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Exams :) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Primary spontaneous pneumothorax conservative Rx
-Criteria
-Management

A

Criteria - haemodynamically stable (no hypotension/tachycardia/tachypnoea/hypoxaemia), no severe chest pain

Observe 4 hours
Discharge w/ safety net advice
Repeat CXR every 2 weeks until resolved
Refer to resp if still pressent after 8 weeks

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2
Q

?Type of lung cancer
-Central airways
-Smokers
-Rapid doubling time

A

Small cell lung cancer

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3
Q

Classification of severity levels of asthma (+features)

A

Mild/Moderate
-Can walk
-Speak whole sentences in 1 breath
-O2 Sats >94%

Severe
-Use of accessory muscles/tracheal tug
-Short phrases only
-Obvious resp distress
-Sats 90-94%

Life-threatening
-Redcued consciousness
-Cyanosis
-O2 Sats <90%
-Poor resp effort, absent breath sounds

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4
Q

LLN for FEV1 ratio

LLN for FEV1

A

LLN for FEV1 ratio >0.7
LLN for FEV1 >0.8

Ratio = the lower number

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5
Q

Updated change in most recent Asthma Handbook re: Adult/adolescent treatment?

A

Low-dose budesonide-formoterol as needed

(as alternative to maintenance low-dose ICS)

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6
Q

Bronchiectasis management principles (7)

A

Early recognition/treatment of infec exacs
Minimise exposure to resp infections
Airway clearance techniques - chest physio
Pulmonary rehab
Immunisation - pneumococcal/flu
Regu;ar exercise - maintain weight/muscle strength
Manage comorbidities

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7
Q

Pneumovax schedule for people >12mths (kids –> adults) diagnosed with at risk condition

A

1st dose Prevenar 13 at diagnosis
2nd dose Pneumovax 23 1 year later (or age 4, whichever later)
3rd dose Pneumovax 23 - 5 years later

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7
Q

Pneumovax schedule for people >12mths (kids –> adults) diagnosed with at risk condition

A

1st dose Prevenar 13 at diagnosis
2nd dose Pneumovax 23 1 year later (or age 4, whichever later)
3rd dose Pneumovax 23 - 5 years later

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8
Q

Pleural effusion DDx (transudate vs. exudate)

A

Transudate
-Heart failure (90%) of cases
-Nephrotic syndrome (hypoproteinaemia)
-Liver failure w/ ascites
-Constrictive pericarditis
-Hypothyroidism
-Ovarian tumour

Exudate
-Infection (bacerial penumonia, empyema, TB)
-Malignancy (bronchial Ca, mesothelioma)
-Lymphoma
-Sarcoidosis
-CTD (SLE,RA)
-Acute pancreatitis

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9
Q

Fitness to fly (based on Sats)

Resting sats <88% at sea level, long-term O2
Long-term O2 but sats correct w/ O2
Resting sats <92% or unable to walk 50m w/o stopping
Impaired exercise capacity (sats92-95%)
Good exercise capacity

A

Resting sats <88% at sea level, long-term O2 – should not fly
Long-term O2 but sats correct w/ O2 - high risk, needs to fly w/ O2 and increase flow rate by 1-2L/min
Resting sats <92% or unable to walk 50m w/o stopping - very likely torequire supplemental O2
Impaired exercise capacity (sats92-95%) - consider specialist referral for hypoxia challenge test
Good exercise capacity - safe to fly

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10
Q

PE Risk Factors (6)

A
  • Surgery
    • Acute/chronic medical illness (heart/lung disease, IBD etc.)
    • Cancer
    • Hormone factors (pregnancy, OCP, HRT)
    • Known thrombophilia
    • BMI >30, varicose veins, immobilisation/travel
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11
Q

When to Apply WELLS/PERC

A

Clinical suspicion of PE/DVT –> Wells Score, score >4 needs imaging (clinical signs/symptoms of DVT, PE most likely dx. or any other RF)

If Wells low risk –> PERC rule –> D-dimer –> imaging

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12
Q

PE management/dosing

A

Rivaroxaban 15mg BD 3/52 –> 20mg daily

Apixaban 10mg BD for 1/52 –> 5mg BD

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13
Q

Meds used for altitude illness prevention

A

Ibuprofen (600mg TDS) - High altitude headache
Acetazolamide 125mg BD
Dexamethasone 2mg QID or 4mg BD (not longer than 10 days)

