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Resp3 Flashcards

Acute resp

1
Q

What is the definition of a pulmonary embolus?

A

An emboli lodged within the pulmonary circulation.

The lung parenchyma is ventilated but not perfused.

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2
Q

What are the risk factors for a pulmonary embolus?

A 
Hx/FHx of DVT
Long periods of stasis (eg. flights)
Recent surgery
Pregnancy
OCP/oestrogen
Smoking
Malignancy
Cardio-respiratory Dx
Hypoxaemia
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3
Q

What is the presentation of a PE?

A 
Sudden onset
Pleuritic chest pain
SOB
\+/- haemoptysis
\+/- haemodynamic compromise
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4
Q

What will you find on examination of a Pt with a PE?

A 
Tachypnoea
Tachycardia
Lower limb swelling/redness/hotness
Cyanosis
May have signs of shock
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5
Q

What is the scoring system used to dictate an investigation?

A

Well’s score

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6
Q

What should you do if the Well’s score is >4?

A

Admit to hospital

Perform a CTPA

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7
Q

What should you do if the Well’s score is <4?

A

Measure the D-dimer
If D-dimer is positive, admit and do CTPA
If D-dimer is negative, consider alt diagnosis

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8
Q

What other investigations other than CTPA/D-dimer can you do for a PE?

A

ECG

CXR

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9
Q

What would an ECG show on a Pt with a PE?

A

Sinus tachycardia
Right axis deviation
RBBB
S1Q3T3

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10
Q

What would an CXR show on a Pt with a PE?

A

Pleural effusion

Elevation of hemidiaphragm

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11
Q

What would your first line manage be for a Pt with a PE?

A

Analgesia
Oxygen >94%
Fluids

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12
Q

How would you manage a haemodynamically unstable Pt with a PE?

A

Thrombolysis (eg. alteplase)

Embolectomy

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13
Q

How would you manage a haemodynamically stable Pt with a PE?

A

LMWH/fondaparinux for 5 days/INR>2

Start warfarin at the same time

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14
Q

What is the definition of a pneumothorax?

A

Accumulation of air in the pleural space

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15
Q

What are the types of pneumothoraces?

A

Primary spontaneous pneumothorax

Secondary spontaneous pneumothorax

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16
Q

What is the difference between a primary and secondary spontaneous pneumothorax?

A

P- no underlying respiratory illness

S- associated with lung pathology

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17
Q

What is the presentation of a pneumothorax?

A

Sudden onset
SOB
Chest pain

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18
Q

What are the risk factors for a pneumothorax?

A

Underlying lung disease
Smoking
CTD
Trauma

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19
Q

What will you find on examination of a Pt with a pneumothorax?

A

Reduced/absent breath sounds
Reduced/absent vocal resonance
Hyper-resonance
Reduced chest expansion

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20
Q

What investigations would you do on a Pt with a pneumothorax?

A

CXR

CT

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21
Q

Why is a CXR important for a pneumothorax?

A

Can differentiate between a bullae and pneumothorax

Can locate the pneumothorax

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22
Q

Why is a CT important for a pneumothorax?

A

Can differentiate between a bullae and pneumothorax
Can locate the pneumothorax
Is more sensitive than a CXR

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23
Q

What is the management plan for a 40 yr old Pt with a primary pneumothorax <2cm?

A

O2

Consider discharge

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24
Q

What is the management plan for a 40 yr old Pt with a primary pneumothorax >2cm?

