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Flashcards in Respiratory Deck (24)
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1
Q

Well’s criteria for PE

A
Clinical signs of DVT (3)
Pulmonary embolism most likely (3)
Tachycardia (1.5)
Immobilisation (1.5)
Previous PE/DVT (1.5)
Haemoptysis (1)
Malignancy (1)
2
Q

Indications for PE thrombolysis

A

Hypotension

Shock

3
Q

Poor prognostic markers for PE

A
Right ventricular dysfunction
Troponin elevated (negative patients will do well)
ANP/BNP elevated
4
Q

PFT changes in obesity

A
FEV1 lower
FVC lower
FRC lower
ERC lower
RV lower
TLC lower
tends to be a restrictive defect with low FVC with increased FEV1/FVC ration as FVC is lowered more than FEV1 is lowered
5
Q

CURB65 pneumonia score

A
Confusion
Urea > 7
RR > 30
BP < 90 or DBP < 60
65 years or older

> 2 suggests severe pneumonia at high risk of death

6
Q

MDR TB

A

resistant to at least 2 1st line TB drugs

eg: rifampicin, isoniazid

7
Q

XDR TB

A

resistant to rifampicin, isoniazid
AND any fluoroquinolone AND one of capreomyin, kanamycin, amikacin
a/w HIV
high mortality rate

8
Q

TB Rx

A

RIPE 2/12
RI maintenance 4/12
longer if meningitis, disseminated, spinal, MDR, XDR
add steroids if large pleural effusion, pericardial disease, meningitis

9
Q

Churg Strauss

A
asthma
eosinophilia
pulmonary infiltrates
neuropathy
paranasal sinus abnormality
pANCA 50-60%
small-medium vessel vasculitis
Rx: steroids + - cyclophosphamide
10
Q

Granulomatosis with polyangiitis

Wegeners granulomatosis

A

CXR: nodules, alveolar opacities, pleural opacities, diffuse hazy opacities
cANCA 90%
small-medium vessel vasculitis
URT, LRT, kidneys

11
Q

O2 Hb dissociation curve

to the right:

A

shifted to the right = O2 affinity of Hb is reduced
02 unloads into tissues more readily
- exercise: (hot, acidotic, need more O2)
- acidosis (increased H+)
- increased CO2
- increased temperature
- increased 2-3 diphosphoglycerate (2,3-DPG)

small addition of CO shifts curve to the left; making it harder for O2 to get into tissues as it is more tightly bound to Hb

12
Q

A-a gradient calculation

A

PAO2 = FiO2 (Patm - PH2O) - PaCO2/0.8

if assume at sea level on room air:
PAO2 = 150 - (5/4 PaCO2)

normal = 5-10
increases with age so: normal < age/4 + 4

increased gradient with decreased O2, CO2 or both
eg: diffusion defect, V/Q mismatch, right - left shunt

13
Q

SMART COP tool for pneumonia severity

A

2 points for O2, pH, SBP
all else 1 point (bracket for > 50yo)

S = SBP < 90
M = multilobar on CXR 
A = albumin < 35
R = RR > 25 (30 if > 50yo)
T = tachycardia > 125bpm
C = confusion
O = PaO2 < 70 (< 60)
            < 93% (< 90%)
            PaO2/FiO2 < 333 (< 250)
P = pH < 7.35
14
Q

pleural fluid analysis

A

exudate?
pleural fluid : serum albumin > 0.5
pleural fluid : serum LDH > 0.6

infection, malignancy
glucose low
pH < 7.2 suggests poor prognosis / severe infx

transudate: CCF, ascites, nephrotic sx

15
Q

Restrictive lung defect on RFTs with normal DLCO

A

normal RV - inspiratory dysfx: obesity, kyphoscoliosis, ank spond
increased RV - insp and exp dysfx: bilateral diaphragm paralysis, GBS, MG, MD

16
Q

Causes of increased lung compliance

A

age

emphysema - this is due to loss alveolar walls and associated elastic tissue

17
Q

Causes of decreased compliance

A

pulmonary oedema
pulmonary fibrosis
pneumonectomy
kyphosis

18
Q

A -a gradient

A

PaO2 should equal FiO2 X 5
age/4 + 4
A-a gradient increases by 5-7% for every 10% increase in FiO2

19
Q

Lights criteria

A

pleural - serum LDH > 0.6
pleural - serum protein > 0.5

pH < 7.3 - RA, CA, complex pneumonia, TB, SLE, oesophageal rupture
gram stain indicates complicated parapneumonic effusion requiring drainage

20
Q

legionella

A

haemolysis

21
Q

coxsackie B

A

pleuodynia - intercostal muscle inflammation

pleuritis

22
Q

UIP

A

honeycombing

basal predominant

23
Q

COPD GOLD class

A

1 FEV1 > 80 SABA
2 LABA
3 LABA + ICS
4

24
Q

DLCO

A

raised in pulmonary haemorrhage EG goodpastures