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Year 3 Medicine > Resp > Flashcards

Resp Flashcards

1
Q

What are the anatomical classifications of Pneumonia?

A

Bronchopneumonia (patchy consolidation of different lobes)
Lobar Pneumonia (Congestion, Red Hepatisation, Grey Hepatisation, Resolution)

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2
Q

What are the four aetiological classifications of Pneumonia?

A

Community Acquired, Hospital Acquired, Immunocopromised, Aspiration

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3
Q

Name three causative organisms of Community Acquired Pneumonia

A

Streptococcus Pneumoniae, Haemophilus Influenza, Moraxella Catarrhalis

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4
Q

Name three causative organisms of Hospital Acquired Pneumonia

A

Staphylococcus Aureus (inc MRSA), Klebsiella Pneumoniae, Pseudomonas Auerginosa

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5
Q

Name two causative organisms of Immunocompromised Pneumonia

A

Pneumocystis Jiroveccii (fungi) and TB

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6
Q

What type of organisms are responsible for aspiration pneumonia?

A

Anaerobes

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7
Q

What lung is more likely to be affected by aspiration pneumonia

A

Right

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8
Q

Name four symptoms of Pneumonia

A

Dyspnoea, Cough (Purulent), Fever, Pleuritic Chest Pain

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9
Q

Name four signs of Pneumonia

A

Tachycardia, Tachypnoea, Cyanosis, Confusion

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10
Q

What would you find OE of Pneumonia?

A

Decreased expansion, Dull percussion, Bronchial Breathing, Increased vocal resonance, Crackles

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11
Q

What are you looking for on a CXR of Pneumonia?

A

Infiltrates, Cavities, Effusion

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12
Q

When would you do an ABG in a pneumonia patient?

A

if pO2<92%

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13
Q

Apart from a CXR and ABG, name three investigations you could do for pneumonia, and what would you expect them to show?

A

Urine - Pneumococcal/Legionella antigens
Bloods - raised WCC, raised CRP, raised urea
Sputum - Microscopy, culture and staining

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14
Q

How is the severity of pneumonia scored?

A

CURB 65 - actually calculates the mortality but from this the severity can be inferred
Confusion, Urea>7mmol/l, Resp Rate>30, BP Systolic<90, Age>65

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15
Q

What is the management of mild CAP?

A

500mg Amoxicillin for 5 days

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16
Q

What is the management of moderate CAP?

A

500mg Amoxicillin AND 200mg Doxycycline for 5 days

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17
Q

What is the management of severe CAP?

A

IV Co-Amoxiclav and ORAL Clarithromycin

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18
Q

What is the management of HAP?

A

Mild/Moderate - Oral Co-Amoxiclav
Severe - IV Co-Amoxiclav (Or tazocin)
Fluids
Analgesia
Follow up CXR at 6/52

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19
Q

What is Pneumovax?

A

Vaccination against pneumococcal pneumonia
GIven to over 65s, immunosupressed, diabetics
Lasts for 6yrs

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20
Q

Name 5 complications of Pneumonia

A

Respiratory Failure, Hypotension, AF, Pleural Effusion, Empyema

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21
Q

What is Interstitial Lung Disease?

A

Umbrella term for disorders causing fibrosis of the lungs

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22
Q

What are the 5 classifications of ILD?

A

Idiopathic, Granulomatous, Occupational, Rheumatic, Iatrogenic

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23
Q

What are the causes of Idiopathic ILD?

A

Usual Interstitial Pneumonia, Acute Interstitial Pneumonia, Non Specific Interstitial Pneumonia

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24
Q

Name a granulomatous cause of ILD

A

Sarcoidosis - systemic inflammation characterised by non caseating granulomas

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25
Q

Name three drugs causing ILD

A

Bleomycin, Nitrofurantoin, Amioderone

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26
Q

What is Extrinsic Allergic Alveolitis?

A

Hypersensitivity reaction
Can be acute (more reversible) or chronic (less reversible)

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27
Q

Name three symptoms of ILD

A

Dry cough, Exertional Dyspnoea, Malaise

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28
Q

Name three signs of ILD (hint:3Cs)

A

Cyanosis, Clubbing, Crepitations (fine)

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29
Q

Name three investigations carried out for ILD, and what they would show

A

Bloods - ABG and looking for underlying cause
CXR- reduced lung volume, lower zone shadowing
Spirometry - Restrictive Pattern

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30
Q

What would a biopsy of UIP type ILD show?

