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Year 3 MedEd > Resp2 > Flashcards

Resp2 Flashcards

Chronic SOB

1
Q

What is the definition of asthma?

A

A chronic inflammatory airway disease with intermittent airway obstruction and hyper-reactivity

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2
Q

What are the associations with asthma?

A 
Worse in the morning and night
Hx atopy/eczema
FHx
Smoker
Pets
Occupation
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3
Q

What can be seen on examination of a Pt with asthma?

A

May be normal
Nasal polyposis
Wheeze

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4
Q

What investigations would you do on a Pt with asthma?

A

Peak expiratory flow rate
Spirometry (FEV1:FVC ratio)
Bloods

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5
Q

What does an FEV1:FVC ratio of <0.7 indicate?

A

An obstructive pulmonary disease

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6
Q

What are the types of obstructive pulmonary diseases?

A

Asthma

COPD

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7
Q

What is the order of treatment for asthma (in accordance to the BTS guidelines)?

A 
SABA
SABA + ICS
LABA + ICS
Trials (LTRA, LAMA, theophylline)
\+OCS
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8
Q

When should you consider moving up to the next step of treatment (in accordance to the BTS guidelines)?

A

If the Pt needs to use the SABA 3+ times in a week

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9
Q

What are the 4 categories of acute asthma?

A

Moderate
Acute-severe
Life threatening
Near fatal

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10
Q

How do you define moderate asthma?

A

If the PEF is 50-75%

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11
Q

How do you define acute-severe asthma?

A

If the PEF is 33-50%

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12
Q

How do you define life threatening asthma?

A

If the PEF is <33%

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13
Q

How do you define near fatal asthma?

A

If the pCO2 is raised

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14
Q

What investigations would you do on a Pt with acute asthma?

A 
Basic obs
PEF
O2 sat
ABG
Serum K+ and glucose
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15
Q

A patient has come in with an exacerbation of asthma. What is the first treatment you would administer?

A

Oxygen.

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16
Q

A patient has come in with a moderate exacerbation of asthma. Oxygen has been administered. What is the next line of management?

A

Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 100mg

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17
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen has been administered. What is the next line of management?

A 
Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 100mg
Neb ipratropium bromide 0.5mg
(Same for life threatening exacerbation)
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18
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen, salbutamol, prednisolone, hydrocortisone, and ipratropium bromide has been administered and the patient has not recovered. What is the next line of management?

A

IV magnesium sulphate AND call for senior help

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19
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen, salbutamol, prednisolone, hydrocortisone, ipratropium bromide, and magnesium sulphate has been administered and the patient has not recovered. A senior has arrived to help. What is the next line of management?

A

IV aminophylline

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20
Q

A patient has come in with an acute-severe exacerbation of asthma. Oxygen, salbutamol, prednisolone, hydrocortisone, ipratropium bromide, magnesium sulphate, and IV aminophylline has been administered and the patient has not recovered. A senior has arrived to help. What is the next line of management?

A

ITU and intubate

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21
Q

A 17 year-old girl presents to the local A&E complaining of worsening shortness of breath, despite use of what she describes as her ‘blue inhaler’. On examination her oxygen saturations are 95%, she is afebrile and has a BP of 101/67. The attending physician takes an ABG and the results are shown below. Grade the severity of this patient’s asthma attack.

pH: 7.25
pCO2: 7.4 kPa (4.5-6.0)
pO2: 10.4 kPa (>10.5)
HCO3: 23 mmol/l

A. I cannot tell from the information available
B. Moderate
C. Acute severe
D. Life threatening
E. Near fatal
A

E. Near fatal

Her pCO2 is raised, classifying this exacerbation as near fatal.

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22
Q

A 26-year-old bus driver presents to the GP complaining of a worsening shortness of breath. On examination, the patient is afebrile, has a BP of 110/85 and has a marked wheeze on auscultation. The only medications the patient is on is a blue inhaler. What is the next most appropriate treatment step as per the treatment guidelines for this condition?

A. Replace the blue inhaler with a brown, low-dose inhaled corticosteroid
B. Replace the blue inhaler with a long-acting beta-agonist medication
C. Replace the blue inhaler with a long-acting muscarinic agonist medication
D. Add an inhaled low-dose corticosteroid to her medications, taken OD
E. Add oral corticosteroid tablets to her medications, taken OD

A

D. Add an inhaled low-dose corticosteroid to her medications, taken OD

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23
Q

What is the definition of COPD?

