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AKT > Respiratory 1 > Flashcards

Respiratory 1 Flashcards

1
Q

Classification of asthma
PEFR
Speech
RR
Pulse

A

Moderate, severe, life threatening
PEFR 50-75%, 33-50%, <33%
Speech - normal, can’t complete sentences, silent chest
RR <25, >25, feeble respiratory effort
Pulse <110, >110, exhaustion

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2
Q

Life threatening signs (5)

A

sats <92%, normal CO2, bradycardia, dysrhythmia, hypotension

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3
Q

Mx acute asthma in secondary care

A
  1. SABA
  2. Ipratropium bromide
  3. IV magnesium sulphate
  4. IV aminophylline

Prednisolone 40-50mg

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4
Q

Criteria for discharge following asthma admission (3)

A

PEFR >75% of best or predicted
Off nebs for 12-24 hours
Inhaler technique

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5
Q

Bronchitis disease course
Sx 4

Don’t bother

A

3 weeks with cough for longer
Cough, sore throat, rhinorrea, wheeze

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6
Q

How to differentiate between pneumonia and bronchitis?
Symptoms
Signs

A

Sputum, wheeze, SOB in pneumonia
O/E: systemic features in pneum

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7
Q

Bronchitis Mx (3)

A

Analgesia
Fluid intake
Abx if CRP 20-100 - doxy

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8
Q

Acute exacerbation of COPD common bacteria (3)

A

H. influenza
Strep pneum
Moraxella catarrhalis

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9
Q

Mx COPD
(2)
Abx of choice (3)

A

Increase SABA
Pred 30mg OD 5/7
Abx - amoxi/ clarithro/ doxy

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10
Q

A1AT (alpha 1 antityrpsin deficiency) what is it?
Chromosome location

A

Emphysema/ COPD in young non smokers
Chrm 14

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11
Q

Features A1AT deficiency
(Impacts two organs)

A

Lungs - panacinar emphysema in lower lobes
Liver - cirrhosis and HCC in adults, cholestasis in children

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12
Q

A1AT - what do you see on spirometry?

A

Spirometry = obstructive

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13
Q

Prevention
Treatment of AMS (acute mountain sickness) (1)
Medication (1)
How much altitude can you gain per day (1)

A

Acetozolamide
Descent
500m per day

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14
Q

Gas findings with acute mountain sickness

A

Metabolic acidosis
Compensatory respiratory alkalosis
Increases RR and improves oxygenation

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15
Q

Acute mountain sickness can develop into? (2)

A

HAPE and HACE - high altitude pulmonary oedema and cerebral oedema

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16
Q

Mx HACE (2)

A

Descent
Dexamethasone

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17
Q

Mx HAPE (4)

A

Descent
Nifedipine, dex, acetazolamide, oxygen

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18
Q

Most common form of asbestos related lung disease
When do they form?

A

Pleural plaques
Latent period of 20-40 years

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19
Q

What is asbestosis?
When?
Don’t bother

A

Typically causes lower lobe fibrosis
15-30 years post exposure

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20
Q

Malignant disease from asbestos
Most dangerous form

A

Mesothelioma
Crocidolite blue

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21
Q

Mx mesothelioma
Prognosis

A

Palliative chemo
Poor prognosis 8-14 months

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22
Q

Mx mesothelioma
Prognosis

A

Palliative chemo
Poor prognosis 8-14 months

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23
Q

Diagnostic tests for asthma (3)
Hint: classified by age
<5yo
5-16yo
>16yo

A

< 5yo clinical judgement
5-16 - spirometry with bronchodilator reversibility test
>16 - spirometry with bronchodilator reversibility test + FeNO test

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24
Q

FeNO interpretation

A

adults = > 40 positive
children => 35 positive

25
Q

Spirometry interpretation

A

FEV1/FVC ratio < 70% = obstructive

26
Q

Reversibility test - if FEV1 has improved by ? in a volume of ?

A

Positive if FEV1 has improved by 12% or more in a volume of 200mls of more

27
Q

Chronic asthma adults mx (7)

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + leukotriene receptor antagonist (LTRA)
  4. SABA + ICS + LABA (if LTRA effective then to continue)
  5. SABA +/- LTRA + MART with low dose ICS
  6. SABA +/-LTRA + MART with medium dose ICS
  7. SABA +/-LTRA
    AND
    MART with high dose ICS
    OR
    LAMA
    OR
    Theophylline
28
Q

What is a MART

A

ICS and LABA

29
Q

Low medium and high dose ICS
What are the doses

A

<= 400mcg
400-800
>800

30
Q

When to refer an asthmatic patient to secondary care? (3)
How many courses of steroids?
What step on the pathway
How many prescriptions in 1 year

A

> 2 courses of steroids in 12 months
On step 4 of tx pathway
12 SABA prescriptions in 1 year

31
Q

Occupational asthma common cause

A

Isocyanates (spray paint and foam moulding)

32
Q

How often should we consider stepping down treatment for asthma?
How much do you reduce steroids by?

