Respiratory

Question 0

What are the causes of a transudative pleural effusion?

Answer 0

LVF
Cirrhosis
Hypoalbuminaemia
Peritoneal dialysis

Less common: Hypothyroid, meigs syndrome, mitral stenosis

Question 1

What are the signs of a pneumothorax?

Answer 1

Tachycardia, tachypnoea
Reduced expansion
Hyperresonant percussion
Reduced or absent breath sounds
Low sats (despite oxygen... Tension?)
Hypotension (tension)

Question 2

What is the safe triangle for the insertion of chest drains?

Answer 2

1 intercostal space below spacular posteriorly
4th intercostal space anteriorly
Apex of the axilla

Question 3

What are the exudative causes of pleural effusion?

Answer 3

Malignancy
Parapneumonic effusion

Less common: RA, pancreatitis, pulmonary infarction

Question 4

Light’s Criteria for Pleural Effusion

Answer 4

It is an exudate if:
Fluid protein / serum protein is > 0.5
Fluid LDH / serum LDH > 0.6

Or
Fluid LDH > 2/3 of upper limits of a normal serum LDH

Question 5

CURB 65 score

Answer 5

Confusion - NEW, AMT < 8
Urea over 7
RR over 30
BP - systolic less than 90 or diastolic less than 60

65 years or older

Question 6

Interpreting the CURB 65

Answer 6

Likelihood of pneumonia

0—0.7%
1—3.2%
2—13.0%
3—17.0%
4—41.5%
5—57.0%

0-1: outpatient
2-3: admit
4-5: consider ITU

Question 7

ECG changes in Pulmonary Embolus

Answer 7

S1Q3T3 (seen in 20% PEs)

S1 = large S wave (downwards) in I

Q3 = q wave in III

T3 = inverted T wave in III

RBBB and R axis deviation
sinus tachy