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Finals > Respiratory guidelines > Flashcards

Respiratory guidelines Flashcards

1
Q

Asthma investigation

  • what do all adults get
  • what do children get
A

FeNO and spirometry with reversibility

children only get FeNO if spirometry inconclusive

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2
Q 
Astham investigation
- diagnostic cutoffs
reversibility
FEV1/FVC ratio
FeNO
A

12% reversibility (AND 200ml in adults)
ratio of <0.7
FeNO >40ppb (>35 in children)

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3
Q

Asthma treatment escalation ADULTS

A 
SABA
\+ low dose ICS
\+ LABA
\+ LRTA or moderate dose ICS (stop LABA if not working)
specialist
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4
Q

Asthma treatment escalation CHILDREN

A 
SABA
\+ very low dose ICS
Step 2 (>5) = LABA or LTRA
Step 2 (<5) = LTRA
Step 3 = increase to low dose ICS. Add LABA/LRTA and stop LABA if not helpful
specialist
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5
Q

Acute asthma attack categories

A

Life threatening = PEFR<33, silent chest, <92%, normal CO2
Acute severe = >110bpm, cant complete sentences, PEFR33-50, RR>25
Moderate = 50-75% PEFR

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6
Q

Acute asthma management
standard
escalated

A 
standard
- oxygen driven nebs (salbutamol and ipratropium)
give ipra 4-6hourly, salbutamol back to back
pred/hydrocortisone for at least 5d
escalated
- magnesium
- IV aminophylline
IV salbutamol, intubation etc
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7
Q

COPD Ix

- if you suspect COPD what 3 things do you get

A

CXR (?mass), FBC (2’ polycythaemia), spirometry/reversibility testing

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8
Q

Grading of COPD cutoffs

A 
All based on FEV1
Mild=  >80 WITH symptoms and FEV1/FVC <0.7
mod = 50-80
severe = 30-50
very severe = <30
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9
Q

COPD treatment escalation

A

1) SABA or SAMA
2) asthmatic features = LABA+ICS; no asthmatic features = LABA/LAMA
3) oral theophylline

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10
Q

Antibiotic prophylaxis in COPD?

A

Azithromycin

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11
Q

Asthmatic features for COPD step 2???

A

1) previous history of asthma or atopy
2) eosinophilia
3) diurnal variation of PEFR >20%
4) FEV1 variation >400ml

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12
Q

When do you assess someone for LTOT if has COPD

A

FEV1 <30% (i.e. very severe)
cyanosis/polycthaemia
oedema/raised JVP

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13
Q

How do you assess someone for LTOT?

A

ABGs on two separate occasions

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14
Q

Based on the ABGs, when do you offer LTOT for COPD

A

pO2 <7.3

pO2 7.3-8 + oedema, polycythaemia, pul HTN

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15
Q

COPD exacerbation Mx

A

Nebulised bronchodilators and prednisolone 7-14d

Abx if sign of infection –> amox + clari

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16
Q

CURB65 score and meaning

A 
Confusion <=8/10 AMTS
urea >7
RR >=20
BP <=90/60
65+
0-1 = home with amox 5d (depending on CRP test)
2-3 = hospital with amox+clari 7d
4-5 = ITU with coamox/tazocin 7d
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17
Q

CRP point of care test in GP for penumonia

A

Helps you decide if Abx are needed if they score CURB0
>100 = yes
20-100 = delayed
<20 = no

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18
Q

Abx guideline:

  • CAP
  • atypical CAP
  • HAP
A

CAP = amox
atypical CAP = clarithromycin
HAP depends on when it has occurred after admission (remember HAP is defined as at least 48 hours after admission):
- if within first 5d = coamox, cefurox
- if after 5th day of admission = taz, cipro, ceftaz

19
Q

2ww lung cancer referral for CXR

A

40+ and any of:
- cough, fatigue, SOB, pain, weight loss, anorexia

need 2 of them if never smoked

20
Q

2ww lung cancer referral for clinic straight away

A

40+ and haemoptysis or abnormal CXR

21
Q

best Ix for lung Ca

A

CT (hence why you do it if CXR negative and youre still suspicious)

