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MSRA > Respiratory > Flashcards

Respiratory Flashcards

1
Q

COPD management?

A

SABA or SAMA (ipratropium) first line as PRN

If remains breathless, determine if has asthmatic/steroid responsive symptoms:

  • Previous diagnosis of asthma or atopy
  • High eosinophils
  • Variation in FEV1 over time (at least 400ml)
  • Diurnal peak expiratory flow variation.

No asthma features
- Add LAMA and LABA regularly

Asthma features:
- Add LABA and ICS

For both, if no improvement: LAMA, LABA and ICS regularly along with SABA PRN

Moculytics - if chronic cough
Theophylline if the above doesn’t work/can’t tolerate
Prophylactic abx - azithromycin in some pts

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2
Q

Deep sea diving rules for those whom have had pneumothoraxes?

A

Avoid life long unless had pleurectomy

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3
Q

Peripheral tingling during exercise makes what diagnosis more likely?

A

Dysfunctional breathing

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4
Q

Restrictive picture on spirometry?

A

Ratio >70% and FVC decreased, FEV1 normal/reduced

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5
Q

Bronchiectasis and eosinophilia in a question likely allude to what?

A

Allergic bronchopulmonary aspergillosis - allergic reaction to aspergillus

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6
Q

CURB-65 score factors?

A

C Confusion (abbreviated mental test score <= 8/10)
U urea > 7 mmol/L
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

(in primary care take away U)

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7
Q

CURB score thresholds?

A

consider home-based care for patients with a CURB65 score of 0 or 1 - low risk (less than 3% mortality risk)

consider hospital-based care for patients with a CURB65 score of 2 or more - intermediate risk (3-15% mortality risk)

consider intensive care assessment for patients with a CURB65 score of 3 or more - high risk (more than 15% mortality risk)

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8
Q

Asthma treatment guidelines?

A
  1. Newly-diagnosed asthma
    - Short-acting beta agonist (SABA)
  2. Not controlled on previous step OR Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking
    - SABA + low-dose inhaled corticosteroid (ICS)
  3. If not controlled:
    - SABA + low-dose ICS + leukotriene receptor antagonist
    (LTRA)
  4. Next:
    - SABA + low-dose ICS + long-acting beta agonist (LABA)
    - Continue LTRA depending on patient’s response to LTRA
  5. Next:
    - SABA +/- LTRA
    - Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS
  6. Next:
    - SABA +/- LTRA + medium-dose ICS MART
    OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA
  7. Next:
    - SABA +/- LTRA + one of the following options:
    – increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART)
    – a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline)
    seeking advice from a healthcare professional with expertise in asthma
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9
Q

Urgent CXR for cancer in primary care for which patients?

A

Offer an urgent chest x-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:

  • cough
  • fatigue
  • shortness of breath
  • chest pain
  • weight loss
  • appetite loss

Consider an urgent chest x-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over with any of the following:

  • persistent or recurrent chest infection
  • finger clubbing
  • supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  • chest signs consistent with lung cancer
  • thrombocytosis
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10
Q

In pleural aspiration what does the pH level determine?

A

If below 7.2 then chest drain should be placed if they are ?infection

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11
Q

Criteria for discharge in an asthmatic exacerbation?

A
  • The patient being stable on their discharge medication (i.e no nebulisers or oxygen) for 12-24 hours
  • The inhaler technique being checked and recorded
  • PEF >75% of the best or predicted.
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12
Q

Criteria for moderate asthma attack?

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

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13
Q

Criteria for severe asthma attack?

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

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14
Q

Criteria for life-threatening asthma attack?

A 
PEFR < 33% best or predicted
Oxygen sats < 92%
'Normal' pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
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15
Q

Causes of an obstructive picture on siprometry?

A

COPD
Asthma
Bronchiectasis

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16
Q

Common causes of bilateral hilar lymphadenopathy?

A

Sarcoidosis and TB

17
Q

Do you follow-up/monitor pleural plaques?

A

Nah.

Benign. They are not associated with cancer.

18
Q

When would you start BiPAP for COPD exacerbation?

A

Acidosis

19
Q

If COPD exacerbation still getting worse despite NIV what is next course of action?

A

ITU

20
Q

Contraindications to bupropion?

A

epilepsy, pregnancy and breast feeding.

Having an eating disorder is a relative contraindication

21
Q

Smoking cessation drugs to offer? Can you combine?

A

NRT, varenicline or bupropion

Not in any combination

22
Q

When talking acid-base status, if there has been some effort to compensate but it is still abnormal that is called?

A

partially compensated

23
Q

Exudate and transudate protein level, what is lights criteria?

A

exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L

if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:

  • pleural fluid protein divided by serum protein >0.5
  • pleural fluid LDH divided by serum LDH >0.6
  • pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
24
Q

Most common SEs of varenicline?

A

Nausea

25
Q

For COPD retainers if critically ill what O2 therapy should be given?

A

In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given via a reservoir mask at 15 l/min. Hypoxia kills

26
Q

Acute presentation of mitral stenosis?

A

Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur

27
Q

Classic presentation of granulomatosis with polyangiitis?

A

pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum) is characteristic of granulomatosis with polyangiitis

28
Q

Varencicline mechanism of action?

A

nicotinic receptor partial agonist

29
Q

Buproprion mechanism of action?

A

norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

30
Q

ABG results for CO2 retainers?

A

ABG triad for chronic CO2 retention:

  • Normal pH
  • High pCO2
  • High HCO3
31
Q

Management of pneumothorax?

A

Primary pneumothorax

Recommendations include:
- if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise, aspiration should be attempted
- if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

Secondary pneumothorax

Recommendations include:
- if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
- otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted.
- All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

32
Q

Treatment of acute asthma exacerbation in primary care?

A

Course of 5 days prednisolone

33
Q

What FEV1 (% of predicted) corresponds to what degree of COPD?

A

> 80 - Mild (need Sx)
50-79% - Moderate
30-49% - Severe
< 30% - Very severe

34
Q

Is coal dust related to cancer risk?

A

No

35
Q

Adverse effects of tetracyclines?

A
  • discolouration of teeth: therefore should not be used in children < 12 years of age
  • photosensitivity
  • angioedema
  • black hairy tongue
36
Q

What bacterium is associated with pneumonia in COPD pts?

A

Haemophilis influenzae

MSRA (22 decks)

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