RESPIRATORY Flashcards
severity of airflow obstruction can be graded according to
predicted FEV1 following the use of bronchodilators
severity of airflow obstruction, stages
FEV1 > 80% stage 1 or mild COPD
FEV1 50–79% stage 2 or moderate COPD
FEV1 30–49% stage 3 or severe COPD
FEV1 < 30% stage 4 or very severe COPD
appropriate tool to use for the annual review of asthma in a child aged four years
Childhood Asthma Control Test (or Mini Asthma Quality of Life Questionnaire or Paediatric Asthma Quality of Life Questionnaire)
clinical feature is MOST likely to suggest an alternative diagnosis to chronic obstructive pulmonary disease (COPD)
Haemoptysis
assessment of patients for LTOT should include the measurement of arterial blood gases when
two occasions at least three weeks apart
What is the threshold NUMBER of exacerbations per year, if any, after which long-term antibiotics are recommended for treating adult bronchiectasis?
3
If inhaled corticosteroids are not controlling a person’s asthma symptoms, then NICE recommendswhat to add
leukotriene receptor antagonist (LTRA)
If inhaled corticosteroids are not controlling a person’s asthma symptoms, then BTS/SIGN recommend
adding in a long-acting beta-2 agonist
acute severe asthma episode is defined as any one of
Peak expiratory flow (PEF) 33–50% best or predicted
respiratory rate ≥ 25 breaths per minute
heart rate ≥ 110 beats per minute
inability to complete sentences in one breath
CRB65 -RR and BP
RR >=30, SBP <=90, DBP <=60
steroid and dose for ECOPD
pred 30mg for 5 days
drugs which may cause pulmonary fibrosis
nitrofurantoin, methotrexate, cytotoxic drugs, amiodarone, heroine
suspicion for lung cancer - next step
get urgent chest xray
indications for urgent referral to respiratory for cancer?
needs to have chest xray first (CT scan indicated, or persistent haemoptysis for smokers/exsmokers age 40 or over)
asthma would be defined as life-threatening when
Peak expiratory flow rate (PEFR) < 33% best or predicted
Pulse oximeter oxygen saturation < 92%
Altered conscious level
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent chest
age when LTRA is added after SABA
2-5 years old
treatment for pseudomonas in bronciectasis
cipro for 7-14 days
NICE) advises that an urgent chest X-ray should be considered to assess for lung cancer in people aged 40 years or over with any of the following
Persistent or recurrent chest infection
Finger clubbing
Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
Chest signs consistent with lung cancer
Thrombocytosis
indication of endometrial cancer and therefore pelvic ultrasound should be considered in women aged 55 years and over
Thrombocytosis with visible haematuria or vaginal discharge
occupational asthma involves peak flow reading at work and at home twice each for how many weeks
3 weeks
characterised by the development of large conglomerate masses of dense fibrosis usually in the upper lung zones usually caused by methotrexate and rheumatoid arthritis
Progressive massive fibrosis
how many days of antibiotic course should be started for infective exacerbations of bronchiectasis
7-14 days
TEST recommended to confirm a diagnosis of COPD
Post-bronchodilator spirometry
alternative treatment’ for her mild intermittent asthma
Behavioural programmes centred on breathing exercises such as the Buteyko metho
percentage of cases of occupational asthma is caused by sensitiser-induced disease
90
why long-acting muscarinic antagonists (LAMAs) are NOT recommended for people with acute asthma
The onset of bronchodilation is too slow
disease associated with non-cystic fibrosis bronchiectasis
Rheumatoid arthritis
For CAP, patients can expect what to resolve in how many weeks (5x)
One week: the fever should have resolved
Four weeks: the chest pain and sputum production should have substantially reduced
Six weeks: the cough and breathlessness should have substantially reduced
Three months: most symptoms should have resolved but fatigue may still be present
Six months: most people will feel back to normal
Spirometry may under-diagnose and over-diagnose what population
under-diagnose younger adults and over-diagnose elderly patients
