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Year 3 > MedED acute resp > Flashcards

MedED acute resp Flashcards

1
Q

what type of resp tract infection is pneumonia?

A

lower

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2
Q

what is a HAP?

A

a pneumonia that occurs 48 hrs after hospital admission

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3
Q

how long after admission to hospital does HAP occur?

A

48 hrs or more

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4
Q

what are the 3 common organisms for CAP?

A

strep pneumoniae
mycoplasma pneumoniae
heamophilius pneumoniae

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5
Q

what are the 3 common organisms for HAP?

A

staph aureus
pseudomonas aerunginosa
klebsiella

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6
Q

what are the 4 common organisms for atypical pneumonia?

A

mycolpasma pneumoniae
legionella pneumoniae
chlamydia psittaci
chalmydia pneumoniae

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7
Q

what is the most common organism for CAP?

A

strep pneumoniae

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8
Q

in what patients is there a higher risk of aspiration pneumonia?

A

stroke

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9
Q

what are rf for pneumonia?

A

smoking
recent travel
immunocompromised

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10
Q

what pneumonia is associated with faulty air con?

A

legionella

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11
Q

what pneumonia is associated with pet birds?

A

chlamydia psittaci

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12
Q

what is chlamydia psittaci pneumonia associated with?

A

keeping pet birds

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13
Q

what is legionella pneumonia associated with?

A

faulty air con- hotels, offices etc

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14
Q

what are typical symptoms of pneumonia?

A

high fever
SOB
productive cough (usually green or yellow sputum)
pleuritic chest pain

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15
Q

what are atypical symptoms of pneumonia?

A 
dry cough
headache 
diarrhoea
myalgia
hepatitis 
confusion
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16
Q

what pneumonia organism is associated with confusion?

A

legionella

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17
Q

what are examination findings in pneumonia?

A 
resp distress
cyanosis
reduced chest expansion
dull percussion
basal coarse crepitations (walking on snow) 
bronchial breathing 
increased vocal resonance
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18
Q

what is heard on auscultation in pneumonia and describe what any of it sounds like

A

basal coarse crepitations- sounds like walking on snow
increased vocal resonance
bronchial breathing

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19
Q

what are atypical examination signs in pneumonia?

A

mycoplasma pneumoniae: transverse myelitis (inflammation of spinal chord), erythema multiforme (round lesions with bullseye appearance), autoimmune haemolytic anaemia

legionella: hyponatraemia, abnormal LFTs

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20
Q

what are atypical examination signs in mycoplasma pneumonia? explain how they look/arise

A 
transverse myelitis (inflammation of spinal chord)- will give neuro symptoms
erythema multiforme (round lesions with bullseye appearance)
autoimmune haemolytic anaemia- SOB, fatigue
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21
Q

what are atypical examination signs in legionella pneumonia? explain how they look/arise

A

hyponatraemia

abnormal LFTs

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22
Q

in what pneumonia might you get transverse myelitis, eyrthema multiforme and autoimmune haemolytic anaemia?

A

mycoplasma pneumoniae

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23
Q

in what pneumonia might you get abnormal LFTs and hyponatraemia?

A

legionella

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24
Q

what ix are done for pneumonia?

A

bedside: sputum MCS
bloods: FBC (high WCC), high CRP, type 1 resp failure on ABG
imaging: CXR (consolidation with fluid level)

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25
Q

what investigations are done for atypical pneumonia? what will you see

A

mycoplasma: blood film (will show red cell agglutination with cold agglutinin)
legionella: has urinary antigens and abnormal LFTs

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26
Q

what investigation might you do for mycolpasma pneumoniae and what will you see?

A

do a blood film, you will see red cell agglutination with cold agglutinin

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27
Q

what will you see in CXR in pneumonia?

A

lobar pneumonia- consolidation in one lobe

bronchopneumonia- consolidation all over the lungs

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28
Q

how do you manage pneumonia?

A

CURB 65

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29
Q

what does CURB65 stand for and what is needed for a point in each catagory?

A 
confusion- AMTS 8 or less
urea- >7 mmol/L
resp rate- >30 
BP- systolic <90
age- over 65
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30
Q

what is needed to get a point for confusion in CURB65?

A

AMTS score 8 or under

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31
Q

what is needed to get a point for urea in CURB65?

A

> 7 mmol/L

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32
Q

what is needed to get a point for resp rate in CURB65?

A

higher than 30

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33
Q

what is needed to get a point for BP in CURB65?

A

systolic under 90 mmHg

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34
Q

what is needed to get a point for age in CURB65?

A

over 65

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35
Q

if CURB 65 score is 1 how is pnuemonia managed?

A

GP and oral abx

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36
Q

if CURB 65 score is 2 how is pnuemonia managed?

