Respiratory Flashcards
Key aspects of COPD management
Active Rx
- Pharmacotherapy
- Pulmonary rehab
- Action plan
- Self-management
Prevention
- Vaccination
- Smoking cessation
- Nutrition
- Co-morbidities
Diagnosis of COPD
Hx, then needs to be confirmed on SPIROMETRY
Persistent airflow limitation (without complete reversibility)
= Post bronchodilator FEV1/FVC <0.7
Complications and comorbidities with COPD (5)
Infections +- hospitalisations
Hypoxaemia
Pulmonary HTN
Heart failure
Polycythaemia
5-As smoking cessation
Ask, Assess, Advise, Assist, Arrange
Ask and identify
Asses nictotine dependence + motivation to quite
Advise about risks of smoking + benefits of quitting
Assist cessation - counselling + pharamcotherapy
Arrange follow-up within 1 wk and 1 month
Key differences between 3 stages of asthma
- mild/mod
- severe
- life threatening
6+ child with asthma. Other than interval Sx, what are indications for preventer (3)
- Asthma symptoms limiting normal activity (school, sports)
- Asthma requiring hospitalization (mod flare) OR req ICU (severe flare)
- 2x exacerbations requiring oral steroids
Non pharma Mx of Paed asthma (5)
- Prepare up to date AAP
- Educate on avoidance of triggers
- Avoid passive smoke exposure
- Advise carrying salbutamol at all times
- Advise annual flu vacc
Management steps for pertussis (4)
- Notify Deparment of Health
- Commence patient on oral azithromyxin for 5/7
- Reccomend treatment of other risk contacts
- pregnancy
- <6mo
- whole house if <6mo or pregnant individual
- any contacts who have exposure to high risk pts - Advise patient to isolate when they have completed 5/7 of antibiotics
4yo boy with symptoms of rhinosinusitis, Mx options (3)
- Oral loratidine OD
- Intranasal nasonex both nostrils BD
- Oral montelukast (singulair) OD
Adult asthma - when is PRN SABA appropiate?
Only if symptoms < twice a month + no risk factors for flare ups
WHen to consider step down of adult asthma management + features of good asthma control (4)
If stable for 2-3 months
Good control
- Day time symptoms <2days/wk
- Need for SABA <2days/wk
- No limitation on activities
- No symptoms during night or on waking
When to step down children asthma treatment?
If stable for 6 months, different to adults who are only 2-3mo
40yo presents with 10/7 muscle aches, intermittent fever, dry cough. Tried amox with GP 5/7 ago, no improvement. Works in a pet store with birds.
DDx (6)
- Psittacosis
- Hypersensitivity pneumonitis
- Pertussis
- Post nasal drip from allergic rhinosinusitis
- Viral URTI
- Atypical pnuemonia (mycoplasma)
KFP: Pt with COPD, exam findings that would warrant admission (6)
- Hypotension SBP <90
- Tachycardia HR >100
- Tachypnoea RR>30
- Hypoxia Sp02 <92% on RA
- Increased WOB
- New onset confusion
KFP: Features on hx the support provisional dx of OSA - note need diversity (5)
- Waking with gasping/witnessed apnoeas
- Excessive daytime sleepiness
(grouped with unrefreshing sleep etc) - Poor concentration
- Low mood
- Nocturia
