obstructive resp diseases

Question 1

pulse rate in moderate vs severe asthma exacerbations

Answer 1

under/over 110bpm

Question 2

person presents with acute asthma attack with raised pCO2..

Answer 2

near fatal - pCO2 is usually low because of hyperventilation so respiratory effort is very low

treat with oxygen, SABA, prednisolone PO

Question 3

what can trigger acute asthma exacerbations?

Answer 3

resp tract infections

Question 4

management for asthma exacerbations (non-severe)

Answer 4

SABA nebuliser, prednisolone, increased dose of ICS

Question 5

RR for moderate/severe asthma exacerbations

Answer 5

under/over 25

Question 6

what are the signs of life-threatening acute asthma exacerbations

Answer 6

silent chest, cyanosis, brady, hypotension, confusion

Question 7

what investigation can be used to monitor asthma overtime

Answer 7

peak expiratory flow (PEF)

Question 8

what are the investigations for suspected asthma in children over 5?

Answer 8

if over 17 = spirometry with BDR +FeNO
5-16 = spirometry with BDR (feno if negative)

Question 9

what are the investigations for suspected asthma in children under 5?

Answer 9

clinical diagnosis - symptoms

Question 10

Acute asthma exacerbations with 90% o2, normal pCO2 indicates…

Answer 10

life-threatening exacerbation

Question 11

typical symptoms of asthma

Answer 11

dry cough, wheezing, chest tightness, & shortness of breath

Question 12

Which monoclonal antibody can be used to treat allergic asthma, especially in patients refractory to corticosteroids?

Answer 12

omalizumab

Question 13

asthma management after diagnosis

Answer 13

short acting beta-2 agonist (SABA) with low dose ICS as needed

Question 14

management for uncontrolled asthma

Answer 14

1. low-dose ICS daily and SABA
2. moderate ICS dose
3. add LAMA

Question 15

after ICS-LABA therapy what if symptoms persist?

Answer 15

add LTRA (leukotriene) / increase ICS dose/ add LAMA (tiotropium)

Question 16

what asthma treatments are NOT safe for children

Answer 16

LAMA (tiotropium), corticosteroids (can be used but linked to growth suppression long-term)

Question 17

what can be offered as a prophylactic for COPD patients with exacerbations

Answer 17

antibiotics- azithromycin (must have TB ruled out, LFT and ECG done prior)

Question 18

man with COPD is on theophylline - he presents with CAP and prescribed clarithromycin. what changes must be made to his COPD treatment

Answer 18

reduce theophylline dose

Question 19

what are the signs of theophylline toxicity

Answer 19

nausea
tremor/seizures
palpitations/tachycardia
(occurs after taking ABX Clarithromycin or Fluoroquinolones - levofloxacin/erythromycin)

Question 20

why is a FBC necessary to do on patients with COPD

Answer 20

rule out secondary polycythaemia (raised RBC due to chronically low o2 levels)

Question 21

what is carbocisteine

Answer 21

mucolytic - given for chronic productive cough

Question 22

What is the home management of COPD exacerbations?

Answer 22

increase bronchodilators
prednisolone for 5 days
ABX if signs of pneumonia (Doxycyline, amoxicillin or clarithromycin)

Question 23

treatment for COPD exacerbations without asthma

Answer 23

1= LABA and LAMA
2= LABA + LAMA+ ICS

Question 24

treatment for COPD exacerbations with asthma

Answer 24

1= LABA +ICS
2=LABA + LAMA+ ICS

Question 25

features of COPD

Answer 25

chronic productive cough, exertional dyspnoea, wheeze, right-sided heart failure and recurrent chest infections

Question 26

what are the signs of right sided heart failure

Answer 26

(as a result of cor pulmonae) = raised JVP / peripheral odema

Question 27

treatment of acute COPD exacerbaions that dont respoond to nebulised bronchodilators

Answer 27

IV theophylline

Question 28

COPD is a term for what two conditions

Answer 28

chronic bronchitis and emphysema