Resp 1

Question 1

Tools for maintaining the airway

Answer 1

Nasopharyngeal tube
Guedal tube (oropharyngeal)
Laryngeal mask
Endotracheal tube

Question 2

Why do anaethesiologist stop ventilation briefly

Answer 2

When being ventilated rapidly, Co2 excretion increased. CO2 is an essential respiratory stimulant. Stop to see if the increase in respiratory drive with CO2 accumulation will stimulate spontaneous breathing

Question 3

Respiratory arrest

Answer 3

When person has cardiac output but not breathing

Question 4

Causes of respiratory arrest

Answer 4

Upper airway obstruction
Hypoxia
Neuromuscular disease
Drugs

Question 5

Common causes of pleuritic chest pain

Answer 5

Pneumonia
Pneumothorax
PE

Question 6

Features to ask for in suspected

Pneumonia

PE

Pneumothorax

Answer 6

Fevers, shivers, aches
Cough
Sputum colour, purulent, or bloog

Cough, haemoptysis, surgery, immobility, pregnancy, estrogen treatment, painful calves, history of DVT

Pain sudden onset, often male and tall

Question 7

Significance of initial investigations for suspected pneumonia

Answer 7

CXR - confirm consolidation
Renal function, electrolytes and glucose - to assess illness severity
FBC and CRP - confirm infection
Blood and sputum cultures - look for causative organism
ABG - assess oxygenation and ventilation

Question 8

CURB 65

Answer 8

Assess severity
C - New Confusion
Urea> 7mmol/L
Resp rate >30bpm
Blood pressure <90/60
Age >65

Question 9

Atypical pneumonia

Answer 9

Pneumonia where symptoms are system (fever, headache,malaise) instead of clinical ( SOB, Sputum,cough)

Question 10

Atypical pneumonia organisms

Answer 10

Mycoplasma (cold agglutinins), Legionella (ULA - urinary legionella antigen), Chlamydia

1. cause more systemic symptoms
2. require serological testing rather than culture to confirm diagnosos
3. Do not respond to penicilins and require macrolides or tetracyclines

Question 11

Microbial tests to determine organism

Answer 11

Blood and sputum cultures
UAT - Urinary antigen testing : legionella, s.pneumoniar
Serology (testing for antibodies)- atypical bacteria

Question 12

CAP severe enough to require admission, antibiotics should include

Answer 12

Combines penicillins (Amoxicillin) and Macrolide (Erythromycin) to cover s.pneumoniae and atypical organisms

Question 13

Reasons for antibiotic failure

Answer 13

1. Wrong antibiotic choice
2. Resistance to antibiotic chosen (Clavulinic acid added to amoxicillin = co- amoxiclav)
3. Antibiotic dosage not potent enough
4. Secondary infections

Question 14

Organisms linked to aspiration pneumonia

Answer 14

Anaerobes from the mouth - Bacteroides, Fusobacterium, Peptoccocus
Gram -ve bacteria - Klebsiella, pseudomonas spp;aeruginosa

Antibiotics : MAT/Cephalosporin (Cefotaxime) 1g and Metronidazole 500mg to cover anerobes

Question 15

Organisms linked to HAP

Answer 15

P.aeruginosa

S.aureus including methicillin resistant strains

Question 16

Organisms linked to CAP

Answer 16

S.pneumoniae
H.influenzae
atypical

Antibiotics: Amoxicilin (Co-amoxiclauv) 500mg TDS 5/7 and Erythromycin or Tetracyclines to cover atypical

Question 17

C.difficile

Answer 17

Spread by faeco-oral route
Broad spectrum antibiotics -Normal flora killed, overgrowth of c.diff - Profuse debilitating diarrhoea
stool sample
Vancomycin (10-14days) and Metronidazole

Question 18

Usual doses of
Amoxicillin
Doxycycline

Answer 18

500mg TDS 5/7

200mg on day 1 then 100mg BD 6/7