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MRCP 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

percentage oxygen delivered by nasal cannula at 1,2 and 4 litres

A

1 litre- 24%
2 litre- 28%
4 litre - 36%

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2
Q

Rough equivalents nasal canulla to venturi masks

A

1 litre nasal canula= 24%, blue venturi= 24%
2 litre nasal canula= 28%, white venturi= 28%
4 litre nasal; canula= 36%, yellow venturi= 35%

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3
Q

Blue Venturi mask oxygen flow rate and % oxygen delivered

A

flow rate= 2-4L
% oxygen delivered= 24%

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4
Q

white Venturi mask oxygen flow rate and % oxygen delivered

A

flow rate= 4-6L
% oxygen delivered= 28%

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5
Q

Yellow Venturi mask oxygen flow rate and % oxygen delivered

A

flow rate= 8-12 L
% oxygen delivered= 35%

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6
Q

Red Venturi mask oxygen flow rate and % oxygen delivered

A

flow rate= 10-15 L
% oxygen delivered= 40%

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7
Q

Green Venturi mask oxygen flow rate and % oxygen delivered

A

flow rate= 12-15 L
% oxygen delivered= 60%

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8
Q

simple face mask oxygen flow rate and % oxygen delivered

A

flow rate= 5-10 L
% oxygen delivered= 30-40%

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9
Q

Non-rebreather mask (reservoir mask) oxygen flow rate and % oxygen delivered

A

flow rate= 15 L
% oxygen delivered= 70%

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10
Q

Medications contra-inidicated in asthmatics

A
  • Beta-blockers (contra-indicated)
  • NSAIDs (C/I if previous exacerbation related to NSAID or aspirin use)
  • adenosine
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11
Q

6 Indications of hxt of severe asthma

Admission should be considered for patients with a history of severe asthma and any adverse psychosocial factor regardless of the severity of the current episode.

A
  • Previous near-fatal asthma (ventilation, ICU)
  • Previous admission for asthma in the last year
  • Requiring maintenance therapy of 3 or more classes of asthma medication
  • Heavy use of β2 agonist
  • Repeated ED attendances with asthma
  • ‘Brittle asthma’ (uncontrolled asthma despite maximum maintenance treatment or recurrent sudden severe episodes when asthma well controlled)
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12
Q

Moderate asthma features

A

Moderate acute asthma:

  • PEFR 51-75% best or predicted
  • No features of acute severe asthma

Mild asthma exacerbation:

  • PEFR >75% best or predicted
  • No features of acute severe asthma
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13
Q

Acute Severe asthma features (4)

A

The absence of any life-threatening feature and presence of any one of the following factors indicates that the current exacerbation is severe.

  • PEFR <50% best or predicted
  • Respiratory rate 25/min
  • Heart rate 110/min
  • Inability to complete sentences in one breath
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14
Q

Life threatening asthma features (9)

A

The presence of any one of the following signs or results indicates that the current exacerbation is life-threatening.

  • Reduced conscious level
  • Signs of exhaustion
  • Hypotension
  • Arrhythmia
  • Cyanosis
  • Poor air entry/ poor respiratory effort
  • Silent chest
  • PEFR <33% best or predicted
  • SpO2 <92% or PaCO2 normal (4.6-6.0 kPa)
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15
Q

Near Fatal asthma features

A

Raised PaCO2 and/or needing high inflation pressures if ventilated.

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16
Q

Indications for ITU involvement asthmatics

A
  • Deteriorating PEFR
  • Persistent or worsening hypoxia
  • Hypercapnea (or falling pH on arterial gas sample)
  • Exhaustion, feeble respiration
  • Reduced conscious level
  • Respiratory arrest
17
Q

what complication to consider if sudden deterioration of asthma patient

A

spontaneous pneumothorax

Always consider a spontaneous pneumothorax as a cause of sudden deterioration in asthmatics.
Chest percussion and tracheal position should be assessed since asthmatics are at risk of developing secondary spontaneous pneumothoraces. Failure to recognise a pneumothorax or tension pneumothorax as the cause of sudden deterioration in asthmatics is associated with a significant mortality. This will be exacerbated if the patient is intubated and ventilated.

18
Q

Indication for mag sulfate in asthma

A
  • severe asthma not responding to broncholdilater
    -life threatening asthma

BTS says can give 50% magnesium sulfate at 1.2-2g (4-8mmol) over 20 minutes

19
Q

fractional exhaled nitric oxide suggestive of asthma

A

> 40ppb

20
Q

Spirometry in asthma

A

FEV1: FVC <70

Reversibility testing: an FEV1 increase >12% or 200mls, improvement of >400mls is strongly suggestive (after bronchodilator or trial of oral/inhaled steroids)

21
Q

Role of PEFR monitoring in diagnosing asthma (atleast BD for 2-4 weeks)

A

If there is diagnostic uncertainty based on FeNO and Spirometry

> 20% variability would be expected

22
Q

NICE 7 Steps chronic asthma management

A

Step 1: SABA alone (minority of patients)
Step 2: low dose ICS
Step 3: add LTRA
Step 4: add LABA and review LTRA
Step 5: MART Regime
Step 6: Moderate dose ICS
Step 7: High Dose ICS. LAMA or theophylline, and refer to asthma specialist

23
Q

PEFR criteria before discharging and asthmatic patient

A
  • PEFR >75% patient’s best/predicted value
  • duirnal variability on PEFR monitoring should be <25%
24
Q

stepwise

A

MRCP 2 (10 decks)

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