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
What is the most important investigation for pleural effusion?
Thoracocentesis
Do COPD patients with fever or yellow sputum likely have an infection?
Yes
What is the most important way to decrease mortality in COPD patients?
Stop smoking
Describe the respiratory changes in a patient with normal breathing versus when they present with exaggerated symptoms in the ER.
Normally: PO2 decreased, PCO2 increased, pH respiratory acidosis. Exaggerated symptoms in ER: PO2 decreased, PCO2 increased, pH respiratory acidosis.
Spirometry of pt with COPD “Obstructive lung disease”:
FEV1, FVC and FEV1/FVC ratio …………………
compliance……………………………………
Most imp way to decrease mortality in pt with COPD…
Spirometry of pt with COPD “Obstructive lung disease”:
FEV1, FVC and FEV1/FVC ratio ………………… decreased
Residual volume and total lung capacity… increased
Lung compliance……………………………………increased
Most imp way to decrease mortality in pt with COPD… stop smoking
Types of ABG WITH COPD pt?? vvvvvvvvvvvv imp
NORMALLY= NO EXAGGERATION
PO2……….
PCO2………
PH………….
When he comes with EXAGGERATED SYMPTOMS in the ER
PO2……….
PCO2…….
PH………..
If you by mistake give the pt high flow oxygen????? Vvv imp
PO2……..
PCO2……
PH…….
First step…….decrease the O2 flow
If respiratory failure???
PO2……..MARKED DROP (USUALLY BELOW 60%)
PCO2……..
PH…………
1st step… intubation
Types of ABG WITH COPD pt?? vvvvvvvvvvvv imp
NORMALLY= NO EXAGGERATION
PO2……….DECREASED
PCO2………INCREASED
PH………….RESPIRATORY ACIDOSIS
When he comes with EXAGGERATED SYMPTOMS in the ER
PO2……….decreased
PCO2……..INCREASED)
PH………..RESPIRATORY ACIDOSIS
If you by mistake give the pt high flow oxygen????? Vvv imp
PO2……..INCREASED
PCO2…….INCREASED
PH…….RESPIRATORY ACIDOSIS
First step…….decrease the O2 flow
If respiratory failure???
PO2……..MARKED DROP (USUALLY BELOW 60%)
PCO2……..INCREASED
PH…………RESPIRATORY ACIDOSIS
1st step… intubation
What are the consequences of mistakenly giving a patient high flow oxygen in terms of PO2, PCO2, and pH?
PO2 increased, PCO2 increased, pH respiratory acidosis. First step: decrease the O2 flow.
What are the respiratory parameters in a patient with respiratory failure?
PO2 marked drop (usually below 60%), PCO2 increased, pH respiratory acidosis. First step: intubation.
What is the initial management step for a COPD patient with marked dyspnea in the ER?
First step: administer oxygen.
How can you identify oxygen toxicity in a patient?
By ABG showing high O2, high CO2, and respiratory acidosis. First step: decrease the flow of oxygen.
Describe the treatment approach for a COPD patient with very low O2 saturation (<60%).
First step: intubation.
What is the recommended treatment for a COPD patient presenting with sudden chest pain, indicative of pneumothorax?
Treatment of pneumothorax in COPD patient is the same as for secondary pneumothorax. If more than 30% pneumothorax, chest drain; if less than 15-30%, aspiration with possible chest drain if failed; if less than 15%, conservative management.
What is the most common cause of blood-stained mucous?
Acute bronchitis.
What are the most common risk factors for tuberculosis (TB)?
Immigrant and nurse.
Common scenario in the AMC exam
COPD patient with marked dyspnea in the ER
First step……
How you know that you caused o2 toxicity????
By ABG………..
First step …………
COPD WITH very LOW O2 saturation (<60%) first step……
COPD pt with sudden chest pain…….
Common scenario in the AMC exam
COPD patient with marked dyspnea in the ER
First step……..O2
How you know that you caused o2 toxicity????
By ABG……….. HIGH O2, HIGH CO2& RESPIRATORY ACIDOSIS
First step …………decrease the flow of oxygen
COPD WITH very LOW O2 saturation (<60%) first step……intubation
COPD pt with sudden chest pain…….pneumothorax (rupture of bleb)
TTT of pneumothorax in COPD pt= TTT of 2ry pneumothorax
If more than 30%…………..
If less than 15-30%………..aspiration….
.if failed…..
If less than 15%……..
TTT of pneumothorax in COPD pt= 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
Describe the initial steps in managing an immigrant from an endemic area presenting with prolonged cough, dyspnea, night sweats, and weight loss.
First step: chest X-ray.
What is the definitive test for diagnosing TB?
Sputum analysis.
What is the recommended investigation for an asymptomatic patient suspected of TB?
Mantoux test or QuantiFERON.
How do you interpret a positive Mantoux test result?
Positive Mantoux test: Chest X-ray. If positive chest X-ray, isolation and quadruple therapy; if negative chest X-ray, isoniazid + vitamin B6 for 6-9 months.
What are the important complications of isoniazid and rifampin in TB treatment?
side effect
Isoniazid: peripheral neuropathy (give vitamin B6); Rifampin: red coloration of urine.
What is the immediate management step for a nurse suspected of having TB?
Immediate isolation.
