Respiratory System Flashcards
This deck covers Chapters 63-67 in Rosens, compromising all of respirology.
List 8 causes of secondary spontaneous pneumothorax
- Asthma
- COPD
- CF
- Pneumonia
- TB
- PCP
- Lung cancer
- Mets
- Pulmonary infarct
- Connective tissue disorders
- Sarcoidosis
List 6 antibiotics which cover pseudomonas
- Aminoglycosides
- Pip-Tazo
- Meropenem
- Ciprofloxacin
- Ceftazidime
- Cefepime
What is mucormycosis?
Invasive fungal (Rhizopus) sinusitis
Presentation
- Grey, friable, non-bleeding turbinates
- Immunocompromised patients
Diagnosis
- Swabs, BCx, Biopsy
Treatment
- Stat ENT
- Amphotericin B
Which antibiotics are recommended for inpatient treatment of CAP?
Community-acquired
- Ceftriaxone + Azithro
- Levo/Moxi
ICU
- Ceftriaxone + Levofloxacin + Vanco
- Pip-Tazo + Vanco
HAP - symptoms started 48h after admission
- Cefepime + Ciprofloxacin + Vanco
Describe the Pneumonia Severity Index. List the 4 main categories.
Mortality predicting scoring system
- Demographics
- Comorbidities
- Physical exam findings
- Lab/DI findings
>90 points = >9% mortality = admission
How do you determine the size/severity of a pneumothorax on a chest x-ray? Give USA and UK guidelines.
USA (3 letters = 3 cm)
- From top
- <3 cm = small
- >3 cm = big
UK (2 letters = 2 cm)
- From side at hilum
- <2 cm = small
- >2 cm = large
As a percentage:
- Small = <15%
- Moderate = 15-60%
- Large = >60%
What are 6 indications for intubation in asthma?
Hypoventilation
- Respiratory muscle fatigue
- Weak breathing efforts
- Exhaustion
- Silent chest
- Hypercapnia
- Progressive acidemia
Hypoxia
- SpO2 <90% on oxygen
- Cyanosis
Airway Protection
- Decreasing LOC
- Hypotension
- Cardiac dysrhythmia/ischemia
Diagnosis? Etiology? Presentation? Treatment?

Diagnosis
- Diphtheria
Etiology
- C. diphtheriae
Presentation
- Sore throat, fever
- Bull neck
- Pseudomembranes
Treatment
- Erythromycin 500 mg PO/IV QID x14d
- PCN V 250 mg PO QID x14d
- Antitoxin
- Public Health
- Consider contact prophylaxis
List the GOLD classification system for COPD severity
Mild
- FEV1 >80% predicted
Moderate
- FEV1 50-80% predicted
Severe
- FEV1 30-50% predicted
Very Severe
- FEV1 <30% predicted
- Pseudomonas risk
- Right-sided heart failure
Provide 10 DDx for asthma
- Valvular heart disease
- CHF
- COPDE
- Pneumonia
- Laryngeal edema
- Laryngeal cancer
- Foreign body
- Vocal cord dysfunction
- Bronchial stenosis
- PE
- Anaphylaxis
- GERD
- Addison’s
Why does 100% oxygen improve the resolution time of a pneumothorax?
- Air in pleural space is 21% oxygen, 79% nitrogen
- Filling lungs with only oxygen creates a diffusion gradient causing nitrogen to leave pleural space into alveoli
- Increases resolution speed by 400%
Which antibiotics are recommended for outpatient treatment of CAP?
Healthy, no comorbidities, <60 y/o
- Amoxicillin x7d
- Doxycycline x7d
- Cefuroxime x5d
Comorbid, >60 yo, recent ABx
- Levofloxacin x5d
- Amox/Clav + Azithromycin x5d
What are 3 ultrasound findings of pneumothorax?
