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Resp Flashcards

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1
Q

Lung abscess

A
  • hx of cough while eating
    *systemic symptoms (low grade fever, night sweats, wt loss)
    *cough productive of foul smelling sputum
    *CXR:- cavitation
  • hx of LOC, alcohol/drug use, seizure, swallowing dysfunction, Parkinsons
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2
Q

next investigation for Pt with likely CAP and negative CXR

A

HRCT of the chest
* dehydration and being on immunosuppressant e.g prednisone can lead to negative CXR despite signs of CAP

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3
Q

what test distinguishes asthma from COPD

A

spirometry before and after inhaled bronchodilator
*asthma is reversible ( post FEV1/FVC >70%)
*COPD is partially/ non reversible

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4
Q

Pre pulmonary obstructive shock

A

*obstruction involving RT atrium, Rt ventricle or pulmonary arteries e.g. PE, tension pneumothorax
* high CVP, Low/ N PCWP (less bld going from RT to LT heart)

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5
Q

Post Pulmonary obstructive shock

A

*obstruction involving the Lt side of the heart/ aorta
e.g severe aortic stenosis, aortic dissection
* CVP high, PCWP high

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6
Q

Aspirin exacerbated respiratory disease presentation

A

TRiAD
*ashtma
*chronic rhinosinusitis with nasal polyps
*NSAIDs/aspirin sensitivity

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7
Q

next investigation in pt with Parkinson’s, hx of coughing when eating, recurrent pneumonia 2o polygenic bacteria

A

swallow study –> bacterial aspiration

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8
Q

initial step in mgx of pt with likely TB

A

place pt in respiratory isolation before proceeding with further investigations

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9
Q

initial management of pt with massive haemoptysis > 600ml/24hrs or 100ml/hr

A

ABC’s
bronchoscopy

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10
Q

how to prevent episodes of exercise induced bronchoconstriction

A

administer combined corticosteroids, beta agonist 10 mins before exercise

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11
Q

Bronchiolitis presentation

A

*viral induced LRTI in <2yr olds
*follows URTI, peaks day 3-5/7
* c/o cough, crackles, wheezing, increased work of breathing
*CXR :- -peribronchial cuffing, inc interstitial markings
*MGX:- supportive, maintain fluid intake

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12
Q

Bronchiectasis features

A
  • hx chronic cough productive of copious thick sputum
    *recurrent exacerbations with mucopurulent sputum +/- hemoptysis
  • CXR :- inc interstitial markings
    *HRCT diagnostic test –> bronchial dilatation
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13
Q

Hypersensitivity pneumonitis

A

*immunologic response to inhaled Ag e.g. mold
* c/o fever, malaise, dyspnoea, non productive cough
*CXR interstitial opacities

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14
Q

wedge shaped opacity on CT is pathognomic of which condition

A

PE

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15
Q

ACEI - bradykinin induced SE vs asthma

A

bradykinin will cause dry cough but no wheezing, bronchoconstriction or PFT changes

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16
Q

hallmark pathogenesis of asthma

A

leucocyte induced bronchoconstriction

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17
Q

next step in mgx of pt with hx of 8/52 chronic dry cough

A

pulmonary function test to rule out asthma

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18
Q

mgx measures that will reduce mortality in all pts with COPD

A

smoking cessation

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19
Q

methotrexate induced lung toxicity features

A
  • a hypersensitivity pneumonitis
    *occurs within 1-12/12 taking MTX
    *CT scan showing inflammation (consolidation and fibrosis ( reticulation)
    *BAL:- lymphocytosis
    *Bld test:- eosinophilia
    *exclude infection first
  • discontinuing MTX is diagnostic and therapeutic
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20
Q

chronic bronchitis differentiating features

A
  • form of COPD
    *hx of smoking
  • daily cough worse during flareups
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21
Q

acute bronchitis

A

*self limiting illness follows a viral infection
* pt usually well with symptoms of cough >5/7-3/52 +/- sputum
*examination:- wheezing, rhonci
*mgx:- supportive, inh bronchodilators
*abx not needed

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22
Q

GERD + Asthma mgx

A

PPI improves peak flow rate and asthma symptoms

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23
Q

CF bronchiectasis features

A
  • young pt
    *recurrent episodes of dypnoea
    *cough with copious sputum, haemoptysis, wt loss
    *examination:- digital clubbing, crackles
    *upper lobe involvement
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24
Q

Sarcoidosis PFT features

A

*restrictive pattern
*N FEV1, FVC
*N/ increased FEV1/FVC
*increased TLC
*decreased DLCO

