Passmed resp Flashcards
name 2 ddx for post surgery sob
atelectasis, pneumonia and pulmonary embolism
what is atelectasis
common post operative complication in which basal alveolar collapse can lead to respiratory difficulty
caused by airways becoming obstructed by bronchial secretions
sx control in non cf bronchiectasis
Inspiratory muscle training + postural drainage
ROME for ABGs
Respiratory = Opposite
low pH + high PaCO2 i.e. acidosis, or
high pH + low PaCO2 i.e. alkalosis
Metabolic = Equal
low pH + low bicarbonate i.e. acidosis, or
high pH + high bicarbonate i.e. akalosis
What does a PaCO2 > 6.0 kPa indicate?
PaCO2 > 6.0 kPa suggests a respiratory acidosis (or respiratory compensation for a metabolic alkalosis)
What does a PaCO2 < 4.7 kPa indicate?
PaCO2 < 4.7 kPa suggests a respiratory alkalosis (or respiratory compensation for a metabolic acidosis)
What does a bicarbonate < 22 mmol/l (or a base excess < - 2mmol/l) indicate?
suggests a metabolic acidosis (or renal compensation for a respiratory alkalosis)
What does a bicarbonate > 26 mmol/l (or a base excess > + 2mmol/l) indicate?
metabolic alkalosis (or renal compensation for a respiratory acidosis)
Haemoptysis
Dyspnoea
Bibasal crackles and S3 are the most reliable signs
Pulm odema
Haemoptysis
Pleuritic chest pain
Tachycardia, tachypnoea
PE
Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity
Aspergilloma
Haemoptysis Dyspnoea Atrial fibrillation Malar flush on cheeks Mid-diastolic murmur
Mitral stenosis
What causes cannonball metastases?
Renal CC -> Lungs
Mediastinal widening causes ..name 3
vascular problems: thoracic aortic aneurysm lymphoma retrosternal goitre teratoma tumours of the thymus
Both large effusion and lung collapse look white on XRay - easy easy way to differentiate?
Collapse - trachea pulled towards white
Effusion - pushed away
[also have increased spaces between ribs]
diabetic and alcoholic patients ->
cavitating upper lobe pneumonia
klebsiella
[more common in alcoholic and diabetics
may occur following aspiration
‘red-currant jelly’ sputum
often affects upper lobes]
sarcoid metabolic change
Sarcoidosis may cause hypercalcaemia
1st line mx in unilateral pleural effusion ?
If unstable?
pleural aspiration
immediate chest drain
Bilateral hilar lymphadenopathy most common causes
TB
Sarcoidosis
What is kartanger syndrome? Name 2 features
Primary ciliary dyskinesia
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
Adult new diagnosis of asthma Ix
Fractional exhaled nitric oxide + spirometry/bronchodilator reversibility test
Occupational asthma key ix/mx?
Serial PEF at home and work
Referral to resp specialist
Multiple arthritis and raised ACE?
sarcoidosis
[hyperCa]
