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Phase 3a - GP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Environmental triggers of asthma?

A

Infection
Night time or early morning
Exercise
Animals
Cold, damp or dusty air
Strong emotions

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2
Q

What 2 drugs can worsen asthma?

A

Beta-blockers (e.g., propranolol), and NSAIDs (e.g., ibuprofen or naproxen)

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3
Q

Sx of asthma

A

Shortness of breath
Chest tightness
Dry cough
Wheeze

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4
Q

Ix for asthma

A

Spirometry with bronchodilator reversibility
Fractional exhaled nitric oxide (FeNO)

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5
Q

Define the following:
1. FEV1
2. FVC

A
  1. The volume of air forcefully exhaled from the lungs in the first second of a forced breath.
  2. Total volume of air forcefully exhaled from the lungs after taking a deep breath.
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6
Q

Spirometry results in asthma:
1. FEV1
2. FVC
3. FEV1/FVC Ratio

A
  1. Reduced FEV1
  2. Normal or Reduced FVC
  3. Reduced FEV1/FVC ratio < 0.7
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7
Q

Step by step Tx for asthma (adults)

A

According to BTS not NICE → (NICE switches the last 2 steps)

Step 1 → SABA (e.g. salbutamol)
Step 2 → SABA + ICS (e.g. beclomethasone inhaler)
Step 3 → SABA + ICS + LABA (e.g. salmeterol)
Step 4 → SABA + ICS + LABA + LTRA (e.g. montelukast) → if LTRA no tolerated then stop and increase ICS dose instead

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8
Q

What’s the mode of action of Beta-2 adrenergic receptor agonists?

A

They are bronchodilators - adrenalin acts on the smooth muscle of the airways to cause relaxation. Stimulating the adrenalin receptors dilates the bronchioles and reverses the bronchoconstriction present in asthma.

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9
Q

What is the reliever treatment for asthma?

A

SABA

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10
Q

What’s the mode of action of Long-acting muscarinic antagonists?

A

Work by blocking acetylcholine receptors. Acetylcholine receptors are stimulated by the parasympathetic nervous system and cause contraction of the bronchial smooth muscles. Blocking these receptors dilates the bronchioles and reverses the bronchoconstriction present in asthma.

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11
Q

What lifestyle modifications would you suggest for a px with asthma?

A

Yearly flu jab
Regular exercise
Avoid smoking (including passive smoke)
Avoiding triggers where appropriate

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12
Q

What’s the criteria for mild/moderate asthma exacerbation?

A

SaO2 >92% in air

Vocalising without difficulty

Mild chest wall recession

Moderate tachypnoea

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13
Q

What’s the criteria for severe asthma exacerbation?

A

SaO2 <92%

PEFR 33-50% best or predicted

Cannot complete sentences in one breath or too breathless to talk/feed

Heart rate >125 (over 5 years old) or >140 (2-5 years old)

Respiratory rate >30 (over 5 years) or >40 (2-5 years).

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14
Q

What’s the criteria for life-threatening asthma exacerbation?

A

SaO2 <92%

PEFR <33% predicted

Silent chest

Poor respiratory effort

Cyanosis

Hypotension and exhaustion

Confusion

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15
Q

Tx of severe acute asthma exacerbation?

A

Oxygen to maintain sats 94-98%
Nebulised ipratropium bromide
ICS
IV magnesium sulphate
IV salbutamol
IV aminophylline

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16
Q

What are the 2 types of COPD?

A

Chronic bronchitis
Emphysema

17
Q

What is Chronic bronchitis aka blue bloater?

A
  1. Persistent inflammation of the bronchial tubes
  2. Due to exposure to irritants stimulates the mucus-producing glands in the airway epithelium.
  3. Increased mucus production can obstruct airways
  4. Chronic inflammation and mucus hypersecretion can lead to ciliary dysfunction, impairing the clearance of mucus and debris.
  5. As the airways become obstructed and airflow is limited, there is impaired gas exchange in the lungs.
18
Q

What is emphysema aka pink puffers?

