Pulmonary Flashcards
Child with prologed cough >2 Ws and fever… Next step:
serology for pertussis
Best inv of BA:
spirometry before and after SABA (++ FEV1> 15% at least)
Most imp parameter to be assessed in spirometry of pt with BA:
FEV-1
Most imp parameter to be assessed in spirometry of pt with GB$:
FVC
Management of acute attack???
Pt with low O2 saturation next step
1st step:
If no response:
give O2
inhaled salbutamol…..up to 12 puffs
oral cortisone
Best way to give puffs to the kids:
spacer
Most common SE of inhaled cortisone:
oropharyngeal candida
Most serious sign in status asthmaticus:
silent chest
If cyanosis in asthma first step:
intubation
Long term management:
First line:
If still symptomatic:
If still symptomatic:
SABA
inhaled cortisone
LABA
Prevention of asthma
Best way:
avoid dust and smoking
Drug used for prevention by inhalation:
fluticasone
Asthma with exercise what to use?
salbutamol before the exercise
HOW TO ASSES CRITICAL CASES???
Confused/drowsy, AGITATION vv IMP
Pt returned from long flight develops acute chest pain& dyspnea. Exam shows clear lung… Dx:
pulmonary embolism (PE)
Best inv of PE/ Inv of choice of PE:
CTPA
Inv of choice in pregnant, pt with ESRD or allergy:
V/Q scan
TTT of choice of PE:
LMWH followed by warfarin
Duration of warfarin use:
3-6 Ms with target INR of 2-3
Pt with contra-indication to anti-coagulation, non-compliant with anti-coagulation recurrent despite anticoagulant…… next step:
IVC filter
Pt with cough and dyspnea. Exam shows dullness to percussion& ++ TVF… Dx:
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
MC CO:
strep pneumonia
Best way to give O2 in pneumonia:
1st: mask 2nd: venture (NOT nasal canula)
TTT:
Criteria of severity:
1-confusion/ empyema
2-respiratory distress
3-tachycardia
4-hypoxia or cyanosis
When to say severe:
2 or more of the above criteria
Mild cases ……Outpatient ttt:
………oral Amoxycillin
Severe cases…….Inpatient ttt:
Iv flucloxacillin + IV cefotriaxone
If MRSA:
add vancomycin
If mycoplasma pneumonia:
doxycyclin
Pneumonia with dry cough+ skin lesion (EM)… Dx:
mycoplasma pneumonia
TTT of mycoplasma pneumonia:
Doxycycline
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:
pneumothorax
Management of tension pneumothorax:
immediate needle decompression
Site of needle insertion:
2nd Inercostal Space at MCL
Tall smoker young male with pneumothorax and no obvious cause:
1ry pneumothorax (spontaneous pneumothorax)
When to do aspiration in primary pneumothorax???
Symptomatic even if small
if aspiration failed:
chest tube
if pneumothorax not symptomatic :
conservative and follow up CXR
Pt with pneumothorax of any cause (asthma, COPD…etc):
2ry pneumothorax
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
Most imp inv of pleural effusion:
thoracocentesis
COPD Pt came with fever OR yellow sputum:
infection
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
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……….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
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%…………..chest drain
If less than 15-30%………..aspiration…..if failed…..chest drain
If less than 15%……..conservative
MCC of blood stained mucous:
Acute bronchitis
MC RF of TB:
immigrant, nurse
Immigrant from endemic areas came with prolonged cough, dyspnea, night sweat and wt loss……………… 1st step:
chest X-ray
Definitive test of TB:
sputum analysis
Inv of choice of asymptomatic pt:
mantoux test OR quantiferon
Interpretation of mantoux test:
-ve test………………………….. Reassure
+ve test………………………… Chest X-ray
Then;
If +ve chest X-ray….. Isolation and quadriple therapy
If -ve chest X-ray… isoniazide+ vitamin B6 for 6-9 ms
Imp complication of isoniazid:
peripheral neuropathy (give vitamin B6)
Imp complication of rifampin:
red coloration of urine
Nurse with suspected TB:
immediate isolation
Immigrant with suspected TB and +ve mantoux test… next step:
isolation (before X-ray)………..VVVVVVVVV IMP
Most common affected lobe of the lung in TB:
Upper lobe
MCC of decreased TB incidence at Australia:
good isolation (NOT vaccination)
Old smoker with any chest complaint+ wt loss… Dx:
lung cancer until proven
Old smoker with weakness, parathesia at hand, CXR shows mass at apex… Dx:
pancost tumor
Old smoker with congested neck veins and arm swelling, CXR shows mass at apex… Dx:
pancost tumor
1st step in lung cancer pt with pleural effusion:
horacocentesis
Lung cancer with systemic manifestation:
para-neoplastic $
1st step in pt with suspected lung cancer:
chest CT
Inv of choice of lung cancer:
BRONCHOSCOPY and biopsy
Asymptomatic pt with small lung mass at CXR … 1st step:
ask for old x-ray
Spirometry of pt with lung fibrosis “Restrictive lung disease”:
FEV1, FVC………………… decreased
FEV1/FVC ratio……… normal
Residual volume, total lung capacity& lung compliance… decreased
TTT of pulmonary fibrosis:
cortisone
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:
Bowel habit (NOT family H/O of cystic fibrosis)
Most imp inv of CF:
sweat chloride test
Male pt with bronchiectasis, sinusitis, male sterility… Dx:
immotile cilia $
Male pt with bronchiectasis, sinusitis, dextro-xardia… Dx:
Kartagner $
MCC of acute hemoptysis:
Acute bronchitis
MCC of chronic hemoptysis:
Bronchiectasis
Inv of choice of bronchiectasis:
spiral CT scan
TTT of infection with bronchiectasis:
amox clav ( augmentin )
Farmer with cough, dyspnea while on work BUT is free of symptoms on the week end :
= hypersensitivity pneumonitis. Most imp advice… Change the job
Asbestosis increase risk of:
mesothelioma (NO screening available; try to avoid prolonged exposure)
Silicosis increase risk of:
TB reactivation
Most imp cause of confusion in respiratory failure:
CO2 narcosis
First test……pulse oximetry
Second inv……ABG
Management……intubation
Most imp drug in acute pulmonary edema:
IV furosemide
MC RF of mesothelioma:
Asbestosis
Patient with chronic cough and pleural thickening on CXR:
mesothelioma…..next step……..CT chest …..vvvvvvvv imp
Inv of choice of mesothelioma:
Bronchoscopy& biopsy
Pt with prolonged symptoms of chest infection not responding to abs, CXR shows pleural effusion… Dx:
Empyema
Definitive TTT of empyema:
chest tube + continues abs
N:B: ( 2016 statistics )
Most common cancer causing mortality in Australia:
lung
Most common cancer affecting males in Australia:
prostate
Most common cancer affecting females in Australia:
breast
Most common cancer in Australia overall:
MELANOMA
Most common cancer in incidence in Australia:
prostate
Fastest tumour to cause death:
pancreatic
