respi Flashcards
A 37-year-old woman presents to A&E with shortness of breath, a dry cough and a fever. She has recently been on a business trip to Romania and stayed in a local hotel.
What is the best investigation to obtain a definitive diagnosis in this patient?
urinary antigen for legionaire disease
what is the most common cause of pneumonia in HIV patient
strep pneumoniae
what are the ecg changes you will see in a patient with COPD?
prominent p wave in the anterior chest lead. absent r wave in the right sided leave nad right axis deviation
what is teh procedure that is shown to reduce mortality in the ARDS patient
low tidal volume mechanical ventiation…ARDS presents with acute onset respiratory failure which fails to improve with supplemental oxygen, the symptoms of which include severe dyspnoea, tachypnoea, confusion, and presyncope.
Physical examination typically reveals fine bibasal crackles, but no other features of heart failure.
klebsiella is which type of bacteria
gram negetive anaerobic rod
in a patient with asthma who is on saba and ics what would e the addition after that according to te BTS guideline
bts suggests adding laba but nice recomends addint LTRAntagonist
legs and arms weakness that gets better on working and bilateral ptosis in a patient with weight loss nd haemotysis is most likely di=ue to
lambert eatons and the antibody will be voltage gated sodium channel antibdy
target lesions with pneumonia history
mycoplasma pneumonia… preceeding flu like symptoms
what are the causes of exudative pleural effusion
ra, tb,pneumonia and malignancy like mesothelioma…meigs is associated with transudative type of effusion
how can you ensure that the chest drain is patent
if there is swinging of fluid during respiration
ace is raised in
sarcoidosis
adult onset asthma, nasal congestion ,parathesia in leg and glomerulonephritis. what is the most likely antibody present
p-anca/ mpo anca….for chrugg strauss disorder.
having a brain fog and nocturia reduced libido and fatigues in a overweight patient
obstructive sleep apnoea
which drug is linked with pulmonary fibrosis?
methotrexate
ct with signet ring sign is the pathognomic for
bronchiectasis
what is the ecg finding you will find in a copd patient and physical exam finding?
right ventricular hyoertrophy and right ventricularhaeve….you will also see p pulmonale meaning really high p wave
in a case of tension pneumothorax what Is the management
its a medical emergency and you do not require a chest x-ray and decompression if the chest with 14-16 gauge needle is the most imp
what is the antibiotic used for aspirational pneumonia and has a potential side effect of increasing the inr
metronidazole
in an emergency situation where you see hypercalcemia what is the management
iv saline fluid …. look out for lung cancer- small cell,…. patient with weight loss and cough.
what is the cause of pulmonary effusion?
due to hight pressure in the cappilary fluid leaks out from the capillary into the pleural cavity.
what is the limit if rr in CURB 65
30
A 75-year-old man presents with increasing shortness of breath, right-sided pleuritic chest pain and haemoptysis over the course of 2 months. Before retiring, he spent 40 years working as a miner. A chest X-ray shows a large right-sided pleural effusion. what is the material he is most exposed to causing him symptoms?
asbestose - there is a lag between the exposure and the presentation and it is a highly malignant type of tumour(mesothelioma),
what is the most common cause of ARDS
SEPSIS OF PULMONARY ORIGIN….ards is life threatening non cardiogenic pulmonary oedema and it will present with new fine bibasal creps and opacification on the chest xray
The cough has progressively worsened, and now he is producing large amounts of green sputum with red streaks. He has had frequent episodes in the past which have required hospital admission. On examination he has finger clubbing, nasal polyps and coarse inspiratory crackles.
cystic fibrosis. sweat sodium and chloride will be more than 60
aesbestose causes the pulmonary fibrosis in which zone
lower zone
in a patient with copd background who has come in with exacerbation of copd and after the oxygen therapy is found to have high co2 concentration what is the managemnt
you do NIV
in malignancy and empyma what is the ph of the pleural fluid
its low-<7.2.
