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Final Med > resp > Flashcards

resp Flashcards

1
Q

lung cancer SIADH

A

small cell lung cancer

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2
Q

what is the definition of a chronic cough?

A

greater than 8 weeks

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3
Q

what is the definition of acute cough?

A

less than 3 weeks duration

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4
Q

the presence of sputum indicates

A

infection or inflammation

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5
Q

bloody streaked sputum

A

infection or bronchiectasis

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6
Q

pink and frothy sputum

A

pulmonary oedema

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7
Q

asthma displays what cough pattern

A

diurnal variation (worse at night and the early morning)

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8
Q

CURB 65 score

A 
confusion AMTS less than 8/10
urea greater than 7 mM
respiratory rate greater than 30 min 
blood pressure less than 90 and less than 60 diastolic 
greater than 65 year old
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9
Q

when is a bronchial washing indicated?

A

bronchoscopically to get a sputum sample free of upper airway flora this is undertaken if pneumonia does not respond to typical antibiotics and you sustepct an atypical organism.

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10
Q

along with the CURB 65 score what other considerations would you have in deciding clinically if she needs to be admitted.

A

severity
comorbitity with COPD
hospital aquired
immunocompromised or suspicion of an unusual organism
pneumonia treated by antibiotics in the past weeks
predisposition to C. Diff with the abx

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11
Q

complication of pneumonia

A

spread of infection (effusion, empyema, abcess, septicaemia)
damage due to local structures (pneumothorax, and bronchiectasis)

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12
Q

clinical features of asthma

A

greater than 1 of wheeze, breathlessness, chest tightness and cough
1. worse in the morning or night
2. triggered by exercise, allergen exposure, cold air or after taking aspirin and B blockers
history of atopy
family history of atopy or asthma
wheeze on auscultation
otherwise unexplained low FEV1 PEF or serum eosinophilia

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13
Q

features suggestive of an alternative diagnosis other than asthma

A

normal physical exam and or FEV1 PEF when symptomatic
hyperventilation syndrome- dizziness, lightheaded ness, perpheral tingling
chronic productive cough without wheeze or breathlessness
symptoms only with colds
voice disturbance
significant smoking history over 20 pack years
cardiac disease

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14
Q

lung cancer in the hilar region most likely to be

A

squamous cell

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15
Q

post viral cough symptomatic relief options

A

antitussives (cough suppressants)
1. brainstem cough centre depression - codeine, dextromethorphan (non-opioid)
2. p. receptor sensitivity reduction- benzocaine
inhaled corticosteroids or oral antihistamines-
3. inhaled ipratropuim bromide- blocks efferent limb of cough reflex

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16
Q

pathophysiology of COPD and hypoxia

A

airway music impairs ventilation
lungs are hyper inflated
hypoxic vasoconstriction mechanism blunted- blood travels through areas of poorly perfumed lung
patients given venturi masks which allow the clinician to control the amount of oxygen given.

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17
Q

bovine cough secondary to lung cancer explain

A

recurrent laryngeal nerve compression due to malignancy pnacoast tumour or surgery

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18
Q

widespread patchy infiltrates in both lung fields what is the causative organism

A

staph aureus

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19
Q

strep pneumonia CXR pattern

A

lobar pneumonia

20
Q

adenovirus CXR pattern

A

interstitial pneumonitis and air bronchogram not visible.

21
Q

primary ciliary dyskinesia what is it and what the signs?

A 
AR disorder that affects the protien machinery used by epithelial cells to rhythmically beat their cilia. 
complications: 
braonchiectasis 
rhinitis and sinusitis 
otitis media
male infertility 
sinus invertus
22
Q

kartageners syndrome

A

triad of bronchiectasis, sinusitis, and situs invertus

23
Q

what is the difference between a transudate and an exudate?

A

transudate low protien less than 25 g due to the failures
liver, heart, renal (nephrotic syndrome), malabsorption or malnutrition
increased hydrostatic pressure constrictive pericarditis
exudate is greater than 35 g of protein infection, inflammatory cells, or malignancy

24
Q

lights criteria when do we use it and what is it?

A

used when fluid in the pleural space has between 25-35 g of protein.
exudative if
pleural fluid protein/ serum protien is greater than .5
pleural fluid lactate dehydrogenase/ serum LDH is greater than .6
pleural fluid LDH norte than 2/3 the ULN serum LDH

25
Q

how are lung ca classified?

A
  1. non small cell (80)

adenocarcinoma (40) squamous (30)

26
Q

which are the most common primary ca to met to the lung?

A

colorectal
breast
renal
female genital tract ovary and cervix

27
Q

extrapulmonary manifestation of lung ca

A
  1. ectopic ACTH adrenocorticotropic hormone secretion- cuhingoid features, próx muscle weakness, and skin hyperpigmentation
  2. hypercalcaemia 2nd to bone mets or PTH realted peptide secreting lung cancer *confusion, polyuria, polydipsia, hypotonia, hyporeflexia, and muscle weakness
  3. eaton lambert syndrome proximal muscle weakness that improves on repetition
  4. bone mets causing pain
  5. hypertrophic pulmonary osteoarthropathy rare
28
Q

small cell is assoc with ectopic exocrine secretion of?