All as per eTG + AJGP Article

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14
Q

Contraindications to high altitude travel

A

○ Severe COPD
○ Unstable asthma
○ Severe IHD, CCF
○ Pulmonary hypertension
○ Complicated pregnancy

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15
Q

Interstitial lung disease clin. features
+findings on HRCT
+findings on spirometry

A

Clin. features: prgoressive SOB, dry cough, reduced ET. Fine creps on ausc. Oxygen desat during exercise

HRCT - nodules, cysts, ground glass changes, honeycomb change, traction bronchiectasis, septal thickening

Spirometry: Normal FEV1 ratio, low FVC, low FEV1, reduced lung volumes

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16
Q

COPD spirometry diagnosis
+what is a positive bronchodilator response?

A

FEV1/FVC ratio <0.7
FEV1<80% predicted

200ml increase AND 12% change in FEV1

17
Q

COPD severity classifications (which spirometry measurement is used?)

A

FEV1
Mild = 60-80%
Moderate 40-60%
Severe <40%

18
Q

COPD non-pharm optimisation (3)

A
  1. Stop smoking
  2. Pulmonary rehabilitation (for symptomatic pts
  3. Regular exercise - 150mins/week - walk until breathless - short rest - resume
19
Q

COPD exacerbation management (3)

A

Salbutamol 4-8 puffs + spacer q3-4hourly (equiv to 2.5mg nebuliser)
Pred 30-50mg for 5/7 then stop
Abx - (if change in sputum volume/colour, fever) - Amoxicillin 500mg TDS OR 1g BD 5/7
OR Doxycycline 100mg daily 5/7

Oxygen - aim sats 88-92%

CXR, IV Abx and sputum MCS not usually needed in community pts

  • Pulm rehab can be commenced immediately
20
Q

Prevention strategies against inhaled foreign bodies - Paeds
Management step if suspected (1)

A

Avoid commonly aspirated foods in kids <15mths age (e.g popcorn, hard lollies, raw carrot)
Avoid nuts if <4 y.o

Referral to ENT on call or ED presentation

21
Q

Findings that INCREASE probability of asthma in adults

A

> 1 of wheeze/SOB/cough/chest tightness
Recurrent/seasonal symptoms
Worse at night/early morning
Obvious triggers incl. exercise, cold air, meds (beta-blockers), viral infections, allergies, laughing
FHx of asthma/allergies
Hx of allergies (rhinitis, eczema)
Symptoms began in childhood
Widespread wheeze audible on ausc
FEV1/PEF lower than predicted
Eosinophilia/IgE rise w/o explanation
Rapid relief w/ SABA

22
Q

Findings that DECREASE probability of asthma in adults

A

Dizziness, light-headedness
Isolated cough with NO other resp symptoms
Chronic sputum
No wheeze on ausc. when symptomatic
Change in voice
Symptoms only present during URTIs
Heavy smoker
Cardiovascular disease
Normal spirometry/PEF when symptomatic

23
Q

Asthma DDx - Cough
Asthma DDx - wheeze
Asthma DDx - SOB

A

Cough
-Pertussis
-GORD
-Rhinosinusitis
-Medication side effect (e.g ACEi)
-Bronchiectasis
-COPD
-Idiopathic pulmonary fibrosis
-Inhaled freign body
-Habit -cough syndrome

Wheeze
-COPD
-Resp infections
-Upper airway dysfunction

SOB
-Poor fitness
-Hyperventilation
-Anxiety
-CCF
-Pulmonary HTN
-Lung Ca

24
Q

Stepwise asthma management Adults/Adolescents (5)

A
  1. SABA Prn
  2. Regular low dose ICS + SABA Prn OR Symbicort Prn
  3. Regular daily low dose ICS-LABA (maintenance + reliever OR + Saba prn)
  4. Regular daily med-high dose ICS-LABA (maintenance + reliever OR +Saba PRN
  5. Specialist Rx
25
Q

Criteria for good asthma control (4)

A
  1. Daytime symptoms ≤2 days per week
  2. SABA reliever use ≤days per week
  3. No limitation of activities
  4. No symptoms during night/on waking
26
Q

Budesonide ICS low/medium/high dose
1. Adults
2. Kids

A
  1. Adults
    -Low 200-400
    -Medium 500-800
    -High >800
  2. Kids
    -Low 200-400
    -High >400 (max 800)
27
Q

