Resp Flashcards
(19 cards)
Causes of pulmonary fibrosis
This chest x-ray is from a 25 year old man who presented with a cough, a pyrexia and green sputum. What is the most likely diagnosis?
Right middle lobe pneumonia
Clinical signs of pneumonia?
- Decreased expansion on affected side
- Dull to percussion
- Increased tactile vocal fremitus
- Bronchial breathing
Essential investigations to order for for pneumonia?
- Lateral CXR
- Blood and sputum cultures
Management of pneumonia?
- Amoxicillin or benxylpenicillin and erythromycin/clarithromycin
Define septic shock
Severe infection and endotoxin release resulting in release of potent vasodilators, hence causing a fall in total peripheral resistance.
Peripheries thus feel warm or hot.
Since BP=COxTPR, BP falls to dangeous levels
How does noradrenaline treat septic shock?
- Potently stimulates alpha and beta 1 receptors
- Main effect is peripheral vasoconstriction, hence shuts off non-essential organs such as gut
- Used to maintain BP in septic shock
A 30 year old man collapses on the way back from X-ray. He had presented to casualty with sharp chest pains. The X-ray that was taken is shown. What is the diagnosis?
Tension pneumothorax
- Air is pushing the mediastinal structures to the right side.
How do you manage tension pneumothorax?
- Aspirate with wide (14-16 gauge) bore
Respiratory causes of clubbing?
- Bronchiectasis
- Lung cancer
- CF
- Interstitial lung disease
- Empyema
- Fibrosing alveolitis
Clinical signs of CO2 retention?
- CO2 flap
- Bounding pulse
- Vasodilatation (warm hands)
- Paiplloedema
- Mental changes
- Drowsiness
Causes of obstructive airways?
- asthma=reversible airways obstruction
- emphysema=irreversible
Management of acute severe asthma?
- Administer high dose oxygen
- Nebulised salbutamol 5mg drive by oxygen
- steroids: 100mg IV hydrocortisone, 40mg prednisolone daily
- IF severe: transfer to ITU, aminophylline 100-200mg by slow IV bolus, ventilate
Signs of acute severe asthma?
- not talking talking
- PF<150lpm
- cyanosed
- tahcycardia >120bpm
- paradox >20mmHg
- silent chest
- ‘normal’ CO2
What is Pancoast’s syndrome?
- Apical lung tumour
- Horner’s syndrome: anhydrosis, ptosis, myosis
- Neuropathy of C8/T1 + wasting
Endocrine manifestations of lung cancer?
- SIADH- managed with fluid restriction
- Hyperparathyroidism
- Ectopic ACTH
Clinical signs of obstructive lung disease?
- hyperexpansion
- barrel chest
- tracheal tug
- decreased expansion
- hyperresonant
- expirator wheeze
What antibiotic class do you start patients on if infective exacerbation of COPD?
Cephalosporin due to high risk of Haemophilus infection
Clinical signs suggesting pleural effusion?
- Stony dull percussion
- Plaster at lung base suggesting recent tap
- Reduce voval fremitus
- Reduced air entry
- Normal trachea
