Resp Flashcards

Question

Indications for home oxygen therapy

Answer 1

- PaO2 < 7.2 kPa - Clinically stable non smoker - PaO2 7.3-8 and pulmonary HTN + cor pulm - Terminally ill patient

Answer 2

Acute exacerbation of COPD 1. Increased breathlessness, increased sputum production. 2. Managment - ABC - O2 24-28% - Aim for: PaO2 > 8kPa with rise in PaCO2 not greater than 1.5kPa. - Nebulized salbutamol 5mg/4hr + impratropium bromide 500ug/6hrs - Steroids: IV hydrocort 200mg + PO prednisolone 30-40mg Continue for 7-14 days - Antibiotics if infection suspected Amoxicillin 500mg/8hr PO - Physio: sputum expectoriation - Not responding: Repeat nebulizer Consider aminophylline - NR: Consider nasal PPV if RR > 30 - NR: Consider intubation/ventilation if CO2 rising.

Answer 3

1. Definition - Irreversible dilatation of airways due to inflammation and destruction of airway walls from persistently infected mucus. - Usually medium to small sized airways effected. 2. Signs and symptoms - Chronic cough - Purulent sputum - Hemoptysis *massive* - Recurrent pneumonia - Local crackles = inspir + expir - Wheeze - Clubbing - Difficult to differentiate from chronic bronchitis 3. Findings on investigation - PFT: Obstructive pattern - XRY: Linear atelectasis, loss of volume, honeycomb structures 4. Treatment - Vaccination: influenza & pneumovax - Antibiotics - Inhaled steroids - Oral steroids for acute exacerbations - Chest physio - Pulmonary resection if necessary

Answer 4

1. Hypoxemic - PaO2 < 60mmHg - PaO2 < 8kPa 2. Hypercapnic - PaCO2 > 50mmHg - PaCO2 > 6kPa

Answer 5

- Dyspnea - Restlessness - Agitation - Confusion - Central cyanosis - Polycythemia - Pulmonary hypertension - Cor pulmonale

Answer 6

- Headache - Dyspnea - Drowsiness - Asteixis / flapping tremor - Warm peripheries - Plethora - Raised ICP - Tachycardia - Bounding pulses

Answer 7

1. Low FiO2 = high altitude 2. Hypoventilation 3. Shunting 4. Low mixed venous O2 content 5. V/Q mismatch

Answer 8

1. High inspired CO2 2. Low total ventilation 3. High deadspace ventilation 4. High CO2 production - fever, sepsis

Answer 9

COPD patients: Goal SaO2 88-92% | Everyone else: Goal SaO2 94-98%

Answer 10

1. Definition: - Hypoxia: PaO2 < 8kPa - Normal or low PaCO2 2. Cause - V/Q mismatch: asthma, COPD, pulmonary edema, PE - Shunt: alvelar collapse, intracardiac shunt, intrapulmonary shut = AVM - Low inspired O2: High altitude 3. Treatment - Reverse pathology / underlying cause - Maintain oxygenation - Increase FiO2 **Supplementing O2 won't work if shunting is the problem** - PEEF/CPAP: to recruit alveoli

Answer 11

1. Definition - PaCO2 increased = hypercapnia - PaO2 decreased = hypoxia 2. Causes: - Increased CO2 production: fever, sepsis - Alveolar hypoventilation: COPD, asthma, chest wall disorder, CF. - Hypoventilation: Central = stroke Drugs = opiates, benzo NMJ = GB, MG, fatigue 3. Treatment - Find and fix cause - Same as above - maintain oxygenation, mechanical ventilation if necessary.