A

Patchy and honeycombing

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31
Q

Name four managements of ILD

A

1) Remove offending cause
2) Stop smoking
3) Medication
4)Oxygen

In some cases can do lung transplant

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32
Q

Name the two possible pharmacological interventions for ILD

A

N - Acetyl Cystiene (anti-oxidant properties)
Pirfenidone (downregulates growth factors and reduces fibrosis, FVC between 50 and 80%)

Acute exacerbations - corticosteroids

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33
Q

Define Asthma

A

Chronic inflammatory disease of the airways causing intermittent and reversible airway obstruction

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34
Q

Name four pathological changes in asthma

A

Basement membrane thickening
TH2 mediated mast cell degranulation (Prostaglandins, Leukotrienes, Histamines)
Mucus Hypersecretion
Smooth Muscle hypertrophy and hyperplasia

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35
Q

Name three symptoms of Asthma

A

Dyspnoea, Intermittent cough, Wheeze

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36
Q

Name three signs of Asthma

A

Tachypnoea, Decreased air entry, Audible wheeze

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37
Q

Name the features of mild Asthma

A

No features of severe asthma
PEFR>75%

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38
Q

Name the features of moderate Asthma

A

No features of severe asthma
PEFR 50-75%

Can usually be managed at home

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39
Q

Name the features of severe Asthma

A

PEFR 33-50%
Incomplete sentences
RR>25
HR>110

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40
Q

Name the features of life threatening Asthma

A

PEFR<33%
pO2<92%
Cyanosis
Poor resp effort/silent chest
Any normal pCO2

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41
Q

Name the features of near fatal Asthma

A

raised pCO2

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42
Q

What is the management of acute asthma?

A

Aim for 94-98% O2
5mg Nebulised salbutamol (every 15 mins)
40mg Oral Prednisolone

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43
Q

What is the management of severe asthma?

A

500mcg Nebulised Ipratropium Bromide (Antimuscarinic)
Back to Back Salbutamol

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44
Q

What is the management of life threatening asthma?

A

ITU
CXR
IV Aminophylline (Adenosine Antagonist)
IV salbutamol

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45
Q

Name the 5 features of an asthma discharge plan

A

PEFR>75%
No nebulisers/o2 requirements in past 12-24h
Inhaler technique checked

Check that:
5 days oral prednisolone
GP follow up in 2 working days
Resp Clinic follow up in 4 weeks
Asthma Nurse referral

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46
Q

What is the definition of COPD?

A

Progressive airway obstruction with little or no reversibility.
Umbrella term for Chronic Bronchitis and Emphysema

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47
Q

Name 3 causes of COPD

A

Smoking
Alpha 1 Anti-Trypsin
Industrial Exposure (soot)

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48
Q

Name 3 pathological features of COPD

A

Mucous gland hyperplasia
Mucous gland hypersecretion
Ciliary Dysfunction

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49
Q

Name 5 signs of COPD

A

Tachypnoea, Hyperinflation, Decreased expansion, Hyper resonance, quiet breath sounds

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50
Q

What are 4 complications of COPD?

A

Exacerbations, Polycythaemia, Resp Failure, Cor Pulmonale

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51
Q

What would a CXR of COPD show?

A

Hyperinflation and flattened diaphragm

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52
Q

What would a CT of COPD show?

A

Bronchial wall thickening and air space enlargement

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53
Q

What would Spirometry of COPD show?

A

Obstructive pattern with poor reversibility

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54
Q

State the 5 features of the COPD care bundle

A

Smoking cessation
Pulmonary Rehab
COPD Information Booklet (breathe easy and british lung foundation)
Inhaler technique
Outpatient follow up

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55
Q

What are the requirements for giving LTOT to COPD patients?

A

Have to use it atleast 16/24 every day
Must be a non smoker
Must not retain CO2
If pO2 is constently less than 7.2kPa (or 8kPa with Cor Pulmonale)

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56
Q

What is the definition of Bronchiectasis?

