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GP FELLOWSHIP RNZGP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Exam findings in Bronchiectasis

A

Coarse crackles

Clubbing

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2
Q

Features of Bronchiectasis (exam and history and clues)

A
  • Clubbing
  • Coarse crackles
  • Pseudomonas or HIB colonisation
  • Recurrent infections
  • Minimal smoking history
  • Pleuritic chest pain
  • Haemoptysis
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3
Q

Features of ILD

A
  • Similar clinically to CCF
  • Fine inspiratory ‘velcro’ like crackles on exam - usually bibasally
  • Clubbing (30-50%)
  • Cor pulmonary in advanced disease
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4
Q

Spirometry pattern for ILD

A

Restrictive

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5
Q

Restrictive Spirometry possible causes

A
  • ILD
  • Obesity
  • Kyphoscoliosis
  • Neuromuscular disease
  • Pleural disease
  • Pneumonia
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6
Q

Causes of ILD

A

Connective tissue dx

Sarcoidosis

Drugs (nitrofurantoin)

occupational exposures (dust, mould, asbestos, bird, home brewing)

Idiopathic pulmonary fibrosis

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7
Q

Diagnosis for ILD or Bronchiectasis and findings

A

HRCT

Ground glass or honeycombing
reticular pattern

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8
Q

STEP wise approach to COPD puffers

A
  1. SABA or SAMA
    Salbutamol or atrovent

Add
2. LAMA: “Spiriva” tiotropium
“seebri” Gylcopyrronium
LABA:
Indacterol

OR LAMA/LABA
“spiolto” tiotropium /olodaterol
“brimica” Aclidinium /formeterol

add
3. ICS /LAMA/ LABA (combo)
“Trelegy” Fluticasone, umeclidinium, vilanterol

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9
Q

LAMA/LABA common drugs

A

“spiolto”
tiotropium /olodaterol

“brimica”
Aclidinium /formeterol

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10
Q

LAMA

A

Tiotropium
“Spiriva”

Glycopyrronium
“seebri”

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11
Q

LABA

A

“Serevent”
Salmeterol

Formeterol
“oxis”

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12
Q

ICS/LABA
low med high doses
2 examples

A

“Symbicort”
budesonide/formeterol
Low= 200-400
Med= 500-800
High =>800

“Seretide”
Fluticasone/salmeterol
Low dose: 100-200
Med: 250-500
High 500+

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13
Q

ASTHMA STEPWISE

A
  1. SABA prn
    almost no one
  2. ICS/SABA
    OR ICS/LABA Budesonide & formeterol (symbicort low dose)
  3. ICS/LABA
    (plus prn or SABA prn) LOW dose
  4. ICS/LABA
    (plus prn or SABA prn) medium-high dose
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14
Q

Vague story:
- Young
- Cough and dyspnoea
- Non- acute
- Likely occupational exposure (eg stonemason)
- Possibly other systemic signs (?rash)

DDX

A
  • Interstitial lung disease from occupational exposure (silicosis)
  • Hypersensitivity pneumonitis
  • Work- associated asthma / occupational asthma
  • Sarcoidosis
  • Connective tissue disease (SLE, RA, systemic sclerosis)
  • Emphysema
  • Malignancy
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15
Q

Silicosis increases your risk of:

A

Lung cancer
TB

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16
Q

CRB-65

A

C: Confusion
R: Resp rate >30
B: BP systolic <90
65

1 point each
1-2 consider hospital
3+ - URGENT hospital

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17
Q

Epworth sleepiness scale cut off for concern

A

> 8

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18
Q

Gold standard OSA diagnosis

A

In-laboratory full Polysomnography

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19
Q

Questionnaires for OSA

A

STOP BANG
OSA50

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20
Q

OSA 50 score for testing

A

Obesity (3)
Snoring (3)
Apnoea (2)
Age >50 (2)

> 5

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21
Q

STOP BANG score for testing

A

Snoring
T: tired
O: observed apnoeas
P: Blood Pressure high
B: BMI >35
A: age> 50
N: Neck circ >40
G: Male gender

> 4

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22
Q

Hypersensitivity pneumonitis (common causes)

