Resp conditions (FCM) Flashcards
What are the 4 features of acute severe asthma ?
- Pulse >110bpm
- PEFR 33-50% of normal value
- RR >25/min
- Cant complete sentences
How is a moderate asthma exacerbation characterised? (3 things)
- Increasing symptoms
- PEFR >50-75% of the patient’s best or predicted score
- No features of acute severe asthma
List the 8 things that are indicative of Life- threatening asthma
- PEFR of <33%
- New-onset arrhythmia
- Exhaustion
- Hypotension
- Reduced Glasgow coma score (GCS)
- Reduced respiratory effort
- Cyanosis (usually of the lips)
- Absence of audible breath sounds over the chest (silent chest)
How would you manage someone with a new diagnosis of asthma? (6 steps)
- Explain the diagnosis and the aims for treatment which is to get complete control of the disease (no daytime symptoms, no asthma attacks, no nocturnal symptoms, improved lung function)
- Assess their baseline peak flow (and ensure they have their own peak flow)
- Ensure the person has a personalised asthma plan
- Ensure that the person is up to date with all vaccinations
- Provide sources of information (Asthma UK) + advise them to avoid triggers - weight loss and smoking cessation If appropriate
- Initiate drug treatment (at the level of their symptoms) - review in 4-8 weeks
- salbutamol
- or salbutamol and Montelukast (LRTA)
- next step is SABA, LTRA and LABA (Salmeterol)
What criteria best describes Chronic Bronchitis?
Cough, Sputum production for at least 3 months in each of two consecutive years
What best describes Emphysema?
Condition that causes a loss of parenchymal lung texture and reduces surface area available for gas exchange
What is cor pulmonale ?
Impaired right ventricular function as a result of respiratory disease
What is COPD ?
A common chronic inflammatory lung condition that causes obstructed airflow from the lungs
How do you diagnose COPD?
spirometry with a post bronchodilator test
What type of TB would affect the lungs, liver and spleen causing organomegaly?
Miliary TB
This causes small calcifications on the lungs
How would you manage a pneumothorax?
- Decompression
- Large bore needle inserted into the Second intercostal space, midclavicular line
What is glandular fever?
Aka - infective mononucleosis.
Commonly caused by EBV
Spread through saliva or semen/ blood
Symptoms of glandular fever? (3 things)
- Sore throat
- Cervical lymphadenopathy
- Fever
How do you confirm a diagnosis of glandular fever?
- FBC
- Monospot test - immunocompetent
- EBV serology test in children younger than 12 years of age and in people who are immunocompromized.
Management of glandular fever (5 things)
- Symptomatic relief with paracetamol or ibuprofen.
- Reassurance that the condition is usually self limiting and that fatigue is common.
- Encouraging the person to return to normal activities as soon as possible. Exclusion from work or school is not necessary.
- Advising the person to avoid heavy lifting and contact or collision sports for the first month of the illness (to reduce the risk of splenic rupture).
- Advising on ways to limit the spread of the disease (for example by avoiding kissing and by not sharing eating utensils).
New!
Asthma management ?
- SABA (salbutamol)
- Low dose ICS (inhaled corticosteroid)
- CHECK ADHERENCE BEFORE ADDING ANYTHING ON
- LTRA (montelukast ) - then review in 4-8weeks
(SABA+ICS +LTRA)
IF STILL UNCONTROLLED
- Add LABA (salmeterol)
What condition is a hallmark for ‘red-currant jelly’ sputum?
Klebsiella pneumoniae
Note: Klebsiella is more common in alcoholics
COPD management if they have asthmatic features?
- SABA (salbutamol) or SAMA (Ipratropium) - if breathless and has exercise limitations
- LABA (salmeterol or formoterol) + ICS (ENDS IN ‘sone’)
- IF STILL HAS SX
LABA+LAMA+ICS
COPD management if they don’t have asthmatic features?
- SABA (salbutamol) or SAMA (Ipratropium) - if breathless and has exercise limitations
- LABA+LAMA
- IF STILL SX –
LABA+LAMA + ICS (3 month trial)
if controlled continue and review annually
What should you be awar eof in people taking ICS with a bg of COPD?
Increased risk of pneumonia
What is included in the rescue pack for COPD?
- oral corticosteroids (if not contraindicated)
- 30 mg oral prednisolone once daily for 5 days - Amoxicillin (first line)
What do you do if a patient with COPD sees no improvements in 2-3 days
- Send sputum for culture
- try another first line abx
- Amoxicillin 500 mg three times a day for 5 days (FIRST CHOICE)
- Doxycycline 200 mg on first day, then 100mg once a day for 5-day course in total
- Clarithromycin 500 mg twice a day for 5 days.
What is the difference between a transudative and exudative pleural effusion ?
Transudative:
- Caused by increased hydrostatic pressure
- Low protein and LDH
- Usually bilateral
Exudative:
- Caused by inflammation and increased capillary permeability
- High in protein and LDH
What supplement is offered to those on abx for TB treatment? +why
Pyridoxine – to help prevent the side effect of peripheral neuropathy from isoniazid
Number of points - Low - high clinical risk for developing PE on wells score
Low - <2 points
Moderate- 2-5 points
High- >6 poins
