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MedEd Tutorials > 21. Acute Resp > Flashcards

21. Acute Resp Flashcards

1
Q

What is pneumonia?

A

Alveoli infection!

Split into CAP and HAP (after 48 hours in hospital)

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2
Q

What are the causative organisms of pneumonia?

A

CAP - Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus pneumoniae

Atypical - Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydia psittaci
Chlamydia pneumoniae

HAP - Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella

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3
Q

Risk factors for pneumonia

A 
Smoking
Recent travel
Faulty air conditioning - legionella
Pet birds - chlamydia psittaci 
Immunocompromised
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4
Q

Pneumonia symptoms?

A

Typical
Fever, SOB, productive cough, pleuritic chest pain

Atypical
Dry cough, headache, diarrhoea, myalgia, hepatitis, confusion (legionella)

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5
Q

Pneumonia O/E?

A 
Reduced chest expansion
Dull percussion
Basal coarse crepitations 
Bronchial breathing
Increased vocal resonance

Atypical - mycoplasma - transverse myelitis, erythema multiforme, AI haemolytic anaemia
legionella - hyponatraemia abnormal LFTs

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6
Q

Pneumonia investigations?

A 
Sputum MCS
Bloods
ABG - type I resp failure
Pleural fluid MCS
CXR on imaging

Mycoplasma will have red cell agglutination on blood film
Legionella has urinary antigens and strange LFTs

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7
Q

Management of pneumonia?

A 
CURB-65
Confusion < or = 8
Urea >7
Resp rate >30
SBP <90
Age >65

Score of 1 is GP and oral abx
Score of 2 is A&E with IV abx
3 or more is hospital admission, IV abx and consider ITU

Typical - amoxicillin and then co-amoxiclav
further
Doxycycline if pen allergic
Atypical - clarithromycin

PJP needs co-trimoxazole for HIV patients

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8
Q

What is acute bronchitis?

A

Infection of bronchi, upper resp tract

Usually viral e.g. rhinovirus, flu, RSV, COVID

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9
Q

Risk factors for bronchitis?

A

Smoking

CF and COPD

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10
Q

Signs and symptoms of acute bronchitis?

A

Minimally/nonproductive cough for weeks
Dyspnoea, chest pain and tightness with wheezing from this
Mild fever (high or long would suggest pneumonia)

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11
Q

How might we investigate acute bronchitis?

A

Generally clinically based

If CXR it’s to exclude pneumonia

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12
Q

Managing acute bronchitis?

A

Paracetamol and ibuprofen as required
Hydration
If cough persists for more than 2 weeks, inhaled corticosteroids
If underlying lung pathology used oral antibiotics

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13
Q

What is a PE?

A

One or more emboli that blocks an artery in the lung. This usually comes from a thrombus in the veins that has moved.

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14
Q

Symptoms of PE?

A

Pleuritic chest pain
Dyspnoea
Collapse if acute massive
Haemoptysis

S1Q3T3 pattern on ECG for acute massive

CXR shows westermark’s sign (check this)

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15
Q

How are we assessing a PE?

A

Well’s score
>4 is high risk, needs CTPA
<4 do d-dimer, low risk

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16
Q

How to manage a PE?

A

Haemo stable? (<90)

Yes
Resp support
Anticoag - heparin for 5 days, warfarin for 3 months

No
Resp support
Thrombolysis (alteplase)
Embolectomy

17
Q

VTE prevention?

A

Compression stockings

LMWH e.g. tinzaparin

18
Q

What is a pneumothorax?

A

Abnormal collection of air in the pleural space between lung and chest wall

19
Q

Types of pneumothorax?

A

Primary
Secondary to pre-existing condition
Tension pneumothorax - lung compression with tracheal deviation, silent chest etc.
Medical emergency, ONE WAY VALVE

20
Q

What is ARDS?

A

Non-cardiogenic pulmonary oedema

21
Q

What is berlin criteria?

A

Berlin Criteria:

  1. No alternative cause for pulmonary oedema eg. cardiac failure
  2. Rapid onset < 1 week
  3. Dyspnoea
  4. Bilateral signs on CXR
22
Q

What is ARDS caused by?

A

Hypoxaemic lung injury!

Sepsis
Pneumonia
Ventilation
Severe burns
Acute pancreatitis
Transfusion reactions and OD
23
Q

What is the aetiology of ARDS?

A

The body responds with a profound inflammatory response to hypoxia.
Alveolar collapse from oedema.

24
Q

How do we manage ARDS?

A

ITU referral
Lie patient prone
Ventilator

25
Q

How do we investigate ARDS?

A

CXR - bilateral, diffuse opacities (lungs look white)

26
Q

How do we manage ARDS?

A

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MedEd Tutorials (32 decks)

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