A
  • Bird fancier’s lung
  • Farmer’s lung
  • Mushroom worker’s lung
  • Humidifier’s lung
  • Grain processing
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23
Q

Stages of TB

A

Primary TB (usually contained by immune system)

Post primary disease (Reactivation) - usually within 5 years of initial infection

Latent
- no signs or symptoms
- Granulomatous lesion

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24
Q

Cystic fibrosis differentials (chronic WET cough in child)

A
  • Protracted bacterial bronchitis
  • Primary cilliary dyskinesia
  • Primary immunodeficiency
  • Congenital cardiac disease
  • Recurrent aspiration (eg TOF)
  • A1antitrypsin deficiency
  • Bronchiectasis
  • Recurrent bronchiolitis
  • TB
  • FB aspiration

NOTE:
Not GORD or post viral cough = not productive

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25
Q

Pattern of inheritance CF

A

Autosomal recessive

Both parents must carry
If both then 1/4 chance

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26
Q

Manifestations of cystic fibrosis

A

GI
- Meconium ileus
- Steatorrhea
- Rectal prolapse
- Pancreatic exocrine insufficency

OTHER
- Failure to thrive, faltering growth
- Osteoporosis
- Hypochloraemic hyponatraemic alkalosis

Respiratory
- Bronchiectasis
- Sinusitis
- Nasal polyposis
- Chronic cough

27
Q

Pertussis antibiotics

A

First line:
Azithromycin 10mg/kg day 1 (500mg), then 5mg/kg (250mg)for 4 more days

or clarithromycin 7.5mg/kg BD (500mg) for 7 days

28
Q

Pertussis: who gets antibiotics

A
  • Infants <6 months
  • Parents / household members of infants <6 months
  • If had symptoms for less than 21 days
  • those in a household with someone in their last month of pregnancy
29
Q

Good control of asthma….

A
  • Daytime symptoms =<2 days
  • Need SABA =<2 days
  • No limit to activity
  • No nocturnal symptoms
30
Q

Children asthma preventers

A

ICS (flixotide JNR)
Montelukast

(NO LABAS)

31
Q

Adolescents asthma how to treat (child or adult)

A

adult
use labas

EG Symbicort is good

32
Q

Respiratory history questions

A
  • Smoking
  • Travel
  • Occupational exposure to possible irritants
  • Vaccination history
  • Sputum production
  • Systemic symptoms eg fever
  • Asthma history eg wheeze
  • Medication history eg ACEi
  • Exposure to birds
  • Post tussive vomiting
33
Q

Respiratory presentations (don’t forget)

A
  • Pertussis (prolonged cough)
  • TB (overseas, cough, weight loss)
  • Pulmonary abscess (weight loss)
34
Q

Pertussis investigations (time course)

A

PCR & culture <4 weeks of cough
Serology >4 weeks of cough

35
Q

Pneumothorax rule of criteria for conservative management

A

TRAUMATIC!!! - if traumatic then not for conservative

  • BP <90
  • Tachycardia
  • Tachypnoea
  • Hypoxia
  • Severe chest pain or breathlessness
36
Q

What is conservative management for pneumothorax?

A

ED observation 4 hours
Then DC home with 2 weekly CXRs

37
Q

Small cell lung cancer radiological features

A

Central lesion (perihilar mass)
Mediastinal LN enlargement

38
Q

Optimising chronic lung disease

A
  • Vaccination
  • Pulmonary rehabilitation
  • Early recognition and treatment of infective exacerbations with antibiotics
  • Regular exercise to maintain weight, muscle mass and strength.
  • Minimising exposure to respiratory infections
39
Q

Signs of exacerbation of bronchiectasis

A
  • Increased sputum purulence
  • Increased suputum volume or viscocity
  • Increased cough (may be associated with wheeze, breathlessness or haemoptysis)
40
Q

Severe exacerbation of bronchiectasis - indications for hospitalisation

A
  • Worsening hypoxaemia (from baseline)
  • Resp distress
  • Confusion
  • Sepsis
41
Q

Contact with birds- what two diagnoses to consider

A
  • Hypersensitivity pneumonitis (bird fancier’s disease)
  • Psittacosis (chlamydia psittaci)
42
Q

