Resp p2 Flashcards
What are the causes of clubbing?
Carcinoma
- Bronchial
- Mesothelioma
Chronic lung suppuration
- Empyema, abscess
- Bronchiectasis, CF
Fibrosis
- Idiopathic pulmonary fibrosis / CFA
- TB
What are the other causes of clubbing?
Cardiac
- Infective Endocarditis
- Congenital cyanotic heart disease
- Atrial myxoma
Cirrhosis
- Crohn’s, uC
- Coeliac
- Cancer: GI lymphoma
Other
- Thyroid Acropachy
- Upper limb AVMs or aneurysms
- Unilateral clubbing
What are the causes of pneumonia?
Community Acquired Pneumonia
- Pneumococcus, mycoplasma, haemophilus
- S. aureus, Moraxella, Chlamydia, Legionella
- Viruses: 15%
Hospital Acquired Pneumonia
- >48hrs after hospital admission
- Gm-ve enterobacteria, S. aureus
Aspiration
- ↑ Risk: stroke, bulbar palsy, ↓GCS, GORD, achalasia
- Anaerobes
Immunocompromised
- The usual suspects, plus
- PCP, TB, fungi, CMV/HSV
What are the causes of lung abscess?
Aspiration
Bronchial obstruction: tumour, foreign body
Septic emboli: sepsis, IVDU, RH endocarditis
Pulmonary infarction
Subphrenic / hepatic abscess
How is HAP managed?
How is aspirational pneumonia mxd?
Mild / <5d: Co-amoxiclav 625mg PO TDS for 7d
Severe / >5d: Tazocin ± vanc ± gent for 7d
Co-amoxiclav 625mg PO TDS for 7d
What are some causes of pulmonary oedema?
Transudates
- ↑ capillary hydrostatic pressure § CCF
- Iatrogenic fluid overload
- Renal failure
- Relative ↑ in negative pressure pulmonary oedema
- ↓ capillary oncotic pressure
- Liver failure
- Nephrotic syndrome
- Malnutrition, malabsorption, protein-losing enteropathy
- ↑ interstitial pressure
- ↓lymphatic drainage: e.g. Ca
Exudates - ARDS
What are some causes of VQ mismatch?
- Vascular: PE, PHT, Pulmonary Shunt (R → L)
- Asthma (early): Pneumothorax, Atelectasis
What are the signs and sx of a PE?
Symptoms
- Dyspnoea
- Pleuritic pain
- Haemoptysis
- Syncope
Signs
- Fever
- Cyanosis
- Tachycardia, tachypnoea
- RHF: hypotension, ↑JVP, loud P2
- Evidence of cause: DVT
How would you investigate a PE?
- Bloods: FBC, U+E, clotting, D-dimers
- ABG: normal or ↓PaO2 and ↓PaCO2, ↑pH
- CXR: normal or oligaemia, linear atelectasis
- ECG: sinus tachycardia, RBBB, right ventricular strain
- (inverted T in V1-V4)
- S1, Q3, T3 is rare
- Doppler US: thigh and pelvis (+ve in 60%)
- CTPA + venous phase of legs and pelvis
- 85-95% sensitivity
- V/Q scan no longer used
What are the sx of cor pulmonale?
- Dyspnoea
- Fatigue
- Syncope
What are the signs of `cor pulmonela?
- ↑ JVP c¯ prominent a wave
- Left parasternal heave
- Loud P2 ± S3
- Murmurs
- PR: Graham Steell EDM
- TR: PSM
- Pulsatile hepatomegaly
- Fluid: Ascites + Peripheral oedema
How do you Ix cor pulmonale?
- Bloods: FBC, U+E, LFTs, ESR, ANA, RF
- ABG: hypoxia ± hypercapnoea
-
CXR
- Enlarged R atrium and ventricle
- Prominent pulmonary arteries
- Peripheral oligaemia
- ECG: P pulmonale + RVH
- Echo: RVH, TR, ↑ PA pressure
- Spirometry
- Right heart catheterisation