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25
Foreign body aspiration features
*sudden onset resp distress *unilateral decreased breath sounds and wheezing *unilateral hyperinflation and mediastinal shift *mgx:- rigid bronchoscopy to identify and remove FB
26
tension pneumothorax
*CXR :- air without lung markings, ipsilateral collapse, mediastinal shift * reduced breath sounds affected side
27
bacterial aspiration pneumonia- in hospital predisposing factors
*taking psychotic/sedative meds *gastric suppressive meds *anaesthesia *intubation *NG feeding
28
desired 'settings' for mechanical ventilation in ARDS
*negative fluid balance to reduce risk of pulmonary oedema *aim for sats at 92-96% *limit tidal volume to avoid over inflating alveoli *permissible degree of hypercapnia and low pH to avoid excess VT
29
greatest risk factor for severe life threatening asthma
hx of previous intubation
30
empyema
exudative effusion with low glucose level 2o high metabolic activity of leucocytes 2o bacteria *high LDH
31
pt on ventilation develops resp alkalosis -> next step
if Tidal volume appropriate --> reduce resp rate
32
Pneumonia features
*fever, hypoxaemia *V/Q mismatch with RT to LT shunting if large part of lung affected hypoxaemia may not respond to O2
33
solitary pulmonary nodule
*<3cm in size *rounded opacity *surrounded by lung parenchyma * no lymphadenopathy
34
malignancy indicators of solitary pulmonary nodules
*irregular borders *>0.8cm in size *hx of smoking *FHx of lung Ca Mgx:- surgical excision
35
mgx of pneumothorax
* small <2cm in a stable pt --> supplemental O2 *large in a stable pt --> needle throacostomy *large in an unstable pt--> chest tube placement if
36
myocardial contusion presentation
*hypotension *tachycardia *arrhythmia or new heart block
37
thoracic aortic injury
38
Blunt Thoracic Aortic Injury
* occurs in pts who undergo rapid deceleration *widening of mediastinum + Lt sided haemothorax/effusion * CT angiography for stable pt and TOE for unstable pt *Mgx:- emergency surgical repair
39
ARDS
*gradual decompensation *diffuse pulmonary oedema *crackles on auscultation
40
Venous Air Embolisim
*follows trauma, certain surgery, central line placement *sudden onset dyspnoea, hypotension, tachycardia, clear lungs on auscultation *can lodge in RT ventricle --> cardiac arrest
41
Lung abscess features
* 1-2/52 c/o fever, cough, night sweats, wt loss and foul smelling sputum *mild hyponatraemia *hx of impaired consciousness *fluid level on CXR *due to aspiration of oropharyngeal anaerobic bacteria
42
gastric acid induced lung injury
*chemical pneumonitis 2o aspiration of gastric acid *usually occurs over hours *sgnificant dyspnoea, minimal fever
43
sarcoidosis hilar lymphadenopathy
* bilateral never unilateral
44
squamous cell carcinoma
*central lesson --> unilateral hilarity mass *c/o cough, dyspnoea, haemoptysis and hyper cal anemia 2o PTH related protein release
45
RT mainstem bronchus intubation
*hypoxaemia *reduced breath sounds on the LT/ contralateral side (not being ventilated) *elevated peak and plateau pressure
46
Pneumothorax on ventilation
* increased risk in Pts with COPD on positive pressure ventilation *sudden onset tachypnea, dyspnoea, hypoxemia *decreased breath sounds on the affected side *elevated peak and plateau pressure
47
acute onset PE
*tachycardia, tachypnea, low grade fever, hypoxaemia *prophylactic LWMH may not eliminate risk of PE in high risk pts ( malignancy, recent surgery esp abdominal)
48
anaphylaxis transfusion reaction
*occurs in pts with IgA deficiency *hives, wheezing, stridor, rash+/- angioedema
49
Transfusion related lung injury
* occurs within mins - hrs of transfusion *result of massive release of inflammatory mediators * acute onset resp failure, hypoxaemia, tahcypneoa, tachycardia, bilateral pulmonary infiltrates, bilateral crackles
50
empyema 2o aspiration
* turbid pleural fluid *foul smelling pleural aspirate *2o oral strep and anaerobes *gradual presentation *wt loss
51
Hereditary hemorrhagic telengectasia
AD mutation leading to angiogenesis *nasal AVM --> epistaxis *pulmonary AVM --. haemoptysis + CXR smooth, well demarcated pulmonary nodules *continuous bruit over location GI --> iron deficiency anaemia Mgx:- emobolisation
52
tracheobronchial injury
* seen in pts with blunt trauma to chest and extensive extra pulmonary air e.g persistent large air leak chest tube *Ix of choice :- bronchoscopy *require surgical repair
53
Venous Air Embolism mgx
*high flow O2 ( to help absorption of air embolus) *Lt lateral decubitus position ( stop air embolus from moving trapping it)
54
pulmonary contusion
*<24 hrs after blunt trauma *leading to alveolar haemorrhage and oedema *tachypnoea, hypoxaemia, decreased breath sounds *CXR patchy, non lobar, irregular alveolar infiltrates
55
bronchial mucus plug
*can lead to large volume atelectasis/ lung collapse *CXR opacification of the entire lung and mediastinal shift towards the atelectasis
56
diaphragm perforation
*occurs as a realist of blunt abdominal trauma *c/o resp distress and small bowel obstruction symptoms (colicky, vomiting) *CXR herniation of stomach and bowel into chest cavity
57
chronic lung transplant rejection
*occurs >1yr after *progressive fibrosis leading to obstruction wheezing
58
CMV pneumonitis
*occurs commonly within 1st year of lung transplant *acute onset *fever *interstitial pulmonary infiltrates +/- small pleural fluid
59
pneumonitis features
*dypnoea *fever *dry cough *interstitial infiltrates
60
diaphragmatic weakness
*dyspnoea on exertion *orthopnea * paradoxical breathing movement ( abdomen goes in during inspiration) * can be due to phrenic nerve injury 2o surgery
61
postoperative atelactasis
*can occur 2-5/7 postop *dyspnoea, tachypnoea *hypoxia, low CO2 due to hyperventilation and high pH *resp alkalosis *dullness to percussion, decreased breath sounds
62
how to prevent postoperative atelactasis
*postoperative deep breathing exercises/ incentive spirometry *adequate post op pain control *stop smoking >4-8/52 pre-op

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