A

A&E + IV abx

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37
Q

if CURB 65 score is 3 or more how is pnuemonia managed?

A

hospital admission, IV abx and consider ITU

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38
Q

what abx are used to treat typical pneumonia?

A

amoxicillin

co amoxiclav if severe

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39
Q

what abx are used to treat atypical pneumonia?

A

clarithromycin

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40
Q

what abx are given if the causative organism of pneumonia is not known and why?

A

amoxicillin- covers typical organisms

clarithromycin- covers atypical organisms

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41
Q

what does AMT stand for?

A

abbreviated mental test score

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42
Q

what abx is given in pneumonia if they are allergic to penicllin?

A

doxycycline

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43
Q

what abx is given for pneumocystitis jiroveci?

A

co trimoxazole (trimethoprim and sulfamethoxazole)

44
Q

what pneumonia is associated with HIV?

A

pneumocystis jiroveci

45
Q

what is pneumocystis jiroveci associated with?

A

HIV

46
Q

what type of infection is acute bronchitis usually?

A

viral

47
Q

what are some typical organisms for acute bronchitis?

A 
rhinovirus
parainfluenza
influenza a or b
respiratory syncytial virus
coronavirus
48
Q

what type of resp tract infection is acute bronchitis?

A

upper

49
Q

what are rf for acute bronchitis?

A

smoking

cystic fibrosis and copd (anything that impairs airway clearance)

50
Q

what are symptoms of acute bronchitis?

A

dry or minimally productive cough
SOB
wheeze
mild fever

51
Q

how does fever differ in acute bronchitis vs pneumonia?

A

acute bronchitis= low fever

pneumonia= high fever

52
Q

what type of fever do you get in pnuemonia?

A

high

53
Q

what type of fever do you get in acute bronchitis?

A

low

54
Q

how is acute bronchitis diagnosed?

A

usually clinically based on presentation and hx and exam

55
Q

is CXR needed in acute bronchitis?

A

no, but might do

56
Q

how is acute bronchitis managed?

A

paracetamol and ibuprofen as needed
bedrest
hydration

if cough is present >2 weeks= inhaled ICS

if they have underlying lung pathology eg copd/asthma oral abx (amoxicillin for 7 days or doxycycline if penicillin allergy for 7 days)

57
Q

how is management of acute bronchitis different if the patient is healthy, if their cough has lasted over 2 weeks and if they have underlying lung pathology?

A

healthy= paracetamol/ibuprofen, hydration, bed rest
cough over 2 weeks= inhaled ICS
underlying lung pathology= amoxicillin 7 days or if allergic to penicillin doxycycline

58
Q

where is an embolus formed and where does it get lodged in a PE?

A

clot is formed in the veins

clot is lodged in the pulmonary arterial system

59
Q

what are rf for PE?

A

OCP

pregnancy

60
Q

what do you ask a radiologist for in PE?

A

CTPA

61
Q

what are symptoms of PE?

A

pleuritic chest pain
SOB
collapse if severe

62
Q

what is an acute massive PE?

A

sudden complete occlusion of a pulmonary artery

63
Q

what is an acute small PE?

A

sudden incomplete occlusion of a pulmonary artery

64
Q

what is a chronic PE?

A

chronic occlusion of pulmonary microvasculature

65
Q

how does chronic PE present?

A

exertional dyspnoea

66
Q

in what type of PE might you get haemoptysis?

A

acute small PE

67
Q

what is seen on ECG in PE?

A

S1Q3T3
right axis deviation
right bundle branch block
sinus tachycardia

68
Q

what happens of HR in PE?

A

it increases

69
Q

what is a buzzword for PE?

A

s1q3t3

70
Q

what is seen on CXR in PE?

A

westermark’s sign

71
Q

what is westermarks sign seen in?

A

PE on a CXR

72
Q

what is seen in s1q3t3?

A

s wave in lead 1 (the s point on the ECG is deep and negative)
q wave in lead 3
inverted t waves in lead 3

73
Q

what score is used to determine the risk of a PE?

A

well’s score

74
Q

what is done after calculating well’s score?

A

if its 4 or over order a CTPA

if its under 4 order a d dimer

75
Q

in PE when do you do a CTPA and when do you do a d dimer?

A

if wells score is 4 or above do a CTPA

if wells score is under 4 do a d dimer

76
Q

how is PE managed?

A

if they are haemodynamically stable: respiratory support and anticoagulation (fondaparinux first line/heparin for 5 days or warfarin for 3 months)

if they are haemodynamically unstable: first line thrombolysis (alteplase first line/ streptokinase/ rt-PA) and second line surgery embolectomy

77
Q

how is haemodynamically stable PE managed? give specific drug names and courses?

