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Year 3 Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is asthma?

A

Reversible airway obstruction resulting in cough, dyspnoea and wheeze

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2
Q

What are some precipitating factors for asthma?

A

Cold weather, pets, smoking/passive smoking, NSAIDs, beta blockers

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3
Q

What are some symptoms of asthma?

A

Dyspnoea, wheeze, nocturnal cough

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4
Q

What are some signs of asthma?

A

Tachypnoea, wheeze, decreased air entry

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5
Q

What would spirometry show in asthma?

A

Obstructive pattern - narrow airways => inc time for air to be breathed out
Decreased FVC and FEV1
Reduced FEV1:FVC

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6
Q

What is the aim of asthma management?

A 
No daytime symptoms
No need for rescue medications 
No asthma attacks 
No limitations on exercise 
Normal lung function PEF >80% predicted
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7
Q

What is step 1 of asthma control?

A

Short acting inhaled beta agonist, salbutamol

Use as required

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8
Q

What is step 2 of asthma management?

A

Add low dose, regular inhaled corticosteroid

Beclometasone

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9
Q

What is step 3 of asthma management?

A

Leukotriene receptor antagonist, Montelukast

In addition to low dose ICS

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10
Q

What is step 4 of asthma management?

A

Long acting beta agonist, salmeterol

Review use of LTRA

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11
Q

What is step 5 of asthma management?

A

PO prednisolone
High dose inhaled corticosteroid
Requires specialist input

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12
Q

How is mild asthma defined?

A

PEFR >75% of predicted

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13
Q

How is moderate asthma defined?

A

PEFR 50-75% of predicted

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14
Q

How is severe asthma defined?

A

PEFR 33-50% of predicted
Inability to complete full sentences
RR >25
HR >110

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15
Q

How is life threatening asthma defined?

A

PEFR <33% of predicted
Sats <92%, pO2 <8kPa
Cyanosis, poor respiratory effort, silent chest
Exhaustion

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16
Q

How is near fatal asthma defined?

A

Raised pCO2

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17
Q

What is the management of an acute severe asthma attack?

A

A-E assessment
Aim for O2 sats 94-98%, ABG if sats <92%
5mg nebulised salbutamol - can repeat every 15 mins
40mg PO prednisolone/100mg IV hydrocortisone

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18
Q

What is the criteria for safe discharge after an asthma exacerbation?

A

PEFR >75%
No regular nebs for 24 hrs
Asthma nurse review of inhaler technique
Provide PEFR meter & asthma plan
GP follow up in 2 days, resp clinic follow up in 4 wks

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19
Q

What is COPD?

A

Progressive airway obstruction, which is not fully reversible
Includes chronic bronchitis and emphysema

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20
Q

What is the pathophysiology of COPD?

A

Mucous gland hyperplasia
Loss of function of cilia
Chronic inflammation => fibrosis of small airways
Alveolar wall destruction => emphysema

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21
Q

What are causes of COPD?

A

Smoking
alpha 1 anti-trypsin deficiency
Occupational exposure

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22
Q

What is the MRC dyspnoea scale?

A

Used to quantify breathlessness and it’s effect on activity

1 - only breathless with strenuous activity
2 - SOB when walking up a hill or when hurrying
3 - Walks slower than normal on level surface
4 - stops for breath after 100m/few mins of walking
5 - too breathless to leave the house

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23
Q

What are some symptoms of COPD?

A

Productive cough
Dyspnoea
Wheeze

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24
Q

What are signs of COPD?

A

Barrel chest
Use of accessory muscles
Reduced air entry
Wheeze

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25
Q

What would spirometry show in COPD?

A

Obstructive pattern
FEV1 <80%
FEV1:FVC <70%

26
Q

What are the fundamentals of COPD management?

A 
Smoking cessation 
Pneumococcal and influenza vaccines
Pulmonary rehabilitation 
Personalised management plan 
Pharmacological management 
LTOT
27
Q

What is the pharmacological management of COPD?

A

1) SABA or SAMA as needed
2) Combination of both, or LABA + ICS
3) SABA + SAMA + ICS if having exacerbations

28
Q

What is pulmonary rehabilitation?

A

Programme of supervised activity, unsupervised home exercise, nutritional advice and disease education
Aims to improve exercise tolerance, and prevent worsening of symptoms

29
Q

When should LTOT be offered in COPD?

A

pO2 <7.3kPa consistently
Non-smokers
Not retaining high levels of CO2

30
Q

What investigations should be done for COPD exacerbations?

A 
ABG
CXR 
FBC, CRP, U&amp;Es
ECG 
Blood culture 
Sputum culture
31
Q

What is the management of a COPD exacerbation?

A

Nebulised salbutamol and ipratropium
Controlled oxygen therapy
30mg prednisolone PO - continue for 7 days
Antibiotics if signs of infection

IV aminophylline if not improving
NIV if type 2 respiratory failure and pH 7.25-7.35

32
Q

What are causes of interstitial lung disease?

A

Usual interstitial pneumonia
Extrinsic allergic alveolitlis
Sarcoidosis, RA, SLE
Occupational/environmental

33
Q

What is seen on spirometry in ILD?

