Respiratory Conditions Flashcards

Question

Step 5 asthma management

Answer 1

SABA +/- LTRA med dose of ICS Switch ICS/ LABA for MART that includes low dose ICS

Answer 2

acute exacerbation of asthma (or an asthma attack) is the progressive worsening of symptoms including dyspnoea, wheeze, cough, and chest tightness over an acute or subacute time period. - reduced pulmonary function, demonstrated by a reduced peak expiratory flow rate (PEFR

Answer 3

- Increasing symptoms. -PEFR >50-75% of the patient's best or predicted score. -No features of acute severe asthma.

Answer 4

-PEFR 33-50% of the patient's best or predicted score. -Respiratory rate (RR) ≥ 25 breaths per minute. -Heart rate (HR) ≥ 110 beats per minute. -Inability to complete sentences in one breath.

Answer 5

-PEFR <33% of the patient's best or predicted score. -SpO₂ <92%. -In life-threatening asthma exacerbations, PaCO₂ will be normal. If the PaCO₂ rises, then this is now classed as a near-fatal asthma exacerbation. -PaO₂ <8kPa. -Absence of audible breath sounds over the chest (silent chest). -Cyanosis (usually of the lips). -Reduced respiratory effort. -New-onset arrhythmia. Exhaustion. -Reduced Glasgow coma score (GCS). -Hypotension.

Answer 6

Raised PaCO₂ (>6kPa) and/or need for mechanical ventilation.

Answer 7

-provoked by viruses (the most common being rhinovirus) -bacteria -allergens such as mold and pet dander -or tobacco smoke.

Answer 8

-PEFR or forced expiratory volume in one second (FEV1). -PEFR is expressed as a percentage of the patient's best or predicted score prior to coming into hospital. The predicted score is based on the patient's age and height, but should only be used if the patient does not have an accurate best score from the last two years.

Answer 9

1. Remove cap and shake 2. Breathe out gently 3. 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 4. Hold breath for 10 seconds, or as long as is comfortable 5. For a second dose wait for approximately 30 seconds before repeating steps 1-4.

Answer 10

histology, following a thoracoscopy

Answer 11

Cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure In small cases, the abdomen can also be affected

Answer 12

Dyspnoea, weight loss, chest wall pain Clubbing 30% present as painless pleural effusion Only 20% have pre-existing asbestosis History of asbestos exposure in 85-90%, latent period of 30-40 years

Answer 13

Symptomatic Industrial compensation Chemotherapy, Surgery if operable Prognosis poor, median survival 12 months

Answer 14

suspicion is normally raised by a chest x-ray showing either a pleural effusion or pleural thickening the next step is normally a pleural CT if a pleural effusion is present fluid should be sent for MC&S, biochemistry and cytology (but cytology is only helpful in 20-30% of cases) local anaesthetic thoracoscopy is increasingly used to investigate cytology negative exudative effusions as it has a high diagnostic yield (around 95%) if an area of pleural nodularity is seen on CT then an image-guided pleural biopsy may be used

Answer 15

Non-invasive ventilation is needed

Answer 16

idiopathic pulmonary fibrosis

Answer 17

cough: may or may not be productive sore throat rhinorrhoea wheeze --------------------------------- usually normal chest expansion but some patients also have Low-grade fever Wheeze

Answer 18

History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia. Examination: No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.

Answer 19

acute bronchitis is typically a clinical diagnosis however, if CRP testing is available this may be used to guide whether antibiotic therapy is indicated

Answer 20

analgesia good fluid intake consider antibiotic therapy if patients: are systemically very unwell have pre-existing co-morbidities have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately) NICE Clinical Knowledge Summaries/BNF currently recommend doxycycline first-line doxycycline cannot be used in children or pregnant women alternatives include amoxicillin

Answer 21

Pulmonary arterial hypertension (PAH) is a rare, progressive disorder characterized by high blood pressure in the arteries of the lungs, leading to right heart failure and ultimately death if untreated.

Answer 22

PAH can be idiopathic, heritable, or associated with other conditions such as connective tissue diseases, congenital heart disease, HIV infection, or drug/toxin exposure.

Answer 23

Symptoms include shortness of breath, fatigue, chest pain, fainting, swelling in the ankles or abdomen, bluish lips or skin (cyanosis), and palpitations.

Answer 24

Diagnostic tests include echocardiography, right heart catheterization, chest X-ray, pulmonary function tests, blood tests (BNP, NT-proBNP), and imaging studies (CT, MRI).

Answer 25

Treatment may include medications such as calcium channel blockers, prostacyclin analogs, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors, as well as lung transplant in severe cases.

Answer 26

Prognosis varies depending on the underlying cause, severity of symptoms, and response to treatment, but PAH is generally a progressive and life-threatening condition if left untreated.

Answer 27

* prostacyclin analogues: treprostinil, iloprost * endothelin receptor antagonists * non-selective: bosentan * selective antagonist of endothelin receptor A: ambrisentan * phosphodiesterase inhibitors: sildenafil

Answer 28

oral calcium channel blockers

Answer 29

Squamous Cell Carcinoma (SCC) ## Footnote SCC typically originates in the squamous cells lining the airways.

Answer 30

Smoking ## Footnote Non-smokers can also develop SCC.

Answer 31

Central airways (near the main bronchi) ## Footnote SCC is typically found in this region.

Answer 32

Grows more slowly ## Footnote SCC is more localized at diagnosis compared to SCLC.

Answer 33

Coughing, hemoptysis, chest pain, shortness of breath ## Footnote These symptoms indicate potential lung issues.

Answer 34

Surgery, chemotherapy, radiation ## Footnote Treatment options vary based on detection stage.

Answer 35

Neuroendocrine tumor ## Footnote SCLC accounts for about 10-15% of lung cancers.

Answer 36

Neuroendocrine cells in the lungs ## Footnote These cells have characteristics of both nerve and hormone-producing cells.

Answer 37

Smoking ## Footnote Almost all cases of SCLC occur in smokers.

Answer 38

Central part of the lungs ## Footnote This is similar to the location of SCC.

Answer 39

SCLC is aggressive, grows rapidly, and tends to metastasize early ## Footnote It often spreads to distant sites like the liver, bones, and brain.

Answer 40

Weight loss, fatigue, paraneoplastic syndromes ## Footnote Examples of paraneoplastic syndromes include SIADH and Cushing's syndrome.

Answer 41

Chemotherapy and radiation ## Footnote Surgery is rarely an option due to early metastasis.