- Lung point
- No lung sliding
- Barcode sign (M-mode)
- No B-lines
List 6 causes of cavitation on chest x-ray
CAVITY
- Cancer
- Autoimmune (Wegner’s, RA)
- Vascular (septic emboli)
- Infection (TB)
- Trauma (pneumatocele)
- Youth (bronchogenic cysts)
List the 8 steps to instruct patients on how to use an MDI
- Assemble
- Shake
- Take cap off
- Place in mouth
- Exhale fully
- Acuate device while slow inhale
- Hold breath 10 seconds
- Wait 1 minute before reuse
List 6 contraindications to NIPPV
- Respiratory arrest
- Cardiac arrest
- Hemodynamic instability
- Decreased LOC
- Agitated patient
- Aspiration risk
- Facial trauma
- Recent esophageal surgery
List the components of the CURB-65 score.
- Confusion
- Uremia >7
- RR >30
- BP <90
- 65 - age
Validated against PSI - CURB-65 is better
- Score of 0 - 1% mortality
- Score of 1 - 3% mortality
- Score of 2 - 7% mortality (Admission)
- Score of 3 - 14% mortality (Admission)
What are 4 indications for admission with COPD?
- Significantly off baseline
- New hypoxia
- Poor response to treatment in ED
- Significant comorbidities
- Poor social situation
What are the indications for ABx in COPDE?
Gold Criteria, 2+
- Increased dyspnea
- Increased sputum
- Sputum colour change
Or anyone on PPV
According to the Canadain Thoracic Society and Canadian Pediatric Society, what is required to diagnose asthma in the preschooler (age 1-5)
- Documented wheezing or other airflow obstruction by a health care provider
- Documented reversibility after SABA +/- oral steroid
- No clinical suspicion of other causes
Provide the CAEP criteria for classifying asthma exacerbation severity
Mild
- FEV1 or PEFR >60% of predicted (300L/min)
- Good relief with beta-agonists
- Discharge
Moderate
- FEV1 or PEFR 40-60% of baseline (200-300L/min
- Partial relief with beta-agonists
- May be a candidate for discharge
Severe
- FEV1 <40% after treatment or (PEFR <100L/min)
- No relief with beta-agonists
- Admit
Near-Death
- Hypoxic
- Silent chest
List 8 criteria for severe CAP
Vitals
- Temp <36
- BP requiring aggressive IVF
- RR >30
- Altered LOC
Bloodwork/Imaging
- PaO2/FiO2 <250 (ARDS)
- Multilobar
- BUN >20
- WBC <4
Outline vent settings that are appropriate in ARDS
- FiO2 = titrated for SpO2 88-95%
- RR = 20
- VT = 6 cc/kg
- PEEP 5-10 cmH2O
- Pplateau <30 cmH2O
- pH 7.3 - 7.45
Consider proning (50% RRR/17% ARR in PROSEVA study)
List 10 causes of respiratory decompensation in COPD
- COPDe
- Pneumonia
- PTX
- PE
- Lung cancer
- Pollution
- Trauma (rib fracture)
- Medication non-adherence
- Iatrogenic (inadequate therapy)
- ACS
- CHF
- Neuromuscular disorder
- Pulmonary compression (obesity)
A patient presents with SOB, fever, known IVDU. What is this? What is the treatment?

PCP Pneumonia
- Pneumocystis jiroveci
Diagnosis
- CXR shows diffuse bilateral infiltrates
- LDH elevated
- Get HIV screen
Treatment
- Septra 5/25 mg/kg QID
- Clindamycin/Primaquine as alternative
- Steroids in severe disease
- A-a gradient >35
- PaO2 <70 mmHg
- Respiratory failure
List 6 causes of a transudative pleural effusion.
Transudative
- CHF
- Cirrhosis
- Nephrotic syndrome
- Nephritic syndrome
- Hypoalbuminemia
- Peritoneal dialysis
- Myxedema
- PE
- SVC syndrome
Describe 4 unique clinical findings with Scarlet Fever
- Sandpaper rash - perioral sparing, blanching
- Pastia’s lines - desquamating rash, worse in skin folds
- Forcheimer spot - on palate
- Strawberry tongue
What vent settings would you use after RSI of an asthmatic?
