Pulmonary Flashcards
Describe the next investigation when managing a child with prolonged cough over 2 weeks and fever, according to the content.
Serology for pertussis.
What is the best initial investigation for bronchial asthma according to the content?
Spirometry before and after SABA (with FEV1 increase of at least 15%).
What is the most important parameter to assess in spirometry for a patient with bronchial asthma according to the content?
FEV-1.
What is the most important parameter to assess in spirometry for a patient with chronic obstructive pulmonary disease (COPD) according to the content?
FVC.
Management of acute attack???
Pt with low O2 saturation next step…….
1st step………
Best way to give puffs to the kids……
If no response…….
Management of acute attack???
Pt with low O2 saturation next step…….give O2
1st step………inhaled salbutamol…..up to 12 puffs
Best way to give puffs to the kids……spacer
If no response…….oral cortisone
How should an acute asthma attack be managed according to the content?
Start with inhaled salbutamol (up to 12 puffs), then consider oral cortisone if no response.
What is the most common side effect of inhaled cortisone according to the content?
Oropharyngeal candidiasis.
Describe the most serious sign in status asthmaticus according to the content.
Silent chest.
What is the first step if a patient with asthma presents with cyanosis according to the content?
Intubation.
How should puffs be administered to children with asthma according to the content?
Using a spacer.
What is the first-line treatment for long-term management of asthma according to the content?
SABA (Short-acting beta agonist).
Long term management:
First line…………
If still symptomatic…….
If still symptomatic………..
Long term management:
First line………….SABA
If still symptomatic…….inhaled cortisone
If still symptomatic………..LABA
What is the best way to prevent asthma exacerbations according to the content?
Avoiding dust and smoking.
What drug is commonly used for prevention of asthma by inhalation according to the content?
Fluticasone.
What is the recommended management for asthma triggered by exercise according to the content?
Using salbutamol before exercising.
How should critical cases be assessed according to the content? asthma
Look for confusion, drowsiness, and agitation as very important signs.
Pt returned from long flight develops acute chest pain& dyspnea. Exam shows clear lung… Dx:
pulmonary embolism (PE)
Describe the best investigation for diagnosing pulmonary embolism (PE) according to the content.
CTPA (CT pulmonary angiography).
Best inv of PE/ Inv of choice of PE…………………………..
Inv of choice in pregnant, pt with ESRD or allergy…
Best inv of PE/ Inv of choice of PE………………………….. CTPA
Inv of choice in pregnant, pt with ESRD or allergy… V/Q scan
What is the treatment of choice for PE according to the content?
LMWH (Low molecular weight heparin) followed by warfarin.
These patients, and those presenting with massive PE, may require pulmonary angiography (still regarded as the gold standard test). Treatment is anticoagulation, typically with low molecular weight heparin followed by 6 months of warfarin. Thrombolytic therapy is reserved for the acute massive presentation.
What is the duration of warfarin use in PE treatment according to the content?
3-6 months with a target INR of 2-3.
What is the next step for a patient with contraindications to anticoagulation and recurrent PE despite anticoagulant therapy according to the content?
IVC filter placement.
Describe the diagnosis of a patient presenting with cough and dyspnea, dullness to percussion, and increased tactile vocal fremitus according to the content.
Pt with cough and dyspnea. Exam shows dullness to percussion& ++ TVF… Dx: pneumonia.
Pneumonia.
Pt with cough and dyspnea. CXR shows pneumonic patch…
Dx: pneumonia
Pt with cough and dyspnea. Exam shows dullness to percussion& – TVF…
Dx: pleural effusion
What is the most common causative organism of community-acquired pneumonia according to the content?
Streptococcus pneumoniae.
How should oxygen be administered in pneumonia according to the content?
First with a mask, then with a venturi mask (not nasal cannula).
What are the criteria of severity in pneumonia according to the content?
Confusion, respiratory distress, tachycardia, hypoxia, or cyanosis.
When to say severe……….for criteria pneumonia
When to say severe……….2 or more of the above criteria
Describe the treatment for mild cases of pneumonia
Outpatient treatment with oral Amoxicillin
Severe cases…….pneumonia
Inpatient ttt…………..Iv flucloxacillin + IV cefotriaxone
If MRSA………..
add vancomycin
If mycoplasma pneumonia….
doxycyclin
Pneumonia with dry cough+ skin lesion (EM)… Dx:
TTT of mycoplasma pneumonia…
Pneumonia with dry cough+ skin lesion (EM)… Dx: mycoplasma pneumonia
TTT of mycoplasma pneumonia… Doxycycline
What is the management for pleural effusion?
Tube decompression
Trauma + dullness + decreased breath sound…..
Management of pleural effusion…
Site of chest tube insertion…
Trauma + dullness + decreased breath sound…..pleural effusion
Management of pleural effusion… tube decompression
Site of chest tube insertion… 5th intercostal space at MAL
Trauma + resonance + decreased breath sound…
Management of tension pneumothorax…
Site of needle insertion……
Trauma + resonance + decreased breath sound…pneumothorax
Management of tension pneumothorax… immediate needle decompression
Site of needle insertion…… 2nd Inercostal Space at MCL
When to do aspiration in primary pneumothorax???
1- Symptomatic even if small
if aspiration failed………..
if pneumothorax not symptomatic …….
Pt with pneumothrax of any cause (asthma, COPD…etc)…
When to do aspiration in primary pneumothorax???
1- Symptomatic even if small
if aspiration failed………..chest tube
if pneumothorax not symptomatic …….conservative and follow up CXR
Pt with pneumothrax of any cause (asthma, COPD…etc)… 2ry pneumothorax
TTT of 2ry pneumothorax:
If more than 30%………….
If less than 15-30%………..
…..if failed…..
If less than 15%……..
TTT of 2ry pneumothorax:
If more than 30%…………..chest drain
If less than 15-30%………..aspiration…..if failed…..chest drain
If less than 15%……..conservative
How is tension pneumothorax managed?
Immediate needle decompression
Define primary pneumothorax
Spontaneous pneumothorax in a tall, young male smoker with no obvious cause
Middle age male smoker with history of chronic productive cough and and hyperinflated lung………
MCC of distress in pt with COPD……………………
Most imp Sign of distress in pt with COPD…
Middle age male smoker with history of chronic productive cough and and hyperinflated lung………COPD
MCC of distress in pt with COPD…………………… infection
Most imp Sign of distress in pt with COPD… pursing lips
What is the next step if aspiration fails in primary pneumothorax?
Insertion of a chest tube
Describe the treatment for secondary pneumothorax if it is more than 30%
Insertion of a chest drain