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MSRA Revision > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Asthma - Diagnosis

  1. Symptoms better away from work - what to do?
  2. What 2 tests should all patients be offered?
A

Asthma - Diagnosis

  1. Refer to resp as ?occupational disease
  2. FeNO and spirometry with reversibility
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2
Q

Asthma - Spirometry

  1. FeNO level, what’s positive in adults?
  2. Spirometry: what FEV1/FVC ratio is indicative of asthma?
  3. Spirometry reversibility: what degree of reversibility is significant in adults?
A

Asthma - Spirometry

  1. > 40ppb
  2. <0.7 = obstructive
  3. Improved FEV1 by 12% / 200ml
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3
Q

Asthma Diagnosis - Children

What differences to adults?

A

Ashtma Diagnosis - Children

Only offer FeNO if normal spirometry, if <5yo clinical judgement

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4
Q

COPD Acute Exacerbation - Management

  1. What bug is most commonly responsible?
  2. Initial management?
  3. Severe T2RF?
A

COPD Acute Exacerbation

  1. Haemophilus influenzae
  2. Nebs, Pred 30mg 5d, Abx only if productive sputum
  3. BiPAP
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5
Q

Primary Pneumothorax - Management

  1. <2cm and not SoB
  2. > 2cm OR SoB - 1st-line
  3. > 2cm, SoB and 1st line failed
A

Primary Pneumothorax Management

  1. Discharge with advice
  2. Aspirate
  3. Chest drain
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6
Q

Secondary Pneumothorax

  1. Pt >50yo and SoB and >2cm
  2. Air 1-2cm
  3. <1cm
A

Secondary Pneumothorax

  1. CHest drain
  2. Aspirate
  3. O2 and admit
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7
Q

Mesothelioma

  1. Occupational association?
  2. First line Ix and finding?
  3. Definitive Ix’s?
A

Mesothelioma

  1. Asbestos exposure
  2. CXR: pleural thickening / plaques
  3. Pleural CT, biopsy
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8
Q

Idiopathic Pulmonary Fibrosis (IPF)

  1. Diagnosis?
  2. Drug causes?
  3. Management?
A

Idiopathic Pulmonary Fibrosis (IPF)

  1. Restrictive spirometry (FEV1 normal, FVC decreased, FEV1:FVC increased). Ground glass CT appearance
  2. Methotrexate, Amiodarone, Nitrofurantoin
  3. Pulmonary rehabilitation, Pirfenidone (limited evidence)
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9
Q

Smoking Cessation

1. What are the drug options?

A

Smoking Cessation
1. Nicotine replacement therapy
Varenicline
Buproprion

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10
Q

Smoking Cessation - Varenicline

  1. Drug class
  2. Contra-indications
A

Smoking Cessation - Varenicline

  1. Nicotine partial agonist
  2. Depression or self-harm
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11
Q

Smoking Cessation - Buproprion

  1. Drug Class
  2. Contra-indications
A

Smoking Cessation - Buproprion

  1. Norepinephrine / Dopamine re-uptake inhibitor
  2. Epilepsy, pregnancy
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12
Q

Asthma Stable Treatment Cascade

A
  1. SABA (Salbutamol)
  2. SABA + low-dose ICS (Beclometasone)
  3. SABA + low-dose ICS + Leukotriene Receptor Antagonist (LTRA)(Montelukast)
  4. SABA + low-dose ICS +/- LTRA (if effective) + LABA (Salmeterol)
  5. SABA +/- LTRA + Maintenance and reliever therapy (MART)(combined ICS and fast-acting LABA, e.g. formoterol)
  6. SABA +/- LTRA + medium-dose MART
  7. SABA +/- LTRA + high-dose MART or Theophylline trial
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13
Q

Asthma Exacerbation - Discharge Criteria

A
  1. Stable on meds for 24h
  2. Inhaler techinque checked
  3. PEFR >75% best / predicted
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14
Q

COPD Staging (GOLD)

  1. What is the diagnosit criteria for COPD?
  2. How is it staged?
A
  1. FEV1:FVC <0.7
  2. 1 (Mild) FEV1 >80% Pred.
    2 (Mod) FEV1 50-80% Pred
    3 (Severe) FEV1 30-50% Pred
    4 (V Severe) FEV1 <30% Pred
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15
Q

Sarcoidosis

Presentation?

A 
Sarcoidosis
Erythema nodosum
B/L hilar lymphadenopathy
Swinging fever
SoB
Hypercalcaemia
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16
Q

Pneumothorax

What advice to give after an event?

A

Stop smoking
No air travel for 6 weeks
Avoid diving for life

17
Q

COPD - Stable Management

  1. Conservative Advice
  2. Vaccinations?
A
  1. Stop smoking

2. One-off pneumococcal vaccine, annual influenza

18
Q

COPD - Pharmacological Management

A
  1. SABA (Salbutamol) / SAMA (Iptraopium Bromide) PRN
  2. If atopic: add low-dose ICS
  3. If non-atopic: add LABA (salmeterol) or LAMA (Tiotropium)
  4. Add LAMA / LABA (if not yet)
  5. Theophylline
  6. Prophylactic Azithromycin
19
Q

Management of Bronchiectasis - Main Points

A

Physiotherapy and postural drainage
Antibiotics only for exacerbations
Bronchodilators and surgery for selected cases only

20
Q

Asthma Exacerbation - Scoring Severity

  1. Mod- symptoms, PEFR
  2. Severe- symptoms, PEFR
  3. Life-Threatening - symptoms, PEFR
A 
Asthma Exacerbation - Scoring Severity
1. Mod
PEFR 50-75%
RR<25, HR<110
2. Severe
PEFR 33-50%
Can't complete sentences
RR>25, HR>110
3. Life-threatening
PEFR<33%
Normal CO2
Silent chest
HR and BP dropping
21
Q

CURB-65 parameters

A 
C - Confusion
U - Urea >7
R - RR>30
B - SBP<90 or DBP<60
65 - Age>65
22
Q

CURB-65 What to DO

A 
0-1  = treat at home
>1 = admit
>3 = consider ICU
23
Q

Churg-Strauss Syndrome

  1. Description
  2. Features
  3. Ab association
A

Churg-Strauss Syndrome

  1. Description - ANCA-associated small vessel vasculitis
  2. Features - asthma, eosinophilia, paranasal sinusitis
  3. Ab association - pANCA
24
Q

Wegener’s Granulomatosis (Granulomatosis with Polyangiitis)

  1. Clinical features?
  2. Ab association
  3. Treatment
A

Wegener’s Granulomatosis (Granulomatosis with Polyangiitis)

  1. Epistaxis, nasal crusting, SoB, haemoptysis, glomerulonephritis, saddle-shaped nose deformity
  2. cANCA
  3. Steroids, cyclophosphamide, plasma exchange
25
Q

Kartagener’s Syndrome

  1. Description
  2. Clinical features
A

Kartagener’s Syndrome

  1. Primary ciliary dyskinesia
  2. Dextrocardia, bronchiectasis, subfertility, recurrent sinusitis

MSRA Revision (6 decks)

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