Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCGP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Features severe asthma exacerbation

A

Peak flow 33-50% predicted
Cannot complete sentences
RR>25
HR>110
Sats>92%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features life threatening asthma exacerbation

A

Peak flow <33% predicted
Sats<92%
Silent chest, cyanosis, or poor respiratory effort
Arrhythmia or hypotension
Exhaustion, altered consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors severe asthma

A

Prev ICU/admissions
3+ classes of medication
High use SABA?3x per week
Non compliance/psychosis
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management acute exacerbation asthma

A

O2, salbutamol nebs, admit

If mild:
5-10 puffs salbutamol using tidal breathing + aerochamber
prednisolone 40mg OD 5 days
+/- amoxicillin 500mg TDS 5 days

Quadruple inhaler ICS dose until recovered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you diagnose asthma in adults with spirometry?

A

If pre BD spirometry shows obstruction (FEV1/FVC ratio <0.7) perform reversibility with SABA
12% (and >200mls) increase in FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you diagnose asthma in adults with peak flow diary?

A

Complete 2-4 week peak flow diary
Evidence of 20% peak flow variability supports asthma diagnosis.
Once on treatment with ICS expect peak flow to increase and variability reduce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you diagnose asthma in adults with FeNO?

A

FeNO >40 consistent with
asthma (steroid naive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Triggers for asthma exacerbation

A

Allergens- hayfever, rhinitis
Exercise
Cold air
Medications, e.g. aspirin and beta blockers
Occupational
Viral infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

6 questions to assess asthma control

A

Nocturnal disturbance- woken with coughing and wheezing?
Impact on ADLs
Cough, wheeze, chest tightness, breathlessness, during the day?
Reliever therapy use
Concordance with preventer use
Use of PO corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

1st step asthma management in adults

A

ICS+immediate acting LABA as MART regime
Symbicort Turbohaler 200/6
1 dose PRN up to 8 doses/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Step 2 asthma management adults

A

MART regime:
Symbicort Turbohaler
200/6, 1 puff BD
Max doses/day: 12

Fostair NEXThaler
100/6, 1 puff BD
Max doses/day: 8

Trial montelukast 10mg at night 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Step 3 asthma management adults

A

MART regime:
Symbicort Turbohaler
200/6, 2 puff BD
Max doses/day: 12

Fostair NEXThaler
100/6 2 puffs BD
Max doses/day: 8

Trial montelukast 10mg at night 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Step 4 asthma management in adults

A

Continue MART regime + LAMA
Add on Spiriva Respimat
2.5mcg 2 doses OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Step 5 asthma management adults

A

Referral ?biologics
Symbicort Turbohaler
400/12, 2 doses BD + spiriva respimat 2.5mcg 2 doses OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When would you refer adults with asthma?

A

-Diagnostic uncertainty
* Complex comorbidity
* Suspected occupational asthma
* Poor control following treatment at Step 4
* ≥2 courses of oral steroids/ year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Step 1 children with asthma

A

Age<6
Clenil 100mcg 1 dose BD + SABA PRN (with spacer)

Age 6-11
Budesonide100mcg Turbohaler 1 dose BD + SABA PRN (Terbutaline 500mcg Turbohaler)

Age>12
Budesonide 100mcg Turbohaler 1-2 doses BD + SABA PRN (Terbutaline 500mcg Turbohaler)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Step 2 children with asthma

A

Age<6
6 week trial montelukast 4mg ON

Age 6-11
6 week trial montelukast 5mg ON

Age>12
6 week trial montelukast 5mg ON or 10mg if age>15

18
Q

Step 3 children with asthma

A

Age<6 refer, mod dose ICS + SABA Clenil modulite 100 mcg
2 doses BD via spacer

Age 6-11
ICS/LABA plus PRN SABA
Symbicort 100/6 Turbohaler 1 dose BD

Age>12
Adult MART Symbicort 100/6 Turbohaler 1 dose BD
(max 8 doses/24 hrs) + emergency SABA

19
Q

Step 4 children with asthma

A

Age<6 Refer

Age 6-11
Refer
ICS/LABA Mod Symbicort 100/6
Turbohaler 2 doses BD

Age>12
MART Symbicort 200/6
Turbohaler 1-2 doses BD
(max 8 doses/24 hrs)

20
Q

Diagnosis asthma in children

A

Peak flow diary (1-2 week) age 5-17
Skin prick test, Allergen-specific IgE, Blood eosinophils age 3-17
Spirometry with reversibly testing age ≥ 12
Fractional exhaled Nitric Oxide (FeNO) age ≥ 12

21
Q

If no objective evidence but strong clinical suspicion asthma in children?

A

Perform treatment trial
Including in children age 3-5 years
with “episodic wheeze”:
* Commence ICS for 8 weeks: Clenil
modulite 200mcg BD
* Review response at 8 weeks

No response
- Discontinue treatment
- Consider alternative diagnosis
Positive response
- Discontinue treatment
- If symptoms recur, restart low dose
ICS as maintenance therapy

22
Q

How to differentiate asthma from COPD

A

Asthma: response to SABA>200 mL and >12% improvement of FEV1.