A

respiratory support

anticoagulation- fondaparinux or heparin for 5 days OR warfarin for 3 months

78
Q

what drugs are used to anticoagulate someone with haemodynamically stable PE and how long are they given for?

A

fondaparinux or heparin for 5 days

warfarin for 3 months

79
Q

how is haemodynamically unstable PE managed?

A

IV thrombolysis- first line alteplase, can also use streptokinase or rt-PA
second line embolectomy

80
Q

according to NICE guidelines who needs a VTE risk assessment in hospital and when is it done?

A

everyone needs one within 24h of admission

81
Q

how is VTE risk assessment done? how do you remember this?

A

TEDs and tinz
mechanical= TED compression stockings
pharmacological= LMWH tinzaparin

82
Q

what is TEDs and tinz used to remember?

A

how to do VTE risk assessment
mechanical= TED compression stockings
pharmacological= LMWH tinzaparin

83
Q

how is LMWH given?

A

subcut injection

84
Q

in what space does air collect in a pneumothorax?

A

pleural space

85
Q

what is the difference between a traumatic and spontaneous penumothorax?

A 
traumatic= damage to parietal pleura
spontaneous= damage to visceral pleura
86
Q

what pneumothorax is associated with damage to parietal vs visceral pleural?

A 
parietal= traumatic 
visceral= spontaneous
87
Q

out of the parietal and visceral pleura which is closer to the lung and how do you remember this?

A

visceral in innermost and closer to the lung

when you have a ‘visceral reaction’ its intense so that one most be closer

88
Q

the gap between what is the pleural space?

A

parietal and visceral pleura

89
Q

what is primary v secondary pneumothorax?

A 
primary= young and otherwise healthy patient
secondary= existing lung pathology eg copd
90
Q

what are rf for pneumothorax?

A

smoking
male
marfans syndrome

91
Q

how is primary pneumothorax managed?

A

if they are not SOB or <2cm discharge and ODP review
if >2cm or SOB perform needle aspiration
if needle aspiration works then observe and give o2
if needle aspiration doesnt work then insert a chest drain

92
Q

how is secondary pneumothorax managed?

A

if its >2cm or they are SOB insert a chest drain
if its <1cm observe and give o2
if its between 1cm and 2cm needle aspiration then observe and o2
if between 1cm and 2cm and needle aspiration doesnt work insert a chest drain

93
Q

when is a chest drain used to manage a pneumothorax?

A

if they have a primary pneumothorax >2cm or are SOB and needle aspiration doesn’t work
if they have a secondary pneumothorax >2cm or are SOB chest drain straight away
if they have a secondary pneumothorax 1cm-2cm and fine needle aspiration isnt sucessful

94
Q

when is fine needle aspiration used to manage a pneumothorax?

A

if they have a primary pneumothorax >2cm or are SOB first line
if they have a secondary pneumothorax 1cm-2cm first line

95
Q

when can you discharge someone as management for a pneumothorax?

A

if they have a primary pneumothorax <2cm and they arent SOB

96
Q

what happens in a tension pneumothorax?

A

everytime the patient breathes in more and more air gets trapped in the lungs till eventually there is so much air in the lungs that the trachea deviates and theres a mediastinum shift

97
Q

where does the trachea deviate in tension pneumothorax and how do you remember?

A

away from the side
remember by thinking about what happens, more and more air gets trapped everytime they breath in and so there is less space on that side so everythin is pushed away from it

98
Q

how is tension oneumothorax managed?

A

insert a large bore cannula in the 2nd ICS MCL just above the 3rd rib to avoid puncturing the neurovascular bundle

99
Q

what colour are large bore cannulas?

A

orange or grey

100
Q

what is ARDS?

A

non cardiogenic pulmonary oedema

101
Q

what criteria is used to identify ARDS and what does it contain?

A 
berlin criteria:
no alternative cause for the pulmonary oedema 
rapid onset <1 week
SOB
bilateral signs on CXR
102
Q

what causes ARDS?

A

acute hypoxemic lung injury

103
Q

what are some examples of things that cause ARDS?

A 
sepsis
acute pancreatitis
covid 19
pneumonia
ventilation
severe burns 
tranfusion reactions 
drug OD
104
Q

why do people die due to tension pneumothorax? explain the process

A

due to severe hypotension
the mediastinal shift reduced outflow of blood from the heart and this causes hypotension and will eventually lead to death

105
Q

what is aetiology of ARDS?

A

a huge inflammatory response causes bursting and collapse of alveoli

106
Q

what is seen on CXR in ARDS?

A

diffuse bilateral opacities

107
Q

how is ARDS managed?

A

refer them to ICU

may be intubated, lie the patient prone (on tummy)

Year 3 (104 decks)

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