A

Chronic dilation of one or more bronchi due to chronic inflammation leading to poor mucociliary clearance

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57
Q

Name the four main categories of Bronchiectasis causes

A

Post infective, Immune deficiency, Genetic Deficiency, Obstruction

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58
Q

Name two post infective causes of Bronchiectasis

A

Whooping Cough
TB

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59
Q

Name an immune deficiency causing Bronchiectasis

A

Hypogammaglobulinaemia

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60
Q

Name four genetic defects causing Bronchiectasis

A

Cystic Fibrosis, Primary Ciliary Dyskinesia, Youngs Syndrome (Bronchiectasis, SInusitis, Reduced Fertility), Kartageners Syndrome (Bronchiectasis, Sinusitis, Situs Inversus)

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61
Q

Name the four main infective organisms in Bronchiectasis

A

Haemophilus Influenza
Streptococcus Pneumoniae
Staphylococcus Aureus
Pseudomonas Auerginosa

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62
Q

State 3 symptoms of Bronchiectasis

A

Persistent cough, copious sputum production, intermittent haemoptysis

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63
Q

State 3 signs of Bronchiectasis

A

Clubbing, Coarse crepitations, Wheeze

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64
Q

What is the gold standard investigation for Bronchiectasis, and what does it show?

A

HRCT
Dilation of the bronchi to larger than the adjacent blood vessel (sygnet ring sign)

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65
Q

State 5 management options in Bronchiectasis

A

Airway Clearance (flutter valve,mucolytics,physio)
Antibiotics
Flu Vaccine
Steroids
Pulmonary Rehab

66
Q

Name 2 mucolytics

A

Acetyl Cysteine
Bromhexine

67
Q

Define Cystic Fibrosis

A

Autosomal recessive mutation on chromosome 7, leading to abnormalities of CFTR gene (reducing chlorine secreiton and hence mucous dilution)

68
Q

How is Cystic Fibrosis diagnosed?

A

History of CF in Sibling/Positive Newborn Test
AND
Sweat Test/Genotyping/Nasal Potential Difference

69
Q

Describe 3 ways CF can present

A

Meconium Ileus
Intestinal Absorption (reduced pancreatic enzymes)
Recurrent Chest Infections

70
Q

Name 4 complications of CF

A

Respiratory Infections
Low Body Weight
Distal Intestinal Obstruction Syndrome (usually ileocaeca region, palpable RIF mass)
CF related diabetes

71
Q

What lifestyle advice would you give CF patients?

A

No smoking
Avoid other CF patients
Avoid Jacuzzis
NaCl tablets in hot weather
Flu Vaccine

72
Q

Give 5 risk factors for PE

A

COCP/HRT
Recent surgery
Reduced mobility
Malignancy
Leg Fracture

73
Q

PE may be asymptomatic, however give 4 ways in which they can present

A

Acute Dyspnoea
Pleuritic chest pain
Haemoptysis
Syncope

74
Q

Give 4 signs of a PE

A

Pyrexia
Tachycardia
Tachypnoea
Raised JVP

75
Q

What is a massive PE

A

A PE causing haemodynamic compromise, causing hypotension

76
Q

What investigations would you do for a PE

A

ABG
D Dimers (only if WELLS score<4)
ECG (S1Q3T3)
CTPA

77
Q

How would you manage a PE?

A

DOAC or warfarin

Long-term anticoagulation or IVC filter

Dabigatran and warfarin require bridging anticoagulation with heparin (until INR >2)

78
Q

How would you manage a massive PE?

A

Thrombolysis with alteplase

79
Q

What are the contraindications to thrombolysis?

A

Stroke less than 6 months ago
GI bleed less than 1 month ago
Bleeding disorder

80
Q

Name four classifications of Pneumothorax

A

Spontaneous (Primary or Secondary)
Traumatic
Tension
Iatrogenic (post central line/pace maker)

81
Q

Give 5 risk factors for a Pneumothorax

A

Pre-existing lung disease
Tall and thin
Smoking
Diving
Marfans

82
Q

How would a pneumothorax present?

A

Asymptomatic
OR
Sudden onset dyspnoea, pleuritic chest pain, reduced expansion, diminished breath sounds

83
Q

When do you NOT do a CXR in pneumothoraces?

A

If a tension pneumothorax is suspected

84
Q

How do you manage a tension pneumothorax?

A

Large bore needle into 5th intercostal space mid axillary line

85
Q

How do you manage a primary pneumothorax?

A

If lung markings are more than 2cm from chest wall then give O2 and insert a large bore needle into 4th intercostal space mid axillary line
If this is unsuccessful then try a chest drain

86
Q

What are the two types of pleural effusion?

