Lecture 9: Resp 1

Question 1

DLCO

Answer 1

conductance term

Causes of low value

• True
  
  • – reduced or lost alveolar surface area
  • – reduced or lost capillary surface area
  • – increased diffusion distances
• Fictitious
  
  • – anemia
  • – carboxyHb

Question 2

Arterial blood gases: 3 Causes of hypoxemia

Answer 2

• Hypoventilation
• Ventilation to perfusion mismatch
• Intracardiac or intrapulmonary shunt
• note: Must calculate A - a gradient in MCQ

Question 3

26 year old law student

History

Acute onset of cough, fever, purulent sputum and dyspea

No travel Hx

No immunosuppression Physical exam

T 38.5oC, RR 32, BP 130/75 HR 100

Auscultation: crackles RML

Answer 3

CAP or NAP

Note: gram -ve therapy for NAP

Question 4

32 year old bank teller

History

Acute onset of cough, fever, purulent sputum and dyspea

No travel Hx

Known to be HIV positive Physical exam

T 39oC, RR 34, BP 115/70 HR 110

Auscultation: diffuse crackles

ABGs (RA): pO2 44, pCO2 32, pH 7.47, HCO3 23

Answer 4

• Immunocompromised Host
• Many different organism including weird ones
• Often need invasive diagnostic testing (almost always bronchoscope)
• Note: Septra only used in Pneumocystis pneumonia

Complications

• Acute
  
  • Parapneumonic effusion
  • Empyema
  • Lung abscess
  • Respiratory failure
• Severe CAP progressing to ARDS

Question 5

22 year old engineering student from China

History

Cough, purulent sputum production for 3-4 months

Intermittent streaking of blood in sputum

Non smoker, no immunosuppression

10kg wt loss

Physical exam

T 38oC, RR 26, BP 130/75 HR 90

Auscultation: nil

Answer 5

• Dx: Tb
• Note: PPD no role in Dx active Tb

Question 6

CURB-65

Answer 6

• determines admit and prognosis
• Confusion
• Urea > 7 mmol/L
• Resp. rate > 30 /min.
• BP: SBP < 90 mmHg, DBP< 60 mmHg
• >65 YO

Scores

• 0 or 1: home rx
• 2: hospital rx
• >3: manage in hospital as severe pneumonia