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Year 3 Pathologies > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is Asthma?

A
  • Chronic respiratory condition with airway inflammation and hyper-responsiveness
  • Variable over time
  • Eosinophilia
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2
Q

What are the Royal College of Physicians 3 questions for Asthma?

A

No to all Q’s consistent with controlled asthma

  • ‘Have you had difficulty sleeping because of your symptoms?’
  • ‘Have you had your usual symptoms during the day?’
    (cough, wheeze, chest tightness or breathlessness)
  • ‘Has your asthma interfered with your usual activities?’

Expanded Score with frequency of symptoms (0-3)

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3
Q

What is the ACQ-5 for Asthma?

A
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4
Q

H&E for Asthma

A
  • Cough - worse at night
  • Breathlessness
  • Wheezing
  • Recent upper respiratory tract infection
  • Chest tightness
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5
Q

RF for Asthma

A
  • Other atopic features
  • Eczema
  • Hayfever
  • Allergic rhinitis
  • Family history
  • Smoking
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6
Q

Investigations for Asthma

A
  • Spirometry with bronchodilator reversibility
    • Reduced FEV1 - improvement by 12% or more
    • Normal FVC
    • FEV1/FVC < 70%
  • FeNO for eosinophilic inflammation (not for <5yr)
    • 40 ppb or more is positive in adults
    • 35 ppb or more is positive in children
  • Peak expiratory flow rate
  • Chest X-ray
  • FBC: Eosinophils: > 0.3
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7
Q

Severity of acute Asthma exacerbation?

A
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8
Q

Management for Asthma

A
  • SABA
  • Add ICS if regular exacerbations
  • Add LABA
    • Increase ICS if not responding well
  • Add LTRA

EXTRA FLASHCARD FOR HOW EACH MED ACTS

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9
Q

Management of Acute Asthma attack

A
  • Hospital admission for life-threatening and unresponsive severe, or previous near-fatal attack, pregnancy, if using oral corticosteroid or presentation at night
  • 15L oxygen via non-rebreathe mask, target 94-98%
  • SABA - salbutamol, terbutaline
    • Nebulised in life-threatening
  • Corticosteroid
    • 40-50mg oral prednisolone for 5 days or until patient recovers
  • SAMA if not responding/severe or life-threatening - ipratropium bromide
  • If still not responding and becoming acidotic, senior critical care support, intubation and ventilation
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10
Q

Criteria for discharge for acute asthma attack

A
  • Stable on discharge medication for 12-24 hours
  • Inhaler technique checked and recorded
  • PEF >75% of best or predicted
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11
Q

What is Allergic Bronchopulmonary Aspergillosis (ABPA)

A
  • Hypersensitivity reaction to bronchial colonisation by Aspergillus fumigatus mould
  • Typically affects patients with asthma
  • Presentation similar to asthma, with fever, malaise, mucus expectoration and haemoptysis
  • Peripheral blood eosinophilia
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12
Q

What is Asthma COPD overlap syndrome?

A

Diagnosed when you have symptoms of both asthma and COPD.

Not a separate disease

“Persistent airflow obstruction with features of asthma”

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13
Q

H&E for A+COPD OS

A

People diagnosed with ACOS typically experience symptoms more frequently than people with asthma or COPD alone and have reduced lung function. Symptoms include:

  • Difficulty breathing
  • Frequent shortness of breath
  • Excess mucus (more than usual)
  • Wheezing
  • Feeling tired
  • Frequent coughing
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14
Q

Investigations for A+COPD OS

A

Lung function tests - obstructive pattern

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15
Q

What is Acute Bronchitis?

A

Self-limiting lower respiratory tract infection

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16
Q

What is Acute Bronchitis usually caused by?

A
  • Rhinovirus
  • Parainfluenza
  • Influenza A / B
  • Respiratory Syncytial Virus
  • Coronavirus
17
Q

H&E for Acute Bronchitis

A
  • Cough, may be productive
  • Dyspnoea and wheezing
  • Mild fever
  • Exclusion of other causes
18
Q

RF for Acute Bronchitis

A
  • Infection exposure
  • Smoking
19
Q

Investigations for Acute Bronchitis

A

Usually clinical diagnosis
BUT
Consider CXR if:
- suspected pneumonia
- elderly patient
- persistent cough > 6 weeks
- history of chronic illness

20
Q

Management for Acute Bronchitis

A

If otherwise healthy - paracetamol + ibuprofen

If cough > 2 weeks - inhaled corticosteroids

If patient has underlying lung pathology - Amoxicillin / Doxycycline

SABA + Antitussives if wheezy / disrupting sleep

21
Q

What is Pneumothorax?

A

A collapsed lung - when air leaks into the space between your lung and the chest wall, the air pushes on the outside of the lung and makes it collapse
Can be a complete lung collapse or only a portion of the lung

22
Q

H&E of Pneumothorax

A

Sudden onset:
- Dyspnoea
- Pleuritic chest pain
- Sweating
- Tachypnoea
- Tachycardia
- Hyperresonance on percussion
- Absent breath sounds
- Decreased tactile vocal fremitus

23
Q

Investigations of Pneumothorax

A

Chest X-ray:
- Regions of dark around the edge of the lung (darker than lung)

24
Q

How can Pneumothorax be classified?

A

Primary - in absence of underlying lung disease

Secondary - in presence of underlying lung disease

25
Q

RF of Pneumothorax

A
  • pre-existing lung disease : COPD, asthma, cystic fibrosis, lung cancer, pneumocystis pneumonia
  • connective tissue diseases : Marfan’s, rheumatoid arthritis
  • ventilation, including non-invasive ventilation
  • catamenial pneumothorax - cause of 3-6% of spontaneous pneumothoraces occurring in menstruating women (thought to be caused by endometriosis within the thorax)
26
Q

What is management of Pneumothorax dependent on?

A

Depends on type, size + clinical status of patient

27
Q

Management of Primary Pneumothorax

A
  • <2cm rim of air and no dyspnoea: discharge
  • > 2cm rim of air and/or dyspnoea: pleural aspiration
  • If this fails (>2cm or dyspnoea), insert chest drain
28
Q

Management of Secondary Pneumothorax

A
  • If rim of air <1cm, give oxygen and admit for 24 hours
  • Rim of air between 1-2cm: pleural aspiration
    • If this fails, then insert chest drain
  • Patient >50 and rim of air >2cm and/or dyspnoea: chest drain
  • If chest drain fails → video-assisted thoracoscopic surgery (VATS)
29
Q

Management of Tension Pneumothorax

A
  • May occur following thoracic trauma when a lung parenchymal flap is created.
  • This acts as a one way valve and allows pressure to rise.
  • The trachea shifts and hyper-resonance is apparent on the affected side.
  • Treatment is with emergency needle thoracocentesis and chest tube insertion.

Year 3 Pathologies (12 decks)

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