Respiratory Flashcards
(56 cards)
dx: Pink frothy sputum, swollen ankles
Acute pulmonary edema
LMNOP reverse
NYHA criteria (note beta-blocker only when fluid status is stabilized)
Daily weighs, salt and water restriction.
Device therapy if indicated
Precipitants of acute pulmonary edema
MAD HATTER 3P Myocardial infarction Anemia Drugs - NSAID, negative inotropes, compliance Hypertension Arrythmia Temperature (infection) Thyroid (hyper or hypothyroid) Endocarditis, eclampsia Renal failure, rupture of chordae 3P - peri-op, PE, pregnancy
70 yo M retired army officer, constant dyspnea 2 years at rest, productive cough, thick sputum
COPD
Spirometry to confirm diagnosis
Typical organisms for bronchiolitis
RSV (most common in children
12 month old M o increased work of breathing (link) o widespread expiratory wheeze and crepitations, expiration is also prolonged + hyperinflation o +/- fever o May have reduced oxygen saturation o signs of dehydration
Bronchioliitis
Diagnosis is clinical
Treatment is supportive - oxygenation, fluid, nutrition. Admit to hospital for signs of moderate-severe
CXR will show hyperinflation - flattened diaphragm on AP, barrel-chest on lateral
inspiratory stridor, increased work of breathing + absent cough with low pitched expiratory stridor (often snoring) and drooling. No swallowing. Prefers to sit upright.
Acute epiglottitis
Emergency, give IV abx and send to hospital
Typical organism for acute epiglotitis
H inluenzae type B
Chest tap - what are the anatomical landmarks
5th AAL
2nd MCL
Done immediately above costal margin
Recurrent attacks of slow onset SOB, uncoordinated breathing, palpitaitons, lightheadedness, fatigue, agitation O/E chest normal
Anxiety
Paper bag rebreathing
COPD - Outline main management for acute exacerbation
Bronchodilator - inhaled, dual if not responsive
Systemic steroid - pred po once daily, 7-14 days
Antibiotics - amoxicillin or doxycycline
Oxygen therapy - target O2 saturation levels of 88 – 92, and nasal prongs (2L/min) OR venturi mask (28% and 4L/min) .Take ABG, If ABG results show respiratory acidosis (pH 45 OR signs of CO2 retention – asterexis, confusion consider NIPPV (biPAP)
Diagnosis of bronchiectasis
high resolution CT scan
Most likely diagnosis of persistent morning cough
smoking
Yellow sputum in the absence of infection
Asthma (eoisnophilis)
Smoking
Copious quantities of yellow-green sputum
Pseudomonas
Bronchiectasis
Red flags of sick child with resp. illness
Behaviour - irritability, fatigue, drowsiness
Resp rate
Accessory muscle use
Poor feeding
22 yo migrant from east timor, 4 months of persistent cough, mucus production and flecks of blood, anorexia, tired, night sweats, weight loss, feverish and mild headache.
Probability diagnosis - TB
Must not miss - carcinoma of lung
Pitfalls - bronchiectasis, cystic fibrosis, sarcoidosis, wegeners, churg-straus, whooping cough
Common benign causes of persistent cough
URTI with post-viral cough chronic bronchitits post-nasal drip ASthma Smoker's cough
TB investigations and diagnosis
Quantiferon (does not distinguish latent vs active disease)
Ziel-Neelson stain of sputum (3x early morning)
PCR
CXR
TB management
Isolation and quarantine Reportable disease Medications 2x4, 4x2 - 2 months of 4 agents - rifampicin, isoniazid, pyrazinamide, ethambutol - 4 months of rifampicin and isoniazid
TB drug side effects
o Risk factors;
10% serious AE
Risk factors: age, female, pre existing liver disease/Hep B or C co infection)
o Ethambutanol: reversible optic neuritis/neuropathy (need to monitor color vision)
o Isoniziad: epilepsy, peripheral neuritis, hepatitis (pyridoxine can be prescribed if peripheral neuropathy)
o Rifampicin: orange body fluids, CYP450 drug inducer (warfarin, steroids), severe drug interactions with pill (need alternative contraceptive) , hepatotoxicity
o Pyrazinamide: hyperurecemia (gout), polyarthralgia, hepatotoxicity (monitor LFTs)
18 m.o female cough + vomit
Cough and coryza for one week (catarrhal phase), followed by a more pronounced cough in spells or paroxysms (paroxysmal phase). Paroxysms may be precipitated by feeding. Paroxysms cause redness of face.
Inspiratory whoop and vomiting often follows a coughing spasm.
Infants may develop apnoea and/or cyanosis with coughing spasms, instead of having inspiratory whoop.
?Sick contact
Other family members frequently have a cough (>70% of household contacts are also infected).
Whooping cough
Laboratory confirmation is not necessary for diagnosis, but may be helpful for infection control.
A nasopharyngeal aspirate/swab for PCR is the investigation of choice. The test is usually negative after 21 days, or 5-7 days after effective antibiotic therapy has been commenced.
Pertussis serology (IgA) may be detectable 2 weeks after the onset of the illness but rarely affects clinical management.
CXR findings in TB
- primary: tuberculoma + ipsilateral hilar adenopathy
- latent TB: Ranke complex - subpleural calcified tuberculosis caseasting granuloma (tuberculoma) + calcified ipsilateral hilar node
- secondary TB: cavitary lesion in apical posterior segment of upper lobe, absence of lymphadenopathy
3yo, recurrent bouts of cough for 18 months, associated wheeze, thin pale, failure to thrive, large pale, bulky offensive stools, basal crackles on auscultation
Cystic fibrosis autosomal recessive CFTR gene mutation Heel prick test - population screening Confirmed with sweat test
Early and aggressive tx of respiratory infection - physio, early abx
High choloric diet
Replace enzymes + fat soluble vitamins supplementation
Dietary referral and weight monitoring
Male infertility
Delayed puberty
18 months, recent URTI, 3 hours, loud, harsh brassy cough, worse when starts to cry, worse at night, fever, hoarse voice
Inspiratory stridor due to submucosal edema in trachea
Signs of respiratory distress - suprasternal and sternal retraction
Expiratory component suggests tracheal and subglottic component
Croup - acute laryngotracheobronchitis
Virus - parainfluenza virus, transmitted by respiratory drops
Usually occurs 6 months to 6 years
ddx - laryngitis (isolated hoarse voice), rule out epiglottitis foreign body, bacterial tracheitis
Admit to hospital if stridor at rest or biphasic stridor, irritable, restless, anxious
** stridor being soft despite substantial respiratory effort suggests significant obstruction**