A

Aspirate

If unsuccessful, insert an intercostal drain

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25
What is the management plan for a Pt >50yr OR with a secondary pneumothorax <1cm?
High flow O2
26
What is the management plan for a Pt >50yr OR with a secondary pneumothorax 1-2cm?
Aspirate If <1cm, high flow O2 If still >1cm, intercostal drain
27
What is the management plan for a P t>50yr OR with a secondary pneumothorax >2cm?
Intercostal drain
28
What would you find on examination of a tension pneumothorax that you wouldn't find in a normal pneumothorax?
Tracheal deviation Distended neck veins Displaced apex beat
29
What is the definition of a pneumonia?
Inflammation of the alveoli which can be caused by bacteria, viruses or fungi. Inflammation results in air sacs filling with fluid or pus
30
What are the types of pneumonia?
Community-acquired pneumonia Hospital-acquired pneumonia Aspiration pneumonia
31
What are the common causes of CAPs?
Streptococcus pneumoniae | Haemophilus influenzae
32
What is the presentation of pneumonias?
``` Fever Malaise Rigors Productive cough Pleuritic chest pain ```
33
What will you find on examination of a Pt with pneumonia?
``` Pyrexia Cyanosis Tachypnoea Confusion Decreased expansion Dull percussion Increased vocal resonance Bronchial breathing ```
34
What investigations would you do on a Pt with pneumonia?
Bloods (FBC, CRP) Sputum sample- MC&S Blood cultures if severe CXR
35
What is the scoring system to assess the severity of a pneumonia?
``` CURB 65 Confusion Urea >7mmol/L RR >=30 BP: SBP<90mmHg, DBP<=60mmHg Age >=65 ```
36
What would you do for a Pt with a CURB-65 score of 0-1?
Treat at home if possible
37
What would you do for a Pt with a CURB-65 score of 2?
Consider hospital treatment
38
What would you do for a Pt with a CURB-65 score of 3+?
Severe, treat in ITU
39
What is the management for a Pt with pneumonia?
Antibiotics Oxygen Analgesics Fluids
40
What antibiotics would you give a low severity pneumonia?
Oral amoxicillin
41
What antibiotics would you give a moderate severity pneumonia?
Oral/IV amoxicillin + macrolide (eg. clarithromycin)
42
What antibiotics would you give a high severity pneumonia?
IV co-amoxiclav + macrolide (eg. clarithromycin)
43
Where is Legionella pneumophila commonly found?
Aqueous environments - air conditioning - whirlpool spas - contaminated water supplies - airplanes
44
What is the difference between Legionnaire's disease and Pontiac fever?
Legionnaire's disease- Legionella pneumonia | Pontiac fever- non-pneumatic Legionella
45
What is the presentation of a Legionella pneumonia?
``` Prodromal flu-like symptoms Dry cough (can become productive) GI symptoms (nausea, D+V) ```
46
What investigations would you do for a Legionalla pneumonia?
Sputum culture Urinary antigen detection U+E for hyponatraemia CXR- bi-basal consolidation
47
What is the treatment for Legionella pneumophila?
IV macrolide or fluoroquinolone | Clarithromycin or ciprofloxacin
48
What is Pneumocystis jirovecii?
Opportunistic fungal infection AIDS defining illness Causes pneumocystis pneumonia (PCP)
49
What are the risk factors for a Pneumocystis jirovecii infection (PCP)?
Recurrent bacterial pneumonias Significant weight loss HIV
50
What is the treatment for a Pneumocystis jirovecii infection (PCP)?
High dose IV co-trimoxazole
51
Which patients are at risk of a Pseudomonas aeruginosa infection?
Bronchiectasis | Cystic fibrosis
52
What is the treatment for a Pseudomonas aeruginosa pneumonia?
Piptazobactam | Piperacillin + tazobactam
53
What is the presentation of a Mycoplasma pneumoniae infection?
Insidious onset Persistent cough Low grade fever Seen in close community settings (boarding school, uni, army bases)
54
What investigations would you do for a Mycoplasma pneumoniae infection?
CXR | PCR
55
What is the treatment for a Mycoplasma pneumoniae pneumonia?
Erythromycin/clarithromycin
56
What kind of patients commonly present with Staphylococcus aureus infections?
IVDU
57
What are the risks of Staphylococcus aureus infections?
Can arise from blood-borne spread of organisms form an area of infection Can develop into septicaemia
