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Y3 Clinical Case Revision > Respiratory > Flashcards

Respiratory Flashcards

1
Q

causes of COPD

A 
smoking
asbestos exposure
coal mining
asthma
pollution
chronic bronchitis
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2
Q

MRC dyspnoea scoring

A 
1 = no breathlessness unless v strenuous activity
2 = SOB when hurrying on level / walking up hill
3 = walks more slowly, stops after 1 mile / 15 mins of walking 
4 = stops after 100 yards / few mins of walking (on level ground)
5 = too SOB to leave house / SOB upon dressing
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3
Q

COPD treatments - mortality benefit

A

LTOT
smoking cessation
lung volume reduction

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4
Q

investigations for PE

A

Well’s score
D dimer +/-
CTPA
V/Q scan (can be performed if concern of radiation)

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5
Q

components involved in anaphylaxis

A

IgE
mast cells
basophils
histamine

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6
Q

treatment of anaphylaxis

A

remove trigger + maintain airway
IM adrenaline 500 MCG
IV hydrocortisone 200 mg
IV chlorphenamine 10 mg

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7
Q

mild asthma

A

PEFR > 75%

no sx of sev asthma

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8
Q

mod asthma

A

PEFR 50-75%

no sx of sev asthma

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9
Q

sev asthma

A 
Any one of the following:
PEFR 33-50%
cannot complete full sentences
RR > 25
HR > 110
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10
Q

life threatening asthma

A

Any one of the following:
PEFR < 33%
SpO2 <92% or ABG pO2 <8
cyanosis, poor respiratory effort, near / fully silent chest
exhaustion, confusion, hypotension, arrhythmias
normal pCO2

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11
Q

near fatal asthma

A

raised pCO2

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12
Q

acute asthma management

A 
OSHITME
Oxygen
Salbutamol 5mg NEB (every 15 mins / back-to-back)
Prednisolone 40mg PO 
Ipratropium bromide 500 MCG NEB
Theophylline = aminophylline IV
Magnesium sulfate
Escalate care = refer to ITU / intubation
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13
Q

COPD exacerbation management

A 
Oxygen: 88-94% SpO2
NEB salbutamol + ipratropium bromide 
Prednisolone 30 mg STAT PO + OD for 7 days
Abx if CRP ^ / sputum +ve
CXR
consider IV aminophylline 
consider NIV (BiPAP) if T2RF / acidosis 
if pH < 2.5 ref to ITU
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14
Q

CURB-65 criteria

A 
Confusion
Urea > 7
RR > 29 
BP systolic < 90 diastolic < 60
Age > 65
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15
Q

first line abx for COPD exacerbations

A

amoxicillin

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16
Q

massive haemoptysis definition

A

> 240 ml in 24 hours
OR
100 ml / day over consecutive days

17
Q

massive heamoptysis management

A 
lie pt on side of lesion (if known)
oral / IV tranexamic acid for 5 days 
x NSAIDs, aspirin, anticoags
Consider Abx
Consider vit K
CT aortogram - bronchial artery embolisation
18
Q

tension pneumothorax presentations

A

hypotension
tachycardia
dev of trachea away from pneumothorax
dev of mediastinum away from pneumothorax

19
Q

tension pneumothorax management

A

large bore IV annual into 2ng ICS

chest drain into affected side

20
Q

? PE management

A

oxygen, fluid resuscitation if indicated
Well’s score
> 4 - CTPA
< 4 - D dimer
offer interim anticoagulation: apixaban (DOAC)

21
Q

confirmed PE management

A

LMWH + dabigatran

22
Q

massive PE features

A

hypotension / imminent cardiac arrest

evidence of right heart strain on CT / echo

23
Q

massive PE management

A

consider thrombolysis with IV alteplase

24
Q

absolute contraindications to thrombolysis

A 
haemorrhage / ischaemia stroke < 6 months
bleeding disorder
GI bleed < 1 month
aortic dissection 
CNS neoplasia
recent trauma or surgery
25
Q

complications of thrombolysis

A 
IC haemorrhage / stroke 
reperfusion arrhythmias
anaphylactic shock / allergic reaction
systemic embolisation of thrombus
bleeding 
hypotension
26
Q

What is the pathophysiology of COPD?

A

mucus hypersecretion
ciliary dysfunction
emphysema
chronic inflammation

27
Q

What comprises the COPD care bundle?

A 
nebulisers
steroids
smoking cessation, diet advice
pulmonary rehab
bronchodilators
antimuscarinics
mucolytics
LTOT
lung volume reduction
28
Q

When can LTOT be offered

A

recurrent SpO2 <7.2 kPa OR <8kPa + cor pulmonale
non CO2 retainers
non smokers
benefit > mobility loss associated

29
Q

what is the pathophysiology behind asthma?

A

airway epithelial cell damage
^ goblet cell + SM cell hyperplasia
inflammatory reaction involving mast cells, eosinophils, T lymphocytes (histamine, cytokines, leukotrienes, prostaglandins)
mucus plugging

Y3 Clinical Case Revision (17 decks)

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