Acute respiratory Flashcards
Using which system is PE risk calculated?
Well’s criteria
How is Well’s score used in acute SOB patients?
If >4 a PE is likely: admit and do immediate CTPA
If <4 it is less likely: perform a D-DIMER and only do CTPA if this is pos
What might an ECG show in PE?
Right axis deviation, RBBB
Recall 2 things that may be seen on CXR in PE
Pleural effusion
Elevation of hemidiaphragm
Differentiate the management of PE depending on whether the patient is haemodynamically stable or not
Stable: LMWH or fondaparinux until INR>2, warfarin
Unstable: alteplase to thrombolyse
How does the chest sound on auscultation in the case of pneumothorax?
Hyperresonant
What is the key size of pneumothorax above which there must be medical intervention?
2cm
When is it appropriate to aspirate a pneumothorax rather than drain it?
Primary pneumothorax >2cm when pt is <50 yrs
1-2cm pneumothorax when it is a secondary pneumothorax/ pt is >50
What should be done to manage larger pneumothoraces?
intercostal drain
What would make a pneumothorax an emergency?
If it were a tension pneuothorax
What is a tension pneumothorax?
Build up of air in the pleural space due to a one-way valve
Recall how a tension pneumothorax appears on examination
Reduced breath sounds
Tachycardia and tachypnoea
Deviation of trachea and displacement of apex beat (as mediastinum pushed out of place)
What is the immediate treatment required in tension pneumothorax?
Immediate needle decompression using wide boar needle in 2nd ICS at MCL
Define pneumonia
Inflammation of the alveoli caused by an infective pathogen
Results in air sacs filling with fluid/ pus
What is the most common community acquired cause of pneumonia?
Streptococcus pneumoniae
Which patients are most likely to acquire H. influenzae pneumonia?
COPD
Which patients are most likely to acquire klebsiella pneumonia?
HIV
What is the most common cause of hospital-acquired pneumonia?
Staphylococcus aureus
Recall the classic symptoms of pneumonia
Fever
Rigors
Productive cough
Pleuritic chest pain
Recall the 4 key examination findings upon chest examination in pneumonia
Reduced chest expansion
Dull percussion
Increased vocal resonance
Bronchial breathing
What are the 2 key things to look for on CXR in pneumonia?
Lobar or multilobar?
Is there conolidation?
Recall the medical management of pneumonia depending on severity
Low: oral amoxicillin
Moderate: oral amoxicillin + macrolide
Severe: IV co-amoxiclav + macrolide
What score is used to assess pneumonia severity?
CURB 65
Recall the CURB 65 criteria
Confusion Urea >7 Resp rate >30 BP <90/60 >65 (age)
What is the name of the disease caused by legionella that is non-pneumonatic?
Pontiac fever
What is the first line of medical management of legionnaire’s disease?
IV macrolide (clarithromycin)
What investigation confirms a diagnosis of legionella?
Urinary antigen detection
Which electrolyte imbalance is caused by legionella?
Hyponatraemia
What would be seen on CXR in legionnaire’s diease?
Bibasal consolidation
Recall the medical management of staph aureus pneumonia when it is S. aureus and when it is MRSA
S. aureus: flucloxacillin
MRSA: vancomycin
Which pathogen causes pneumocystis pneumonia?
Pneumocystic jirovercii (fungus)
In which demographic of patients is pneumocystic pneumonia most commonly seen?
HIV+
It is an AIDS-defining illness
What is the treatment for pneumocystis pneumonia?
High dose IV co-trimoxazole
In which demographic of patients is pseudomonas pneumonia most commonly seen?
Those with bronchiectasis/ cystic fibrosis
Recall one unusual symptom of pneumocystis pneumonia?
Purple patches on nose
Recall the approach to presenting CXRs
RIPE: Rotation Inspiratory effort Penetration Exposure ABCDE: Airway Breathing Circulation Diaphragms Everything else (eg foreign bodies, bones)
Recall the ABCDE of what you would see on a CXR in heart failure
Alveolar shadowing Kerley B lines Cardiomegaly Upper lobe Diversion Pleural Effusion
