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
What is croup
Xray sign
Treatment
Larygotracheitis
Steeple sign
Steroids inhaled adrenaline
What does phosgene smell like
Musty hay, newly mown grass
Inhalation of chlorine gas causes lung injury by what toxic chemicals
Hydrochloric and hypochlorous acids
What is silo filler disease
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
What is mesothelioma
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
What are 5 groups of pulmonary hypertension
1: pulmonary arterial hypertension
2: left heat disease
3: lung disease
4: chronic thromboembolic pulmonary htn
5; multifactorial
What is definition pulmonary hypertension
Mean pulmonary arterial pressure > 25 at rest of 30 during exercise
Normal 15-30
What are 3 paraneoplastic syndromes associated small cell lung cancer
Cushing syndrome
SIADH
Lambert Eaton myasthenia gravis
Symptoms of horners syndrome
Causes
Miosis
Ptosis
Anhidrosis
Common causes: genetic, damage sympathetic nerves cervical artery dissection, pancoast tumours
What is pancoast tumour
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
Wesley croup severity score
Wesley croup severity score
Wesley croup severity score treatment
Wesley croup severity score treatment
Treatment aspiration pneumonia
Same as CAP unless signs of abscess or empyema
- ceftriaxone and azithromycin
What is most common lung cancer type r
Adenocarcinoma
What paraneoplastic syndrome associated with squamous cell lung cancer
Hypercalcaemia
Moana
Groan abdo
Stone
Bones
What lung cancers central vs peripheral
Small cell lung cancer - central
Non small cell lung cancer
Adenocarcinoma: peripheral
Squamous cell carcinoma/ central
Large cell
Central/ small/ squamous
