Respiratory Disorders and their Management Flashcards

Question

Asthma

Answer 1

Constricted airways during attack and production of excess mucus

Answer 2

Peak flow amplitude FEV1/FVC ratio <70% Bronchodilators response

Answer 3

History Duration/onset Triggers Severity of illness ``` Signs on examination Elevated resp rate Inability to complete sentence Peripheral cyanosis - bluish discolouring - hypoxia Audible wheeze ``` Bedside tests Heart rate Respiratory rate Peak flow rate

Answer 4

``` Wheeze Cough, chest tightness, dyspnoea (laboured breathing), nocturnal duration Exertion Dust Change in temp Emotional situations Occupation ```

Answer 5

Eczema Nasal polyps Cushingoid (on steroids) Wheeze Assess RR Heart rate SpO2 Speaking ability

Answer 6

Metered Dose inhaler -SABA Inhale with simultaneous depression of canister with breath hold for 10 secs MDI via spacer - 10puffs of salbutamol via spacer equivalent to nebuliser Give 4 puffs initially then 2 puffs every 2mins up to max of 10puffs Breath actuated

Answer 7

Not taking correct treatment Failure to attend appts Self discharge

Answer 8

Main cause of cancer related death | 2nd most common in UK

Answer 9

Risk of spread from primary tumours | Enlargement of lymph nodes is indicative of malignant infiltration

Answer 10

85% Squamous cell Adenocarcinoma Adenocarcinoma in situ

Answer 11

``` Dependant upon stage of disease Sometimes very minor Sob Chest pain Cough Haemoptysis ```

Answer 12

Weight loss Low appetite Low energy levels

Answer 13

High calcium (PTH release or bone involvement) - nausea, confusion, abdo pain, constipation SIADH - confusion, fits, lethargy Hypertrophic pulmonary osteoarthropathy Neuromuscular weakness

Answer 14

SVCO due to mediastinal disease Brain metastasis - confusion nausea Bone mets - path fracture, pain Liver mets - abdo pain

Answer 15

``` Finger nail clubbing Cachexia Horner’s syndrome Neck nodes Chest signs Palpable liver SVCO ```

Answer 16

Radiographs, CT

Answer 17

Staging tool Detailed Contrast

Answer 18

Infusion of FD glucose | Detects cancer, infection and vasculitis

Answer 19

Image guided - chest, liver, nodes Bronchoscopy Thoracoscopy for pleural disease Surgical

Answer 20

0: able to carry out all normal activity without restriction 1: restricted in strenuous activity 2: ambulatory and capable of all self care 3: symptomatic in chair/bed >50% day 4: completely disabled

Answer 21

``` Stage WHO performance status Chemotherapy for extensive RT for limited disease Immunotherapy ```

Answer 22

ILD Diffuse parenchymal lung disease Lung fibrosis

Answer 23

Idiopathic Drug reaction Extrinsic allergies

Answer 24

Difficult breathing Cough Onset of symptoms may identify aetiology EAA - extrinsic allergic alveolitis – post exposure IPF – chronic AIP - ACUTE INTERSTITIAL PNEUMONIA – rapid onset

Answer 25

``` Signs of CTD Nail clubbing Sclerodactyly - symptomatic sclerosis Lower zones - AIP Upper zone crackles for EAA Chest squeaks suggest small airway disease ```

Answer 26

``` Idiopathic pulmonary fibrosiskFEV1/FVC ratio preserved Male Older population Median survival 3 years Lower zone Restrictive spirometry Diagnosis can be made from CT ```

Answer 27

``` Supportive Rehab Pirfenidone when FVC < 80% Nintenadib FVC 50-80% Opiates Role of steroids is controversial ```

Answer 28

Extrinsic allergic alveolitis Trigger not clear classic - baking, mould exposure predominant upper zone predominance

Answer 29

Avoid antigen Trial of corticosteroid Ca and vit supplements Bisphosphonates maybe

Answer 30

Excessive daytime sleepiness Cessation of flow for 10 secs Hypopnea - reduction of flow for 10 secs by >30%

Answer 31

Obstructive sleep apnoea -OSA Central Mixed

Answer 32

``` Obesity >17 inch collar Men 2-3x more likely Age Craniofacial abnormalities e.g short mandible ```

