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meded lectures > Acute Resp > Flashcards

Acute Resp Flashcards

1
Q

A gentleman presents with acute breathlessness and chest pain. O/E his respiratory rate is 25bpm with good air entry in all fields. His ECG shows right axis deviation. What is the most likely diagnosis?

Pneumothorax
Pneumonia
COPD
Pulmonary Embolism

A

Pulmonary Embolism

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2
Q 
A 35 year old lady presents with acute onset SOB, chest pain and one episode of haemoptysis. She has recently noticed a swelling in the left leg. O/E her RR is 28 and HR is 105. You suspect a pulmonary embolism. What is the most appropriate investigation to perform?
Chest X-Ray
CTPA
D-Dimer
ECG
A

CTPA

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3
Q

A 23 year old student presents to A&E with SOB. He says it came on suddenly. O/E his trachea is undisplaced with reduced breath sounds on the left. A chest x-ray confirms a 1cm pneumothorax. What is the most appropriate management?

Immediate chest decompression
Intercostal drain
Aspiration
High flow oxygen

A

High flow oxygen

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4
Q

What is the presentation of a pulmonary embolism

A 
SUDDEN ONSET 
1. SOB 
2. pleuritic chest pain
(pain on inspiration)
3. +/- haemoptysis 
4. +/- haemodynamic compromise
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5
Q

What are signs of pulmonary embolism

A
  1. Tachypnoea
  2. tachycardia
  3. cyanosis
  4. May have sign of shock
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6
Q

What scoring system is used to investigate pulmonary embolism

A

Well’s score

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7
Q

Describe the Well’s criteria for PE

A 
3 POINTS
1. signs and symptoms of PE
2. alternative diagnosis unlikely 
1.5 POINTS
1. Immobile for 3 days/surgery in the past 4 weeks
2. HR>100
3. Previous PE/DVT
1 POINT
1. Haemoptysis 
2. Malignancy
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8
Q

Pulmonary embolism investigations: how is the Well’s criteria used

A

Well’s score:
>4 (PE likely): admit to hospital and perform an immediate CTPA

<4 (PE unlikely): perform a D-dimer
-ve: consider different diagnosis

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9
Q

Pulmonary embolism investigations: how is the Well’s criteria used

A

Well’s score:
>4 (PE likely): admit to hospital and perform an immediate CTPA

<4 (PE unlikely): perform a D-dimer
-ve: consider different diagnosis
+ve: admit to hospital to perform an immediate CTPA

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10
Q

What other investigations should be considered with a possible diagnosis of pulmonary embolism

A

ECG

  • sinus tachycardia
  • right axis deviation
  • RBBB
  • S1 Q3 T3 (very uncommon)

CXR

  • pleural effusion
  • elevation of hemidiaphragm
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11
Q

What is the management plan for pulmonary embolism

A

Analgesia
oxygen
fluids

If haemodynamically stable:

  • LMWH or fondaparinux for at least 5 days or until INR >2
  • start oral anticoagulation WARFARIN at the same time

If haemodynamically unstable:
- Thrombolysis e.g. Alteplase

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12
Q

Define pneumothorax

A

accumulation of air in the pleural space

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13
Q

What is a primary spontaneous pneumothorax

A

a pneumothorax with no underlying respiratory illness

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14
Q

What is a secondary spontaneous pneumothorax

A

a pneumothorax which is associated with underlying lung pathology
such as COPD, CF, Lung Ca

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15
Q

What is the presentation of a pneumothorax

A

SUDDEN ONSET

  • SOB: severity depends on size of pneumothorax
  • chest pain: same side as pneumothorax
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16
Q

What are the signs of pneumothorax

A
  1. reduced/absent breath sounds
  2. reduced/absent vocal resonance
  3. hyper-resonant
  4. reduced chest expansion
17
Q

What are the risk factors for pneumothorax

A
  1. underlying lung disease
  2. connective tissue disorders (e.g. Marfans)
  3. smoking
  4. trauma
18
Q

What are the 2 main investigations to diagnose a pneumothorax

A
  1. CXR

- look for lung markings to differentiate

19
Q

What are the 2 main investigations to diagnose a pneumothorax

A
  1. CXR
    - look for lung markings to differentiate between bullae and pneumothorax
    - important to determine size of pneumothorax
  2. CT
    - will also differentiate between emphysematous bullae
20
Q

How does the size of a primary pneumothorax affect its management (where patient is <50 years old)

A

<2 cm: oxygen + consider discharge

> 2 cm: Aspiration
If unsuccessful: intercostal drain

21
Q

How does the size of a secondary pneumothorax (or the patient is >50 years old) affects its management plan

A

<1 cm: High flow oxygen

1-2 cm: Aspiration
If size is reduced to <1 cm: high flow oxygen
If size is >1 cm: put in an intercostal drain

> 2 cm: put in an intercostal drain

22
Q

What is a tension pneumothorax

A

Build up of air in the pleural space due to a one way valve
Air can get into the space during inspiration but not out during expiration
This pushes the mediastinum across cavity

23
Q

What is a tension pneumothorax

A

Build up of air in the pleural space due to a one way valve
Air can get into the space during inspiration but not out during expiration
This pushes the mediastinum across cavity
This reduces venous return to the heart

24
Q

On examination, how is a tension pneumothorax picked up

A
  1. reduced breath sounds
  2. tachypneoa
  3. tachycardia
  4. Deviated trachea
  5. Distended neck veins
  6. Displaced apex beat
25
Q

What is the management of a tension pneumothorax

A

Immediate needle decompression,
2nd intercostal space,
mid-clavicular line
+ oxygen

26
Q

What is the diagnostic investigation for pneumonia

A

CXR

27
Q

25M presents to A&E with a fever and a cough. He says he has been generally unwell over the last year . O/E he is acutely SOB with a RR of 28. You also note an incidental finding of purple patches on his nose. What is the most likely causative organism?

Pseudomonas Aeruginosa
Strep Pneumoniae
Pneumocystis Jiroveci
Mycoplasma pneumoniae

A

Pneumocystis Jiroveci

28
Q

55M presents with a cough and fever. He recently travelled to New York to speak at a conference. After bloods revealed Na+: 130, you decide to test the urine. What is the most likely causative organism?

Haemophilus Influenza
Pseudomonas Aeruginosa
Legionella Pneumophilia
Pneumocystis Jiroveci

A

Legionella Pneumophilia

29
Q

10F presents to A&E with a fever and a cough and O2 sats: 92%. Her parents don’t seem worried as they are used to bringing her into hospital for treatment for her respiratory illness

Pseudomonas Aeruginosa
Haemophilus Influenzae
Staph Aureus
Coronavirus

A

Pseudomonas Aeruginosa

30
Q

A known IVDU is brought into A&E, he was found unconscious by two friends who were worried he might have overdosed. You notice an abscess in his groin. Temp: 39, HR 120, BP 90/50. You immediately admit him.

Haemophilus Influenzae
Staph Aureus
Coronavirus
Legionella Pneumophilia

A

Staph Aureus

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