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Respiratory > Pneumonia, PE, oedema, pneumothorax > Flashcards

Pneumonia, PE, oedema, pneumothorax Flashcards

1
Q

S+S PE

A

SOB, pleuritic CP, syncope, tachycardic, potentially have fever, low sats

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2
Q

1st line investigations for PE

A

CXR
Wells score:over 4 = PE likely, under 4 = unlikely
If over 4 = LMWH + CTPA
Under 4 = D dimer.
If positive, CTPA
If they have an allergy to contrast, do V/Q perfusion ABG (mildly alkalotic)

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3
Q

Acute management of PE

A

O2, vascular access, NSAIDs or weak opioid
LMWH unless massive thrombolysis (then fluid challenge first)
Warfarin within 24hrs
LMWH for 5 days until INR over 2

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4
Q

Long term management of PE

A

3 month warfarin then assess

Continue if unprovoked PE

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5
Q

1st line investigations + results for pneumonia

A

CXR (consolidation), ECG, bloods (raised CRP, WCC, urea)
Culture bloods + sputum
ABG
CURB65 = ICU >3
Pneumococcal + legionella urinary testing
Pneumonia = S+S of LRTI + radiological signs

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6
Q

What is CURB65?

A 
Confusion <8 AMTS
Urea >7
RR >30
BP <90/<60
Age >65

30 day mortality

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7
Q

1st line management for low severity CAP

A

Amoxicillin
Allergic: clindamycin or tetracycline
5 days

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8
Q

1st line management for moderate-high severity CAP (Curb >2)

A

Amox + macrolide (clarithromycin) 7-10 days - ADMIT

High severity: clarithromycin + cefotaxime IV - ADMIT

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9
Q

1st line management for HAP

A

Ceftriaxone + metronidazole

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10
Q

What are the organisms that cause CAP?

A 
Gram positive:
Strep pneumoniae
H influenza - commonly COPD
Staph
Mycoplasma
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11
Q

What are the organisms that cause HAP?

A 
Gram negative:
Pseudomonas
Mycoplasma
Legionella
Chlamydia pneum
Staph aureus
Pneumonia developing >48hrs after admission
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12
Q

What are the S+S of legionella?

A

Flu, dry cough, bradycardic

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13
Q

How to manage legionella?

A

Clarithromycin or erythromycin for 14 days

Report to PHE

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14
Q

How to distinguish aspiration pnemumonia

A

Sudden onset in someone with hx of vomiting or swallowing problems
May look like pulmonary oedema on CXR
Distinguish by fever, bloods

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15
Q

Management of severe croup

A

Nebulised adrenaline 1:1000

Dex or pred

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16
Q

Investigations for ?asthma

A

ABCDE
ABG - high CO2 + low O2 (when breathing slows)
CXR, ECG, bloods
Fractioned exhaled nitric oxide for diagnosis

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17
Q

Pneumothorax S+S

A

Abrupt SOB
Dull heavy chest pain
Hyperresonant
Reduced air entry (absent breath sounds)

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18
Q

Management of tension pneumothorax

A

Needle decompression (large bore cannula 2nd ICS mid clav) - then CXR + chest drain (5th IC space, mid axillary line)

19
Q

Presentation of HF with pulmonary oedema, and what heart sounds are produced?

A

Acute SOB
Pink frothy sputum
Chest pain
Triple/ gallop rhythm

20
Q

Management of pulmonary oedema

A

O2
If wheezy: salbutamol nebs, ipratropium bromide + hydrocortisone
Diamorphine 2.5mg, anti-emetic, furosemide GTN

21
Q

Diagnostic criteria for acute respiratory distress syndrome

A

Hypoxaemia

Bilateral CXR infiltrates

22
Q

S+S of acute respiratory distress syndrome

A

SOB
RR
Bilateral crackles

23
Q

What is type 1 resp failure?

A

Hypoxaemia (eg asthma)

24
Q

What is type 2 resp failure?

A

Hypoxia + hypoventilation causing high CO2

25
Q

Causes of type 2 resp failure

A

COPD, opiate OD

26
Q

Management of resp failure

A

O2 in venturi mask, nebs, steroidsCPAP

27
Q

Organisms causing pneumonia + characteristics

A

Strep pneumoniae = most common, high fever, rapid onset, pleuritic chest pain, herpes labialis
H influenza = common in COPD
Staph aureus = follows influenza infection
Mycoplasma pneu = dry cough, atypical x ray
Legionella = hyponatraemia + lymphopenia
Klebsiella = alcoholics, causes cavitation
Jiroveci = HIV
Chlamydia psittaci = pet bird dead
Coxiella bunetii = Q fever - people working in animal houses

28
Q

Simple vs tension pneumothorax

A 
Simple = air in pleural cavity, not under pressure
Tension = air drawn into pleural space with each breath
29
Q

Causes of pneumothorax

A 
Primary:
Spontaneous (tall young males)
Trauma
Secondary:
Chronic disease - COPD (bullae), pneumonia, cancer, connective tissue diseases, asthma 
Iatrogenic - from PICC lines
30
Q

Management of primary pneumothorax

A

Aspirate if >2cm, discharge if <2cm

If failed, chest drain (5th IC space, mid axillary line) + admit

31
Q

Management of secondary pneumothorax

A

If >2cm, insert chest drain (5th IC space, mid axillary line)
If 1-2cm, aspirate then admit

32
Q

How to determine between primary + secondary pneumothorax?

A

Primary = spontaneous, <50 y/o, no comorbidities

33
Q

CXR for pneumothorax

A

Black - no lung markings

34
Q

Follow up for pneumonia

A

CXR in 6 weeks

35
Q

When else is d dimer raised?

A

Pregnancy
Cancer
PE
Renal disease

36
Q

What is a PERC score?

A

Pulmonary embolism rule out criteria

37
Q

How does LMWH work?

A

LMWH - Factor 10a inhibitor - affects clotting cascade

38
Q

When can you get a stroke from a DVT?

A

If you have PFO

All stroke pts have an echo to check for PFO

39
Q

Clinical signs (chest expansion, trachea, percussion, breath sounds, vocal resonance) for pneumothorax

A

chest expansion: reduced on affected side
trachea: shifted to affected side in simple + away from affected side in tension
percussion: hyperresonant on affected side
breath sounds: reduced on affected side
vocal resonance: reduced on affected side

40
Q

Clinical signs (chest expansion, trachea, percussion, breath sounds, vocal resonance) for pneumonia

A

chest expansion: can be reduced on affected side
trachea: central or shifted towards side of lobar collapse
percussion: dull over affected area
breath sounds: reduced, coarse creps, bronchial breathing
vocal resonance: increased

41
Q

Clinical signs (chest expansion, trachea, percussion, breath sounds, vocal resonance) for pleural effusion

A

chest expansion: reduced on affected side
trachea: central or shifted away from affected side if large
percussion: stony dull
breath sounds: reduced
vocal resonance: reduced

42
Q

Clinical signs (chest expansion, trachea, percussion, breath sounds, vocal resonance) for pulmonary oedema

A 
chest expansion: equal
trachea: central
percussion: dull bases
breath sounds: fine inspiratory creps 
vocal resonance: reduced
43
Q

Ix for TB

A

Sputum
Early morning urine
Tissue biopsy = needs to be in saline (some to micro, some to pathology)

Respiratory (8 decks)

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