Answer 33

``` Excessive daytime sleepiness Snoring Restless sleep Nocturia Decreased libido Impaire concentration ```

Answer 34

Reduction of flow primarily due to obstruction at posterior pharynx Upper airway collapse

Answer 35

0-24 scale 11-14 mild sleepiness 15-18 moderate sleepiness >18 severe

Answer 36

Cheap Easy to use Can be used at home Can show false negative Less sensitive in thin patients/issues with tissue perfusion Measure 4% desaturation rate (ODI) - >10 events per hours suspicious

Answer 37

Limited vs Full Full considered Gold standard Full PSG requires hospital admission Measurement of EEG, eye & limb movements, nasal flow, thoraco-abdominal movement, ECG & oxygen saturation

Answer 38

Untreated x2-3 risk of RTAs CHD, CCF, hypertension and CVD Insulin resistance and T2 diabetes

Answer 39

Weight loss Continuous positive airway pressure Mandibular advancement device Pharmacotherapy and surgery

Answer 40

Delivery of constant pressure by face/nasal mask Abolition of apnoeas and hypopnoeas with improvement in o2 sat effective

Answer 41

``` Role when CPAP not tolerated Mild-moderate OSA Anterior displacement of the mandible Variable results of trials MAD better than no-MAD CPAP better than MAD for Reduction of AHI/ODI Sleep fragmentation MAD better than CPAP for patient preference ``` MAD better than UPPP for AHI/ODI but snoring same for both.

Answer 42

Short acting bronchodilators e.g salbutamol Relief of symptoms For PRN use Use in COPD & Asthma Immediate bronchodilation 4-6hour duration Increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muscle

Answer 43

``` Increased HR & palpitations Tremor Hypokalaemia Headache Nervousness ```

Answer 44

LABD - last for >12hrs Alternative to increasing dose of steroids Given by inhaled route Not to be used in monotherapy in Asthma High selectivity for B2 adenoceptor in pulmonary tissue Can increase glucocorticord receptor availability Concern of sudden cardiac death when used in monotherapy

Answer 45

Relief of symptoms - mainly for COPD Reduction in exacerbation freq in copd attacks improvement in FEV1 BLOCK BRONCHOCONSTRICTION EFFECT OF VAGAL STIMULATION ON BRONCHIAL SMOOTH MUSCLE --> DILATION

Answer 46

Possible effect on urinary retention Dry mouth Possible adverse cardiovascular effects (seen in severe cardiac disease) Aggravated glaucoma if deposited in eye

Answer 47

``` Mainstay of asthma medication Prevent symptoms Reduces risk of exacerbations and death Usually twice daily medication Not useful in acute attack Binds to cytosolic GR with reduction in cytokines Reduces bronchoconstriction and airway inflammation benefit for 4-6 weeks ```

Answer 48

Oral candida due to changes in oral environment Voice change Risk of skin bruising Bone mineral density change and cataracts with high dose

Answer 49

e.g prednisolone Given in acute asthma or chronically in severe asthma Avoid if possible as long term therapy but essential if asthma worsens Clearer role in eosinophilic asthma Time to efficacy 4hours for IV & PO routes

Answer 50

``` Weight gain Hyperglycaemia Skin change Hyper tension Eye change Mood change Reduce bone mineral density ```

Answer 51

``` Tablets and IV Acute/chronic asthma Mechanism unclear but involves increased stimulation of beta adrenoceptors by cAMP, due to reduced metabolism Serum level monitoring required 1-2 months Drug interactions Increase ```

Answer 52

``` Nausea Vomiting Palpitations headaches dyspepsia arrthymias confusion ```

Answer 53

Oral Chronic asthma Exercise induced asthma Leukotrienes produced after breakdown of tissue Promote smooth muscle contraction and inflammatory changes in airway wall

Answer 54

``` Headache N+V Sleep disturbance Sore throat GI disturbance ```

Answer 55

``` Potentially dangerous Delivered by mask, nasal cannula needs to be CONTROLLED Reservoir bag for very unwelll Uncontrolled i.e conc guessed - full face mask, cannula - highly dependent of resp rate ```

Answer 56

SpO2 94-98% unless hypercapnia risk

Answer 57

1 - hypoxia | 2 - hypercapnia/CO2 build up

Answer 58

Pulmonary oedema

Respiratory Disorders and their Management Flashcards

Gain knowledge about the symptoms, signs and management of COPD Asthma Lung Cancer Fibrotic Lung Disease Obstructive Sleep Apnea Appreciate the action of different drugs used to manage patients with Asthma or COPD