Resp Flashcards
What is pleural fluid results for empyema
Positive gram stain/ culture
PH<7.2
WCC > 50,000
Fluid glucose <40mg/dl
Fluid lactate Dehydrogenase >1000Iu/l
Grossly purulent fluid
What is lights criteria
- pleural fluid protein: serum protein >0.5
- Pleural fluid LDH: serum LDH >0.6
- Pleural fluid LDH >2/3 upper limit normal serum LDH
Any 1 = exudate
Causes of exudate
Malignancy
Bacterial/ viral pneumonia
TB
PE
Pancreatitis
Eosophageal rupture
Chylothorax/ haemothorax
Causes of transudate
Heart failure
Hypoalbuminaemia
Liver cirrhosis
Nephrotic syndrome
PE
What is positive Tuberculin skin test
What type sensitivity reaction
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
What causes TB
Mycobacterium tuberculosis
Stages of TB symptoms/ finding
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
Management of spontaneous pneumothorax
Small <2 cm: no resp compromise, observation with oxygen
Large 2-3cm symptomatic, needle aspiration or chest tube
Recurrent: VATS pleurodesis
Spontaneous pneumothorax risk factors
Tall, thin, male age 10-30, marfans, cigarette smoking, COPD, TB, ILD, CF, pneumonia, PCP
Primary vs secondary spontaneous pneumothorax
Primary: without underlying lung condition
Secondary: with underlying lung condition
What is PCP
CXR
Abg findings
Treatment
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
Lung abscess vs empyema
Definition
Most common causes
Diagnosis
Treatment
What are the atypical bacterial pneumonia pathogens
Mycoplasma pneumonia
Chlaymdia
Legionella pneumonia - most linked to server community acquired pneumonia
Symptoms of legionella pneumonia
Pleuritic chest pain
Sob
Cough
Relative bradycardia
GI: nausea, diarrhoea
Neurological:
Hyponatraemia
Involvement of other systems: myocarditis, pancreatitis, pyelonephritis,
Where does legionella come from
Epidemics
Associated water sources
Air travel/ air con
Legionella treatment
Azithromycin
Doxycycline
Levofloxacin
What intervention in COPD reduce long term mortality
Oxygen outpatient therapy
Indications for long term oxygen Therapy
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
What corticosteroid has least mineralocorticoid effect
Dex
Is ipratropium safe in pregnant asthmatic exacerbations
Yes
What is most common causes of croup
Parainfluenza virus
What is most common cause of hand foot and mouth disease
Coxsackie virus
What is most common causes Diagnosis of epiglottis
Haemophilia influence
What is most common causes of Bacterial sinusitis and ottitis media in children
Strep pneumonia