Need for LTOT in COPD is assessed by measuring ABG when
on two occasions, at least three weeks apart
In COPD, Long-term oxygen should be offered to those with a partial pressure of oxygen (PaO2) of
< 7.3 kPa when stable or < 7.3 kPa and < 8 kPa when there is associated peripheral oedema, pulmonary hypertension, secondary polycythaemia or nocturnal hypoxaemia, or oxygen saturation levels are 92% or less breathing air
first-line treatment for patients with progressive chronic pulmonary sarcoidosis
Prednisolone
Finger clubbing is suggestive of which dieases (3x)
lung cancer, interstitial lung disease, or bronchiectasis. NOT COPD
risk factors for continuing symptoms of post-acute COVID-19 (4x)
Older age, high BMI, female sex and asthma
When is pulmonary rehabilitation indicated for management of COPD
indicated in patients who have functional impairment or an MRC dyspnoea score of 3 or above
Basic support for patients with COPD (3x)
supported to stop smoking and offered a pneumococcal vaccination and an annual influenza vaccination
Long term oxygen therapy (LTOT) should be prescribed for at least
15 hours a day
high-risk CAP treatment
Co-amoxiclav + clarithromycin
patient on regular low dose ICS + SABA - not working, next step?
Switch to MART
Pulmonary fibrosis spirometry
proportionally reduced FEV1 and FVC, FEV1/FVC>70
GOLD guidelines recommend additional investigations at the diagnosis of COPD with
chest x-ray, pulse oximetry and alpha-1 antitrypsin deficiency screening
The typical COPD patient tends to present at a younger age (<45 years) with
lower lobe emphysema
self-management plan option for exacerbations should be advised for asthma according to NICE
quadrupling inhaled corticosteroid (ICS) therapy
staging of COPD is based on
FEV1 % of predicted
Exertional saturations should only be checked in patients with
resting saturations of 96% and higher who have exertional symptoms such as breathlessness or light-headedness.
NICE guidelines recommend additional investigations at the diagnosis of COPD with
BMI, FBC
recommended management of non-cystic fibrosis bronchiectasis
Airway clearance techniques
percentage of cases of occupational asthma is caused by sensitiser-induced disease?
90
recommended duration of abx for bronchiectasis if indicated
14 days
findings support a diagnosis of asthma (feno, fev1, pef)
eosinophil count is above the laboratory reference range
-FeNO level is 50 ppb or more.
- if the FEV1 increase is 12% or more and 200 ml or more from the pre-bronchodilator measurement on spirometry.
- if PEF variability (expressed as amplitude percentage mean) is 20% or more.
antibiotic is the preferred antibiotic to reduce the number of infective exacerbations for bronchiectasis
azithromycin
Patient on CPAP for OSA, DVLA reqs for renewal of licence (Group 1 and 2)
Group 1 - every 3 years, Group 2 - every year review
Which has more excacerbations and by how much, COPD or ACOS
ACOS, three times
should be referred for specialist assessment due to the need for further investigations
People with suspected occupational asthma
latest asthma guidance states that in a patient with symptoms, what are required to diagnose asthma
abnormal FENO (>50ppb) or raised serum eosinophils
first line diagnostic test for asthma for adults
blood eosinophils or FeNO
first line diagnostic test for asthma for children
FeNO
suspected asthma, first line diagnostic is normal, next? Results?
do spirometry, FEV1 >=12% and in adults must be >=220mL increase OR FEV1 >=10% predicted
if second line diagnostics for asthma normal or not available, what to do next and result?
Peak flow variability for 2 weeks. Asthma is confirmed if PEF variability >= 20%
If Peak flow variability is normal in trying to diagnose asthma, what to do in children and asults?
Children: do skin prick for house or dust mite OR total IgE AND eosinophils (positive if IgE raised AND eosinophils >0.5)
Adults: bronchial challenge test
Asthma OUT OF CONTROL if any of
Restricting normal activities.
Exacerbation requiring oral steroids.
Using reliever inhaler ≥3 days/week
Waking due to asthma ≥1 nights/w.
