Flashcards in Respiratory Deck (47)
What are the restrictive / obstructive patterns for FEV1 + FVC
Obstructive: FEV1 reduced / FEV1:FVC reduced
Restrictive: FVC and FEV1 reduced / FEV1:FVC normal
What is Kco + TLco?
What can reduced Kco/TLco indicate?
What can it exclude?
Kco = diffusion capacity of lung per unit area for CO
TL = diffusion capacityt for total lung capacity for CO
A reduction can indicate a problem with gas exchange
= alveolar or vascular disease
= rules out chest wall / diaphragm probs
What patient groups is pneumonia more common in? (5)
What are the clinical S+S of pneumonia? (5+8)
Acute systemic illness: fever/rigors/vom
Cough: initially dry then mucopurulent
Pleuritic pain (+ poss referred to shoulder / anterior abdo wall)
Confusion/delirium - in elderly pts (who may have v few symptoms)
Reduced chest expansion (affected side)
Dullness to percussion (affected side)
Increased vocal resonance
?Upper abdo tenderness (if lower lobe)
What is the definition of HAP?
Pneumonia developing 48hrs after admission (with no signs of incubation on admission)
Someone hospitalised in the past 10d
List the causative organisms for CAP (6)
Typical bact (60-80%):
mycoplasma / chlamydia / legionella
influenza / parainfluenza
What is seen on CXR for pneumococcal pneumonia?
Which patient group is most susceptible?
Which patient group is most susceptible to H.Influenzae
Classical lobar pneumonia + rust-coloured sputum
Immunosuppressed - vaccine given
COPD pts (the encapsulated strain)
What is seen on CXR of mycoplasma pneumonia?
What patient group?
How does it present?
Widespread patchy consolidation across multiple lobes
Long H/o extra-pulm features:
Rash, Hepatitis, D+V, Pericarditis, Meningoencephalitis
What is seen on CXR of legionella pneumonia?
What pt group?
What are some other features? (3)
Bilateral consolidation on lung bases
Smokers / recently returned from holiday (air conditioning units)
Neuro involvement (CN palsies)
What pt groups are susceptible to Chlamydia pneumonia?
Infants (URTI) + Elderly (CAP)
What Ix are done in pneumonia? (6+2)
Obs / sats assessment
Sputum sample (culture +/- mycoplasma PCR)
Urine in mod/severe (for L/S.pneumonia)
Serum mycoplasma IgG if suspect
Throat swab in viral transport medium if severe/suspect viral
Describe the CURB65
Classify the severities
Confusion: AMT < 8
Resp rate >30
BP <90 SBP or <60 DBP
0-1 = non-severe
2 = moderately severe
>2 = severe
Describe the treatment for CAP at diff severities
Non-severe: oral amoxi / doxi as outpatient
Mod severe: admit + oral amoxi/doxy + clarithro
Severe: admit HDU + IV co-amoxi + clarithro OR levofloxacin + vanco
ADD Metronidazole if aspiration suspected
PLUS chest physio for all for effective coughing
Describe the management for HAP
Assess MRSA RFs:
Longterm indwelling line/catheter
From nursing home w. skin breaks
Mild = oral doxy
Severe = oral co-trimoxazole
What are some complications of pneumonia? (4)
Parapneumonic effusion / empyema
Lung abscess (clubbing)
How and why are pts followed up after a pneumonia?
CXR 6wks after
Ensure resolved and not due to obstrn e.g. lung cancer
What are the S+S of TB? (7+2)
Malaise / wt loss / anorexia / night sweats
Mucoid wet cough
Fever / Apical crackles
How is a pt with suspected active TB investigated? (4)
Microscopy - acid-fast bacilli (24hrs)
Culture - 6wks
IF sputum samples -ve
Bronchoscopy + biopsy
OR Broncho-alveolar lavage
CXR - upper lobe cavities / pleural effusions / lymphadenopathy
Ix extra-pulm if suspect
How is latent TB investigated (eg contact tracing)? (3)
Mantoux test (inject TB Ag + size of reaction)
Interferon-y release assay (IGRA)
Standard bloods (FBC/UEs/LFTs) - rule out other causes/baseline
How is a pt with active TB managed?
If admitting - isolation
If not - specialist TB service
Assess RFs (prev TB Tx / adherence / contacts / HIV)
2m isoniazid (+pyridoxine) + rifampicin
+ ethambutol + pyrazinamide
4m isoniazid (+pyridoxine) + rifampicin
How is latent TB managed?
3m - isoniazid (+ pyridoxine) + rifampicin
How is contact tracing done in confirmed cases of TB?
All household - trace / assess for latent
Casuals - only trace if infectious (10%+ of close develop TB) or if contact eg HIV
What are the main SEs for:
Ison - neuropathy/enceph (pyridoxine prevents)
Rifamp- deranged LFTs
Etham- optic neuritis
What are the common sites + features of non-pulmonary TB (6)
Joints/spinal - mono arthritis
Cutaneous - lupus vulgaris/erythema nodosum
Renal - sterile pyuria
Pericarditis - chest pain
What are the S+S of a pneumothorax
Asymp (small one + young)
Sudden unilateral pleuritic pain w. Progressive dyspnoea
Hyperesonance on percussion
Reduced vocal resonance
Reduced breath sounds
How is a tension pneumothorax clinically differentiated from a normal?
Trachea deviated from affected side
Neck veins dilated (venous return)
+ poss haemodynamic compromise
NB check chest drain - could be blocked
How is a tension pneumothorax treated?
Large bore cannula ics2 mid-clav
Insert chest drain
How is a pneumothorax treated?
If <2cm air rim or not SOB:
discharge + fortnightly CXR + advise smoking cessation
If >2cm or SOB:
Aspirate or chest drain if fails
If recurrent (>2) or not resolving within 5d - surgery indicated (pleurectomy/ talc pleurodesis)
List the causes of transudative pleural effusion (5)
Cardiac failure: hydrostatic backpressure from LHF
Liver failure: reduced protein prodn = reduced oncotic pressure
Renal failure: nephrotic synd reduced oncotic pressure
Ovarian tumours (Meig's)