A

Transudative (pleural protein<30g/l)
Exudative (pleural protein>30g/l)

87
Q

Give 3 causes of a transudative pleural effusion

A

Heart Failure, Cirrhosis, Hypoalbuminaemia

88
Q

Give 3 causes of an exudative pleural effusion

A

Malignancy, Infection (eg parapneumonic effusion), Inflammatory (RA)

89
Q

How would you diagnose a pleural effusion?

A

CXR
Ultrasound guided pleural aspiration (biochemistry,cytology,microbiology)

90
Q

How might a patient with Pleural Effusion present? What would you find OE?

A

May be asymptomatic OR dyspnoea/pleuritic chest pain
OE: stony dull percussion,reduced expansion, diminished breath sounds

91
Q

Name three different types of management for a pleural effusion

A

Always test sample first - for pH and protein content (can culture as well)

Drain (URGENT if empyema/pH<7.2)
Pleurodesis
Surgery (if increasing collections/pleural thickening)

92
Q

What should you consider before draining a pleural effusion?

A

If you have reached the correct diagnosis

93
Q

Define Obstructive Sleep Apnoea

A

Upper airway narrowing, provoked by sleep causing excessive daytime sleepiness

94
Q

Give two broad causes of Obstuctive Sleep Apnoea

A

Small Pharyngeal Size (neck fat, large tonsils, craniofacial abnormalities)
Excess narrowing (Obesity, Neuromuscular Disease, Muscle relaxants)

95
Q

Give 3 presentations of OSA

A

Snoring, Excessive daytime sleepiness, Nocturia

96
Q

Give 3 diagnostic methods for OSA

A

Epworth Sleepiness Scale, Overnight Oximetry, Sleep Study EEG

97
Q

Give a conservative and a surgical management for OSA

A

Conservative - Lose weight
Surgical - Pharyngeal surgery

98
Q

Describe the two possible ventilation methods used in OSA

A

CPAP - upper airways splinted open with 10mmHg positive pressure, no ventilatory support
bipap - non invasive ventilation, bilevel postive pressure so does provide ventilatory support

99
Q

Give 3 non respiratory presentations of lung cancer

A

SVC Obstruction (raised JVP, upper limb swelling)
Horner’s Syndrome (Miosis, Anhidrosis and Partial Ptosis)
Paraneoplastic (Cushings, Hypercalcaemia)

100
Q

Describe the WHO Performance Status

A

0 - Fully active without restriction
1 - Restricted in strenuous activity but able to carry out light work
2 - Capable of self care but unable to carry out work activities, up and about more than 50% working day
3 - Limited self care, confined to bed/chair more than 50% waking hours
4 - Completely disabled
5 - Dead

101
Q

Give four histological sub types of non small cell carcinoma

A

35% Squamous Cell
27% Adenocarcinoma
10% Large Cell
<1% Adenocarcinoma in situ

102
Q

Why do small cell carcinomas often give rise to paraneoplastic syndromes?

A

They arise from Kulchitskey cells, which are endocrine cells

103
Q

What is Lambert Eaton Syndrome?

A

Syndrome assoicated with Small Cell Carcinoma
Autoimmune attack against VGCCs causing impaired ACh release
Weak Muscles, Difficulty swallowing, Difficulty breathing

104
Q

What is a Hamartoma?

A

Usually a benign cancer
Appears as a lobulated mass with flecks of calcification

105
Q

What is a malignant mesothelioma? What is it strongly related to?

A

A cancer of the mesothelial cells occurring in the pleura of the lungs
Strong association with asbestos exposure
Poor prognosis

106
Q

Define Acute Respiratory Distress Syndrome

A

A type of respiratory failure characterised by wide spread inflammation of the lungs

107
Q

Give 5 causes of ARDS

A

Pneumonia, Vasculitis, Sepsis, Pancreatitis, Malaria

108
Q

How would a patient in ARDS present?

A

Cyanotic, Tachypnoeic, Tachycardic, Peripheral vasodilation, Bilateral fine crackles

109
Q

What is the diagnostic criteria for ARDS?

