Resp Flashcards
A 27-year-old female is admitted with acute shortness of breath. She is known asthmatic, has had one previous admission with an asthmatic attack. Ambulance crew administered 100% oxygen and nebulisers.
On examination, has pulse 110 bpm, O2 sats 92%, temp 37.5°C, BP 160/88 mmHg and resp rate 27/min. Chest auscultation reveals numerous wheezes.
What is most appropriate initial investigation for this patient?
a) Arterial blood gas
b) Blood cultures
c) Chest x ray
d) Full blood count
e) Serum IgE concentration
a) Arterial blood gas
These are features of acute severe asthma. She has tachycardia, tachypnoea and low oxygen saturations associated with high flow oxygen. Elevated BP typical of anxiety associated with acute asthma. Most relevant initial investigation would be ABG as these have prognostic significance.
One should also obtain a chest x ray because of possible other pathology such as pneumothorax or pneumonia that has sparked off this asthmatic attack, but this does not have prognostic significance in asthma.
In a pleural effusion, what is difference between transudate and exudate?
a) transudate: hydrostatic forces favour fluid forced out of vessels so accumulation of fluid in pleura. Exudate: there is damaged or altered pleura (due to inflammatory process) resulting in deposition of PROTEIN AND FLUID in pleural space.
If a patient presented to you with transudative pleural effusion, name 1 likely cause.
Any of: heart failure (most common), hypoalbuminaemia (e.g. nephrotic syndrome, cirrhosis), constrictive pericarditis, hypothyroidism, ovarian fibro producing right-sided effusion (Meig’s Syndrome)
Name 1 common cause of exudative pleural effusion.
Any of: infection (empyema/parapneumonic effusion/tb), malignancy, PE with infarction, connective tissue disease
How is hospital acquired pneumonia defined?
Pneumonia acquired 48 hours after admission to hospital
What organisms cause hospital acquired pneumonia?
Hospital acquired pneumonia tends to be caused by Gram Negative organisms
How would you empirically treat hospital acquired pneumonia?
Aminoglycoside + antipseudomonal penicillin or 3rd generation Cephalosporin
examples of each
aminoglycoside = vancomycin, clarithromycin, clindamycin
antipseudomonal penicillin = piperacillin
3rd gen cephalosproin = ceftriaxone, cefuroxiteme
What are risk factors for COPD - give 1 lifestyle, environmental and genetic risk factor
Lifestyle: cigarette smoke, occupational exposure
Environmental: air pollution, infections
Genetic: alpha-1 antitrypsin deficiency
How would you differentiate between asthma and COPD? Give 3 differences
Main differences are
1) asthma has diurnal variation of peak expiratory flow (also diurnal variation of symptoms) and COPD no difference.
2) on spirometry asthma may be normal but COPD is always abnormal (i.e. FEV1/FVC<0.7)
3) Asthma resp symptoms reversible on medication whereas COPD less convincing reversibility
A 26 year old male was brought in following a collapse. He complained of sudden onset shortness of breath and pleuritic chest pain. On examination his trachea is deviated to the left and there is hyperresonance on the right side of his chest. What is the next appropriate management step?
a) CXR
b) CT Chest
c) Chest drain
d) Large bore cannula in left second intercostal space mid-clavicular line
e) Large bore cannula in right second intercostal space mid-clavicular line
e) Large bore cannula in RIGHT second intercostal space mid-clavicular line
Explanation: Pt has TENSION PNEUMOTHORAX on his RIGHT side as indicated by tracheal deviation (because trachea is deviated to left and hyperressonance is on right side of chest).
DO NOT WAIT FOR CXR, ONCE DIAGNOSED CLINICALLY, TREAT PATIENT STR AIGHT AWAY
52 yo man presents in primary care unwell with cough with green sputum with occasional blood flecks. He is also complaining of shortness of breath and has a cold sore. On examination he is pyrexial, tachypneoic, tachycardic and there is left basal coarse crackles. What is the most likely diagnosis?
a) Viral Pneumonia
b) Pneumonia due to Streptococcus pneumoniae
c) Pneumonia due to Staphylococcus aureus
d) Pneumonia secondary to H. Influenzae Klebsiella pneumoniae
b) Pneumonia due to Strep. pneumoniae
= most common cause of community acquired pneumonia. Also further clues are the cold sore and blood stained sputum which points towards Strep. pneumoniae
Define respiratory failure
Respiratory failure is when pulmonary gas exchange is inadequate and sufficiently impaired to cause HYPOXAEMIA ± hypercapnia. Hypoxia is defined as PaO2 < 8 kPa
Define Type 1 resp failure
Type 1 resp failure is hypoxia (PaO2 < 8 kPa) with low or normal CO2
Define Type 2 resp failure
Type 2 resp failure is hypoxia (PaO2 < 8 kPa) WITH hypErCAPNIA (high CO2 PaCO2 > 6 kPa)
If pt had an angina pectoris & asthma, how would they be treated differently compared to if they didn’t have asthma?
if prescribing β-blockers for angina with asthma, use β1 selective blockers bc non-selective can induce bronchoconstriction via blockage β2 adenoceptors
What commonly causes Type 1 resp failure?
Type 1 resp failure mainly caused by issues of V/Q mismatch, hypoventilation, abnormal diffusion, R to L cardiac shunts. So, most commonly caused by diseases that damage lung tissue (e.g. emphysema, asthma, ARDS, pulmonary fibrosis)
What commonly causes Type 2 resp failure?
Type 2 resp failure mainly alveolar hypOventilation ±V/Q mismatch. E.g., pulmonary disease (emphysema, asthma, obstructive sleep apnoea), neuromuscular disease like Guillan-Barre, conditions reduced resp drive ( sedative drugs, CNS tumour), thoracic wall disease (flail chest, kyphoscoliosis)
Who is at risk of respiratory failure and needs monitoring?
Patients on sedatives, COPD, neuromuscular disease (Guillan-Barre, myasthenia gravis, cervical cord lesions, poliomyelitis), inpatients in general (PE), pulmonary fibrosis, pneumonia, asthma
