Respirology Flashcards

Question

Discuss the pathophysiology and symptoms of COPD

Answer 1

Pathophysiology - airflow limitation caused by inflammatory response to inhaled toxins Signs and Symptoms - Productive cough - Dyspnea - Decreased breath sounds - Wheezes - Prolonged expiratory phase of breathing Investigations - PFT: FEV1/FVC <0.7 with no improvement with bronchodilator - Spirometry increased FRC, RV and decreased VT - CXR: hyperinflation of lung with flattended diaphragm

Answer 2

``` Triggers - Respiratory infection - Environmental pollution - pulmonary embolism - comorbid respiratory or cardiac condition Signs - Change in amount or color/purulence of sputum - More short of breath - change in mood - Fatigue ```

Answer 3

Normal - MRC 1 dyspnea only with strenuous exercise - Normal spirometry Mild - MRC 2 dyspnea when hurring on level ground or walking up hill - FEV1 >80% predicted and FEV1/FVC <0.7 Moderate - MRC 3 walk slower than people because of breathlessness or has to stop for breath - MRC 4 stop for breath after walking 100m - 50% <= FEV1 < 80% predicted - FEV1/FVC <0.7 Severe - MRC 5 too breathless to leave house or breathless with dressing - 30%

Answer 4

``` Education - inhaler - action plan Smoking Cessation - most important intervention to slow lung decline Exercise or Pulmonary Rehabilitation - All patients should exercise Vaccination - influenza - Pneumovax <65 or Prevnar >65 Pharmcotherapy - Mild: SABA prn - Moderate: SABA and LABA/LAAC prn - Severe (>1 AECOPD/year): Long acting anticholinergic + ICS/LABA + SABA prn Oxygen - severe hypoxemia (PaO2 <55mmHg or SaO2 <88%) - PaO2 <59mmHg or SpO2 <89% with evidence of right heart failure or cor pulmonale or erytrhocytosis (Hct >55%) Surgery - lung volume reduction surgery Lung Transplant - FEV1 <25% - PaCO2 >55 - pulmonary hypertension ```

Answer 5

Hospitalized if any of the following - inadequate response to outpatient emergency department management - marked increase in dyspnea - severe underlying COPD, FEV1 <50% - inability to eat or sleep - new cyanosis or worsening hypoxemia - Acute respiratory acidosis - Change in mental status - Insufficient home support - High risk comorbidities

Answer 6

Treatment - target O2 >90% - albuterol 2.5mg by nebulizer Q1-4H or 4-8 puffs with spacer - Ipratropium 500mcg nebulizer Q4H or 2-4 puffs - systemic steroids (prednisone 40mg PO for 5 days) Non-Invasive Positive Pressure Ventilation - respiratory distress: tachypnea >25 RR or use of accessory muscles - respiratory acidosis: pH <7.35 or PaCo2 >45 Antibiotics - uncomplicated (<65yo, FEV1 >50%, <3 exacerbations a year, no cardiac disease) - Azithromycin 500mg POx1d then 250mg Q24H for 4d - Cefuroxime 500mg PO Q12H - Doxycycline 100mg PO Q12H x1d then 100mg Q24H - Septra 1 tab PO Q12H - Complicated (any of above risk factors) - Levofloxacin 750mg Q24H - Amox-Clav 875mg Q12H x1d then 100mg Q24H - Pseudomonas then Cirpofloxacin - Abx for 5d if mild-mod, 7d for severe

Answer 7

``` SABA (blue) - Salbutamol (ventolin) - tachycardia - arrhythmia - irritability - difficulty sleeping - muscle cramps LABA (orange) - formoterol (oxeze) - salmeterol (serevent) - same as SABA ICS (red) - Fluticasone (flovent) - Beclomethasone (ovar) - hoarseness - sore throat - thrust ICS + LABA - Fluticasone + Salmeterol (Advair - purple) - Pulmicort + Oxeze (Symbicort - red) - shaky hands - tachycardia - thrush - sore throat - hoarse Short-Acting Anticholinergic - Ipratropium bromide (atrovent) - dry mouth - urinary retention Long-Activing Anticholinergic - Tiotropium (spiriva) - same as SAAC ```

Answer 8

``` Symptoms - snoring, apnea, choking - morning headache - GERD - poor quality of sleep resulting in daytime sleepiness, impaired memory/concentration and depression Long-term - systemic hypertension - increased risk of stroke or MI - increased risk of AF or CHF - increased risk of pulmonary hypertension as have vasopasm of pulmonary arteries from decreased desats - increased risk of diabetes - increased risk of depression - daytime hypercapnia and hypoxemia ```

Answer 9

``` Indications - symptomatic - AHD >=15 as incrase cardiovascular risk - occupation - presence of comorbid condition Non-Specific - weight loss - avoid substances - positional therapy (side sleeping) - avoid sleep deprivation Nasal continuous Positive Airway Pressure (CPAP) - 1st line - continuous blowing of room air into airway splinting it open - BiPAP for larger adults requiring greater pressure Surgery - for underlying anatomical problem ```

Answer 10

Must have A or B and C A: Excessive daytime sleepiness that cannot be explained B: >=2 - recurrent choking or gasping in sleep - recurrent awakening from sleep - daytime fatigue C: Apnea hypopnea index (apnea + hypopnea/hrs asleep) >5 (mild:6-15/hr, mod:16-30/hr, sev: .30/hr) - hypopnea is decreased airflow by 50% with decreased O2 sat by >4% or EEG arousal

Answer 11

Apnea: cessation of airflow for >10 seconds or 2 breath cycles - obstructive: cessation >10s despite respiratory efforts - central: cessation for >10s with no respiratory effort Risks for OSA - male - older age >45 - obesity, including pregnancy - increased neck circumference (normal is 17.5 in men and 15.5 in women) - substances (smoking, alcohol, sedative, opioid) - medications - any structural abnormality with airway - increased mallampati score - family history

Answer 12

``` Mechanical - post-nasal drip - GERD Infection - TB - pneumonia Inflammation - COPD - Asthma Medication - ACE inhibitor Neoplasm - Bronchogenic carcinoma - lung cancer - lung metatasis Other - intersitial lung disease ```

Answer 13

``` PFT with Methcholine Challenge - if hx suggest asthma PPI - for GERD Abx - pneumonia: purulent sputum, systemic signs of infection Smoking Cessation Stop ACE Inhibitor Non of the Above - CXR - Normal CXR then 3 week empiric anti-histamine for post-nasal drip - if partially effective add nasal glucocorticoid - CT - Bronchoscopy - Cardiac Studies ```

Respirology Flashcards

(37 cards)