gram negetive cocco bacilli is
haemophillus influenza the mostcommon cause of infective exacerbation of copd
what is the 3 findings on xray that confirm copd?
hemi diaphragm flattening, thining of the heart and increased number of anterior ribs on the chest x ray…. because there is trapping of air
increased vocal resonance is there
when there is consolidation
psmoma bodies are found in
mesothelioma
curschmann spiral are seen in
asthma- shep epithelium is whorled by mucous plug
x ray finding of lower lobe consolidation with air fluid levels and central cavitation is due to
lung abscess
ground glass opacification especially in the lower zones
pneumocystis jerovici
coryza like symptoms before pneumonia nad erythema multiforme . what is the test done for confirmation
pcr for mycoplasma pneumonia
what are the four condition for long term oxygen therapy?
if the pao2 is less than 7.3 or its 7.3 to 8 and there is polycythemia or peripheral edema or pulmonary htn or nocturnal hypoxemia
the paraneoplastic syndrome of hyperparathyroidsm is associated with which lung cancer
squamous cell lung cancer
SIADH is associated with whoch type of cancer?
small cell… urine osmolality will be very high and serum sodium low and
what is the lights criteria
pleural fluid to serum protein ratio is more than 0.5 and pleural fluid to serum ldh ratio is more than 0.6 then consider the fluid as exudative
what happens to DLCO in emphysema?
it reduces as there is less surface area to difuse and total lung capacity increases.
which antibiotic used in UTI is known to cause pulmonary fibrosis
nitrofurantoin
fascial flushing with late onset asthma and diarrhoea in a patient with nodule found i the upper lobe what is the most likely first line investigation?
urinary 5 HIAA 24 hr
most common and 2 nd most common cause of svco is
lung tumor and hodgkin lymphoma
in an acute exacerbation of astma patient if the pa co2 is raised thent he attack is termed ad
near fatal
what is te eart sound in cor pulmonale
there is splitting of te second heart sound with
what is the heart defect seen in marfan syndrome patient
aortic root dissection, aortic regur
in pneumothorax what would be the expected vq sacn
very low vq scan in pe there will be very hugh vq around the clot and low vq away from the clot
the indurated purple rash on te face of a sarcoidosis patient is called
lupus pernio
when are antibiotic presecibed in URTI?
when crp>100 or if the patient has asthma
pneumocystis jerovici is best stained in
silver stain
in pulmonary fibrosis what happens to TLCO
reduced
whqt is the o2 sats limit for life threatening asthma
less than 90
what are the 4 conditions a patient needs to meet for lung volume reductio surgery in COPD?
If he is still breathless after a maximum of medical therpay..and his ct shows predominant upper lobe emphysema, FEV1 of more than 20% predicted and pco1 below 7.3 and TICO of mre than 20% predicted
what is the eye manifestation of sarcoidosis?
Anterior uveitis
what is the time frame NICE recommends to get a chets x ray in suspected lung cancer
2 weeks
which medication is recommended by NICE for pulmonary fibrosis
perfenidone
what is the length of anticoagulation therapy in apatient who has thrombophilia and what i sthe target inr
lifelong and target is 3-4
what is the antibiotic recommended for hospital acquired pneumonia
iv cipro because the cause is pseudomonas aeroginosa
which bacteria causig pneumonia is associated with herpes labiais
strep pne
what is the definitive diagnosic of sarcoidosis
biopsy showing non casseating granuloma
what is the characteristic of pleural effusion casued by sle ?
exudative raised ana but low complement
adenosine diaminase is found in pleuritic fluid which type of disease
tb and in RA the pleuritic fluid will have low glucose
which pneumonia is most likely associated with cold haemolytic anaemia
mycplasma neumonia with erythema multiforme(bull eye)
what is the first line investigation of asthma
spirometery and if not conclusive then go for FINO (>40)
curb 65 score of 3 equates to
17 % mortality