22
Q

Difference between SCLC and NSCLC

A

SCLC not usually amenable to surgery, need chemo
NSCLC usually amenable to surgery,
both have radio

23
Q

Idiopathic lung fibrosis

  • gold standard Ix
  • TLCO and spirometry
A
  • high res CT
    restrictive picture on spirometry
    TLCO is low
24
Q

definitive Tx for idiopathic lung fibrosis

A

lung transplant

25
Q

Sarcoidosis useful tests (no diagnostic one)

A 
raised ACE and ESR
restrictive spirometry
non-caseating granuloma formation
bilateral hilar lymphadenpatphy 
upper zone fibrosis
26
Q

Management of sarcoid

A

Don’t treat asymptomatic lymphadenopathy

If Sx –> prednisolone

27
Q

Interpretation of Mantoux test

A

If <6mm = no reaction, immunise
If 6-15mm = medium reaction, ?previous TB or previous vaccination, don’t immunise
If >15mm = big reaction, active TB

28
Q

when do you use interferon gamma quantiferon gold test?

A

if Mantoux equivocal or positive

If Mantoux inaccurate (sarcoid, military TB, lymphoma HIV)

29
Q

Drugs for TB and SEs

A 
Active = 2m RIPE and 4m RI
Latent = 3m RIP or 6m IP
Meningeal = 12m RIPE + steroids
rifampicin = red piss and hepatitis
isoniazid = peripheral neuropathy and hepatitis
pyranzinamide = gout and hepatits
ethambutol = optic neuritis
30
Q

Pneumothorax Mx

A

Primary
<2cm = clinic in 6/52!!
>2cm OR BREATHLESS = aspirate and observe

Secondary
0-1 = admit O2 observe
1-2 = aspirate
>2 = chest drain

31
Q

Wells score PE

A

0-4 is unlikely to be PE. 5+ = CTPA`

PE most likely = 3
DVT present = 3

Recent immobilisation = 1.5
Previous DVT/PE = 1.5
Tachycardia >100 = 1.5

Haemoptysis = 1
Malignancy = 1
32
Q

Well score DVT just the cutoff

Mx based on that

A

0-1 is unlikely –> D-dimer to exclude

2+ is likely ==> USS leg within 4 hours. if cant get one within 4 hours, treat with LMWH assuming its there

33
Q

Do you start LMWH before the CTPA is back

A

yes because it usually takes a number of hours to get done

34
Q

Tx of PE

A

haemodynamically unstable = thrombolysis
stable = LMWH for 5d or until INR>2 for 2days whichever is longer. start warfarin or NOAC witin 24 hours. if warfarin crossover with LMWH, if NOAC just give it 2 hours before dose and don’t carryover.

35
Q

ARDS - how do you exclude thatit is cardiac in origin if unsure

A

pulmonary artery wedge pressure.

36
Q

obstructive sleep apnoea Best Ix and other Ix

A

Sleep studies is best test

Epworth sleepiness scale and multiple sleep latency test also used

37
Q

Mx of obstructive sleep apnoea

A

If sleepiness in daytime –> CPAP at night

If no sleepiness or CPAP not tolerate –> mandibular advancement device

38
Q

pleural effusions and lights

A

protein >35 = exudate
protein <25 = transudate

25-35 use lights criteria
exudate if:
- pleural protein is >50% the serum protein
- pleural LDH >60% plasma LDH
- pleural LDH >2/3rds NORMAL LDH
39
Q

if pleural fluid is exudate?

A

contrast CT and send off sample to lab

40
Q

if pleural fluid is purulent or has pH <7.2

A

chest tube

41
Q

NG tube safety

A

pH <5.5 is happy days

Otherwise need to do a CXR

42
Q

NIV indications in COPD

A

any respiratory acidosis despite maximal therapy

43
Q

when is an aspirate exudate

A

<25 protein = transudate
>35 protein = exudate

in between use lights criteria. Exudate if pleural fluid:

  • protein >50% serum protein
  • LDH >60% serum LDH
  • LDH >2/3rds normal serum LDH

Finals (13 decks)

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