• Inhaled long-acting muscarinic antagonist (e.g. tiotropium)

38
Q

What is the treatment for very severe COPD?

A

LAMA + LABA + ICS
• Inhaled long-acting muscarinic antagonist (e.g. tiotropium)
• Inhaled corticosteroid / long-acting beta agonist combination (e.g. Symbicort)

39
Q

What is the general management for COPD?

A
  1. Smoking cessation
  2. Annual influenza vaccination
  3. Pneumococcal vaccination
40
Q

What is the other options for management of COPD?

A
  • Long term O2 therapy (15hrs/day)

- Lung volume reduction therapy

41
Q

When do you do Long term O2 therapy for COPD?

A 
When pO2 <7.3kPA or pO2 of 7.3 - 8 kPa and one of the following:
•	Secondary polycythaemia
•	Nocturnal hypoxaemia
•	Peripheral oedema
•	Pulmonary hypertension
42
Q

What can cause acute COPD?

A

infective exacerbation

43
Q

What are the investigations for acute COPD?

A
  1. ABG
  2. Pulse oximetry
  3. ECG
  4. FBC w platelets
  5. U + E _ C
  6. CRP
  7. CXR
  8. Sputum microscopy
  9. Vit D
44
Q

What is the treatment for acute COPD exacerbation?

A
  1. Blue Venturi 24% O2
  2. Neb. Salbutamol, 5mg +Neb. Ipratropium Bromide, 0.5mg +Oral Prednisolone 40-50mg + IV Hydrocortisone
    200mg
  3. IV Amoxicillin
  4. 500mg IV aminophylline
  5. BiPAP (NIV)
45
Q

What is sarcoidosis?

A

chronic granulomatous disorder of unknown aetiology, commonly affecting the lungs, skin, and eyes

46
Q

What are the risk factors for sarcoidosis?

A
  1. Age 20-40
  2. FHx sarcoidosis
  3. Scandinavian heritage
  4. History of exposure to beryillium
47
Q

What are the symptoms of sarcoidosis?

A
  1. Cough
  2. Progressive Dyspnoea
  3. Chronic fatigue
  4. Arthralgia
  5. Wheezing
  6. Rhonci
  7. Lympadenopathy
  8. Photophobia
  9. Red painful eye
  10. Blurred vision
48
Q

What are the investigations for sarcoidosis?

A
  1. CXR
  2. FBC
  3. Serum urea
  4. Creatinine
  5. liver enzymes
  6. serum calcium
  7. PFTs
  8. ECG
  9. PPD
49
Q

What is stage 1 of sarcoidosis?

A

bilateral hilar lymphadenopathy

50
Q

What is stage II of sarcoidosis?

A

bilateral hilar lymphadenopathy plus pulmonary infiltrates

51
Q

What is stage III of sarcoidosis?

A

pulmonary infiltrates without hilar lymphadenopathy

52
Q

What is stage IV of sarcoidosis?

A

extensive fibrosis with distortion

53
Q

How do you treat sarcoidosis stage 1?

A

No treatment

54
Q

When do you use corticosteroids for sarcoidosis?

A
  1. Parenchymal lung disease
  2. Uveitis
  3. Hypercalcaemia
  4. Neurological or cardiac involvement
55
Q

What corticosteroids do you use for sarcoidosis?

A
  • Prednisolone 40mg/24 h 4-6 weeks (decrease over 1 year)

- SEVERE: IV methylpredinisolone or immunosuppressant

56
Q

What is the prognosis of sarcoidosis?

A

60% of patients with thoracic sarcoidosis resolve over 2 years, 20% respond to steroid therapy

Z Year3 Conditions (13 decks)

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