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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
What would spirometry show in COPD?
Obstructive pattern FEV1 <80% FEV1:FVC <70%
26
What are the fundamentals of COPD management?
``` Smoking cessation Pneumococcal and influenza vaccines Pulmonary rehabilitation Personalised management plan Pharmacological management LTOT ```
27
What is the pharmacological management of COPD?
1) SABA or SAMA as needed 2) Combination of both, or LABA + ICS 3) SABA + SAMA + ICS if having exacerbations
28
What is pulmonary rehabilitation?
Programme of supervised activity, unsupervised home exercise, nutritional advice and disease education Aims to improve exercise tolerance, and prevent worsening of symptoms
29
When should LTOT be offered in COPD?
pO2 <7.3kPa consistently Non-smokers Not retaining high levels of CO2
30
What investigations should be done for COPD exacerbations?
``` ABG CXR FBC, CRP, U&Es ECG Blood culture Sputum culture ```
31
What is the management of a COPD exacerbation?
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
What are causes of interstitial lung disease?
Usual interstitial pneumonia Extrinsic allergic alveolitlis Sarcoidosis, RA, SLE Occupational/environmental
33
What is seen on spirometry in ILD?
Restrictive pattern Reduced FEV1 and FVC Normal FEV1/FVC
34
How does ILD present?
Dyspnoea on exertion | Non-productive cough
35
What type of granulomas are seen in sarcoidosis?
Non-caseating
36
What investigations are done for sarcoidosis?
CXR - bilateral hilar lymphadenopathy Spirometry Bloods - renal function, ACE, calcium Urinary calcium
37
When is steroid treatment indicated in sarcoidosis?
Hypercalcaemia Eye, heart or neuro involvement Symptomatic
38
What is bronchiectasis?
Chronic inflammation => permanent dilatation of one or more bronchi Poor mucus clearance => predisposition to recurrent/chronic bacterial infections
39
What are some causes of bronchiectasis?
Post infective - whooping cough, TB Genetic - CF, Kartagener's syndrome Bronchial obstruction - tumour RA
40
What organisms commonly cause infections in bronchiectasis?
Haemophilius influenzae Strep pneumoniae Pseudomonas aeruginosa
41
What are symptoms of bronchiectasis?
Persistent cough Purulent sputum Intermittent haemoptysis
42
What are signs of bronchiectasis?
Coarse crackles Wheeze Clubbing
43
What are complications of bronchiectasis?
Pneumonia Pleural effusion Pneumothorax
44
What investigations are done in bronchiectasis?
High resolution chest CT - diagnostic CXR - thickened bronchial walls Spirometry - obstructive pattern Serum immunoglobulins, CF sweat test
45
What is the management of bronchiectasis?
Treat underlying cause Physio => mucus clearance Antibiotics - for exacerbations or prophylactic if frequent exacerbations Supportive - flu vaccine, bronchodilators Pulmonary rehab MRC >3
46
What is cystic fibrosis?
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
How is CF diagnosed?
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
What are some presentations of CF?
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
What are complications of CF?
Respiratory infections Low body weight - due to pancreatic insufficiency => pancreatic enzyme replacement Distal intestinal obstruction syndrome => thick, dehydrated faeces CF related diabetes
50
What lifestyle advice is given for CF?
``` Don't smoke Avoid other CF its Avoid people with colds/infections Avoid jacuzzis Flu vaccine ```
51
What are some features of CF?
``` Chronic sinusitis LRTI Abnormal sweat secretion - high Na Fatty liver, cirrhosis Pancreatic insufficiency, DM Steatorrhoea Male infertility ```
52
What are risk factors for PE?
``` Recent surgery Leg fracture Prolonged bed rest Pregnancy, postpartum COCP Malignancy ```
53
What are symptoms of a PE?
Acute breathlessness Pleuritic chest pain Haemoptysis
54
What are signs of a PE?
Tachycardia Hypotension Pyrexia
55
What features are used in the Wells score?
``` 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
How should the Wells score be used in management of suspected PE?
>4 => CTPA and treat with DOAC | <4 => D-dimer, if +ve => CTPA
57
What investigations are done for a PE?
``` Bloods - FBC, UEs, clotting, D-dimer ABG - low pO2 and low pCO2 CXR - rule out other diagnoses ECG CTPA ```
58
What ECG changes are seen in PE?
Sinus tachycardia RBBB, right ventricular strain,
59
What is the initial management for a PE?
Oxygen if hypoxic Either edoxaban or rivaroxaban LMWH if not suitable
60
When should thrombolysis be offered with PE?
Haemodynamically unstable | Massive PE
61
What are absolute contra-indications to thrombolysis?
``` Haemorrhagic/ischaemic stroke with 6 months CNS neoplasia Recent trauma/surgery GI bleed within 1 months Bleeding disorder Aortic dissection ```
62
What are relative contra-indications to thrombolysis?
Warfarin Pregnancy Advanced liver disease

Year 3 Medicine (11 decks)

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