passmed year 5 Flashcards
Which of the following options confirms that the chest drain is located in the pleural cavity?
Chest drain swinging: Rises in inspiration, falls in expiration
reduced breath sounds and dullness to percussion
pleural effusion
Auscultation reveals normal heart sounds, bilateral coarse crackles, and a widespread polyphonic wheeze. She has a past medical history of pertussis as a toddler and recurrent pneumonia as a teenager.
bronchiectasis
penumonia caused by aspiration
klebsiella
klebsiella normally in what zones of the lung
upper
target O2 sats in asthma
94-98%
mx of brochiectasis
hysical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)
tx in high altitude cerebral oedema
dexamethasone
acetazolamide in prevention
COPD standby medication:
NICE recommend offering a short course of oral corticosteroids and oral antibiotics to keep at home
30-40 year old with basal emphysema and abnormal LFTs
alpha 1 antitrypsin deficiency
Infective exacerbation of COPD
first-line antibiotics are amoxicillin or clarithromycin or doxycycline
Bibasal fine end-inspiratory crepitations
PF
Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation →
ARDS
persistent mouth ulcer
think SCC
ramsay hunt syndrome tx
Oral aciclovir and prednisolone
dix hallpike manouvre reproduces what
rotatory nsytagmus
bird lung is a type of what allevolitis
Extrinsic allergic alveolitis
extrinsice allveolitis affects the upper and middle lobes what is the mx
avoid precipitating factors
Fine end-inspiratory crepitations are seen in
fibrosis
sudden opening of small airways during inspiration that were held closed in the previous expiration.
Coarse crackles heard when
fluid in the lungs
klebsiella caused what extra associated signs
lugn abcess or empyema
what marker might be raised in chronic copd due to another conditition - 2secondary deu to the copd
hematocrit
polycythaemia
what is haematocrit
the ratio of the volume of red blood cells to the total volume of blood.
why are high urea levels a poor prognostic sign in CAP
This is because elevated blood urea nitrogen levels indicate dehydration or reduced renal perfusion, both of which can lead to increased mortality
two paraneoplastic feature of adenocarcinoma of the lung
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
4 things causing lower zone fibrosis - rest all therefore all upper by default
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
occupational asthma caused by things such as working in bakery what should GP advise
Advise the patient to keep a diary of peak flow readings both in and out of work
treatment of alpha-1 antitrypsin deficiency treatment
Lung volume reduction surgery
removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung.
describe brochiectassis presentation or features in an individual
a productive cough with copious amounts of purulent sputum, occasional haemoptysis, wheezing, and is often related to a history of childhood respiratory infections.
nasogastric tubes are safe to use under what ph
Nasogastric tubes are safe to use if pH <5.5 on aspirate
smoking hx
cancer over tb
pancoast tumour dx test
ct if cant see
3 stages of churg strauss - pANCA
There are three stages to the presentation of Churg-Strauss disease.
The initial phase is characterised by allergy with many patients having a history of asthma or allergic rhinitis. This inflammation of the nasal passages can lead to the development of nasal polyps.
The second phase is eosinophilia
The third stage is the vasculitis itself which affects small and medium-sized blood vessels and therefore resulting in damage to many organs. Given this patient’s kidney failure, it appears to be affecting his renal blood supply.
