Respiratory Flashcards
What is recommended inhaler technique for 2 puffs salbutamol?
Guidance suggests that the cap should be removed and the inhaler shaken before delivering the dose while taking a slow breath in. Breath should be held for 10 seconds, there should be a gap of 30 seconds between doses
What causative organism is associated with currant jelly like sputum?
Klebsiella. It is also a/w ascending cholangitis, pleural empyema (following pneumonia). This is seen more commonly in alcoholic and diabetic patients, often following aspiration, and affects upper lobes.
A patient with a chest infection presents with a rash that appears as blisters, surrounded by a pale pink ring and a darker outermost ring. What is the likely causative organism?
The rash is erythema multiforme, associated with Mycoplasma pneumoniae. This is an atypical organism that is treated with 2nd generation tetracyclines e.g. doxycycline and a macrolide e.g. erythromycin.
What is the most common bacterial organism causing infective exacerbation of COPD?
Haemophilus influenzae - 20% is amoxicillin resistant. Other common organisms include S. pneumoniae and Moraxella catarrhalis.
Human rhinovirus is the most important pathogen.
How do you treat an infective exacerbation of COPD?
Amoxicillin or clarithromycin or doxycycline - check trust guidelines
What is the 3rd line Tx for persistent asthma exacerbations after SABA and ICS have been started?
Add a LTRA (NICE 2017) and continue/ stop depending on response before trying a LABA, which is 4th line.
A patient with small cell lung cancer presents with limb weakness that is worse in legs. What is the likely diagnosis?
Lambert-Eaton myasthenic syndrome results from antibodies produced against SCLC cells. Weakness improves with movement.
In myasthenia gravis, face and arms are affected before legs.
A patient undergoes thoracentesis for a large pleural effusion, and the aspirate is turbid and contains pus. What other features of the aspirate would suggest an empyema?
pH <7.2 (bacteria producing CO2), low glucose (<3.4mmol/l; bacteria uses this in respiration), high LDH (>200 or 2-3 x ULN; bacteria uses lactate dehydrogenase to convert glucose into energy)
What guidance and precautions do you give to COPD patients with frequent exacerbations?
Give a home supply of corticosteroids and antibiotics. Contact GP if they use them, and only take antibiotic if coughing up purulent sputum.
A patient with a BG of T2DM and COPD presents with a case of community acquired pneumonia. Aside from antibiotics, what do you prescribe?
A course of steroids should be prescribed due to BG of COPD e.g. 30mg prednisolone OD for 5 days even if no wheeze or dyspnoea present.
How do you manage reactive hyperglycaemia in unwell patients with diabetes?
Monitor CBG regularly during inpatient stay. If glycaemic control worsens, consider long term changes to medication.
How does extrinsic allergic alveolitis present, and how do you treat this?
May be acute (4-8h after exposure) or chronic (weeks-months after exposure). Bird fanciers’ lung (avian proteins), farmers lung (wet hay - Saccharopolyspora) and malt workers lung (Aspergillus clavatus) are some examples. CXR shows upper/ mid zone fibrosis, BAL shows lymphocytosis and no eosinophilia in serum. Manage with trigger avoidance and oral steroids.
In a patient with moderate CAP who is pen-allergic, what would you prescribe?
Doxycycline or clarithromycin (CI in long QT, Hx of C. diff, severe renail impairment)
What drugs can be prescribed for smoking cessation?
Nicotine replacement therapy (NRT), varenicline (nicotinic receptor partial agonist) or buproprion (norepinephrine and dopamine reuptake inhibitor i.e. agonist and nicotinic antagonist) - do not offer in any combination
A pregnant patient has a CO reading of 8ppm. What smoking cessation options are available in pregnancy?
1st line is CBT, motivational interviewing, self-help/ support. Following this, NRT may be tried. Varenicline and buproprion are contraindicated.
