Resp2 Flashcards
Chronic SOB
What is the definition of asthma?
A chronic inflammatory airway disease with intermittent airway obstruction and hyper-reactivity
What are the associations with asthma?
Worse in the morning and night Hx atopy/eczema FHx Smoker Pets Occupation
What can be seen on examination of a Pt with asthma?
May be normal
Nasal polyposis
Wheeze
What investigations would you do on a Pt with asthma?
Peak expiratory flow rate
Spirometry (FEV1:FVC ratio)
Bloods
What does an FEV1:FVC ratio of <0.7 indicate?
An obstructive pulmonary disease
What are the types of obstructive pulmonary diseases?
Asthma
COPD
What is the order of treatment for asthma (in accordance to the BTS guidelines)?
SABA SABA + ICS LABA + ICS Trials (LTRA, LAMA, theophylline) \+OCS
When should you consider moving up to the next step of treatment (in accordance to the BTS guidelines)?
If the Pt needs to use the SABA 3+ times in a week
What are the 4 categories of acute asthma?
Moderate
Acute-severe
Life threatening
Near fatal
How do you define moderate asthma?
If the PEF is 50-75%
How do you define acute-severe asthma?
If the PEF is 33-50%
How do you define life threatening asthma?
If the PEF is <33%
How do you define near fatal asthma?
If the pCO2 is raised
What investigations would you do on a Pt with acute asthma?
Basic obs PEF O2 sat ABG Serum K+ and glucose
A patient has come in with an exacerbation of asthma. What is the first treatment you would administer?
Oxygen.
A patient has come in with a moderate exacerbation of asthma. Oxygen has been administered. What is the next line of management?
Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 100mg
A patient has come in with an acute-severe exacerbation of asthma. Oxygen has been administered. What is the next line of management?
Neb salbutamol 5mg Oral prednisolone 40-50mg IV hydrocortisone 100mg Neb ipratropium bromide 0.5mg (Same for life threatening exacerbation)
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?
IV magnesium sulphate AND call for senior help
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?
IV aminophylline
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?
ITU and intubate
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
E. Near fatal
Her pCO2 is raised, classifying this exacerbation as near fatal.
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
D. Add an inhaled low-dose corticosteroid to her medications, taken OD
What is the definition of COPD?
Chronic airway obstruction that is not fully reversible, encompassing emphysema and chronic bronchitis.
What signs on general inspection may indicate COPD?
Tar staining
Cyanosis
Barrel chest
Tripod-ing
What signs on palpation and percussion may indicate COPD?
Reduced expansion
Hyper-resonance
What signs on auscultation may indicate COPD?
Reduced air movement
Wheezing
Coarse (hair-like) crackles
What FEV1 percentage indicates a mild COPD?
> 80%
What FEV1 percentage indicates a moderate COPD?
50-79%
What FEV1 percentage indicates a severe COPD?
30-49%
What FEV1 percentage indicates a very severe COPD?
<30%
What investigations would you do on a Pt with COPD?
Spirometry Bloods ABG CXR Serum alpha-1 antitrypsin
What is the management for mild COPD?
SABA or SAMA
What is the management for moderate COPD?
SABA+LABA or SAMA+LAMA
What is the management for severe COPD?
LABA+LAMA or LABA+ICS
What is the management for very severe COPD?
LABA+LAMA+ICS
What other management is available for COPD?
Smoking cessation Annual influenza vaccination Pneumococcal vaccination Smoking cessation Long term 02 therapy (15hr/day) Lung volume reduction surgery
When should you give long-term O2 therapy?
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
What is the first line management of a Pt with IE-COPD?
20% O2 (via a blue Venturi mask)
A patient with IE-COPD has been put on a blue Venturi mask. What is the next line of management?
Neb salbutamol 5mg
Oral prednisolone 40-50mg
IV hydrocortisone 200mg
Neb ipratropium bromide 0.5mg
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?
IV amoxicillin
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?
500mg IV aminophylline
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?
BiPAP
When do you give a Pt CPAP or BiPAP?
CPAP- T1RF eg. sleep apnoea
BiPAP- T2RF eg. COPD
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. Replace the SABA with a LAMA
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)
C. COPD
What are the respiratory causes of clubbing?
Malignancy
Empyema/suppurative lung disease
Interstitial lung disease
Cystic fibrosis
What is the definition of interstitial lung disease?
ILD is an umbrella term for a large group of disorders causing lung tissue fibrosis.
Name some ILDs
Idiopathic pulmonary fibrosis
Hypersensitivity pneumonitis/extrinsic allergic alveolitis
Sarcoidosis
Pneumoconiosis
What might a Pt with idiopathic pulmonary fibrosis present with?
SOBOE
Dry cough
No wheeze
What questions should you ask a Pt with IPF?
Smoking status
Occupation (metal/wood exposure)
Exposure to animals/vegetable dust
Drugs (bleomycin, methotrexate, amiodarone)
What would you look for on examination of a Pt with IPF?
Clubbing
Bi-basal, fine, inspiratory crackles
RHF (late stage ILD)
What investigations would you do on a Pt with IPF?
Bloods
ABG
Biopsy- gold standard, not always appropriate
CXR- for late presentation
High-res CT- usually appropriate, esp early presentation
PFTs
What would you see in a CXR of a Pt with IPF?
Ground-glass appearance
Reticulonodular appearance
Cor pulmonale
Honeycombing appearance
What would you see in a HRCT of a Pt with IPF?
Ground-glass appearance
What might a Pt with hypersensitivity pneumonitis present with?
SOBOE
Dry cough
Fever
What questions should you ask a Pt with HSP?
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
What signs should you see in a Pt with HSP?
Clubbing
Mild pyrexia
Bi-basal fine inspiratory crackles
What investigations would you do on a Pt with HSP?
Bloods ABG CXR High res CT Lung function tests Broncho-alveolar lavage
What would a high res CT show for a Pt with HSP?
Ground-glass appearance
What is pneumoconiosis?
Inhalation of coal/silica/asbestos dust
Nodules of collagen and dying macrophages form around the particles
What might a Pt with pneumoconiosis present with?
SOB
Dry cough
What signs should you see in a Pt with asbestosis?
Clubbing
Bi-basal inspiratory crackles
Signs of RHF
What signs should you see in a Pt with silicosis?
Decreased breath sounds
Signs of RHF
What investigations would you do on a Pt with pneumoconiosis?
CXR
CT
Lung function tests- restrictive pattern
What would you see in a CXR of a Pt with pneumoconiosis?
Simple- micro-nodular mottling
Complicated- bilateral lower zone reticulonodular shadowing and pleural plaques
What would you see in a CT of a Pt with pneumoconiosis?
Fibrotic changes
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
D. Hypersensitivity pneumonitis
What is the definition of sleep apnoea?
Recurrent collapse of the pharyngeal airway and apnoea during sleep, followed by arousal from sleep.
What may a Pt with sleep apnoea present with?
Chronic fatigue Snoring Unrefreshed sleep Obesity Truck driver Macroglossia Marfan's
What investigations would you do on a Pt with sleep apnoea?
Sleep studies (polysomnography) TFTs
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
C. Marfan’s syndrome
