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Royal College: Emergency Medicine > Respiratory System > Flashcards

Respiratory System Flashcards

This deck covers Chapters 63-67 in Rosens, compromising all of respirology.

1
Q

List 8 causes of secondary spontaneous pneumothorax

A
  1. Asthma
  2. COPD
  3. CF
  4. Pneumonia
  5. TB
  6. PCP
  7. Lung cancer
  8. Mets
  9. Pulmonary infarct
  10. Connective tissue disorders
  11. Sarcoidosis
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2
Q

List 6 antibiotics which cover pseudomonas

A
  1. Aminoglycosides
  2. Pip-Tazo
  3. Meropenem
  4. Ciprofloxacin
  5. Ceftazidime
  6. Cefepime
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3
Q

What is mucormycosis?

A

Invasive fungal (Rhizopus) sinusitis

Presentation

  • Grey, friable, non-bleeding turbinates
  • Immunocompromised patients

Diagnosis

  • Swabs, BCx, Biopsy

Treatment

  • Stat ENT
  • Amphotericin B
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4
Q

Which antibiotics are recommended for inpatient treatment of CAP?

A

Community-acquired

  • Ceftriaxone + Azithro
  • Levo/Moxi

ICU

  • Ceftriaxone + Levofloxacin + Vanco
  • Pip-Tazo + Vanco

HAP - symptoms started 48h after admission

  • Cefepime + Ciprofloxacin + Vanco
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5
Q

Describe the Pneumonia Severity Index. List the 4 main categories.

A

Mortality predicting scoring system

  1. Demographics
  2. Comorbidities
  3. Physical exam findings
  4. Lab/DI findings

>90 points = >9% mortality = admission

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6
Q

How do you determine the size/severity of a pneumothorax on a chest x-ray? Give USA and UK guidelines.

A

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%
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7
Q

What are 6 indications for intubation in asthma?

A

Hypoventilation

  1. Respiratory muscle fatigue
  2. Weak breathing efforts
  3. Exhaustion
  4. Silent chest
  5. Hypercapnia
  6. Progressive acidemia

Hypoxia

  1. SpO2 <90% on oxygen
  2. Cyanosis

Airway Protection

  1. Decreasing LOC
  2. Hypotension
  3. Cardiac dysrhythmia/ischemia
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8
Q

Diagnosis? Etiology? Presentation? Treatment?

A

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
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9
Q

List the GOLD classification system for COPD severity

A

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
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10
Q

Provide 10 DDx for asthma

A
  1. Valvular heart disease
  2. CHF
  3. COPDE
  4. Pneumonia
  5. Laryngeal edema
  6. Laryngeal cancer
  7. Foreign body
  8. Vocal cord dysfunction
  9. Bronchial stenosis
  10. PE
  11. Anaphylaxis
  12. GERD
  13. Addison’s
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11
Q

Why does 100% oxygen improve the resolution time of a pneumothorax?

A
  • 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%
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12
Q

Which antibiotics are recommended for outpatient treatment of CAP?

A

Healthy, no comorbidities, <60 y/o

  • Amoxicillin x7d
  • Doxycycline x7d
  • Cefuroxime x5d

Comorbid, >60 yo, recent ABx

  • Levofloxacin x5d
  • Amox/Clav + Azithromycin x5d
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13
Q

What are 3 ultrasound findings of pneumothorax?

A
  1. Lung point
  2. No lung sliding
  3. Barcode sign (M-mode)
  4. No B-lines
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14
Q

List 6 causes of cavitation on chest x-ray

A

CAVITY

  1. Cancer
  2. Autoimmune (Wegner’s, RA)
  3. Vascular (septic emboli)
  4. Infection (TB)
  5. Trauma (pneumatocele)
  6. Youth (bronchogenic cysts)
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15
Q

List the 8 steps to instruct patients on how to use an MDI

A
  1. Assemble
  2. Shake
  3. Take cap off
  4. Place in mouth
  5. Exhale fully
  6. Acuate device while slow inhale
  7. Hold breath 10 seconds
  8. Wait 1 minute before reuse
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16
Q

List 6 contraindications to NIPPV

A
  1. Respiratory arrest
  2. Cardiac arrest
  3. Hemodynamic instability
  4. Decreased LOC
  5. Agitated patient
  6. Aspiration risk
  7. Facial trauma
  8. Recent esophageal surgery
17
Q

List the components of the CURB-65 score.

A
  • 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)
18
Q

What are 4 indications for admission with COPD?

A
  1. Significantly off baseline
  2. New hypoxia
  3. Poor response to treatment in ED
  4. Significant comorbidities
  5. Poor social situation
19
Q

What are the indications for ABx in COPDE?

