Respiratory Flashcards
(24 cards)
What is community acquired pneumonia?
Acute inflammation with intense infiltration of neutrophils in and around the alveoli, and the terminal bronchioles – due to bacteria or viruses
What is the most common pathogen in CAP?
pneumococcal/ streptococcal pneumoniae
What are the common signs in CAP on percussion and auscultation?
localised coarse crackles, dullness on percussion
What is the scoring system for CAP? What do they mean?
CRUB65 Confusion, resp. rate >30, urea >7, BP – systolic < 90 (diastolic < 60), age 65
What are the investigation for CAP?
FBC, WBC, CRP, renal function, U&Es, LFTs, blood cultures, pneumococcal, legionella urinary antigen tests, CXR, sputum culture, blood gas, pleural fluid aspiration (biochemistry and culture)
What is the treatment for CAP?
Antibiotics - Amoxicillin
Hospital - Co-amoxiclav
or trust guideline
What is Horner’s syndrome? In what condition does it present in?
Drooping of the upper eyelid (ptosis), constricted pupil (mitosis), absence of sweating over the affected side of the face.
Presents in lung cancer
Symptoms: weight loss, haemoptysis, cough, Horner’s syndrome, SOB, chest pain, fever, N&V, hoarseness, wheezing & stridor, SVC obstruction.
What could be the diagnosis?
Lung cancer
What are the investigations for lung cancer?
FBC - CRP, neutrophil, WBC
CXR
Bronchoscopy
Contrast enhanced CT scan
What are the differential diagnosis for collapse, chest pain and SOB?
PE Acute coronary syndromes, Aortic dissection, Cardiac tamponade, Pneumonia, Pneumothorax, Sepsis
What is pleural effusion?
Excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.
How are pleural effusion classified?
Exudative (high protein) or transudative (low protein).
What does high or low protein mean in pleural effusion?
high protein- exudative (from outside - think infection)
low protein - transudative (from within - think within the body)
What are the common causes of exudative pleural effusion?
Malignancy
Infections such as pneumonia (parapneumonic pleural effusion)
Granulomatous disease such as tuberculosis or coccidioidomycosis, collagen vascular diseases, Other inflammatory states.
What are the common causes of transudative pleural effusion?
Congestive heart failure (CHF),
Cirrhosis
Nephrotic syndrome
PE
What are the symptoms of asthma?
Breathlessness, wheeze, chest tightness, cough
What are the common atopic disorders associated with asthma?
Hay fever, eczema
What can be heard on auscultation for asthma?
Widespread wheeze of the chest
When do symptoms of asthma get worse?
Worse at night and in the early morning
Symptoms in response to exercise, allergen exposure and cold air
After taking aspirin or beta blockers
What are the signs from ABG indicate that the patient’s acute asthma exacerbation has deteriorated?
PaO2 <8 kPa Normal PaCO2 (4.6-6.0 kPa)
What are the signs of life-threatening acute asthma?
silent chest cyanosis poor respiratory effort arrhythmia exhaustion altered conscious level hypotension
What are the initial assessments in severe asthma? And what are their measurements?
Peak flow meter - 33- 50% (Severe), <33% life-threatening
Pulse oximetry - <92% , aim to maintain spO2 94-98%
ABG - severe asthma PaO2 < 8kPa, PaCO2 normal, life-threatening - PaCO2 - raised
BP - hypotension
Heart rate - > 110
reap rate >25
What are the physical and examination signs of acute asthma?
Cyanosis, poor respiratory effort ( due to exhaustion), on auscultation - silent chest
How are acute asthmatic patients managed/treated?
- O2 - aim for 94 -98%
- Beta2 agonist bronchodilators - salbutamol
- Steroid - prednisolone / hydrocortisone
- Ipratropium bromide
_ Magnesium sulphate (IV) - (Theophylline/ aminophylline)