A

One of:
Acute Onset
Bilateral Infiltrates
Pulmonary Capillary Wedge Pressure <19mmHg
Refractory Hypoxaemia

110
Q

Describe the management for ARDS

A

ITU admission
Resp Support - CPAP or mechanical ventilation (low tidal volume though to prevent pneumothorax)
Circulatory Support - Arterial line for haemodynamic monitoring, Inotropes, Vasodilators, Blood transfusions

111
Q

Give 3 risk factors for Sarcoidosis

A

Age (20-40)
Afro-caribbean
HLA DRB1

112
Q

What is Lofgren Syndrome

A

Acute form of Sarcoidosis
Characterised by Fever, Erythema Nodosum, Polyarthralgia, Bilateral Hilar Lymphadenopathy

113
Q

How does Sarcoidosis Pulmonary Disease present?

A

Dry Cough, Progressive Dyspnoea, Chest Pain

114
Q

Describe the stages of Pulmonary Sarcoidosis on a CXR

A

Stage 0 - Normal
Stage 1 - Bilateral Hilar Lymphadenopathy
Stage 2 - Bilateral Hilar Lymphadenopathy and Peripheral Pulmonary Infiltrates
Stage 3 - Peripheral Pulmonary Infltrates alone
Stage 4 - Progressive pulmonary fibrosis, Honeycombing, Bullae

115
Q

How would you manage pulmonary sarcoidosis?

A

Mild/Moderate - 40mg Prednisolone OD then taper
Severe - IV methylpred, Anti TNF, Lung Transplant

116
Q

What is Coal Workers Pneumoconiosis?

A

Workers inhale coal dust, which are ingested by macrophages which then die, release their enzymes and cause fibrosis
Can progress to Pulmonary Fibrosis

117
Q

What would a CXR of Coal Workers Pneumoconiosis show?

A

Many round opacities (especially in upper zone)

118
Q

What is Caplans Syndrome?

A

Pulmonary Fibrosis in coal workers who have rheumatoid arthritis

119
Q

How would a patient with Caplans present?

A

Cough, SOB, Painful joints and morning stiffness

120
Q

What three investigations would be indicated in Caplans and what would they show?

A

CXR - Well defined nodules (potentially cavitating like TB)
Spirometry - Mixed restrictive and obstructive
Bloods - RF, ANA

121
Q

What is Silicosis?

A

Inhalation of silica particles which are fibrogenic. Associated with metal mining/stone quarrying/ceramic manufacture

122
Q

How does Silicosis present?

A

Progressive Dyspnoea
Increased incidence of TB

123
Q

What two investigations would be indicated in Silicosis?

A

CXR - Miliary Pattern in upper/mid zones
Spirometry - Restrictive

124
Q

What is characteristic of Bronchiectasis on CXR?

A

Tram Tracks

125
Q

How would you treat a COPD exacerbation?

A

No purulent sputum - supportive, likely viral
Purulent Sputum - Amoxicillin TDS 5d (or Doxycycline if Pen allergic)

+Prednisolone
+ supportive nebs if required

126
Q

What antibiotics would you use for Aspiration Pneumonia?

A

Co-Amoxiclav

127
Q

What antibiotics would you use for Pneumonia caused by an atypical pathogen?

A

Co-Amoxiclav + Doxycycline/Clarithromycin

128
Q

What antibiotics would you use for Ventilator Assisted Pneumonia?

A

IV Piperacillin and Tazobactam

129
Q

What is the difference between acute bronchitis and pneumonia?

A

May get similar symptoms
Less likely to get productivity in acute bronchitis
Significantly milder
Appears normal on a CXR

130
Q

When would you refer a CAP?

A

Severe systemic symptoms
Unresponsive to Abx
Unable to take oral abx

Cosndier if CURB 1-2
Admit if CURB 3

131
Q

How should pneumonia respond to abx?

A

After 1 week - no fever
After 1 month - chest pain and sputum production reduced
After 6 weeks - cough resolved
After 3 months - only fatigue present
After 6 months - resolved

132
Q

Give three primary care considerations for patients after CAP

A

6 week CXR (if non resolving or risk of malig)
Pneumococcal vaccine?
Smokng Cessation

133
Q

Name a non respiratory drug that can be prescribed in ILD and supports lung function

A

PPI

134
Q

What is FeNO testing for asthma?

A

Typically only in >17y

Not used in patients taking oral steroids

Breathe out into machine like spirometry which detects nitric oxide concentration

> 40ppb in airways indicates allergic inflammation and asthma

135
Q

What bronchodilator reversibility suggests asthma?