A

ADH and ACTH

29
Q

squamous cell ca is assoc with what secretion

A

PTHrP

30
Q

pulmonary embolism features

A

sudden onset breathless with or without pleuritic pain
someone with an inflamed limb and or risk factors for blood clots
tachycardia
hypoxia
looks at the WELLS criteria

31
Q

boerhaaves perforation

A

sudden onset of severe chest pain immediately following an episode of vomiting.
pleural effusion dullness to percussion absent breathe sounds and decreased vocal resonance
subcut emphysema is present in a minority of cases.
abdominal rigidity sweating fever tachycardia and hypotension

32
Q

what is COPD?

A

chronic obstructive pulmonary disease. It is a disease processes that encompasses two other disease processes going on at the same time: chronic bronchitis and emphysema.
It is important to illicit in the history of chronic bronchitis (chronic productive cough (10ml) on most days for 3 months for 2 consecutive years) and permanent SOB

33
Q

what are the risk factors for COPD?

A 
smoking (more than 20 pack years)
occupational exposure (coal mines or tunnel workers)
alpha antitrpsin def (liver failure and family history)
34
Q

What are the basics of interpretation of the spirometry test?

A

Look to see whether it is an obstructive or restrictive/normal picture?
FEV1 less than 70% in obstructive and greater than 70% in restrictive and also normal lungs.
Then looking at the total lung capacity this will be reduced in restrictive lung disease (forced vital capacity less than 70%)

35
Q

what would make you suspicious of pneumocystis jiroveci pneumonia?

A

dry cough, shortness of breathe, low oxygen saturation or desaturation on exercise, and diffuse interstitial shadowing throughout the lungs on the chest radiograph

in someone from africa, and also check for AIDS

36
Q

definition of asthma

A

chronic reactive airway causing episodic airway obstruction leading to bronchiospasms increased mucus secretion and mucosal oedema.

37
Q

So you have a 65 patient with a productive cough with green sputum, a fever of 38. On auscultation they have crepitaciones throughout the right hemithorax. They are not confused. Labs come back and the urea is 3. The Blood pressure is 128/88. RR is 18. No prior history of a chest infection. What should you give?

A

CURB score is 1
This is a community acquired pneumonia
give amoxicillin 1 g every 8 hours

if patient was younger add Clarithromyocin Po 500 mg every 12 hours

penicillin allergic doxycycline 200 mg
then 100 mg every 24 hours
duration is 5 days

38
Q 
SO you have a 67 year old patient come in with a fever, green sputum, cough.  The respiratory rate is 31.  
Urea is 4. 
Blood pressure is 137/87 
Patient is alert. 
What would you give?
A

2 cURB score
moderate
amoxicillin 1 g every 8 hours
plus clarithromyocin 500 mg every 12 hours

if penicillin allergic give levofloxacin 500 mg every 12 hours (QT prolongation) ECG

39
Q 
You have a 67 year old patient that comes in with a letter from the GP stating that she has had a productive cough for the past 4 days and green sputum. She is pyrexic with a fever of 38.3 
RR is 34
blood pressure is 87/56. 
Urea is 8 
What are you going t give her?
A 
CURB 65 score of 5 
SEVERE 
7 days duration but may need more 
co- amoxicilav IV 1.2 g 
every 8 hours

plus clarithromyocin Po

if penicillin allergic give levofloxacin PO 500 mg every 12 hours 
plus vanc (if you thin staph aureus)
40
Q

How long is the period before you can wonder if it is hospital aquired?

A

5 days after hospital admission

14 days after discharge

41
Q

What would you give first line in a hospital aquired pneumonia?

A

piperacillin/ tazobactam IV
4.5g every 8 hours

if severe
add vancomycin
add gentamicin (heamodynamically unstable)

42
Q

In a hospital aquired pneumonia what would you prescribe in a patient with penicillin allergy?

A

vancomycin IV
plus ciprofloxacin IV 400 mg every 12 hours

if aspiration metronidazole 500 mg every 8 hours

43
Q

Sepsis source unclear antibiotics

A

piperacillin/ tazobactam IV 4.5 g every 8 hours

plus gentamicin IV

44
Q

What if you thin that the patient may have MRSA?

A

add vancomycin

45
Q

What is the treatment for a lower urinary tract infection that is not complicated?

A

Nitrofuratoin Po 50 mg every 6 hours

46
Q

If it is an upper UTi what antibiotics would you give

A

co-amoxiclav plus gentamicin

47
Q

What do you give a patient with toxic mega colon with C diff infection ?

A

Vancomycin plus metronidazole

Final Med (35 decks)

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