Respiration Flashcards
What does hyper resonance on percussion signify?
Tension pneumothorax
How should a tension pneumothorax be managed acutely?
Needle decompression with a wide bore cannula in the second intercostal space mid-clavicular line
How is a massive pneumothorax managed?
Wide bore chest drain
How is a massive PE managed?
Unfractionated heparin
Thrombolysis
What scores are used in PE?
Pulmonary embolism rule out criteria (PERC)
Wells score
What do you do if Wells gives unlikely?
D dimer
If positive then CTPA
What is sarcoidosis?
A chronic granulomatous disorder.
Granulomas are inflammatory nodules full of macrophages
Who is a typical sarcoidosis patient?
20-40 year old black female presenting with SOB and cough and erythema nodosum
What is erythema nodosum?
Modules of inflamed subcutaneous fat on the shins
What is screening test for sarcoidosis?
Serum ACE
What is raised in sarcoidosis?
Calcium
What is shown on a CXR in sarcoidosis?
Hilar lymphadenopathy
What is diagnostic for sarcoidosis?
US guided biopsy from bronchoscopy
Shows non-caseating granulomas with epithelial cells
What are the signs of sarcoidosis?
Lungs: mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules
Systemic symptoms: fever, weight loss, fatigue
Liver: nodules, cirrhosis, cholestasis
Eyes: uveitis, conjunctivitis, optic neuritis
CNS: nodules, diabetes insipidus, encephalopathy
Heart: BBB, heart block, myocardial muscle involvement
Kidneys: stones secondary to hypercalcaemia, nephrocalcinosis, interstitial nephritis
PNS: facial nerve palsy, mononeuritis multiplex
Bones: arthralgia, arthritis, myopathy
How is sarcoidosis managed?
- Oral steroids (add bisphosphonate)
- Methotrexate
What is Light’s criteria?
Pleural fluid protein/serum protein >0.5
Pleural fluid LDH/serum LDH >0.6
Pleural fluid LDH >2/3 of the normal upper limit of the serum LDH
Suggests exudative
What is an exudative pleural effusion?
High protein content >30g/L
What is a transudative pleural effusion?
Low protein content <30g/L
What causes an exudative pleural effusion?
Related to inflammation causing protein leaking out of tissues into the pleural space:
Cancer
Infection
RA
What causes a transudative pleural effusion?
Related to fluid moving across or shifting into the pleural space:
Congestive cardiac failure
Hypothyroidism
Hypoalbuminaemia
Meigs syndrom (benign ovarian tumour, pleural effusion, ascites)
Which way does trachea deviate in pleural effusion?
Away from
What are the CXR findings for a pleural effusion?
Blunting of the costophrenic angle
Fluid in the lung fissures
Tracheal deviation away from and mediastinal deviation
Why is a chest drain inserted in a pleural effusion with pH <7.2?
Suggests empyema
What is bronchiectasis?
Permanent dilation of the large airways due to chronic infection. Occurs due to damage to the airways