Fluticasone propionate (Flixotide) ICS low/medium/high dose
1. Adults
2. Kids

A
  1. Adults
    -Low 100-200
    -Medium 250-500
    -high >500
  2. Kids
    -Low 100-200
    -high >200 (max 500)
28
Q

Indications for preventer treatment in kids 1-5 y.o

A

Any moderate or higher severity flare-ups (ED/oral steroids)
OR mild flare-ups (community) + symptoms at least once per week

Consider if symptoms every 4-6 weeks

29
Q

Indications for preventer treatment in kids 6-11 y.o

A

Mod-severe flare-ups (>2 in last year needing ED/oral steroids) if flare-ups more than every 6 weeks

OR mild flare-ups (community) + persistant asthma

30
Q

Stepwise asthma management kids 1-5 y.o (4)

A
  1. SABA prn
  2. Low dose ICS OR montelukast
  3. Low dose ICS + montelukast OR high dose ICS
  4. Specialist
31
Q

Stepwise asthma management kids 6-11 y.o (4)

A
  1. SABA prn
  2. ICS low dose OR montelukast
  3. ICS low dose + monetlukast OR ICS-LABA low dose OR ICS high dose
  4. Specialist
32
Q

Pred dose & duration for asthma exacs
1. Adults
2. Kids

A
  1. Pred 37.5-50mg daily for 5-10 days
  2. Pred 1mg/kg (max 50mg) for 3-5 days
33
Q

DDx restictive lung patterns LFTs

A

-ILD (asbestosis, sarcoidosis/hypersensitivity pneumonitis, IPF)
-Pleural effusion (or pleural thickening/disease)
-Chest wall disease (NMD, diaphragm palsy, obesity, kyphoscoliosis)

34
Q

Recommended bronchodilator withholding times prior to spirometry
○ SABA
○ SAMA (e.g atrovent)
○ LABA w/ BD dosing (e.g formoterol, salmeterol
○ LABA w/ daily dosing OR LAMA

A

○ SABA - 4 hours
○ SAMA (e.g atrovent) - 12 hours
○ LABA w/ BD dosing (e.g formoterol, salmeterol) - 24 hours
○ LABA w/ daily dosing OR LAMAs - 36 hours

35
Q

Define narcolepsy
Define cataplexy
Diagnostic narcolepsy test

A

Narcolepsy - chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep
Cataplexy - sudden loss of muscle tone in response to intense emotion

Multiple sleep latency test/sleep study

36
Q

OSA Examination features (5 categories)

A
  • BMI
    • Craniofacial structure, jaw position (retrognathia/micrognathia), neck circumference
    • Oral cavity/tonsils/Mallampati score
    • Nasal airways, congestion, sepal deviations/polyps
  • CVS exam (CCF, HTN)
37
Q

Risk factors for life-threatening asthma attack (9)

A

○ Poor lung function
○ Recurrent ED presentations
○ Hx of food allergy
○ Previous ICU admission
○ Recent hospital admission
○ Frequent reliever use
○ Need for steroid Rx
○ Need for multiple classes of asthma meds
○ Rural location/poor access to tertiary care

38
Q

OSA children - other management options (2)

A

-Intranasal steroid spray trial 6/52
-Leukotreine receptor antagonist (montelukast)

39
Q

-Chronic isolated wet cough >4 weeks w/o better explanation
-Often preceded by viral LRTIs
-O/E “rattly” airway secretions

?Diagnosis
?Treatment

A

Protacted bacterial bronchitis
2/52 min Aug DF (+ another 2/52 if no improvement)

40
Q

Bronchiectasis exac criteria (3)
Abx Rx (1)

A

MUST have all 3 for Abx to be indicated

-Increase in sputum production/viscosity
-Increase in sputum purulence
-Increase in cough (w/ wheeze, SOB, haemoptysis)

Amoxicillin 1g TDS or Doxycycline 100mg BD, for 10-14 days

41
Q

Indications for specialist referral for asthma/COPD (7)

A

-Following life-threatening exac needing hospitalisation
-Frequent asthma ED/GP presentations
-Suspected occupational asthma
-Diagnostic doubt
-Pts w/ poor self-management skills
-Assessment for home O2 therapy
-Assessment for lung transplant

Exams :) (20 decks)

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