What is the next step for an immigrant with suspected TB and a positive Mantoux test result?
Isolation (before X-ray).
Describe the most common affected lobe of the lung in TB.
Upper lobe
What is the most common cause of decreased TB incidence in Australia?
Good isolation (NOT vaccination)
Do in a case of an old smoker presenting with any chest complaint and weight loss.
Diagnose lung cancer until proven otherwise
Do in a case of an old smoker with weakness, paresthesia in hand, and a CXR showing a mass at the apex.
Diagnose pancost tumor
Do in a case of an old smoker with congested neck veins, arm swelling, and a CXR showing a mass at the apex.
Diagnose pancost tumor
What is the first step in a lung cancer patient with pleural effusion?
Thoracocentesis
What is the first step in a patient with suspected lung cancer?
Chest CT
This may involve taking a chest X-ray at the outset. A negative chest X-ray does not nec- essarily exclude lung cancer, particularly where the tumour is in a central airway or is small. Sputum cytol-ogy and serum biochemistry should be arranged. Where the diagnosis of lung cancer is likely, a **chest CT with contrast **is indicated to check for hilar and mediastinal lymphadenopathy (Figure 2). racgp
What is the investigation of choice in lung cancer?
Bronchoscopy and biopsy
Lung cancer with systemic manifestation…
Lung cancer with systemic manifestation… para-neoplastic $
Asymptomatic pt with small lung mass at CXR…
Asymptomatic pt with small lung mass at CXR… 1st step: ask for old x-ray
Describe the spirometry findings in a patient with lung fibrosis (restrictive lung disease).
Decreased FEV1, FVC; normal FEV1/FVC ratio;
decreased residual volume, total lung capacity, and lung compliance
Spirometry of pt with lung fibrosis “Restrictive lung disease”:
FEV1, FVC…………………
FEV1/FVC ratio………
Residual volume,
total lung capacity& lung compliance…
Spirometry of pt with lung fibrosis “Restrictive lung disease”:
FEV1, FVC………………… decreased
FEV1/FVC ratio……… normal
Residual volume, total lung capacity& lung compliance… decreased
Rt sided heart failure 2ry to pulmonary HTN…
Child with FTT+ recurrent chest infection+ steatorrhea… Dx:
Genetic of CF …
MCC of infertility in pt with CF ……
Rt sided heart failure 2ry to pulmonary HTN… cor- pulmonale
Child with FTT+ recurrent chest infection+ steatorrhea… Dx: cystic fibrosis (CF)
Genetic of CF … AR
MCC of infertility in pt with CF …… absence vas deference
Child with rectal prolapse, most imp to ask about … s
Bowel habit (NOT family H/O of cystic fibrosi
What is the treatment of pulmonary fibrosis?
Cortisone
What is the most important investigation for cystic fibrosis?
Sweat chloride test
Describe the genetic inheritance pattern of cystic fibrosis.
Autosomal recessive
Do in a case of a child with rectal prolapse and cystic fibrosis.
Ask about bowel habits (NOT family history of cystic fibrosis)
Do in a case of a male patient with bronchiectasis, sinusitis, and male sterility.
Diagnose immotile cilia syndrome
Do in a case of a male patient with bronchiectasis, sinusitis, and dextrocardia.
Diagnose Kartagener syndrome
What is the most common cause of acute hemoptysis?
Acute bronchitis
What is the most common cause of chronic hemoptysis?
Bronchiectasis
What is the investigation of choice in bronchiectasis?
Spiral CT scan
What is the treatment of infection in bronchiectasis?
Amoxicillin-clavulanate (Augmentin) or doxycycline racgp
Describe the advice given regarding changing jobs in the content.
The advice is to change the job.
What is the increased risk associated with asbestosis according to the content?
Mesothelioma (no screening available; try to avoid prolonged exposure).
What risk does silicosis increase according to the content?
TB reactivation.
What is identified as the most important cause of confusion in respiratory failure in the content?
CO2 narcosis.
What is the first test mentioned in the content for respiratory issues?
Pulse oximetry.
What is the second investigation recommended in the content for respiratory problems?
ABG (arterial blood gas).
What is the management approach suggested in the content for respiratory issues?
Intubation.
What is considered the most important drug in the treatment of acute pulmonary edema according to the content?
IV furosemide.
What is the most common risk factor for mesothelioma as per the content?
Asbestosis.
In a patient with chronic cough and pleural thickening on CXR, what is the next step according to the content?
CT chest (very important).
What is the investigation of choice for mesothelioma according to the content?
Bronchoscopy and biopsy.
In a patient with prolonged symptoms of chest infection not responding to antibiotics and a CXR showing pleural effusion, what is the likely diagnosis according to the content?
Empyema.
What is the definitive treatment for empyema according to the content?
Chest tube insertion and continued antibiotics.
What is identified as the most common cancer causing mortality in Australia in the content?
Lung cancer.
What is the most common cancer affecting males in Australia according to the content?
Prostate cancer.
What is the most common cancer affecting females in Australia as per the content?
Breast cancer.
What is the most common cancer overall in Australia according to the content?
Melanoma.
What is the most common cancer in terms of incidence in Australia according to the content?
Prostate cancer.
According to the content, which tumor is the fastest to cause death?
Pancreatic tumor
