Respiratory Flashcards
Asthma:
how to take inhaler? (5)
- Remove cap and shake
- Breathe out gently
- Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply
- Hold breath for 10 seconds, or as long as is comfortable
- For a second dose wait for approximately 30 seconds before repeating steps 1-4.
Pneumonia:
which most common in alcoholics? (1)
what can this cause? (1)
what else can this occur in? (1)
Klebsiella; gram -ve gut flora
can cause empyema formation (currant jelly sputum)
empyema can caused in ascending cholangitis
Pneumonia:
most common cause COPD? (1)
problem with it? (1)
Haemophilus influenza
Patients diagnosed with pneumonia who have COPD should be given corticosteroids even if no evidence of the COPD being exacerbated
Asthma: complications of steroid inhaled? (1) treatment? (1) risk factors? (4) why isn't prednisolone given?
- oral candidiasis. It can be prevented by rinsing the mouth or brushing the teeth straight after use
- can cause lack of taste
- antifungals= nystatin or miconazole
- Predisposing factors include: immunosuppression, endocrine disorders such as diabetes, use of broad-spectrum antibiotics and also inhaled steroid use.
- pred doesn’t come as inhaler
It should be noted that NICE does not advocate changing treatment in patients who have well-controlled asthma simply to adhere to the latest guidance.
Oxygen:
when should it not be offered routinely? (4)
In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given via a reservoir mask at 15 l/min. Hypoxia kills. Aim for 94-98%
if no evidence of hypoxia:
- myocardial infarction and acute coronary syndromes
- stroke
- obstetric emergencies
- anxiety-related hyperventilation
COPD:
most important intervention to prevent decline? (1)
improve symptoms? (1)
improve survival? (1)
- Smoking cessation is the most effective way to slow the decrease in FEV1. Smoking cessation significantly reduces the rate of progression of COPD, as well as the risk of malignancy. It also improves survival, which is the only therapy other than long term in oxygen in COPD to do so.
- Pulmonary rehabilitation improves symptoms such as dyspnoea, and improves quality of life and emotional function
- Long term oxygen therapy (>15 hours a day) improves survival and reduces pulmonary hypertension in certain subgroups of people with COPD - for example those with a blood gas on 2 occasions of a pO2 of <7.3, or those with a pO2 of 7.3-8 and secondary polycythaemia.
LABA and LAMA are useful in COPD and can improve lung function and symptoms, and reduce exacerbation rates, however are not as effective as smoking at slowing the decrease in FEV1.
Inhaled steroids reduce the need to have rescue therapy and also reduce exacerbations, but are not as effective at slowing the decrease in FEV1. If this patient had asthmatic/steroid-responsive features, it may be a good idea to add a LABA and an inhaled steroid as well.
COPD:
what to do if the patient has regular exarcerbations? (1)
a home supply of corticosteroids and antibiotics - good practice to ask the patient to contact you if they are required to use them, at least to ensure that no further action is required. An antibiotic should be only be taken if the patient is coughing up purulent sputum.
Extrinsic allergic alveolitis:
types? (4)
symptoms:acute (3) chronic (4)
management? (2)
bird fanciers’ lung: avian proteins from bird droppings
farmers lung: spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni)
malt workers’ lung: Aspergillus clavatus
mushroom workers’ lung: thermophilic actinomycetes*
dyspnoea, dry cough, fever about 4-8 hrs after exposure
lethargy, dyspnoea, productive cough,anorexia/weight loss weeks/months after
- avoid precipitating factors
- oral glucocorticoids
(ground glass nodules consistent with hypersensitivity pneumonitis)
Sarcoidosis:
symptoms? (3)
which group more common in? (1)
bilateral hilar lymphadenopathy
- cough
- low-grade fever
- erythema nodosum
Sarcoidosis is also more common in people of Afro-Caribbean ethnicity.
fibrosis, what investigation diagnoses?
high resolution CT
Asthma: important Qs to ask? (1) what two tests should everyone get >17 years old? (2) what's the difference in 5-17? (1) what do you do <5? (1) reversibility testing values? (1)
- as Sx worse AT WORK –> refer to specialist for occupational asthma
- all patients should have spirometry with a bronchodilator reversibility (BDR) test
all patients should have a FeNO test - a FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test
- diagnosis should be made on clinical judgement
-in adults, a positive test is indicated by an improvement in FEV1 of 12% or more and increase in volume of 200 ml or more
in children, a positive test is indicated by an improvement in FEV1 of 12% or more
What does gauge mean in terms of canulas? i.e. which are large bore guages?
Gauge means how many you can get inside a 1 inch (lead) pipe.
–>
22G - paediatric 20G - weedy 18G - sturdy 16G - beefy 14G - large bore
However, The new guidelines state that decompression should now also be performed in the triangle of safety as the general population is becoming too large for a cannula to reach the pleural space
Pleural effusion management BTS guideliens:
what imaging to do? (3)
how to do pleural aspiration? (2)
when do you use Lights criteria? (1)
- PA CXR in all patients
- US recommended for successful pleurla aspiration and is sensitive for detecting pleural fluid septations
- contrast CT increasingly performed to investigate underlying cause, particularly for exudative effusions
- 21G needly and 50ml syringe
- fluid sent for pH, protein, LDH, cytology, microbiology
- protein level is between 25-35 g/L
All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling
Pleural effusion findings:
low glucose? (3)
raised amylase? (2)
heavy blood staining? (3)
Low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
Pleural effusion:
management options? (4)
what to do if septic? (1)
- recurrent aspiration
- pleurodesis
- indwelling pleural catheter
- drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling
if the fluid is purulent or turbid/cloudy a chest tube should be placed to allow drainage
- if the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