A

Every 3 months
25-50% at a time

33
Q

What is bronchiectasis?

A

Permanent dilatation of the airways secondary to chronic infection or inflammation

34
Q

Mx bronchiectasis (3)

A

Physio
Postural drainage
Immunisations

35
Q

Bronchiectasis common causes (4)

A

H. influenza
Psuedomonas aeruginosa
Klebsiella
Strep pneum

36
Q

Suspected COPD Ix (3) and expected results of each

A
  1. post bronchodilator spirometry: FEV1/FVC <70%
  2. CXR hyperinflation, bullae, flat hemidiaphragm
  3. FBC - to r/o polycythaemia
37
Q

Severity of COPD (stages)
Post-bronchodilator FEV1/FVC
FEV1 (of predicted)

A

FEV1 of predicted
Stage 1 Mild >80
Stage 2 Moderate 50-79
Stage 3 Severe 30-49
Stage 4 Very severe <30

Post bronchodilater ratio
FEV1/FVC < 0.7 for all

38
Q

LTOT criteria (5)
FEV1 ?
Consider at FEV1 of

A

FEV1<30% predicted
Consider if 30-49%

Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
Sats <92%

39
Q

What pO2 to offer LTOT?
pO2 of ?
Or p O2 of with (3)

How many ABGs are needed and how far apart? Whilst on what?

A

pO2 <7.3
7.3-8 with either:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

x2 ABG need to have been done three weeks apart whilst on optimum COPD treatment

40
Q

Smoking and LTOT

A

Do not offer LTOT to people who continue to smoke following:
1. Being offered smoking cessation advice rx
2. Referral to specialist stop smoking services

41
Q

LTOT risk assessment (2)

A
  1. Risk of falls from tripping over equipment
  2. Risk of burns and fires for those that live with someone who smokes
42
Q

COPD general mx (4)

A

Smoking cessation advice
Influenza vaccine annual
One off pneumococcal vaccination
Pulmonary rehabilitation

43
Q

Mx COPD (4)

2nd step is determined by?

A
  1. SABA OR SAMA

2nd step is determined by whether the patient has asthmatic features/ features suggesting steroid responsiveness

NO asthmatic features:
2. add LABA + LAMA

Asthmatic features
2. LABA+ICS

All patients
3. LABA+ICS+LAMA
4. PO theophylline

44
Q

When should a theophylline dose be reduced? (2) (which two types of abx)

A

If on macrolides or fluoroquinolone abx

45
Q

Prophylactic abx of choice in COPD

A

Azithromycin

46
Q

Churg Strauss correct name
What is it?

A

Eosinophillic granulomatosis with polyangitis
Small to medium vessel vasculitis

47
Q

Eosinophillic granulomatosis with polyangitis
Features (4)
ANCA type

A

Asthma
Eosinophillia
Paranasal sinusitis
Mononeuritis multiplex
pANCA

Way to remember - Patrick –> cat, breathes funny –> asthma, wet nose –> sinusitis –> Patrick there P-ANCA

48
Q

Wegener’s correct name

A

Granulomatosis with polyangitis

49
Q

Granulomatosis with polyangitis
What is it?
Impacts which organs? (2)
ANCA

A

Vasculitis
Lung and kidney
c-ANCA

50
Q

Granulomatosis with polyangitis/ Wegeners
Features (5)

A

Epistaxis
Nasal crusting
Haemoptysis
Glomerulonephritis
Saddle shaped nose

Way to remember

Wegeners - Nazi
Nazi - begins with N - nasal crusting, Nose saddle shaped, Nose + cough bleeds, reNal issues - Not Patrick therefore C-ANCA

51
Q

What can precipitate Churg Strauss?

52
Q

CXR of Granulomatosis with polyangitis (1)
Renal biopsy findings: (1)

A

Cavitating lesions
Epithelial crescents in Bowman’s capsules

53
Q

Mx Wegener’s (3)

A

Steroids
Cyclophosphamide
Plasma exchange

54
Q

Bird fancier’s lung (avian proteins)
Farmers lung
Malt workers lung
Mushroom worker’s lung
Can cause which disease?

A

Extrinsic allergic alveolitis

55
Q

Extrinsic allergic alveolitis
XR findings (1)
Bronchoalveolar lavage (1)
Blood (1) (eosinophils - high or low)
Mx (1)

A

Upper/mid zone fibrosis
Lymphocytosis
No eosinophillia
Mx steroids

56
Q

Haemoptysis
Systemically unwell
Fever
Nausea
Glomerulonephritis
= which condition?

A

Goodpastures

57
Q

SOB, AF, malar flush, mid-diastolic murmur
= which condition?

A

Mitral stenosis

58
Q

Long hx of cough and daily purulent sputum production = which condition?

A

Bronchiectasis

59
Q

PMH TB, haemoptysis, CXR rounded opacity = which condition?

A

Aspergilloma

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