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Flashcards in Respiratory Deck (29)
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1

Pt presents with fever, night sweats, pleuritic chest pain, dyspnea. They're coughing and bringing up some blood.
The pt is tired and has noticed weight loss + bone pain.

What investigations should be carried out?

TB SUSPECTED

Elevated ESR/CRP. Anaemia.

CXR - Nodules

Tuberculin skin test (Mantoux) - cannot differentiate active vs latent

Sputum smear microscopy + ZN STAIN = acid-fast bacilli

Mycobacterial Culture - Mycobacterium Tuberculosis

2

TB Management

RIPE RI

2 months of:
1. Rifampicin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol

THEN 4 months:
1. Rifampicin
2. Isoniazid

3

What are the 4 classifications of pneumonia?

Community-acquired (CAP)

Hospital-acquired (HAP)

Pneumonia in immunocompromised

Aspiration pneumonia

4

Causes of CAP

Mycoplasma pneumonia
H. influenza
Strep Pneumonia

Pneumocystitis jiroveci - HIV/AIDS

Respiratory syncytial virus - young kids

5

Pneumonia investigations

CXR - lobar/patchy/diffuse shadowing

Silhouette sign - loss of structural borders

6

Pneumonia treatment

Supportive +

Empirical:

Non-severe - amoxicillin + erythromycin

Severe - Clarithromycin + Co-amoxiclav

Then specific Abx

Then Repeat CXR after 6 days

7

Antibiotic for S. pneumoniae

Amoxicillin/ benzylpenicillin

8

Antibiotic for M. pneumoniae

Erythromycin/ clarithromycin

9

Antibiotic for C. pneumoniae

Erythromycin/ clarithromycin

10

Antibiotic for C. psittaci and C. burnetti pneumoniae

Doxycycline

11

Antibiotic for Legionella spp. pneumonia

Clarithromycin +/- Rifampicin

12

Most common lung cancer. 2nd most common.

Most common = SSC

2nd = Adenocarcinoma

13

Pt presents with cough, haemoptysis and chest pain. They have lost weight and are short of breath.

You observe finger clubbing and tests reveal anaemia.

Likely diagnosis?

Lung cancer

14

Pt presents with progressive SOB + Finger clubbing. You note bilateral basal end-inspiratory crackles.

Likely diagnosis? RF?

Asbestosis

RF: Occupation - builder

15

Hypoxia + Hypercapnia

Type 2 Respiratory Failure

16

Management of acute pulmonary oedema

High flow O2
IV Furosemide
IV Morphine
GTN
Urgent CXR

17

Asbestos exposure is a RF for which cancer?

Mesothelioma

(Cancer of pleura)

18

Pt recently underwent a parathyroidectomy. She is becoming increasing SOB. RR 24, O2 drops to 83%, HR 118, BP 108/64, temp 37.9

She's struggling to swallow food. She has no arrhythmias; her pupils are reactive. There are no rashes or abnormal bruising.

Likely diagnosis? Management

Neck haematoma, 2o to parathyroidectomy

Open surgical wound, to release pressure

19

Initial management of a tension pneumothorax

Cannula into 2nd ICS MCL

20

Anaphylaxis tx

IM Adrenaline

21

Pt has had a 2 wk history of productive cough, worsening SOB and left back pain.

His obs reveal RR 22, O2 92%, temp 37.7

Auscultation reveals coarse crackles in the left lung base.

Likely diagnosis?

Pneumonia
- fever
- productive cough
- hypoxia
- unilateral coarse crackle

22

Pt has had a 2 wk history of productive cough, worsening SOB and left back pain.

His obs reveal RR 22, O2 92%, temp 37.7

Auscultation reveals coarse crackles in the left lung base.

Likely diagnosis?
Risk assessment?

Pneumonia
- fever
- productive cough
- hypoxia
- unilateral coarse crackle


CURB-65

23

18-month old pt presents with barking cough and inspiratory stridor, witch accessory muscle use. He responds well to dexamethasone.

Likely aetiology? Pathophysiology? Mx?

CROUP - PARAINFLUENZA VIRUS 1

Pathophysiology:
Inflammation of larynx + trachea

Mx: Steroids + nebulised adrenaline

24

Causes of RESPIRATORY finger clubbing

Asbestosis
Bronchiectasis
Cancer (lung)
Do NOT say COPD
Empyema

Interstitial Lung Disease

25

Extrinsic allergic alveolitis

Triggers
Presentations

Acute vs chronic

Hypersensitivity reaction to ORGANIC dusts/ moulds

Trigger:
- organic dust - fungus
- keeps birds

Acute: asthmatic px
Chronic ILD px
- progressive SOB
- dry cough

26

Pneumoconiosis

Triggers
Presentations

Interstitial lung diesase due to inhalation of INORGANIC dusts

- miners
- silicosis
- asbestosis

27

How to tell difference between extrinsic allergic alveolitis and pneumoconiosis

EAA: ORGANIC

Pneumoconiosis: INORGANIC

28

Signs of a SEVERE asthma attack

- inability to speak complete sentences

- RR >25

- Peak flow 33-50% predicted

29

Signs of a LIFE-THREATENING asthma attack

BECCS

Bradycardia
Exhaustion
Confusion
Cyanosis
SILENT chest