Answer 12

``` Resp causes: - Infectious: TB, lung abscess - Airway disease: COPD, chronic bronchitis, bronchiectasis. - Pulm vasc disease: PHTN, vasculitis, PE - Parencymal disease: pneumonia, wegener's, goodpastures - Malignancy ``` Cardiac causes: - MI - CHF - MS Hem: - Anemia - Coagulopathy

Answer 13

Loss of the angle between the nail and nail fold. The nail fold feels boggy.

Answer 14

Respiratory causes: - Lung ca, mesothelioma - Chronic lung infection: bronchiectasis, TB, empyema, abscess, cystic fibrosis. GI: - IBD (especially Crohn's) - Malabsorption = celiac - GI lymphoma - Cirrhosis Cardiac: - Cyanotic heart disease - Endocarditis - Atrial myxoma - Aneurysms Other: - Thyroid acropachy - Esophageal Ca.

Answer 15

pH: 7.35-7.45 PaCO2: 4.7-6kPa ; 35-45mmHg PaO2: >10.6kPa ; 75-100mmHg HCO3: 24mEq/L

Answer 16

If there is a metabolic acidosis - calculate the anion and osmolar gap. AG: Na - [(CL + HCO3)] = 10-15 mmol/L If the anion gap is increased - is the change in the AG the same as the change in bicarbonate? If no = mixed picture. Osmolar gap = measure - calculated osmolarity = (2[Na] + glucose + urea) = normal 10

Answer 17

**Characterized by increased PCO2 secondary to hypoventilation ** ``` Resp center depression - Stroke - Drugs: opiates, sedatives, anesthesia - Raised ICP - Encephalitis - Central apnea - Supplemental O2 in CO2 retainers (COPD) ``` Neuromuscular disorders - MG - GB - Poliomyositis - Muscular dystrophies - ALS ``` Lung disease - Airway obstruction: asthma, COPD, foreign body - Parenchymal disease: pneumonia, pneumothorax, pulm edema, ARDS ``` Other: - Inadequate mechanical ventilation

Answer 18

**Characterized by decreased PaCO2 secondary to hyperventilation** Hypoxemia - Pneumonia, PE, edema - Severe anemia - Heart failure - High altitude Resp center stimulation - CNS disorders - Hepatic failure - Drugs: stimulants, ASA, catecholamines - Pregnancy - Anxiety - Pain Other cause: - Mechanical hyperventilation

Answer 19

``` MUDPILES Methanol Uremia DKA/starvation/alcoholic Paraldehyde Isopropyl alcohol/Iron/INH Lactic acidosis Ethylene glycol Salicylates ```

Answer 20

``` HARDUP Hyperailmentation Acetazolamide RTA** Ureteroenteric fistual Pancreaticoduodenal fistula increased ```

Answer 21

- Vomiting = loss GI H+ - Exogenous alkali syndrome - Milk alkali syndrome - Diuretics = contraction alkalosis - Post hypercapnea - Hyperaldosterisms - Hypokalemia

Answer 22

1. Pathophy - Inflammatory process in the alveoli that results in thickening, destruction and fibrosis. - Restrictive lung disease - Decreased lung compliance & lung volumes. 2. Upper lung disease - Farmers lung - Ankylosing spondylitis - Sarcoidosis - Silicosis - TB - Neurofibromatosis ``` Lower lung disease - Asbestosis - Drugs: nitrofurantoin, amiodarone, chemo - Rhematological disease - Scleroderma ```

Answer 23

Unknown etiology - Idiopathic pulmonary fibrosis - Sarcoidosis - Histocytosis X ``` ILD associated with known systemic disease Rheumatological - Scleroderma - Rhematoid arthritis - SLE - Mixed CTD ``` Enviro/occupational - Farmers lung - Bird lung - Air conditioners - Silicosis - Asbestosis - Coal workers pneumoconiosis - Berylliosis Drugs - Nitrofurantoi - Methotrexate - amiodarone - Chemotherapy - Ampetamines - Radiation Pulm vasclitis - Wegeners - Churg strauss - Hypersensitivity reaction Inherited disorders - Neurofibromatosis - Tuberous sclerosis - Gauchers disease

Answer 24

- Dyspnea on exertion - Non productive cough - Abnormal breath sounds - Fine end inspiratory crepitations **PF** - Weight loss - Arthralagia (depending on type) - Restrictive pattern on PFTs - Decreased DL due to loss of SA for gas exchange.

Answer 25

