Respiratory

Question 1

What are the indications for placing a chest tube in oatients with suspected pleural infection?

Answer 1

• Patients with frankly purulent or turbid/cloudy pleural fluid .
• presence of organisms identified by culture indicating infection
• Pleural fluid pH < 7.2

Question 2

What is Lights Criteria? (chest drains)

Answer 2

help distinguish between a transudate and an exudate. The BTS recommend using the criteria for borderline cases:
- exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
- if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Question 3

Common cause of pneumonia post influenza infection

Answer 3

Staph aureus

Question 4

What are the potential features/complications of sarcoidosis?

Answer 4

Basically can affect the whole body
Lungs: 90% pts
- mediastinal lymphanenopathy
- pulmonary fibrosis
- Pulmonary nodules

Systemic:
- fever
- fatigue
- hypercalcaemia

Liver
- liver nodules
- cirrhosis
- cholestasis

Eyes:
- Uveitis
- Optic neuritis

Skin:
- erythema nodosum- tender red nodules on shins
- Lupus pernio- raised purple bumps usually on tip of nose
- granulomas - appear in scra tissue

Heart
BBB, HF

Kidneys
- kidney stones
- interstitial nephritis

CNS:
- CNS nodules
- encephalopathy

PNS:
- bells palsy

Bones:
- arthralgia

Question 5

What patients are most commonly affected by sarcoidosis

Answer 5

• 2 peaks of incidence- early adult hood and around 60y
• more common in women
• more common in black people

Typical exam: 20-40 y old black female pt presenting with dry cough and SOB with shin nodules