A

Chronic airway obstruction that is not fully reversible, encompassing emphysema and chronic bronchitis.

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24
Q

What signs on general inspection may indicate COPD?

A

Tar staining
Cyanosis
Barrel chest
Tripod-ing

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25
Q

What signs on palpation and percussion may indicate COPD?

A

Reduced expansion

Hyper-resonance

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26
Q

What signs on auscultation may indicate COPD?

A

Reduced air movement
Wheezing
Coarse (hair-like) crackles

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27
Q

What FEV1 percentage indicates a mild COPD?

A

> 80%

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28
Q

What FEV1 percentage indicates a moderate COPD?

A

50-79%

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29
Q

What FEV1 percentage indicates a severe COPD?

A

30-49%

30
Q

What FEV1 percentage indicates a very severe COPD?

A

<30%

31
Q

What investigations would you do on a Pt with COPD?

A 
Spirometry
Bloods
ABG
CXR
Serum alpha-1 antitrypsin
32
Q

What is the management for mild COPD?

A

SABA or SAMA

33
Q

What is the management for moderate COPD?

A

SABA+LABA or SAMA+LAMA

34
Q

What is the management for severe COPD?

A

LABA+LAMA or LABA+ICS

35
Q

What is the management for very severe COPD?

A

LABA+LAMA+ICS

36
Q

What other management is available for COPD?

A 
Smoking cessation
Annual influenza vaccination
Pneumococcal vaccination
Smoking cessation
Long term 02 therapy (15hr/day)
Lung volume reduction surgery
37
Q

When should you give long-term O2 therapy?

A 
If the pO2 < 7.3 kPa
If the pO2 7.3-8.0 kPa AND they have:
-secondary polycythaemia
-nocturnal hypoxaemia
-peripheral oedema
-pulmonary hypertension
38
Q

What is the first line management of a Pt with IE-COPD?

A

20% O2 (via a blue Venturi mask)

39
Q

A patient with IE-COPD has been put on a blue Venturi mask. What is the next line of management?

A

Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 200mg
Neb ipratropium bromide 0.5mg

40
Q

A patient with IE-COPD has been put on a blue Venturi mask. The patient has been given salbutamol, predmisolone, hydrocortisone, and ipratropium bromide. What is the next line of management?

A

IV amoxicillin

41
Q

A patient with IE-COPD has been put on a blue Venturi mask. The patient has been given salbutamol, predmisolone, hydrocortisone, ipratropium bromide, and amoxicillin. What is the next line of management?

A

500mg IV aminophylline

42
Q

A patient with IE-COPD has been put on a blue Venturi mask. The patient has been given salbutamol, predmisolone, hydrocortisone, ipratropium bromide, amoxicillin and aminophylline. What is the next line of management?

A

BiPAP

43
Q

When do you give a Pt CPAP or BiPAP?

A

CPAP- T1RF eg. sleep apnoea

BiPAP- T2RF eg. COPD

44
Q

A 72-year-old man attends the GP complaining of increased shortness of breath and a cough productive of clear sputum. The GP notes the gentleman has a history of diagnosed COPD and decides to review his medications. The man hands the GP a SABA and a LABA. After conducting spirometry, the GP calculates an FEV1 of 40% expected. What is the next most appropriate treatment step?

A. Replace the SABA with a LAMA
B. Replace the LABA with an LAMA
C. Add a LAMA
D. Add an ICS
E. I need to conduct more tests to determine what medications to review
A

A. Replace the SABA with a LAMA

45
Q

Which of the following is not a respiratory cause of clubbing?

A. Squamous cell lung cancer
B. Interstitial lung disease
C. COPD
D. Cystic fibrosis
E. An empyema (lung abscess)
A

C. COPD

46
Q

What are the respiratory causes of clubbing?

A

Malignancy
Empyema/suppurative lung disease
Interstitial lung disease
Cystic fibrosis

47
Q

What is the definition of interstitial lung disease?

A

ILD is an umbrella term for a large group of disorders causing lung tissue fibrosis.

48
Q

Name some ILDs

A

Idiopathic pulmonary fibrosis
Hypersensitivity pneumonitis/extrinsic allergic alveolitis
Sarcoidosis
Pneumoconiosis

49
Q

What might a Pt with idiopathic pulmonary fibrosis present with?

A

SOBOE
Dry cough
No wheeze

50
Q

What questions should you ask a Pt with IPF?