- FiO2 100%
- VT 4-6 cc/kg
- I:E 1:4 - 1:6
- PEEP 0-5 cmH2O
- RR 8-12
Targets:
- pH >7.1 (permissive hypercapnia)
- SpO2 >92%
List 8 risk factors for death from asthma
- 1 previous ICU admission
- 2 admissions in last year
- 3 ED visits in last year
- Admission in last month
- 2+ MDIs used this month
- Current use/withdrawal from steroids
- Difficulty perceiving asthma symptoms
- Chronic heart disease
- Chronic lung disease
- Psychiatric disease
- Low SES
- Drug use
What are 5 communicating spaces relevant to deep neck space infections?
- Peritonsillar
- Parapharyngeal
- Retropharyngeal
- Danger space
- Pre-vertebral
List 3 suppurative complications and 3 non-suppurative complications of strep infections
Suppurative
- Peritonsillar abscess
- Retropharyngeal abscess
- Cervical lymphadenitis
- Mastoiditis
Non-suppurative
- Rheumatic fever
- Scarlet fever
- Glomerulonephritis
- PANDAS
What antibiotics would you use for a COPDe?
Simple
- Gold criteria positive
- S. pneumoniae, H. flu, M. catarrhalis
- Doxycycline/Cefuroxime/Amox-Clav
Complicated
- FEV1 <50%, >4 COPDe/year, CAD, home oxygen
- As above, plus K. pneumoniae, P. aeurginosa
- Fluoroquinolone/Amox-Clav
Describe four x-ray findings in epiglottitis.
- Thickened epiglottis
- Swollen arytenoids
- Dilated hypopharynx
- Loss of air in valecula
- Prevertebral swelling
What are Light’s criteria? What do they assist with?
Determines if pleural effusion is transudative or exudative
Exudative if:
- Protein - Pleural:Serum >0.5
- LDH - Pleural:Serum >0.6
- LDH - pleural >⅔ of the ULN of serum LDH
Explain the pathophysiology of AERD (Aspirin-Exacerbated Respiratory Disease)
- ASA inhibits COX
- Prostaglandins (PGE2) stabilize mast cells/eosinophils
- Without PGE2, 5-LOX isn’t blocked
- 5-LOX makes leukotrienes
- Leukotrienes cause bronchoconstriction
AERD Symptoms (post-ASA)
- Rhinorrhea
- Conjunctivitis
- Periorbital edema
- Wheeze
List 4 eye and 4 CNS complications of sinusitis
Eye
- Facial cellulitis
- Pre-orbital/orbital cellulitis
- Optic neuritis
- Blindness
CNS
- CVST
- Meningitis
- Cerebral abscess
- Cerebral empyema
List 8 adverse effects of steroid use
- Hyperglycemia
- Immunocompromise
- Cataracts
- Insomnia
- Psychosis
- Delayed wound healing
- Thinning skin
- Striae
- HTN
- Dyslipidemia
- Gastritis
- PUD
- Pancreatitis
- Cushing’s
- Osteoporosis
- AVN
- Adrenal insufficiency
- Myositis
- Amenorrhea
List 6 indications for intubation in COPDe
GCS
- Decreasing LOC
Hypoxia
- Hypoxia
- Severe tachypnea
- Failure of NIPPV
- Cardiovascular instability
Hypoventilation
- Respiratory arrest
- Hypercapnia and acidosis
List 6 causes of exudative pleural effusion
Exudative
- Pneumonia
- Lung abscess
- TB
- Viral illness
- Lung cancer
- Mesothelioma
- Mets
- Lymphoma
- RA
- SLE
- Pancreatitis
- Esophageal rupture
- Chylothorax
- Pulmonary infarct