A

Restrictive pattern
Reduced FEV1 and FVC
Normal FEV1/FVC

34
Q

How does ILD present?

A

Dyspnoea on exertion

Non-productive cough

35
Q

What type of granulomas are seen in sarcoidosis?

A

Non-caseating

36
Q

What investigations are done for sarcoidosis?

A

CXR - bilateral hilar lymphadenopathy
Spirometry
Bloods - renal function, ACE, calcium
Urinary calcium

37
Q

When is steroid treatment indicated in sarcoidosis?

A

Hypercalcaemia
Eye, heart or neuro involvement
Symptomatic

38
Q

What is bronchiectasis?

A

Chronic inflammation => permanent dilatation of one or more bronchi
Poor mucus clearance => predisposition to recurrent/chronic bacterial infections

39
Q

What are some causes of bronchiectasis?

A

Post infective - whooping cough, TB
Genetic - CF, Kartagener’s syndrome
Bronchial obstruction - tumour
RA

40
Q

What organisms commonly cause infections in bronchiectasis?

A

Haemophilius influenzae
Strep pneumoniae
Pseudomonas aeruginosa

41
Q

What are symptoms of bronchiectasis?

A

Persistent cough
Purulent sputum
Intermittent haemoptysis

42
Q

What are signs of bronchiectasis?

A

Coarse crackles
Wheeze
Clubbing

43
Q

What are complications of bronchiectasis?

A

Pneumonia
Pleural effusion
Pneumothorax

44
Q

What investigations are done in bronchiectasis?

A

High resolution chest CT - diagnostic
CXR - thickened bronchial walls
Spirometry - obstructive pattern
Serum immunoglobulins, CF sweat test

45
Q

What is the management of bronchiectasis?

A

Treat underlying cause
Physio => mucus clearance
Antibiotics - for exacerbations or prophylactic if frequent exacerbations
Supportive - flu vaccine, bronchodilators
Pulmonary rehab MRC >3

46
Q

What is cystic fibrosis?

A

Autosomal recessive condition causing a mutation in CFTR gene
Results in defect in Cl- channel=> defective chloride secretion and increased Na absorption at airway epithelium
Leads to thickened secretions, most commonly affects respiratory and GI tracts

47
Q

How is CF diagnosed?

A

At least one phenotypic feature: sibling with CF, +ve newborn screening result

And:
increased sweat chloride secretion - sweat test
Identificaton of CF mutations on genotyping
Demonstration of abnormal nasal epithelial ion transport

48
Q

What are some presentations of CF?

A

Meconium ileus - intestinal obstruction soon after birth due to sticky secretions
Intestinal malabsorption - due to severe deficiency of pancreatic enzymes
Recurrent chest infections - reduced mucociliary clearance
Picked up on new born screening

49
Q

What are complications of CF?

A

Respiratory infections
Low body weight - due to pancreatic insufficiency => pancreatic enzyme replacement
Distal intestinal obstruction syndrome => thick, dehydrated faeces
CF related diabetes

50
Q

What lifestyle advice is given for CF?

A 
Don't smoke 
Avoid other CF its
Avoid people with colds/infections 
Avoid jacuzzis 
Flu vaccine
51
Q

What are some features of CF?

A 
Chronic sinusitis 
LRTI 
Abnormal sweat secretion - high Na
Fatty liver, cirrhosis
Pancreatic insufficiency, DM 
Steatorrhoea 
Male infertility
52
Q

What are risk factors for PE?

A 
Recent surgery
Leg fracture 
Prolonged bed rest
Pregnancy, postpartum
COCP 
Malignancy
53
Q

What are symptoms of a PE?

A

Acute breathlessness
Pleuritic chest pain
Haemoptysis

54
Q

What are signs of a PE?

A

Tachycardia
Hypotension
Pyrexia

55
Q

What features are used in the Wells score?

A 
Clinical signs and sx of DVT 
HR >100bpm
Recently bed ridden/major surgery 
Previous DVT/PE
Haemoptysis
Ca receiving tx, tx within 6/12 or palliative
Alternative Dx less likely
56
Q

How should the Wells score be used in management of suspected PE?

A

> 4 => CTPA and treat with DOAC

<4 => D-dimer, if +ve => CTPA

57
Q

What investigations are done for a PE?

A 
Bloods - FBC, UEs, clotting, D-dimer 
ABG - low pO2 and low pCO2
CXR - rule out other diagnoses 
ECG
CTPA
58
Q

What ECG changes are seen in PE?

A

Sinus tachycardia

RBBB, right ventricular strain,

59
Q

What is the initial management for a PE?

A

Oxygen if hypoxic
Either edoxaban or rivaroxaban

LMWH if not suitable

60
Q

When should thrombolysis be offered with PE?

A

Haemodynamically unstable

Massive PE

61
Q

What are absolute contra-indications to thrombolysis?

A 
Haemorrhagic/ischaemic stroke with 6 months
CNS neoplasia 
Recent trauma/surgery
GI bleed within 1 months
Bleeding disorder
Aortic dissection
62
Q

What are relative contra-indications to thrombolysis?

A

Warfarin
Pregnancy
Advanced liver disease

Year 3 Medicine (11 decks)

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