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F24 > Resp > Flashcards

Resp Flashcards

1
Q

What is pleural fluid results for empyema

A

Positive gram stain/ culture
PH<7.2
WCC > 50,000
Fluid glucose <40mg/dl
Fluid lactate Dehydrogenase >1000Iu/l
Grossly purulent fluid

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2
Q

What is lights criteria

A
  1. pleural fluid protein: serum protein >0.5
  2. Pleural fluid LDH: serum LDH >0.6
  3. Pleural fluid LDH >2/3 upper limit normal serum LDH

Any 1 = exudate

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3
Q

Causes of exudate

A

Malignancy
Bacterial/ viral pneumonia
TB
PE
Pancreatitis
Eosophageal rupture
Chylothorax/ haemothorax

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4
Q

Causes of transudate

A

Heart failure
Hypoalbuminaemia
Liver cirrhosis
Nephrotic syndrome
PE

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5
Q

What is positive Tuberculin skin test
What type sensitivity reaction

A

Type IV hypersensitivity
Mantoux technique - intradermal injection of PPD
Read test 48 hours later
Positive
>5mm in those with HIV, recent contact, clinical evidence of TB, organ transplant, immunocompromised
>10mm IVDU, from high prevalence countries, resident of high congregate settings, comorbidities, children <4, high risk categories, children born in high prevalent regions
>15 mm in no know risk factors

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6
Q

What causes TB

A

Mycobacterium tuberculosis

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7
Q

Stages of TB symptoms/ finding

A

Primary: asymptomatic and progressed to latent
CXR: often normal, hilar lymphadenopayhy, ghon focus
Latent TB: asymptomatic, tuberculin skin test or interferon gamma release asssy
Reactivation: fever, night sweats, weight loss, productive cough, haemoptysis,
CXR: upper lobe infiltrates, apical cavities
Sputum smears for acid fast bacilli x3 sputum culture for AFB

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8
Q

Management of spontaneous pneumothorax

A

Small <2 cm: no resp compromise, observation with oxygen
Large 2-3cm symptomatic, needle aspiration or chest tube
Recurrent: VATS pleurodesis

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9
Q

Spontaneous pneumothorax risk factors

A

Tall, thin, male age 10-30, marfans, cigarette smoking, COPD, TB, ILD, CF, pneumonia, PCP

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10
Q

Primary vs secondary spontaneous pneumothorax

A

Primary: without underlying lung condition
Secondary: with underlying lung condition

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11
Q

What is PCP
CXR
Abg findings
Treatment

A

Pneumocystis jirovecii
Immunosuppressed host (HIV, transplant)
Seen in HIV positive patient with CD4 count <200
Symptoms progress over 2-3 weeks
Fever cough sob
Oxygen desaturation and LDH elevated
CXR: bilateral interstitial infiltrates. Bat wing appearance

Diagnosis: aspiration on bronchoscopy

Treatment
Steroids if Pa02 <70mmHg or A-a gradient >35
Trimethoprim and sulfamethoxazole

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12
Q

Lung abscess vs empyema
Definition
Most common causes
Diagnosis
Treatment

A
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13
Q

What are the atypical bacterial pneumonia pathogens

A

Mycoplasma pneumonia
Chlaymdia
Legionella pneumonia - most linked to server community acquired pneumonia

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14
Q

Symptoms of legionella pneumonia

A

Pleuritic chest pain
Sob
Cough
Relative bradycardia
GI: nausea, diarrhoea
Neurological:
Hyponatraemia
Involvement of other systems: myocarditis, pancreatitis, pyelonephritis,

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15
Q

Where does legionella come from

A

Epidemics
Associated water sources
Air travel/ air con

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16
Q

Legionella treatment

A

Azithromycin
Doxycycline
Levofloxacin

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17
Q

What intervention in COPD reduce long term mortality

A

Oxygen outpatient therapy

18
Q

Indications for long term oxygen Therapy

A

General: Pa02 <55mmHg or SP02 <88%
In Prescence of cor pulmonale
- Pa02<59 or Spo2<89
- ECG evidence p pulmonale
- haematocrit >55%
- clinical evidence of RHF

Specific situations
Pa02>60/ Spo2 >90 with lung disease such as sleep apnea and nocturnal Desat not corrected by CPAP
If desaturates during exercise can be prescribed for then

19
Q

What corticosteroid has least mineralocorticoid effect

A

Dex

20
Q

Is ipratropium safe in pregnant asthmatic exacerbations

A

Yes

21
Q

What is most common causes of croup

A

Parainfluenza virus

22
Q

What is most common cause of hand foot and mouth disease

A

Coxsackie virus

23
Q

What is most common causes Diagnosis of epiglottis

A

Haemophilia influence

24
Q

What is most common causes of Bacterial sinusitis and ottitis media in children

A

Strep pneumonia

25
Q

What is croup
Xray sign
Treatment

A

Larygotracheitis
Steeple sign
Steroids inhaled adrenaline

26
Q

What does phosgene smell like

A

Musty hay, newly mown grass

27
Q

Inhalation of chlorine gas causes lung injury by what toxic chemicals

A

Hydrochloric and hypochlorous acids

28
Q

What is silo filler disease

A

Chemical pneumonitis caused by nitrogen dioxide
Products of combustion in industry or result of military blasts
Entered a silo : bleach like odour

1-2 days post acute respiratory distress
Treatment: supportive care intubation

29
Q

What is mesothelioma

A

Rare cancer that forms from cells of mesothelium
Caused by exposure to asbestos
Site: pleura ( also peritoneum, pericardium, tunica vaginalis)

CXR: unilateral irregular linear opacities at peripheries

30
Q

What are 5 groups of pulmonary hypertension

A

1: pulmonary arterial hypertension
2: left heat disease
3: lung disease
4: chronic thromboembolic pulmonary htn
5; multifactorial

31
Q

What is definition pulmonary hypertension

A

Mean pulmonary arterial pressure > 25 at rest of 30 during exercise
Normal 15-30

32
Q

What are 3 paraneoplastic syndromes associated small cell lung cancer

A

Cushing syndrome
SIADH
Lambert Eaton myasthenia gravis

33
Q

Symptoms of horners syndrome
Causes

A

Miosis
Ptosis
Anhidrosis

Common causes: genetic, damage sympathetic nerves cervical artery dissection, pancoast tumours

34
Q

What is pancoast tumour

A

Superior pulmonary sulcus tumour
Pulmonary neoplasms adjacent to sublavian vessels
Apical pleuropulmonary groove
Shoulder pain
Horners syndrome: ipsilateral ptosis, miosis, anhidrosis
Compression of sympathetic chain and stellate ganglion

35
Q

Wesley croup severity score

A
36
Q

Wesley croup severity score

A
37
Q

Wesley croup severity score treatment

A
38
Q

Wesley croup severity score treatment

A
39
Q

Treatment aspiration pneumonia

A

Same as CAP unless signs of abscess or empyema
- ceftriaxone and azithromycin

40
Q

What is most common lung cancer type r

A

Adenocarcinoma

41
Q

What paraneoplastic syndrome associated with squamous cell lung cancer

A

Hypercalcaemia
Moana
Groan abdo
Stone
Bones

42
Q

What lung cancers central vs peripheral

A

Small cell lung cancer - central
Non small cell lung cancer
Adenocarcinoma: peripheral
Squamous cell carcinoma/ central
Large cell

Central/ small/ squamous

F24 (22 decks)

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