A

Smoking status
Occupation (metal/wood exposure)
Exposure to animals/vegetable dust
Drugs (bleomycin, methotrexate, amiodarone)

51
Q

What would you look for on examination of a Pt with IPF?

A

Clubbing
Bi-basal, fine, inspiratory crackles
RHF (late stage ILD)

52
Q

What investigations would you do on a Pt with IPF?

A

Bloods
ABG
Biopsy- gold standard, not always appropriate
CXR- for late presentation
High-res CT- usually appropriate, esp early presentation
PFTs

53
Q

What would you see in a CXR of a Pt with IPF?

A

Ground-glass appearance
Reticulonodular appearance
Cor pulmonale
Honeycombing appearance

54
Q

What would you see in a HRCT of a Pt with IPF?

A

Ground-glass appearance

55
Q

What might a Pt with hypersensitivity pneumonitis present with?

A

SOBOE
Dry cough
Fever

56
Q

What questions should you ask a Pt with HSP?

A

Inhalation of antigenic organic dusts

  • Farmer’s: mouldy hay w/ thermophilic actinomycetes
  • Bird fancier’s: feathes/bird droppings
  • Mushroom worker’s: compost w/ thermophilic actinomycetes
  • Malt worker’s: mouldy barley w/ aspergillus clavatus
  • Humidifier lung: water-containing bacteria
57
Q

What signs should you see in a Pt with HSP?

A

Clubbing
Mild pyrexia
Bi-basal fine inspiratory crackles

58
Q

What investigations would you do on a Pt with HSP?

A 
Bloods
ABG
CXR
High res CT
Lung function tests
Broncho-alveolar lavage
59
Q

What would a high res CT show for a Pt with HSP?

A

Ground-glass appearance

60
Q

What is pneumoconiosis?

A

Inhalation of coal/silica/asbestos dust

Nodules of collagen and dying macrophages form around the particles

61
Q

What might a Pt with pneumoconiosis present with?

A

SOB

Dry cough

62
Q

What signs should you see in a Pt with asbestosis?

A

Clubbing
Bi-basal inspiratory crackles
Signs of RHF

63
Q

What signs should you see in a Pt with silicosis?

A

Decreased breath sounds

Signs of RHF

64
Q

What investigations would you do on a Pt with pneumoconiosis?

A

CXR
CT
Lung function tests- restrictive pattern

65
Q

What would you see in a CXR of a Pt with pneumoconiosis?

A

Simple- micro-nodular mottling

Complicated- bilateral lower zone reticulonodular shadowing and pleural plaques

66
Q

What would you see in a CT of a Pt with pneumoconiosis?

A

Fibrotic changes

67
Q

A 65-year-old man with a medical background of benign prostatic hyperplasia, presents to the GP with a 1 week history of worsening shortness of breath on exertion. He has a temperature of 38.5C, reports no weight loss but does mention some mild fatigue from his ‘pet pigeons keeping him up all night’ recently. On auscultation, the GP can determine fine, bi-basal inspiratory crackles. What is the most likely diagnosis?

A. COPD
B. Lung cancer
C. Bronchiectasis
D. Hypersensitivity pneumonitis 
E. Idiopathic pulmonary fibrosis
A

D. Hypersensitivity pneumonitis

68
Q

What is the definition of sleep apnoea?

A

Recurrent collapse of the pharyngeal airway and apnoea during sleep, followed by arousal from sleep.

69
Q

What may a Pt with sleep apnoea present with?

A 
Chronic fatigue
Snoring
Unrefreshed sleep
Obesity
Truck driver
Macroglossia
Marfan's
70
Q

What investigations would you do on a Pt with sleep apnoea?

A 
Sleep studies (polysomnography)
TFTs
71
Q

A tall 26-year-old woman comes into the GP complaining of chronic fatigue. Upon further questioning she reports that she ‘can never get a good night’s sleep’ and that she tends to fall asleep a lot at her workplace as a call centre customer service representative. She also mentions that she thinks it may have something to do with a condition her mother had. The only significant finding upon examination is patches of stretchy skin, especially around the neck area. What is the most likely underlying condition leading to disrupted sleep?

A. Obesity
B. Bad sleeping position
C. Marfan’s syndrome
D. Down’s syndrome
E. Chronic fatigue syndrome
A

C. Marfan’s syndrome

Year 3 MedEd (29 decks)

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