58
What investigation would you do for a Staphylococcus aureus infection?
CXR
59
What is seen on a CXR for a Staphylococcus aureus pneumonia?
Patchy consolidation | Breaks for form abscesses which appear as cysts
60
What is the treatment for MSSA?
Flucloxacillin
61
What is the treatment for MRSA?
Vancomycin
62
A gentleman presents with acute breathlessness and chest pain. O/E his respiratory rate is 25bpm with good air entry in all fields. His ECG shows right axis deviation. What is the most likely diagnosis? A. Pneumothorax B. Pneumonia C. COPD D. Pulmonary embolism
D. Pulmonary embolism
63
A 35 year old lady presents with acute onset SOB, chest pain and one episode of haemoptysis. She has recently noticed a swelling in the left leg. O/E her RR is 28 and HR is 105. You suspect a pulmonary embolism. What is the most appropriate investigation to perform? A. Chest X-Ray B. CTPA C. D-Dimer D. ECG
B. CTPA
64
A 23 year old student presents to A&E with SOB. He says it came on suddenly. O/E his trachea is undisplaced with reduced breath sounds on the left. A CXR confirms a 1cm pneumothorax. What is the most appropriate management? A. Immediate chest decompression B. Intercostal drain C. Aspiration D. High flow oxygen
D. High flow oxygen
65
What signs would you expect on physical examination of someone with pneumonia? A. Deviated trachea, ↓ expansion, dull to percussion B. Bronchial breathing, ↓ expansion, ↓ vocal resonance C. Pyrexia, ↓ expansion,  ↑ vocal resonance D. Dull to percussion, ↑ expansion,  pyrexia
C. Pyrexia, ↓ expansion,  ↑ vocal resonance
66
A 55 year old man has a 3 day history of shivering, general malaise & productive cough and is vomiting. The x-ray shows right lower lobe consolidation. He is diagnosed with a moderate pneumonia, what is the first line therapy? A. Oral Amoxicillin B. IV Co-Amoxiclav + Clarithromycin C. Doxycycline D. IV Amoxicillin + Clarithromycin
D. IV Amoxicillin + Clarithromycin
67
A 71 year old gentleman is brought in by his carer with a 4 day history of a fever and a cough. As you go to examine him he shouts and asks that you leave his bedroom. His RR is 30, BP 103/68. The lab phones you a hour later and lets you know his urea is 7.8mmol/L. Where would you manage this patient? A. Admit and treat B. Treat at home C. Consider ITU D. Refer for palliative care
C. Consider ITU CURB-65 score: 4
68
25M presents to A&E with a fever and a cough. He says he has been generally unwell over the last year. O/E he is acutely SOB with a RR of 28. You also note an incidental finding of purple patches on his nose. What is the most likely causative organism? A. Pseudomonas aeruginosa B. Streptococcus pneumoniae C. Pneumocystis jirovecii D. Mycoplasma pneumoniae
C. Pneumocystis jirovecii Purple patch- Kaposi's sarcoma (HHV 8) Indicative of a HIV Pt
69
55M presents with a cough and fever. He recently travelled to New York to speak at a conference. After bloods revealed Na+ of 130, you decide to test the urine. What is the most likely causative organism? A. Haemophilus influenzae B. Pseudomonas aeruginosa C. Legionella pneumophilia D. Pneumocystis jirovecii
C. Legionella pneumophilia Flu-like symptoms Recent travel- airplane Hyponatraemia Urine sample for antigens
70
10F presents to A&E with a fever and a cough and O2 sats: 92%. Her parents don’t seem worried as they are used to bringing her into hospital for treatment for her respiratory illness. A. Pseudomonas aeruginosa B. Haemophilus influenzae C. Staphylococcus aureus D. Coronavirus
A. Pseudomonas aeruginosa Commonly seen in bronchiectasis or cystic fibrosis, which is what this Pt has.
71
A known IVDU is brought into A&E, he was found unconscious by two friends who were worried he might have overdosed. You notice an abscess in his groin. Temp 39, HR 120, BP 90/50. You immediately admit him. A. Haemophilus influenzae B. Staphylococcus aureus C. Coronavirus D. Legionella pneumophila
B. Staphylococcus aureus IVDU Infected abscess Likely in septic shock

Year 3 MedEd (29 decks)

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