SOB Flashcards

1
Q

How to do investigate for Asthma?

A

Spirometry (FEV1/FVC <0.7 shows an obstructive pattern). Shows reversibility if >12% with SABA

FeNO test (>35-40 parts/billion)

PEFR (varies by >20% for >3 weeks)

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2
Q

Whats the general management of asthma?

A

1) SABA
2) SABA + ICS (inhaler used >2 a week)
3) SABA + ICS + LTRA
4) LABA + ICS +/- LTRA
5) LABA + increased ICS +/- LTRA
6) Trials e.g. Theophylline or LAMA
7) Oral Corticosteroids

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3
Q

Examples of each asthma treatment?

A
SABA = salbutamol
ICS = beclometasone, budenoside
LTRA = montelukast
LABA + ICS = symbicort
Oral CS = prednisolone
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4
Q

Asthma life-threatening symptoms?

A

PEF <33% best effort or predicted.
Can they talk
Altered conscious levels, exhaustion, arrhythmia, hypotension, cyanosis, silent chest. poor respiratory effort

Admit to 24hrs

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5
Q

Asthma Severe signs?

A

PEF 33%-50%
RR >25
HR >110
Inability to complete sentences in one breayj

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6
Q

A-E for asthma?

A

Basic obvs, PEFR, ABG (including K+ and Glucose)

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7
Q

Near fatal asthma signs?

A

Increased pCO2

Admit to hospital

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8
Q

General Treatment for acute asthma admittance?

A

1) O2
2) Neb. Salbutamol 5mg + Neb Ipratropium Bromide 0.5mg
3) PO Prednisolone 40-50mg 5days + IV hydrocortisone 100mg

If no response, senior support:
IV magnesium sulphate -> IV aminophylline -> ITU + Intubation

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9
Q

Acute asthma non-admittance treatment?

A

Quadruple inhaled ICS instead of PO prednisolone. Salbutamol back to back

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10
Q

What is COPD made of?

A

Emphysema and Bronchitis

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11
Q

Hx for COPD?

A

SOB, productive cough e.g. white or green, some wheeze

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12
Q

General Abx for COPD?

A

Amoxicillin which you then step up?

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13
Q

RFs for COPD?

A

Increased Age, FHx, occupation and smoking

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14
Q

Signs of COPD?

A

tar staining, cyanosis, barrel chest, reduced expansion, hyper-resonance on percussion.
Auscultation = reduced air movement, wheezing + COARSE crackles (hair-like)
Signs of RHF

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15
Q

Crackle examples?

A
Fine = interstitial lung disease
Coarse = COPD + pneumonoa
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16
Q

What are COPD classifications?

A

FEV/FVC 80% is mild
50-80 = moderate
30-50 = severe
<30 = very severe

17
Q

COPD investigations?

A

Spirometry
ABG
Bloods e.g. alpha1antitypsin for early onsent and minimal smoking or FHx, Hb, U&Es
CXR or further CT chest

18
Q

How to distinguish between COPD and asthma?

A

Serial peak flow measurements

19
Q

COPD management?

A

1) SABA or SAMA
2) No asthma = LABA + LAMA
2) Asthmatic or atopy features= LABA + ICS
3) LAMA + LABA + ICS

20
Q

COD management examples?

A
SABA = salbutamol
ICS = budenoside or beclometasone
LABA + ICS = Symbicort (budenoside + formoterol)
LABA = formeterol, salmeterol
LAMA = tiotrpium, ipratropium??
Oral CS = Prednisolone
21
Q

COPD general management?

A

Smoking Cessation !!
Annual influenza vaccination
pneumococcal vaccination.

Imrpoed survival = smoking cessation, long-term O2, lung volume reduction surgery

22
Q

Criteria for long-term O2?

A

pO2 <7.3kPa

or 7.3-8 with following one: secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension

23
Q

Acute COPD treatment?

A

1) 24% O2 blue venturi (don’t immediately go higher as it kills hypoxic drive)
2) Neb salbutamol 5mg + Nebiprabro 0.5mg. PO prednisolone 4-5days 40-50mg + IV hydrocortisone 200mg +/- IV amoxicillin

Senior support = IV Aminophylline

24
Q

Describe CPAP?

A

CPAP - continuous positive pressure throughout inspiration and expiration. Splints the airway open.
Treatment for Obstructive sleep apnoea (OSA) or T1RF (pneumonia/Pulmonary oedema)

25
Describe BiPAP (NIV)?
Provides a differing air pressure throughout inspiration and expiration. iPAP (20cmH20) to ventilate ePAP (10cmH2O) for alveolar recruitment and removal of waste gas
26
What is not a cause of respiratory clubbing?
COPD
27
What are causes of respiratory clubbing?
SQCC, emypema, interstitial lung disease, cystic fibrosis
28
What is interstitial lung disease examples?
Idiopathic pulmonary fibrosis, hypersensitivit pneumonitis, sarcoidosis
29
Pulmonary fibrosis sympotoms?
SOBOE, dry cough and no wheeze
30
RFs for pulmonary Fibrosis?
Animal, vegetable dusts, smoking status, occupation, drugs e.g.