``` 1. Lights criteria Transudate: Protein [P/S] < 0.5 LDH [P/S] < 0.6 Pleural LDH < 2/3 upper limit of N serum LDH ``` Exudate Protein [P/S] > 0.5 LDH [P/S] > 0.6 Pleural LDH > 2/3 upper limit of N serum LDH 2. Cause of transudate - CHF - Cirrhosis - Nephrotic syndrome - Pulmonary embolism - Hypothryoidism 3. Causes of exudate - Infectious: pneumonia, parapneumonic effusion, empyema. - Malignancy - Inflammatory: collagen vascular disorder, RA, SLE, pulmonary embolism - Intra-abdo: Meigs syndrome, pancreatitis, esophageal rupture. - Trauma

Answer 26

Protein content - < 30g/L = transudate - > 30g/L = exudate - Between 25-35g/L use Lights criteria Glucose content - < 3.3 mmol/L = malignancy, TB, RA pH < 7.2 = infection or malignancy, requires drainage. ``` Cell types - Neutrophilia = infection - Lymphocytes = TB, lymphoma, malignancy - RBC = trauma, cancer, lymphoma ```

Answer 27

Simple effusion: pH > 7.2, LDH < 1/2 serum, glucose > 2.2 Complicated pH < 7.2, LDH > 1/2 serum, glucose < 2.2, positive gram stain = needs drainage

Answer 28

Nodule is defined as being < 3cm Mass > 3cm - Infectious granuloma - Abscess - Aspergilloma - Hamartoma - Bronchiogenic cyst - Fibroma - AVM - Rheumatoid nodule - Sarcoidosis - Primary lung ca - Secondary lung ca - Pulmonary carcinoid

Answer 29

Benign pulmonary nodule - < 3cm, round, regular - Smooth - Calcified pattern - Doubles in > 2 years Malignant pulmonary nodule - >3cm, irregular, spiculated - Ill defined or noticed - NOT calcified - Doubles in < 1 month or < 2 years.

Answer 30

- ACTH = cushing - SIADH - Eaton Lambert

Answer 31

Squamous cell carcinoma | PTH-related peptide = hypercalcemia + hypophosphatemia

Answer 32

Symptoms: - Acute breathlessness - Pleuritic chest pain - Hemoptysis - Dizziness - Collapse Signs: - Pyrexia - Tachycardia - Tachpnea - Hypotension - Raised JVP - Pleural rub - Pleural effusion

Answer 33

Risk factors - Active cancer (1) - Paralysis/immobility (1) - Major surgery (1) Clinical signs - Tenderness along leg (1) - Entire leg swollen (1) - Calf circumference > 3cm (1) - Pitting edema (1) - Collateral superficial veins visible (1) Other: - Alternative as likely or more likely than DVT (-2)

Answer 34

- CXR - ABG: decreased PaO2 and PaCO2 - ECG: S1Q3T3 pattern - D-dimers: High sen, low spec Can exclude PE if normal in low risk patient. - CTPA: Sen & spec; First line - V/Q scan: If CXR normal and no lung disease. - Bilateral venograms

Answer 35

- Give 100% oxygen - Morphine 10mg for pain relief - If critically ill with passive PE consider immediate thrombolysis (50mg Alteplase) - IV access - SC LMWH: Dalteparin 200U/kg o.d Enoxaparin 1mg/kg bid No lab monitoring Avoid in renal failure - UF Heparin IV: 10,000U bolus Then 18U/kg/h guided by aPTT - Systolic BP: > 90 = Warfarin 10mg od < 90 = 500mL colloid Dobutamine 2.5- 10ug/kg/min - Continue warfarin and heparin for 5 days or until INR 2-3.

Answer 36

- If reversible cause = 3-6 mo - PE unprovoked = 6mo to indefinite - Ongoing risk present = indefinite