PHASE 3A/4 > RESP > Flashcards

RESP Flashcards

(52 cards)

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1
Q

name 2 types of lung cancer associated with asbestos. which is MC?

A

mesothelioma

bronchogenic carcinoma - MC

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2
Q

name 3 non-cancerous lung pathologies caused by asbestos

A
  1. pleural plaques - benign
  2. pleural thickening - diffuse
  3. asbestosis - fibrosis
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3
Q

name 4 causes of lung fibrosis in the LOWER LOBES

A
  1. idiopathic p. fibrosis
  2. asbestosis
  3. drugs e.g. amiodarone, methotrexate
  4. connective tissue disorders e.g. SLE
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4
Q

name 5 causes of lung fibrosis in the UPPER LOBES

A
  1. hypersensitivity pneumonitis e.g. farmer’s, pigeon fanciers
  2. coal workers pneumoconiosis
  3. silicosis
  4. sarcoidosis
  5. TB
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5
Q

signs and sx of asbestosis

A
  • occupational hx e.g. construction, shipyard, insulation workers
  • dyspnoea
  • clubbing
  • bilateral end-inspiratory crackles
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6
Q

signs and sx of mesothelioma

A

History of asbestos exposure, latent period 30-40 years
Progressive SOB
Chest pain
Painless pleural effusion
Weight loss

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7
Q

investigations for asbestos-related lung disease

A

spirometry
CXR
high resolution CT (HRCT)

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8
Q

what will be seen on spirometry with asbestosis?

A

restrictive pattern (FEV1/FVC >0.7)
reduced gas transfer

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9
Q

CXR findings for
a) pleural plaques
b) asbestosis
c) mesothelioma

A

a) bilateral calcified plaques in pleura
b) pleural effusion, pleural thickening, mass
c) fibrosis

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10
Q

further ix for mesothelioma

A

pleural CT
MC&S/biochem of pleural fluid
thoracoscopy

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11
Q

define synergistic risk in relation to asbestos exposure and smoking

A

smoking + asbestos = ++++++ risk of bronchogenic carcinoma

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12
Q

management of asbestos-related lung disease

A

STOP SMOKING

asbestosis - conservative

mesothelioma - palliative chemo, manage sx

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13
Q

1st line ix for asthma (ADULTS)

A

blood eosinophil count OR fractional nitric oxide (FeNO)

FeNO will be >50ppb

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14
Q

2nd line ix for asthma (ADULTS)

A

spirometry reversibility

if not available measure PEF twice daily for 2 weeks (diagnose if variability >12%)

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15
Q

3rd line ix for asthma (ADULTS)

A

bronchial challenge test

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16
Q

1st line ix for asthma (KIDS)

A

FeNO (>35)

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17
Q

2nd line ix for asthma (KIDS)

A

spirometry/PEF variability

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18
Q

3rd line ix for asthma (KIDS 5-16)

A

skin prick testing OR
IgE and blood eosinophil count

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19
Q

ix for asthma in kids <5

A

treat with ICS with inhaled review

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20
Q

name an example of a…
a) SABA
b) SAMA
c) LABA
d) LAMA
e) ICS
f) LTRA

A

a) salbutamol, terbutaline

b) ipratropium

c) salmeterol, formoterol

d) tiotropium, aclidinium

e) budesonide, beclomethasone

f) montelukast

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21
Q

what is MART and AIR ?

Study These Flashcards
A

both are combination inhalers of an ICS and LABA

in AIR therapy the combo inhaler is used PRN for sx relief

in MART the combo inhaler is used as maintenance and relief

22
Q

tx of asthma in <5

Study These Flashcards
A

8-12 week trial of low dose ICS (maintenance) and SABA PRN

23
Q

tx pathway of asthma in 5-11y

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A
  1. low dose ICS + SABA
  2. if suitable for MART regime then start on low-dose MART, go to moderate if not working
  3. if not suitable then + LTRA
    then ICS/LABA + SABA PRN
24
Q

