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Respiratory Flashcards

1
Q

Smoking cessation treatment licensed for use in pregnancy

A

Nicotine replacement therapy

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2
Q

COPD treatment - 1st line

A

SABA (salbutamol) prn
or
SAMA (ipratropium) prn

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3
Q

COPD on SABA or SAMA prn - still breathless - no asthmatic features

A

Offer LABA + LAMA

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4
Q

COPD - on SABA or SAMA prn - still breathless - with asthmatic features/steroid responsiveness

A

Consider LABA + ICS

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5
Q

What is Fostair

A

LABA + ICS
(formoterol + beclometasone)

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6
Q

COPD - on LABA + LAMA - symptoms still affecting QOL

A

Consider 3 month trial of LABA + LAMA + ICS

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7
Q

What is Trimbow

A

LABA + LAMA + ICS
(formoterol + glycopyrronium + beclometasone)

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8
Q

What is Ellipta

A

LABA + LAMA + ICS
(vilanterol + umeclidinium + fluticasone)

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9
Q

COPD - on LABA + LAMA - with 1 severe/2 moderate exacerbations in a year

A

Consider LABA + LAMA + ICS

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10
Q

COPD - with no asthmatic features - no improvement after 3 month trial of LABA + LAMA + ICS

A

Revert to LABA + LAMA

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11
Q

COPD with asthmatic features - on LABA + ICS - with symptoms affecting QOL

A

Offer LABA + LAMA + ICS

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12
Q

COPD with asthmatic features - on LABA + ICS - with 1 severe/2 moderate exacerbations in a year

A

Offer LABA + LAMA + ICS

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13
Q

Refer for LTOT assessment in COPD if:

A

FEV1 <30% predicted
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
Sats <92% on air

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14
Q

Moderate asthma attack - PEFR

A

50-75% best or predicted

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15
Q

Severe asthma attack - PEFR

A

33-50% best or predicted

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16
Q

Life-threatening asthma attack - PEFR

A

<33% best or predicted

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17
Q

Moderate asthma attack - RR

A

RR < 25/min

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18
Q

Moderate asthma attack - HR

A

HR < 110 bpm

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19
Q

Severe asthma attack - RR

A

RR > 25/min

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20
Q

Severe asthma attack - HR

A

HR > 110 bpm

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21
Q

Speech in moderate asthma attack

A

Speech normal

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22
Q

Speech in severe asthma attack

A

Can’t complete sentences

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23
Q

Features of life-threatening asthma attack - vitals

A

Bradycardia
Dysrhythmia
Hypotension

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24
Q

Features of life-threatening asthma attack - examinaion

A

Silent chest
Cyanosis
Exhaustion

25
Features of life-threatening asthma attack - behaviour
Feeble respiratory effort Confusion Coma
26
Normal pCO2 (4.6-6.0) is a feature of what degree of asthma attack
Life-threatening
27
Respiratory causes of clubbing
Lung cancer CF Bronchiectasis Abscess/empyema TB Asbestosis, mesothelioma Fibrosing alveolitis
28
Cardiac causes of clubbing
Cyanotic congenital heart disease (Fallot's, TGA) Bacterial endocarditis Atrial myxoma
29
Non cardiac/resp causes of clubbing
Crohn's, UC Cirrhosis, PBC Graves' Whipple's disease
30
Life expectancy at diagnosis of idiopathic pulmonary fibrosis
3-4 years
31
Asthmatic/steroid responsiveness features in COPD
History of asthma/atopy Eosinophilia FEV1 variation >400ml >20% diurnal variation PEFR
32
Mechanism of action of varenicline
Nicotinic receptor partial agonist
33
B in CURB-65
Systolic <=90 / Diastolic <=60
34
Point-of-care CRP in pneumonia - when to offer antibiotics
> 100 mg/L
35
Point-of-care CRP in pneumonia - when to consider delayed prescription
20 - 100 mg/L
36
U in CURB-65
Urea > 7 mmol/L
37
Causes of obstructive lung disease
Asthma COPD Bronchiectasis Bronchiolitis obliterans
38
Adverse effects of nicotine replacement therapy
Flu-like symptoms Headache Nausea & vomiting
39
Options for smoking cessation therapy
Nicotine replacement therapy Varenicline Bupropion
40
Varenicline should be started when
1 week before target stop date
41
Varenicline side effects
Nausea Headache Insomnia/abnormal dreams
42
Varenicline recommended course
12 weeks
43
Varenicline in pregnancy
Contraindicated
44
Varenicline in breastfeeding
Contraindicated
45
Buproprion should be started when
1 - 2 weeks before target stop date
46
Bupropion adverse effects
Low risk of seizure
47
Bupropion is contraindicated in
Epilepsy Pregnancy, breastfeeding (relative: eating disorder)
48
All patients >=17y with suspected asthma should have
Spirometry with BDR test + FeNO test
49
Positive result in FeNO test in adult
>= 40 parts per billion
50
Positive result in FeNO test in child
>= 35 parts per billion
51
In primary-care management of moderate acute asthma, when should prednisolone be started
If PEFR between 50-75%
52
Adult low dose ICS - as budesonide
<= 400 mcg / day
53
Adult moderate dose ICS - as budesonide
400 - 800 mcg /day
54
Adult high dose ICS - as budesonide
> 800 mcg / day
55
*Consider* referral for LTOT assessment in COPD if
FEV1 <50% predicted
56
Adult Low Dose ICS example: Beclometasone diproprionate (Non-proprietary / Clenil Modulite)
Non-proprietary / Clenil Modulite 100mcg/dose x two puffs x twice a day [=200mcg BD]
57
Adult Medium Dose ICS example: Beclometasone diproprionate (Non-proprietary / Clenil Modulite)
Non-proprietary / Clenil Modulite 200mcg/dose x two puffs x twice a day [=400mcg BD]
58
Adult High Dose ICS example: Beclometasone diproprionate (Non-proprietary)
Non-proprietary 200mcg/dose x four puffs x twice a day [=800mcg BD]
59
Adult High Dose ICS example: Beclometasone diproprionate (Clenil Modulite)
Clenil Modulite 250mcg/dose x 2 puffs x twice a day / Clenil Modulite 250mcg/dose x 4 puffs x twice a day [=500mcg-1g BD]

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