Respiratory Flashcards Preview

CP3 Medicine > Respiratory > Flashcards

Flashcards in Respiratory Deck (47)
Loading flashcards...
1

What are the restrictive / obstructive patterns for FEV1 + FVC

Obstructive: FEV1 reduced / FEV1:FVC reduced

Restrictive: FVC and FEV1 reduced / FEV1:FVC normal

2

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

3

What patient groups is pneumonia more common in? (5)

Male
Elderly
Smokers
Alcoholics
Chronic disease

4

What are the clinical S+S of pneumonia? (5+8)

Acute systemic illness: fever/rigors/vom
Cough: initially dry then mucopurulent
SOB
Pleuritic pain (+ poss referred to shoulder / anterior abdo wall)
Confusion/delirium - in elderly pts (who may have v few symptoms)

Tachypnoea
Reduced chest expansion (affected side)
Dullness to percussion (affected side)
Coarse crackles
Bronchial breathing
Increased vocal resonance
?Pleural rub
?Upper abdo tenderness (if lower lobe)

5

What is the definition of HAP?

Pneumonia developing 48hrs after admission (with no signs of incubation on admission)
OR
Someone hospitalised in the past 10d

6

List the causative organisms for CAP (6)

Typical bact (60-80%):
S.Pneumoniae
H.influenzae

Atypical (10-20%):
mycoplasma / chlamydia / legionella

Viruses (10-20%):
influenza / parainfluenza

7

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)

8

What is seen on CXR of mycoplasma pneumonia?
What patient group?
How does it present?

Widespread patchy consolidation across multiple lobes
Younger pts

Long H/o extra-pulm features:
Rash, Hepatitis, D+V, Pericarditis, Meningoencephalitis

9

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)

Proteinuria/haematuria (common)
Neuro involvement (CN palsies)
Hypernatraemia (SIADH)

10

What pt groups are susceptible to Chlamydia pneumonia?

Infants (URTI) + Elderly (CAP)

11

What Ix are done in pneumonia? (6+2)

Obs / sats assessment
FBC/UEs/CRP/LFTs
Blood cultures
Sputum sample (culture +/- mycoplasma PCR)
CXR
Urine in mod/severe (for L/S.pneumonia)

Serum mycoplasma IgG if suspect
Throat swab in viral transport medium if severe/suspect viral

12

Describe the CURB65
Classify the severities

Confusion: AMT < 8
Urea >7
Resp rate >30
BP <90 SBP or <60 DBP
65yrs+

0-1 = non-severe
2 = moderately severe
>2 = severe

13

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

14

Describe the management for HAP

Assess MRSA RFs:
Known/previous
Longterm indwelling line/catheter
From nursing home w. skin breaks

Mild = oral doxy
Severe = oral co-trimoxazole

15

What are some complications of pneumonia? (4)

Parapneumonic effusion / empyema
Lung abscess (clubbing)
Bronchiectasis
Sepsis

16

How and why are pts followed up after a pneumonia?

CXR 6wks after
Ensure resolved and not due to obstrn e.g. lung cancer

17

What are the S+S of TB? (7+2)

Malaise / wt loss / anorexia / night sweats
Later:
Mucoid wet cough
Pleural pain
Small haemoptysis

Fever / Apical crackles

18

How is a pt with suspected active TB investigated? (4)

Sputum:
Microscopy - acid-fast bacilli (24hrs)
PCR
Culture - 6wks

IF sputum samples -ve
Bronchoscopy + biopsy
OR Broncho-alveolar lavage

CXR - upper lobe cavities / pleural effusions / lymphadenopathy

Ix extra-pulm if suspect

19

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

20

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

21

How is latent TB managed?

3m - isoniazid (+ pyridoxine) + rifampicin

22

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

23

What are the main SEs for:
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol

Ison - neuropathy/enceph (pyridoxine prevents)
Rifamp- deranged LFTs
Etham- optic neuritis
Pyraz- hepatotoxic

24

What are the common sites + features of non-pulmonary TB (6)

Joints/spinal - mono arthritis
Cutaneous - lupus vulgaris/erythema nodosum
Meningitic TB
Renal - sterile pyuria
Pericarditis - chest pain

25

What are the S+S of a pneumothorax

Asymp (small one + young)
Sudden unilateral pleuritic pain w. Progressive dyspnoea

Reduced expansion
Hyperesonance on percussion
Reduced vocal resonance
Reduced breath sounds

26

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

27

How is a tension pneumothorax treated?

100% oxygen
Large bore cannula ics2 mid-clav
CXR
Insert chest drain

28

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)

29

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
Peritoneal dialysis
Hypothyroidism (rare)
Ovarian tumours (Meig's)

30

List the causes of exudative pleural effusion (5 - A PAIN)

Infections
Neoplasm
PE (pulm infarct)
Autoimmune (RA/SLE)
Abdo disease: pancreatitis, subphrenic abscess