asthma treatment pathway in 12+ and adults

Study These Flashcards
A
  1. low-dose AIR therapy (ICS+LABA) (PRN)
  2. low-dose MART (maintenance and PRN)
  3. moderate-dose MART
  4. check FeNO and blood eosinophils
    - if either are raised, refer to specialist
    - if neither are raised, trial mod MART + LTRA/LAMA
    - if no improvement try alternative of LTRA/LAMA
  5. refer to specialist
25
treatment pathway of acute asthma attack
1. O2, high dose SABA nebs and oral/IV prednisolone 2. nebulised ipratropium bromide 3. IV magnesium sulphate 4. IV aminophylline
26
criteria for patient discharge following an acute asthma attack (3)
1. stable on discharge meds for 12-24h 2. inhaler technique checked 3. PEF >75%
27
what is bronchiectasis?
irreversible destruction of bronchi due to chronic infection or inflammation obstructive lung disease
28
causes of bronchiectasis (4)
recurrent/severe infections 1. post-infectious e.g. childhood infection, TB, severe pneumonia 2. genetic/congenital e.g. CF 3. systemic disease e.g. RA, vasculitis 4. idiopathic
29
MC organism causing bronchiectasis
haemophilus influenzae
30
signs and symptoms of bronchiectasis
symptoms - persistent productive cough, purulent green sputum - dyspnoea - fatigue - weight loss - rhinosinusitis signs - coarse crackles, wheeze - rhonchi (coarse rattling sounds) - clubbing
31
key investigation and finding for bronchiectasis
high resolution computed tomography (HRCT) - signet ring sign
32
signs of COPD on examination
- tachypnoea - expiratory wheeze - barrel chest - accessory breathing
33
management of bronchiectasis
supportive - stop smoking, chest physio, bronchodilators
34
what are the 5 stages of the MRC dyspnoea scale??
1. not troubled by breathlessness unless on strenuous exercise 2. SOB when hurrying on a level/walking up a slight hill 3. walks slower than most ppl on a level or stops after 15 mins to take a breath when walking at own pace 4. stops for breath after 100 yards 5. too breathless to leave house/breathless when dressing
35
general management of COPD
1. pneumococcal vaccine and annual influenza 2. stop smoking
36
asthmatic features of COPD suggesting steroid responsiveness to guide treatment (4)
1. previous diagnosis of asthma/atopy 2. raised eosinophils 3. FEV1 variation (>400ml) 4. diurnal variation in peak expiratory flow (>20%)
37
COPD treatment pathway
1. SABA or SAMA 2. if no asthmatic features/not steroid responsive - LABA + LAMA (plus continue SABA/SAMA) 2. if asthmatic features/steroid responsive - LABA + ICS (plus continue SABA/SAMA) 3. LABA + LAMA + ICS (plus SABA as required)
38
what prophylactic abx can be given to COPD patients at risk of infection?
azithromycin
39
common bacterial culprit of infective COPD exacerbation
H.influenzae
40
management of mild infective COPD exacerbation
- increase bronchodilator frequency - 30mg prednisolone for 5 days - CONSIDER abx if purulent sputum
41
stepwise treatment of severe infective COPD exacerbation in secondary care
1. O2 therapy - 88-92% 2. nebulised bronchodilator e.g. salbutamol, ipratropium 3. oral prednisolone 4. IV theophylline
42
management of type 2 resp failure in infective COPD exacerbation
if resp acidosis - NIV (BiPaP) - increases O2 and decreases CO2 last line!
43
cystic fibrosis - what protein is abnormal? where is the gene for this protein found?
cystic fibrosis transmembrane conductance regulator (CFTR) gene found on chromosome 7
44
signs of CF in newborns/infancy
failure to pass meconium (meconium ileus) failure to thrive
45
signs and symptoms of CF (resp, GI, GU, general)
resp - wet cough, recurrent infection, nasal polyps GI - malabsorptive stool (steatorrhea), rectal prolapse, stunted growth GU - genital abnormalities in males, fertility/subfertility general - diabetes, short stature
46
why do patients with CF get diabetes and malabsorption issues?
- secretions obstruct pancreatic exocrine ducts - autodestruction of exocrine pancreas - don't produce enzymes needed for digestion and absorption of fats/fat-soluble vitamins
47
why do patients with CF have high chloride in their sweat?
defective CFTR reduces chloride reabsorption > high concs of Na+ and Cl- in sweat
48
common colonisers in CF (4)
1. s.aureus 2. pseudomonas aeruginosa 3. burkolderia cepacia 4. aspergillus
49
1st line ix and results for CF
1. sweat test - positive is >60mmol 2. newborn screening - blood spot test of immunoreactive trypsinogen
50
management of CF a) resp b) GI c) pancreas
a) chest physio twice daily, mucolytics e.g. DNase, saline nebs b) high calorie diet, high fat c) enzyme replacement (creon), fat soluble vitamin supplementation (A, D, E, K)
51
contraindication to lung transplant in CF patients
chronic infection with Burkholderia cepacia
52
PHASE 3A/4
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