A

Gold Criteria, 2+

  • Increased dyspnea
  • Increased sputum
  • Sputum colour change

Or anyone on PPV

20
Q

According to the Canadain Thoracic Society and Canadian Pediatric Society, what is required to diagnose asthma in the preschooler (age 1-5)

A
  1. Documented wheezing or other airflow obstruction by a health care provider
  2. Documented reversibility after SABA +/- oral steroid
  3. No clinical suspicion of other causes
21
Q

Provide the CAEP criteria for classifying asthma exacerbation severity

A

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
22
Q

List 8 criteria for severe CAP

A

Vitals

  1. Temp <36
  2. BP requiring aggressive IVF
  3. RR >30
  4. Altered LOC

Bloodwork/Imaging

  1. PaO2/FiO2 <250 (ARDS)
  2. Multilobar
  3. BUN >20
  4. WBC <4
23
Q

Outline vent settings that are appropriate in ARDS

A
  • 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)

24
Q

List 10 causes of respiratory decompensation in COPD

A
  1. COPDe
  2. Pneumonia
  3. PTX
  4. PE
  5. Lung cancer
  6. Pollution
  7. Trauma (rib fracture)
  8. Medication non-adherence
  9. Iatrogenic (inadequate therapy)
  10. ACS
  11. CHF
  12. Neuromuscular disorder
  13. Pulmonary compression (obesity)
25
Q

A patient presents with SOB, fever, known IVDU. What is this? What is the treatment?

A

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
26
Q

List 6 causes of a transudative pleural effusion.

A

Transudative

  1. CHF
  2. Cirrhosis
  3. Nephrotic syndrome
  4. Nephritic syndrome
  5. Hypoalbuminemia
  6. Peritoneal dialysis
  7. Myxedema
  8. PE
  9. SVC syndrome
27
Q

Describe 4 unique clinical findings with Scarlet Fever

A
  1. Sandpaper rash - perioral sparing, blanching
  2. Pastia’s lines - desquamating rash, worse in skin folds
  3. Forcheimer spot - on palate
  4. Strawberry tongue
28
Q

What vent settings would you use after RSI of an asthmatic?

A
  • 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%
29
Q

List 8 risk factors for death from asthma

A
  1. 1 previous ICU admission
  2. 2 admissions in last year
  3. 3 ED visits in last year
  4. Admission in last month
  5. 2+ MDIs used this month
  6. Current use/withdrawal from steroids
  7. Difficulty perceiving asthma symptoms
  8. Chronic heart disease
  9. Chronic lung disease
  10. Psychiatric disease
  11. Low SES
  12. Drug use
30
Q

What are 5 communicating spaces relevant to deep neck space infections?

A
  1. Peritonsillar
  2. Parapharyngeal
  3. Retropharyngeal
  4. Danger space
  5. Pre-vertebral
31
Q

List 3 suppurative complications and 3 non-suppurative complications of strep infections

A

Suppurative

  1. Peritonsillar abscess
  2. Retropharyngeal abscess
  3. Cervical lymphadenitis
  4. Mastoiditis

Non-suppurative

  1. Rheumatic fever
  2. Scarlet fever
  3. Glomerulonephritis
  4. PANDAS
32
Q

What antibiotics would you use for a COPDe?

A

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
33
Q

Describe four x-ray findings in epiglottitis.

A
  1. Thickened epiglottis
  2. Swollen arytenoids
  3. Dilated hypopharynx
  4. Loss of air in valecula
  5. Prevertebral swelling
34
Q

What are Light’s criteria? What do they assist with?

A

Determines if pleural effusion is transudative or exudative

Exudative if:

  1. Protein - Pleural:Serum >0.5
  2. LDH - Pleural:Serum >0.6
  3. LDH - pleural >⅔ of the ULN of serum LDH
35
Q

Explain the pathophysiology of AERD (Aspirin-Exacerbated Respiratory Disease)

A
  • 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
36
Q

List 4 eye and 4 CNS complications of sinusitis

A

Eye

  1. Facial cellulitis
  2. Pre-orbital/orbital cellulitis
  3. Optic neuritis
  4. Blindness

CNS

  1. CVST
  2. Meningitis
  3. Cerebral abscess
  4. Cerebral empyema
37
Q

List 8 adverse effects of steroid use

A
  1. Hyperglycemia
  2. Immunocompromise
  3. Cataracts
  4. Insomnia
  5. Psychosis
  6. Delayed wound healing
  7. Thinning skin
  8. Striae
  9. HTN
  10. Dyslipidemia
  11. Gastritis
  12. PUD
  13. Pancreatitis
  14. Cushing’s
  15. Osteoporosis
  16. AVN
  17. Adrenal insufficiency
  18. Myositis
  19. Amenorrhea
38
Q

List 6 indications for intubation in COPDe

A

GCS

  1. Decreasing LOC

Hypoxia

  1. Hypoxia
  2. Severe tachypnea
  3. Failure of NIPPV
  4. Cardiovascular instability

Hypoventilation

  1. Respiratory arrest
  2. Hypercapnia and acidosis
39
Q

List 6 causes of exudative pleural effusion

A

Exudative

  • Pneumonia
  • Lung abscess
  • TB
  • Viral illness
  • Lung cancer
  • Mesothelioma
  • Mets
  • Lymphoma
  • RA
  • SLE
  • Pancreatitis
  • Esophageal rupture
  • Chylothorax
  • Pulmonary infarct

Royal College: Emergency Medicine (25 decks)

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