Red flags indicating hospital admission for CAP

A
  • RR >22
  • HR >100
  • SPB <90
  • Confusion
  • O2 <92
  • Multi-lobar involvement
43
Q

Types of occupational interstitial lung disease

A

Pneumoconiosis:
- Silicosis
- Coal worker’s pneumoconiosis,
- Asbestosis

Hypersensitivity pneumonitis
- Farmer’s lung, bird fancier’s lung

Other interstitial disorders
- Textile worker’s lung

44
Q

Causes of pleural effusion

A

Transudate
- CCF
- Liver failure (ascites)
- Nephrotic syndrome

Exudative
- Infection: pneumonia, pleurisy, empyema
- Malignancy: bronchial carcinoma, mesothelioma, metastatis
-SLE/RA
- Pulmonary infarction

45
Q

Legionella pneumonia treatment (cooling systems)

A

Azithromycin 500mg for 3-7 days

46
Q

Oxygen levels safe for flying

A

> 95%

47
Q

When do you need respiratory specialist clearance to fly (oxygen level)

A

<95%

48
Q

Investigations for pulmonary TB

A

CXR
Sputum for acid fast bacilli
Sputum for Mycobacterium PCR
Interferon- gamma release assay (more for latent)

49
Q

Severe croup management (doses)

A

Adrenalin 1:1000 5ml nebulised, repeat 30 mins

PLUS
2mg/kg pred (up to 50)

50
Q

General measures for OSA management (PLUS devices)

A
  • Weight loss 5-10%
  • Smoking cessation
  • EtOH cessation
  • Intranasal corticosteroids
  • Supine positional therapy (with predominately supine OSA)

Devices:
- CPAP (moderate to severe)
- Mandibular advancement splint

51
Q

Causes of Haemoptysis

A

Common:
- URTI (24%)
- Bronchiectasis
- Chronic bronchitis

  • PE
  • Pneumonia
  • TB
  • Bronchogenic carcinoma
  • Blood from nose or throat
52
Q

Markers of severity of croup

A
  • Tachypnoea or bradypnoea
  • Marked increased WOB
  • Decreased level of consciousness/agitation
  • Stridor at rest
53
Q

Spirometry:
1) Cut off for moderate and severe obstruction for predicted FEV1?

2) % for bronchodilator response & terminology for this

A

1) >40%-59%
<40% predicted

2) 12%
“reversible airflow limitation”

54
Q

Indications for specialist review for COPD/Asthma

A
  • Following a life threatening asthma admission
  • Occupational asthma
  • Frequent asthma needing repeat urgent GP visits
  • Moderate obstructive airways disease
  • Assessment for home O2
  • Frequent chest infections
55
Q

Indications for asthma preventer medication
(paediatrics)

A
  • Nocturnal symptoms > twice /month
  • Symptoms restricting activity
  • Admission
  • 2 or more ED presentations
  • 2 or more rounds of oral pred
56
Q

Flixotide junior dose for paeds

A

Fluticasone propionate 50microg 1-2 puffs BD via spacer

57
Q

Two options for preventer in kids

A

Montelukast 5mg PO

Fluticasone propionate 50microg 1-2 puffs BD via spacer

58
Q

Side effects of montelukast

A
  • Suicidal ideation
  • Sleep disturbance
  • Agression
  • Anxiety
59
Q

Exercise induced asthma management (pharmacological)

A

Inhaled corticosteroid

60
Q

Pertussis isolation period

A

After 5 days of anitbiotics
OR
after 21 days of coughing

61
Q

COPD specific LABA

A

Indacaterol

62
Q

Size (mm) cut off for parapneumonic effusion needing sampling (instead of just regular CAP treatment)

A

10mm deep

63
Q

Adult OSA examination

A
  • Retrognathia
  • Mallampati score or tonsillar hypertrophy
  • BMI
  • Neck circumference
  • Nasal patency
  • ECG
  • CVD exam
64
Q

ASTHMA STEPWISE

A
  1. SABA prn **almost no on one
  2. ICS/SABA
    (OR BUDESONIDE/FORMETEROL PRN)
  3. ICS/LABA
    (plus prn or SABA prn) LOW dose
  4. ICS/LABA
    (plus prn or SABA prn) medium-high dose

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