A

An improvement in FEV1 of 12% or more 15-20 minutes after bronchodilator

136
Q

Describe complete management of asthma

A

No daytime symptoms
No night waking
No need for rescue medication
No asthma attacks
No limitations on activity or exercise

137
Q

Name two assessment tools for asthma

A

Asthma control questionnaire
Asthma control test

138
Q

Describe the non-acute step up management for asthma

A

1) SABA
2) SABA + ICS (BD)
3) SABA + ICS +LTRA (oral)
4) SABA + ICS + LABA
5) MART

Consider stepping down after three months of good control

139
Q

When should you start ICS in asthma?

A

If using SABA inhaler >3 times a week
Woken at night weekly

140
Q

Name two types of asthma delivery devices

A

DPI (Dry Powdered Inhalers)
pMDI (Pressured Metred Dose Inhalers)

141
Q

Name two MART inhalers and describe their administration

A

Symbicort (Budesonide and Formoterol
Fostair (Beclometasone and Formeterol)

1 puff in morning, 1 puff in evening, puffs for relief (max 6 per day)

142
Q

State 5 things to monitor at an asthma review

A

Number of asthma attacks
Nocturnal symptoms
Adherence
Asthma management plan
Smoke exposure

143
Q

What are the royal college of physicians’ three questions for controlled asthma?

A

1) Have you had trouble sleeping at night due to your asthma symptoms?
2) Have you had your usual asthma symptoms during the daytime?
3) Is this affecting your ADLs?

144
Q

How often should asthma patients be followed up?

A

Annual review
After any medication change (4-8 weeks)

145
Q

How should you manage asthma exacerbations in the community whilst awaiting admission?

A

Nebulised salbutamol if available

If not MDI - 4 puffs initially, followed by 2 puffs every 2 mins

If severe or life threatening consider giving nebulised ipratropium bromide

146
Q

In diagnosis of COPD, the MRC dyspnoea score can be used. What is it?

A

Measures the severity of breathlessness from 1-5

147
Q

When should COPD patients be referred for pulmonary rehab?

A

If MRC dyspnoea score >3 or recent hospitalisation

Not if unstable angina or unable to walk

148
Q

Name two inhaler managements for COPD

A

SABA and SAMA

149
Q

How should COPD exacerbations be managed in the community?

A

5d oral prednisolone +/- abx

150
Q

When should you suspect bronchiectasis in children?

A

Recurrent chest infections
Chest infections failing to respond to abx
Asthma medication failing

151
Q

Other than HRCT, how can bronchiectasis be investigated?

A

Chest X-Ray
Sputum sample
Spirometry

152
Q

What should be considered in bronchiectasis end of year review?

A

How symptoms are affecting ADLs
BMI (<20 needs nutritional support)
Frequency of exacerbations

153
Q

How should exacerbations of bronchiectasis be managed?

A

Take sputum sample
7-14d antibiotics (eg Amoxicillin)

154
Q

When should you immediately admit people for PE?

A

If signs of haemodynamic instability
If pregnant/given birth 6 weeks ago

155
Q

State 4 items on the WELLs score

A

Previous VTE
Haemoptysis
Tachycardia
Immoblisiation for >3d

156
Q

How would you manage patients with WELLs>4 ?

A

CTPA (if not available within 4 hours then start interim apixaban)

157
Q

How would you manage a WELLs score <4?

A

1) D-Dimer
2) If D-Dimer positive then CTPA (interim anticoag if more than 4 hours)

158
Q

How long should anticoagulation be continued for in PE?

A

First episode provoked - 3 months
First episode unprovoked - 6 months

159
Q

How is asthma diagnosed?

A

> 17y - Spirometry with reversibility AND FeNO
5-16 - Spirometry with reversibility and FeNO if unequivocal
<5 - clinical diagnosis only

160
Q

Describe the step up management of adult asthma

A

1) SABA
2) SABA + ICS
3) SABA + ICS LTRA
4) SABA + ICS + LABA
5) MART

161
Q

What should you always ask in acute exacerbation of asthma?

A

About previous exacerbations - any ITU admissions?

162
Q

Describe the step up management of asthma exacerbation

A

1) Nebulised salbutamol
2) + Prednisolone 40mg
3) Nebulised ipratropium bromide
4) MgSO4
5) ITU opinion for aminophylline/intubation

Year 3 Medicine (10 decks)

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