resp diseases treatments

Question 1

COPD

Answer 1

smoking cessation
vaccines

LABA/LAMA combo
LABA/LAMA/ ICS combo

If patient is well enough to remain at home

• Oral prednisolone (ICS) (5-day course)
• Increase SABA/SAMA
• Antibiotics if evidence of infection (5 day course)

hospital admission = ISOAP

Question 2

Asthma

Answer 2

SABA
ICS
ICS + LABA
Increase ICS
Montelukast

hospital exacerbation = O SHIT MA

Question 3

pneumonia

Answer 3

CAP
- curb 0-2 = amoxicillin
- curb 3-5 = co-amoxiclav IV + doxycycline IV (if penicillin allergic: levofloxin)
- ICU = co-amoxiclav IV + clarithromycin IV

HAP
Non-severe - PO amoxicillin (if penicillin allergic: PO doxycycline)
Severe - IV amoxicillin + gentamicin

aspirate pneumonia
- Non-severe - PO amoxicillin + metronidazole
- Severe - IV amoxicillin + gentamicin + metronidazole

Atypicals
- Doxycycline
- Except Legionella - clarithromycin/erythromycin or levofloxin

Question 4

cystic fibrosis

Answer 4

Chest physiotherapy should be given 2x daily
- CREON tablets to digest fats in patients with pancreatic insufficiency (these replace the missing lipase enzymes)

get your vaccines

Question 5

bronchiectasis

Answer 5

STOP SMOKING

long term antibiotics
-Oral macrolide antibiotic

Question 6

pneumothorax

Answer 6

• No treatment if asymptomatic and small
• <2cm with no breathlessness
  
  • High flow oxygen
• > 2cm and/or breathless
  • High flow oxygen
  • Aspirate via 16-18g cannula , do not exceed 2.5L total aspirate

Acutely unwell:
- Aspiration (5th intercostal space, midaxillary line, safe triangle)
- If aspiration fails, insert chest drain (5th intercostal space, midaxillary line)

Question 7

pleural effusion

Answer 7

LVF – diuretics

Infection – drain, antibiotics (co-amoxiclav), may require surgery
- Simple effusion (pH >7.2) can be treated with antibiotics only
- Complicated effusion (pH <7.2) requires a chest drain and antibiotics

Question 8

lung cancer

Answer 8

SCLC
- Chemotherapy +/- radiotherapy

NSCLC (squamous and adenocarcinomas)
- surgery
- Chemotherapy +/- radiotherapy

Question 9

sarcoidosis

Answer 9

NSAIDS

Question 10

obstructive sleep apnoea

Answer 10

CPAP (continuous positive airway pressure device) offered to patients w daytime sleepiness

Question 11

pulmonary embolism

Answer 11

LMW heparin
thrombolysis

2nd prev = long term anti-coag eg. warfarin, Doac

Question 12

pulmonary hypertension

Answer 12

• Prophylactic anticoagulation (warfarin)
• O2 if hypoxic
• CB (oral nifedipine ,diltiazem)
• Endothelin antagonist (Oral Bosentan,Macitentan)
• PDE5-inhibitor (Oral Sildenafil/Tadalafil)

Question 13

TB

Answer 13

RIPE

• Rifampicin
  
  • orange-red urin
• Isoniazid
  
  • neuropathy
• Pyrazinamide
  
  • gout, joint pain
• Ethambutol
  
  • colour blindness
  • blindness