A
  1. Healthy lung = balance between protease enzymes (which break down proteins) and antiprotease enzymes (which inhibit the activity of proteases).
  2. Exposure to irritants → disrupt this balance → leading to an excess of protease activity.
  3. Protease enzymes (i.e. elastase) break down elastin fibres in alveolar walls.
  4. Loss of elastin → decreased lung elasticity + inability of airways to recoil during exhalation → smaller lung S.A.
  5. Absence of alpha-1 antitrypsin → uncontrolled activity of proteases → further contributing to emphysema development.
19
Q

Deficiency of which protein can lead to emphysema?

A

Alpha-1 antitrypsin

20
Q

Sx of COPD

A

Shortness of breath
Cough
Sputum production
Wheeze
Recurrent respiratory infections, particularly in winter
Barrel chest - lung overfilled with air
Pursed lip breathing
Cyanosis

21
Q

Spirometry results in COPD

A

Obstructive pattern → FEV1:FVC ratio <0.7

Little or no response to reversibility testing with beta-2 agonists (e.g., salbutamol).

22
Q

What would you see in chest x-ray results of a px with COPD?

A

Flattened diaphragm
Hyperinflation
Bullae - air filled spaces

23
Q

What are the 4 stages of severity in COPD?

A

Stage 1 (mild): FEV1 more than 80% of predicted
Stage 2 (moderate): FEV1 50-79% of predicted
Stage 3 (severe): FEV1 30-49% of predicted
Stage 4 (very severe): FEV1 less than 30% of predicted

24
Q

What is acute bronchitis?

A

Inflammation of the bronchi (medium and large tubes) - aka chest cold

25
Q

Sx of acute bronchitis

A

Cough - can last up to 20 days
Sputum - clear
Wheezing
SOB
Fever
Chest discomfort

26
Q

What is bronchiolitis?

A

Inflammation and infection in the bronchioles, the small airways of the lungs - usually seen in children <2yrs.

27
Q

What virus is bronchiolitis usually caused by?

A

Respiratory syncytial virus (RSV)

28
Q

Sx of bronchiolitis

A

Coryzal symptoms. Sx of viral upper respiratory tract infx: running or snotty nose, sneezing, mucus in throat and watery eyes.
Sx of respiratory distress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever (under 39ºC)
Apnoea
Wheeze and crackles on auscultation

29
Q

Sx of resp distress in infants

A

Raised respiratory rate
Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis

30
Q

Difference between wheezing and stridor

A

Wheezing is a whistling sound caused by narrowed airways - heard during expiration

Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway

31
Q

Tx of bronchiolitis

A

Supportive management:
1. Ensuring adequate intake
2. Saline nasal drops and nasal suctioning
3. Supplementary oxygen - if below 92%
4. Ventilatory support - if required

32
Q

How is ventilatory support provided to babies?

Describe the step up approach

A

Step up approach:

  1. High-flow humidified oxygen via tight nasal cannula. It adds “positive end-expiratory pressure” (PEEP) to maintain the airway at the end of expiration.
  2. Continuous positive airway pressure (CPAP).
  3. Intubation and ventilation.
33
Q

What 2 Sx in blood suggest poor ventilation?

A

Rising pCO2

Falling pH - resp acidosis as CO2 is building up

34
Q

What monoclonal antibody targets the RSV virus that causes bronchiolitis?

A

Palivizumab - given as a monthly injection to prevent against bronchiolitis.

35
Q

What is croup?

A

Acute infective respiratory disease. It is an upper respiratory tract infection causing oedema in the larynx.

36
Q

What age group does croup typically affect?

A

Children aged 6 months to 2 years

37
Q

What are causes for croup?

A

MC - Parainfluenza
Other:
Influenza
Adenovirus
Respiratory Syncytial Virus (RSV)

38
Q

Sx of croup

A

Increased work of breathing
“Barking” cough, occurring in clusters of coughing episodes
Hoarse voice
Stridor
Low grade fever

39
Q

Tx of croup

A

Supportive and sit child up.
Stepwise if severe:
Oral dexamethasone
Oxygen
Nebulised budesonide (steroid)
Nebulised adrenaline
Intubation and ventilation

Phase 3a - GP (15 decks)

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