Completely reversible airway obstruction do not have COPD

If a patient with a high clinical suspicion of asthma, consider a trial of 40 mg of prednisolone OD for 2 weeks, then repeat spirometry.

23
Q

Features bronchiectasis

A

Permanent abnormal dilatation of the airways
Impaired mucociliary clearance
Excessive inflammation of airways, mucus production, and bacterial colonisation.

chronic productive cough.
unexplained haemoptysis
Exertional dyspnoea
Recurrent chest infections
Signs of over-inflation of chest
Finger clubbing (now rare)
Pseudomonas on sputum culture

24
Q

Underlying causes bronchiectasis

A

Post TB, Measles, pertussis, pneumonia
Cystic fibrosis
COPD
IBD, RA

25
Q

Diagnosis of bronchiectasis

A

CXR to exclude other causes
Spirometry
Sputum
High resolution CT when well

26
Q

Referral criteria bronchiectasis

A

first isolate of Pseudomonas aeruginosa, or atypical mycobacteria.
persistent haemoptysis.
spirometry shows moderate to severe airflow obstruction or declining lung function over time.
recurrent exacerbations (>3 per year)
known immune deficiency, IBD, RA, or allergic bronchopulmonary aspergillosis (ABPA).
considering long‑term antibiotic therapy.

27
Q

CRB-65

A

Confusion
RR>30
BP: Systolic <90 or Diastolic <60
Aged 65 years or older

If >1 then admit

28
Q

Ix for LRTI

A

Treat empirically/based on prev sputum for 72 hrs
If no improvement: CXR, bloods, sputum culture, consider admission

29
Q

Features COPD

A

airflow obstruction on spirometry, and
a history of smoking, or exposure to other noxious agents.

cough up phlegm or mucus most days.
lose breath more easily than others their age.
suffer recurrent episodes of winter chest infections.

30
Q

COPD findings on spirometry

A

Reduced FEV1 (<80% predicted)
Reduced FVC (but to a lesser extent than FEV1)
FEV1/FVC ratio reduced (<0.7)

Mild – FEV1 more than 80% predicted
Moderate – FEV1 50 to 80% predicted
Severe – FEV1 30 to 50% predicted
Very severe – FEV1 less than 30% predicted

31
Q

Non inhaler management COPD

A

Vaccination (flu, COVID, pnuemococcal)
Exercise + pulmonary rehab
Smoking cessation
Referral for oxygen assessment if SpO2 is <93% and not smoking

Mucolytic – carbocisteine 750 mg twice a day.

32
Q

COPD management

A

Phenotype 1- Dyspnoea with less than 2 exacerbations per year
LABA + LAMA (Anoro Ellipta 55/22 T OD)

Phenotype 2- Two or more exacerbations per year
Prescribe Triple therapy (trelegy OD, trimbow BD)

Phenotype 3- asthma overlap Significant symptomatic or lung function response to steroids. Blood eosinophil counts >0.3
MART plus LAMA (symbicort turbohaler 200/6 TT BD + spiriva respimat TT OD)

33
Q

COPD exacerbation management

A

SABA PRN
Prednisolone (30mg OD 5 days)
Abx if increased sputum purulence, volume + breathlessness

34
Q

Referral criteria COPD

A

diagnostic uncertainty.
patient younger than 40 years, or younger than 55 years with severe disease.
>2 exacerbations a year.
considering pulmonary rehabilitation.
considering nebulised therapy

35
Q

Differential diagnoses for cough

A

Asthma
Gastro‑oesophageal reflux –worse lying down to sleep, after meals, dysphonia.
Postnasal drip
Malignancy – weight loss, dysphonia, dysphagia
ACEi
Cardiac – dyspnoea, palpitations, ankle swelling.

36
Q

Cough>8 weeks

A

USC referral if unexplained haemoptysis or weight loss/hoarseness
CXR
Consider sputum culture x3 (MC+S, acid‑fast bacilli, and fungi)
Consider spirometry
Treat underlying cause (eg trial nasal steroid, asthma treatment, PPI)

37
Q

Causes haemoptysis

A

lung cancer.
TB
bronchiectasis
pulmonary abscess.
Minor haemoptysis:
LRTI
PE
anticoagulant or antiplatelet treatment.
CCF/ mitral stenosis – pink frothy

38
Q

Risk factors for TB

A

Close contacts active TB
Migrants
Age<5/Elderly
Immunosuppressed, HIV, diabetes
Misusing drugs or alcohol
Homeless or in overcrowded housing
Prison leavers

39
Q

ILD causes

A

Idiopathic
RA/Sarcoid
Asbestosis/silica
Chemo, nitrofurantoin

40
Q

Features OSA

A

STOP BANG
Snore loudly
Tired/fatigued
Stopping breathing during sleep
HTN
BMI>35
Age>50
Neck circumference>40cm
Male

MRCGP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions